eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Bipolar Disorder

Author: Bettina E Bernstein, DO, Assistant Professor, Department of Psychiatry, Philadelphia College of Osteopathic Medicine; Private Practice at the Wynnewood House; Consultant, Child Guidance Resource Centers, Early Elementary Education Program, Clinical Affiliate, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia
Contributor Information and Disclosures

Updated: Oct 12, 2009

Introduction

Background

Bipolar disorder is a mood disorder in which feelings, thoughts, behaviors, and perceptions are altered in the context of episodes of mania and depression. Previously known as manic depression, bipolar disorder was once thought to occur rarely in youth. However, approximately 20% of adults with bipolar disorder had symptoms beginning in adolescence.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV TR) does not distinguish adult-onset from childhood- or adolescent-onset symptoms of bipolar disorder. Indeed, the diagnostic criterion for bipolar disorder is the same regardless of the patient's age at the onset of symptoms. Despite clinically important differences in the way mood disorders, particularly behavioral differences, may manifest in a child or an adolescent, no diagnostic accommodation has been made based on age.

The DSM-IV TR uses universal symptoms to define the diagnostic criteria for mood episodes, including major depressive and manic episodes. One true manic episode, with or without psychotic features, is the necessary and sufficient criterion for type I bipolar disorder. A depressive episode is insufficient for this diagnosis, even in the presence of a strong family history of bipolar disorder. Type II bipolar disorder is diagnosed based on at least one hypomanic episode. Therefore, bipolar disorders are viewed as having a spectrum of symptoms that range from mild hypomania to the most extreme mania, which may include life-threatening behaviors, dysphoria, and psychotic features.

Hallmark symptoms of mania include an abnormal, often expansive, and elevated mood lasting for at least 1 week. Mania may also include a decreased need for sleep, racing thoughts or a sense that thoughts are out of control, rapid and often pressured speech, increased goal-directed activities or projects, hypersexuality, reckless behaviors and risk-taking, and delusions of grandeur. Delusions associated with mania frequently center around an expansive sense of self that goes well beyond narcissism, eg, believing oneself to have special (eg, supernatural) powers or to be the chosen leader of the world or universe.

For some, the elevated and elated mood may transform into a state of dysphoria during which agitated and irritable behaviors may develop. Cognitive impairment in mania may manifest as episodes of confusion with a flight of ideas and disorganization of thought. In addition, increased risk-taking may involve physical, emotional, or financial endangerment. Poor insight into one's disorder or behaviors and poor judgment accompany mania. Therefore, the person's financial accounts or important relationships may be in such disarray as to lead to adverse outcomes, including loss of important friends and family support or connections, serious financial setbacks, job losses, legal problems, and homelessness.

Especially in older children and adolescents, the adverse effects of the disorder can contribute to dysfunction in the school setting, potentially leading to expulsion or peer rejection. In addition, adverse health outcomes have recently been associated with psychotic states, including psychosis associated with mania. Such effects include poor eating habits and an increased likelihood of substance abuse, including nicotine dependence, which is known to be associated with serious health consequences, such as early death due to cardiovascular complications of arteriosclerosis, stroke, diabetic ketoacidosis, and cancer.

According to the DSM-IV TR, criteria for a manic episode are as follows:

  • The individual has a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week (or any duration if hospitalization is necessary).
  • During the period of mood disturbance, 3 or more of the following symptoms persisted (4 if the mood is only irritable) and have been present to a significant degree:
    • Inflated self-esteem to levels of grandiosity
    • Decreased need for sleep
    • More talkative than usual, often with pressured speech with a sense of a need to keep talking
    • Flight of ideas or subjective feeling that thoughts are racing
    • Distractibility
    • Increased goal-directed activity or psychomotor agitation
    • Excessive involvement in pleasurable activity that has a high potential for painful consequences (eg, hypersexuality, excessive spending, impetuous traveling)
  • The symptoms do not meet the criteria for a mixed episode.
  • The mood disturbance is severe enough to cause marked social impairment in occupational functioning, social activities, or relationships with others. Hospitalization may be necessary to prevent harm to self or others or if psychotic features are present.
  • The symptoms are not due to the direct physiologic effects of a substance or a general medical condition.

