Pediatric Bipolar Disorder (BD) is a highly morbid pediatric psychiatric disease, consistently
associated with family psychiatric history of mood disorders and associated with high levels of morbidity
and disability and with a great risk of suicide. While there is a general consensus on the symptomatology
of depression in childhood, the phenomenology of pediatric mania is still highly debated and the course
and long-term outcome of pediatric BD still need to be clarified. We reviewed the available studies on the
phenomenology of pediatric mania with the aim of summarizing the prevalence, demographics, clinical
correlates and course of these two types of pediatric mania. Eighteen studies reported the number of
subjects presenting with either irritable or elated mood during mania. Irritability has been reported to be
the most frequent clinical feature of pediatric mania reaching a sensitivity of 95–100% in several samples.
Only half the studies reviewed reported on number of episodes or cycling patterns and the described
course was mostly chronic and ultra-rapid whereas the classical episodic presentation was less common.
Few long-term outcome studies have reported a diagnostic stability of mania from childhood to young
adult age. Future research should focus on the heterogeneity of irritability aiming at differentiating
distinct subtypes of pediatric psychiatric disorders with distinct phenomenology, course, outcome and
biomarkers. Longitudinal studies of samples attending to mood presentation, irritable versus elated, and
course, chronic versus episodic, may help clarify whether these are meaningful distinctions in the course,
treatment and outcome of pediatric onset bipolar disorder.