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Clinical Case Studies
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Complexity and Comorbidity in a Case of Early-Onset Bipolar Disorder

Rebecca J. Knowles

Family Connections, Grants, NM

A reproducible characteristic of early-onset bipolar disorder (BPD) is its atypicality when compared to the adult form. Research and practice consistently confirms early-onset BPD to be chronic rather than acute and continuous rather than episodic, with mixed manic states rather than biphasic and multifarious patterns of comorbidity. Research into successful psychotropic treatments for early-onset BPD is on-going and diverse. Similarly, psychosocial interventions are in the prototype phase. This school-based case study follows an 18-month course of treatment for a 16-year-old female with early-onset BPD comorbid with attentiondeficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder, and situationally predisposed panic attacks. The first 6 months of treatment involved no medications. During this time, intensive psychosocial and cognitive-behavioral interventions including affect-regulation training, behavior modification, self-monitoring, contingency management, educational accommodations, emergency classroom protocols, and intensive psychotherapy were successfully implemented. In the second phase of treatment, after numerous unsuccessful psychotropic trials, the client's mood was stabilized with gabapentin (Neurontin), with methylphenidate (Ritalin) being added to treat her ADHD with astounding results.

Key Words: early-onset bipolar • comorbidity • ADHD • cognitive behavioral • psychotropic • psychosocial

Clinical Case Studies, Vol. 6, No. 3, 232-251 (2007)
DOI: 10.1177/1534650106290464
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