Hypomania is somewhat similar to mania but is less severe and less debilitating than true mania. As such, hypomania is defined as an elevated mood during which (1) no hospitalization has ever been necessary, and (2) no state of delusional or other psychotic thinking ever coincided with the elevated mood. Hypomanic and manic states must impair normal functioning to be considered pathologic states.

An abnormal behavioral episode may be designated a bipolar disorder after the frequency and type of abnormal mood are considered. Therefore, an episode may be reported as a bipolar disorder with a single manic episode, with recurrent manic episodes, or by the mood state of the most recent episode (eg, depressed, mixed, hypomanic, manic). Descriptors such as “with psychosis” or “without psychosis” are used to further clarify and reflect the severity of the state of the disorder.

Mood disturbances in children and adolescents are often more difficult to recognize and diagnose than those in adults. Some of the difficulty arises in recognizing atypical symptoms, including irritability, tantrums, physical aggression, and other behavioral problems, such as expressions of mood disruptions. Perhaps this difficulty is best demonstrated in symptom recognition and proper, but controversial, diagnosis of bipolar disorder in youths. The classic symptoms of mania, including racing thoughts, pressured speech, hypersexuality, and grandiosity, more often match the presentation of bipolar disorder in late adolescence. In childhood- or prepubertal-onset bipolar disorder, such a classic cluster of symptoms is uncommon. Nonetheless, as early as 1921, Kraepelin reported that 38% of his 900 patients who had manic episodes had symptom onset when younger than 20 years, and 0.4% had onset of symptoms when younger than 10 years.

Despite Kraepelin's early observation and description of childhood-onset and adolescent-onset bipolar disorders, the controversy about diagnosing bipolar disorder in young persons persists. This is partially driven by the requirement of discrete episodes of disturbed mood to diagnose bipolar disorder. Unlike what is noted in adults, well-defined and discrete episodes of abnormal mood are often missing in children and adolescents with this disorder. In particular, according to the DSM-IV TR criteria, at least 1 discrete episode of mania or hypomania is necessary to diagnose bipolar disorder type I or II.

Clinicians often use the diagnosis of bipolar disorder not otherwise specified (NOS) in children and adolescents with a chronically mixed or vacillating mood state. Children with this diagnosis may have clinically significant impairment though they do not meeting specific criteria for bipolar disorder type I or II.

Until the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) revisions are approved in 2012, limited nosology will continue to hamper efforts to distinguish among symptoms of adult-, adolescent-, or childhood-onset bipolar disorder, abnormal mood symptoms in adolescents and children, and normal developmental variation in behaviors, oppositional or defiant behaviors, inattention or hyperactivity, and conduct problems. Childhood-onset bipolar disorder frequently has an insidious onset with affective storms often associated with the presentation of mental illness.

Pathophysiology

A genetic predisposition to bipolar disorder may play a role in certain at-risk individuals. Significant early family stressors (eg, early history of abuse and neglect) and early experiences of catastrophic losses (eg, death of or abandonment by primary caregivers) may also predispose children and adolescents to bipolar disorder.

Frequency

United States

The overall prevalence of bipolar I disorder in adolescents is approximately 1%, whereas the prevalence in children is 0.2%-0.4%.

International

Bipolar disorder has roughly equal prevalence across different cultures.

Mortality/Morbidity

Suicide and suicide attempts account for significant sources of morbidity and mortality in individuals with bipolar disorder.

Other sources of morbidity and mortality are associated with poor judgment exercised by individuals with acute mania or psychosis. For example, serious cardiovascular complications, such as stroke and myocardial infarction, and an increased risk for cancer and diabetes can result from poor dietary choices and higher rates of alcohol and nicotine use and abuse.

Studies in the United States have also shown that many persons with serious mental illness (estimates upward of 40%), especially psychosis, obtain substandard medical care owing to noncompliance with medical treatment or the lack of resources to obtain needed treatment.

