INCLUSION CRITERIA (All 5 must be met): Children with BPD
Currently meets criteria for bipolar disorder, manic or mixed, as determined by the K-SADS diagnostic interview.
Treatment-resistant, defined as a history of unsuccessful trials of lithium (documented level of greater than 0.8 mEq/L), valproic acid (documented level of greater than 50 ug/ml), carbamazepine (documented level greater than or equal to 6 ug/ml), a neuroleptic as well as a combination of two of these agents. Each trial must have been at least 6 weeks long. A trial will be considered unsuccessful if the medication was discontinued because of intolerable side-effects.
The child should be in treatment with a community psychiatrist to whom they will return upon completion of the study.
Current CGAS score less than 50
EXCLUSION CRITERIA: Children with BPD
Full scale IQ less than 80
Meets criteria for substance use disorder in the three months prior to randomization
Currently pregnant, lactating, or sexually active without using a barrier method of contraception
Previous treatment with clozapine
History of seizures
History of leukopenia or agranulocytosis
Presence of an unstable medical illness
INCLUSION CRITERIA: CONTROLS
Control subjects will be age- and sex- matched to the BPD subjects. They will have normal physical and neurological examinations, and an identified primary care physician. Both control subjects and their first-degree relatives must be free of current or past psychopathology.
EXCLUSION CRITERIA: CONTROLS
I.Q less than 80; ongoing medical illness; neurologic disorder (including seizures); pregnancy; meeting past or present criteria for any diagnosis on the K-SADS-PL; meeting criterion A of post-traumatic stress disorder (exposure to a traumatic event).