Diagnosis of BD was associated with a higher rate ofsuicide attempts than was diagnosis of apparent unipolarMDD, and both were higher than in cases with mania orhypomania without depression in 6 reports involving a totalof 2,303 children and adolescents diagnosed with a mooddisorder. Additional studies are required to test the findingspresented, to better evaluate the long-term significance ofisolated mania or hypomania without depression in juveniles,and to assess the impact of mixed manic-depressivestates in juveniles. Practical, clinical conclusions pertainingto the evaluation and treatment of juvenile patients includethe need for close consideration of early-onset BD because ofits sometimes-difficult differentiation from MDD and especiallyhigh risk of suicidal behavior