Sex

Pediatric and adolescent bipolar disorder does not appear to have a sexual predilection, although more males with the disorder are referred for treatment than are females.1,2

Age

  • Most patients with bipolar disorder present in early adulthood (age 20-30 y). The second most common age group at presentation is 15-19 years.
  • In contrast to Kraepelin's report that 38% of his patients had an onset when they were younger than 20 years, more recent estimates are that 20%-30% of adults with bipolar I disorder had symptom onset when younger than 20 years. In addition, approximately 20% of youths in whom a major depressive disorder was previously diagnosed develop symptoms consistent with a manic state at a later age. Therefore, an adolescent or child who initially presents with depression may have a hidden bipolar disorder that becomes obvious later in life.
  • Patients with a childhood onset of bipolar symptoms may have a course of illness that is more severe, chronic, and refractory than that of patients with a later onset of symptoms of bipolar disorder. In addition, an early onset of bipolar symptoms seems to be associated with increased risk of mixed mood states (combined symptoms of depression and mania simultaneously) and rapid cycling (>3 episodes of mania in 1 y).

Clinical

History

No laboratory study can be used to confirm the diagnosis of bipolar disorder. Therefore, gathering the history of present and past disturbances of mood, behavior, and thought is critical to properly diagnose a psychiatric condition such as bipolar disorder. Unlike other areas of medicine in which the clinician often relies on laboratory or imaging studies to identify or characterize a disorder, mental health professionals rely almost exclusively on descriptive symptom clusters to diagnose mental disorders. As a consequence, the history is an essential part of the patient examination.

  • The appropriate first step in evaluating a person for a psychiatric disorder is to ensure that no other medical condition is causing the mood or thought disturbance. Therefore, evaluation of the patient is best started by obtaining their oral history of current and past medical and behavioral symptoms and treatments. To further clarify the problem, gathering additional information from family and friends is always urged for a person experiencing an altered mood or behavioral state.
  • After interviewing the patient, perform a physical examination. Gather information from family, friends, and perhaps other physicians who know the patient. The problem might be classified as being primarily caused by a physical health problem or by a mental health problem.
    • While obtaining the history, the physician must explore the possibilities that substance abuse or dependence, trauma to the brain in the present or past, and/or seizure disorders may be contributing to or causing the current symptoms of illness.
    • CNS insults, such as encephalopathy or medication-induced mood changes (ie, steroid-induced mania), must also be considered. Delirium should be excluded first in persons presenting with altered mental states or acute disturbances of mood and conduct, especially when encephalopathy of an infectious, metabolic, or toxic origin is possible.
    • It is critical to take a careful history of alcohol use/abuse, including substance-abuse patterns, as acute drug-intoxication states may mimic bipolar disorder. In communities of lower socioeconomic status, huffing and ingestion of toxic substances, such as methyl alcohol (wood alcohol, gasoline), glue, and sprays, is extremely common among adolescents and can result in very rapid deterioration in mental status. In addition, such activities may result in hypoxia, potentially leading to permanent brain damage. In this setting, appropriate screening tests of blood, urine, and arterial blood oxygen and organ system function may be life-saving.
  • If the physical examination does not reveal a medical condition contributing to the patient's mental state, a thorough mental health evaluation is appropriate. Through observation and interviewing, mental health professionals may learn of mood, behavioral, cognitive, or judgment and reasoning abnormalities.
  • The mental status examination (MSE) is the essential component of a mental health evaluation. This examination goes beyond the mini-mental status examination (eg, Folstein Mini-Mental State Examination to screen for dementia) often used in emergency departments. Rather, the MSE is used to assess the general appearance and demeanor, speech, movement, and interpersonal relatedness of the patient with the examiner and others.
    • Mood and cognitive abilities (eg, orientation to circumstance; attentiveness; immediate-, short-, and long-term modes of memory) are assessed in the MSE. The assessment should be age-appropriate (eg, serial threes test in younger children).
    • Some of the most important components of the MSE are those addressing issues of safety of individuals and members of a community. Therefore, suicidal and homicidal issues are explored.
    • Likewise, screens for the more subtle forms of psychosis, such as paranoid or delusional states, in addition to screens for overt psychosis, such as observing the patient responding to unseen others or other non–reality-based internal stimuli, are explored.
    • Finally, insight into the patient's mental and physical states, the current circumstances of medical or mental healthcare, and the patient's ability to show age-appropriate insight and judgment are assessed and integrated into the evaluation of the global mental state of the patient at that moment. As examples, a child might be evaluated on his or her ability to verbalize potential environmental dangers (eg, why not to accept candy from a stranger, why not to run into the street, to explain how not to pick a fight with an older peer, or to describe the qualities that determine true friendship).
  • Because bipolar disorder may cause a transient but marked impairment of judgment, insight, and recall, several sources of information are crucial to understand a particular patient. Therefore, family members, friends, teachers, caregivers, or other physicians or mental healthcare workers may be interviewed to clarify the full clinical picture.
  • Nonetheless, the patient's subjective experience is essential in the evaluation and treatment processes, and the establishment of a therapeutic alliance and trust early in the assessment is vital to obtaining an accurate and useful history from the patient.
  • Knowledge of the family's psychiatric history is another essential part of the patient's history because bipolar disorder has genetic transmission and familial patterns. A genogram may be developed to further describe a particular patient's risk bipolar disorder based on familial and genetic attributes in the family system.

