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A recent worldwide survey in 11 countries found a median age of onset of about 25 years, 3 with an overall lifetime prevalence of 0.6% for bipolar I disorder (male predominance, although an equal sex ratio has been found in other studies) and 0.4% for bipolar II disorder (female predominance). Milder subthreshold disorders had a worldwide lifetime prevalence of 1.4%. The highest values were found in the United States (1.0%, 1.1%, and 2.4% respectively. 3 Prepubertal mania is rare; typically, minor mood disturbance in adolescence progresses to episodes of depression and then to mania in adult life. 6