Refractory cases
Clozapine is recommended for refractory bipolar
disorder but with caution due to the side effects.
Require regular monitoring with blood tests is
essential.
ECT is rarely used in adolescents, but case
series and reports support its use in severe life-
threatening psychotic depression or treatment-
resistant mania. The response rate for psychotic
disorders is 50–60% [34]. ECT requires appro-
priate consent, and given the mental state of the
patient this is very likely to be under appropriate
legislative powers.
SCHIZOAFFECTIVE DISORDER (SA)
The concept of schizoaffective disorder remains
problematic. Indeed, there is little evidence for
temporal stability for the diagnosis of SA in this age
group [35]; however, genetic studies [36] show that
broadly defined schizoaffective disorder, bipolar
type, is genetically homogeneous. Nevertheless,
there are questions over the distinction between
schizophrenia and bipolar disorder with psychosis
on the grounds of a largely shared genetic basis,
with the exception of copy number variations [37].
ACKNOWLEDGEMENT
Acknowledgement goes to Anthony Richard
James for the helping to prepare the manuscript.
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