Physical

  • The physical examination must include a general neurologic examination, including examination of the cranial nerves, muscular bulk, and tone and deep tendon reflexes.
  • Cardiovascular, pulmonary, and abdominal examinations are also essential, as abnormal pulmonary function or poor vascular perfusion of the brain may cause abnormal mood, behavior, or cognition.
  • Both physical and laboratory thyroid examination should be performed because of the potential mood alteration in hypothyroid and hyperthyroid states and because of the need for baseline studies to ensure safety before and during medication treatment.
  • If these examinations do not reveal a medical condition contributory to the current mental state, a mental health evaluation should be performed (see History).

Causes

  • Genetic and familial factors seem to be highly important in the development of bipolar disorder. Early age of onset of bipolar disorder predicts a higher rate of mood disorder among first-degree relatives. Adolescents who have onset of true mania with childhood-associated psychotic symptoms, such as aggression, mood shifts, or attention difficulties, are at a greater genetic risk (family loading) for bipolar I disorder than adolescents with more adult-related psychotic symptoms, such as grandiosity.
  • Youths with early-onset bipolar disorder include (1) poor or ineffective response to lithium therapy (administered as Eskalith) and (2) an associated increased risk of alcohol-related disorders in the family members of the probands.
  • There is increased psychopathology in children who have at least one biologic parent with bipolar I or bipolar II disorder. Specifically, 28% of the children examined had attention deficit/hyperactivity disorder (ADHD), far above the prevalence of 3%-5% in the general population of school-aged children. In addition, 15% of the children had a bipolar disorder or cyclothymia. Approximately 90% of children who have bipolar disorders had comorbid ADHD. Moreover, both bipolar disorder and ADHD were more likely to be diagnosed in boys than in girls. Studies of bipolar disorder in twins showed a 14% concordance rate in dizygotic twins and a 65% concordance rate (range, 33%-90%) in monozygotic twins. The risk for bipolar disorder in the offspring of a couple in which one parent has bipolar disorder was estimated to be 30%-35%. For an offspring of a couple in which both parents have bipolar disorder, the risk was approximately 70%-75%.3
  • Children with bipolar disorder show a higher incidence of psychotic features than older adolescents or adults.4,5,6
  • Faraone et al further delineated the differences among children with mania, adolescents with childhood-onset mania, and adolescents with adolescence-onset mania.7
    • Socioeconomic status was statistically lower in families of children with mania and adolescents with childhood-onset mania than in others.
    • Increased energy was twice as common in childhood mania as in other forms, euphoria was most common in adolescents with childhood-onset mania, and irritability was least common in adolescents with adolescent-onset mania.
    • On statistical analysis, adolescents with adolescent-onset mania abused psychoactive drugs and had more impaired parent-child relationships than individuals in the other two groups with mania.
    • ADHD was more common in children and adolescents with childhood-onset mania than in patients with adolescent-onset mania. This finding led the authors to theorize that ADHD may be a marker for juvenile-onset mania.
  • Data from this and other studies8 suggest that a subtype of bipolar disorder may exist. This subtype may have a high familial transmission rate, and affected individuals present with childhood-onset of mania symptoms suggestive of ADHD.
  • There are concerns that early-onset mania may be misdiagnosed as ADHD or that more children have comorbid ADHD and bipolar disorder, with a higher rate of familial transmission. One controversy is whether youths who are later diagnosed with bipolar disorder may have a prodromal phase in early life that appears to be ADHD or another behavioral disturbance or whether many simply have bipolar disorder and comorbid ADHD.9,10
  • Cognitive and neurodevelopmental factors also seem to be involved in the development of bipolar disorder, especially in preschool-aged children who later go on to develop bipolar disorder.11,3,12
  • Preschool children with early behavioral disinhibition13 and decreased frustration tolerance may be at a greater risk for bipolar disorder in adolescence or adulthood, as this may reflect underlying early abnormalities of temperament that reflect increased risk for both bipolar disorder and ADHD.14,15
  • Emotion processing seems to be impaired in individuals with bipolar disorder because of a lack of flexibility in though processing.16,15,17
  • Neither the neural nor the genetic basis of bipolar disorder has been definitively elucidated; however, interest has been focused on potential abnormalities in the corpus callosum,18 amygdala,17 decreased protein kinase in platelets,19 and dopamine D4 receptor genotype and abnormalities of the dopamine transporter gene SLC6A3.20
  • A case-cohort study of adolescents with affective disorders revealed that neurodevelopmental delays are overrepresented in early-onset bipolar disorders, as well as in their "unaffected" siblings.21 These delays occur in language, social, and motor development approximately 10-18 years before affective symptoms appear.22
  • Adolescents who had early developmental antecedents were at a higher risk of developing psychotic symptoms. In addition, intelligence quotient (IQ) scores were significantly lower in patients with early-onset bipolar disorder (mean full-scale IQ, 88.8) than in patients with unipolar depression (mean full-scale IQ, 105.8).
  • Finally, a statistically significant difference in the mean verbal IQ and mean performance IQ was found only in patients with bipolar disorder. The reason for this discrepancy is unclear but should be the subject of further investigation.
  • Overall, patients with severe bipolar disorder had a mean IQ lower than that of patients with mild-to-moderate forms of the disorder.
  • Environmental factors also contribute to the development of bipolar disorder. These may be behavioral, educational, family-related, toxic, or substance abuse–induced. Wilens et al (2008) implicated smoking as a potential causal element in patients with bipolar disorder.23
  • Diagnoses of mental health problems increase the risk of suicide in adolescents compared with their healthy peers.
  • Adolescent patients in whom bipolar disorder is diagnosed are at higher risk of suicide than adolescents with other behavioral illnesses. Family conflict and substance abuse exponentially increase this risk.10,24,9
  • Another risk factor for suicide in youths is legal problems. One study showed that 24% of adolescents who attempted suicide had faced legal charges or consequences in the preceding 12 months.23
  • Males with bipolar disorder are at higher risk of death from suicide than are females, who are more likely to attempt suicide numerous times unsuccessfully. This does not imply that suicide attempts in females should not be of concern; rather, suicide attempts in males occur less often, as they tend to be suicide completers. In females, the disorder is also associated with social rejection from female peers.
  • Incarcerated youths have an inordinately high prevalence of mental illnesses. Some are facing legal consequences as a direct result of behaviors that arise from uncontrolled or untreated mental disorders. The manic state of bipolar disorder can be particularly problematic for adolescents, as the disinhibited risk-taking behaviors driven by the disorder can easily lead to legal problems, such as public disorderly conduct, theft, drug seeking or use, and an agitated and irritable mood that results in verbal and physical altercations.

Biologic and biochemical factors

  • Sleep disturbances often aid in defining abnormal mood states of bipolar disorder in either the manic or depressed state. As such, it is helpful to determine the patient's baseline euphonic state sleep pattern (eg, does the patient often get up early or stay up late?).
    • A profoundly decreased need for sleep in the absence of a sense of fatigue is a strong indicator of a manic state. A change in the patient’s usual sleep pattern (eg, from being a "night owl" to an "early riser") may predict a significant change in the patient’s mood state. Sleep studies of the CLOCK genetic areas have utilized functional magnetic resonance imaging (fMRI) to differentiate groups of children and adolescents with bipolar disorder.25
    • An uncomfortable reduction of sleep is a pattern of an atypical depression episode in which more sleep is wanted but cannot be achieved. Conversely, a typical depression episode may be indicated by hypersomnolence, an excessive and irresistible need for sleep.6
    • The biology that drives these sleep anomalies in mood disturbances is not fully appreciated. Some suggest that neurochemical and neurobiologic shifts cause these episodic sleep disturbances in conjunction with other shifts that occur in the evolution of manic or depressed states.
  • Bipolar disorder and other mood disorders are increasingly understood in the context of neurochemical imbalances in the brain.
    • Although the circuits of the brain that modulate mood, cognition, and behavior are not well defined, the database of neuroimaging studies that facilitate increased appreciation of possible modulating pathways (particularly in the amygdala) that connect several brain regions to work in unison to regulate thoughts, feelings, and behaviors is constantly growing.17
    • An association of neurotransmitters acts upon various brain regions and circuits to modify and regulate brain activity. CNS neurotransmitters in brain circuits and their putative effects in activity modification include the following:
      • Serotonin - Mood (happy, sad, euthymic)
      • Dopamine - Pleasure (hedonia, anhedonia)
      • Norepinephrine - Alertness, energy level (lethargy, frenzy, vigilance)
      • Acetylcholine - Memory and cognition
      • GABA - Inhibition of CNS neurons
      • Glutamate - Excitation of CNS neurons
    • One proposal suggests that several neurotransmitters acting in unison but with dynamic balance act as modulators of mood states. In particular, serotonin, dopamine, and norepinephrine appear to modify mood, cognition, and sense of pleasure or displeasure.
    • Pharmacotherapy for the regulation of bipolar mood swings is thought to be based on the use of medications that facilitate the regulation of these and perhaps other neurochemicals to restore a normal mood and cognition.
    • Meditation and deep relaxation, including regular exercise, may also indirectly modulate neurotransmitter levels, increasing endogenous opioid and nicotinic receptor function.

More on Bipolar Disorder

Overview: Bipolar Disorder
Differential Diagnoses & Workup: Bipolar Disorder
Treatment & Medication: Bipolar Disorder
Follow-up: Bipolar Disorder
References
[ CLOSE WINDOW ]

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Further Reading

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Keywords

bipolar disorder, BPD, BPAD, manic depression, mania, depression, hypomania, bipolar I disorder, bipolar II disorder, type I bipolar disorder, type II bipolar disorder, manic episode, conduct disorder, CD, extrapyramidal symptoms, EPS, tardive dyskinesia, TD

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Contributor Information and Disclosures

Author

Bettina E Bernstein, DO, Assistant Professor, Department of Psychiatry, Philadelphia College of Osteopathic Medicine; Private Practice at the Wynnewood House; Consultant, Child Guidance Resource Centers, Early Elementary Education Program, Clinical Affiliate, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia
Bettina E Bernstein, DO is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry and American Psychiatric Association
Disclosure: Nothing to disclose.

Medical Editor

Carol Diane Berkowitz, MD, Executive Vice Chair, Department of Pediatrics, Professor, Harbor-University of California at Los Angeles Medical Center
Carol Diane Berkowitz, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, American Pediatric Society, and North American Society for Pediatric and Adolescent Gynecology
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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