L.R.R. is a 7 year-old boy with a history of an early onset of impulsive, destructive, talkative and agitated behavior. At school, he was hyperactive, restless and even physically aggressive towards his peers. In spite of this behavior, he had a high academic performance which led him to declare that he was “more intelligent than the other boys”. He presented also signs of sexual exacerbation and elation (e.g. he declares to have 8 girlfriends he had already kissed). His father is an alcoholic, his mother has history of postpartum depression and an aunt (maternal side) suffers from schizophrenia. At age of 6, he came to our service referred by his school teacher. His initial treatment was with methylphenidate 30mg/d combined with periciazine 1mg/d, but a hypomanic episode broke through with insomnia, emotional lability, psychomotor agitation and motor tics (e.g. compressing his chin to the chest). The diagnosis of bipolar disorder was established and his subsequent treatment attempts included risperidone 1mg/d, valproic acid 500mg/d, olanzapine 5mg/d, lithium 750mg/d and oxcarbazepine 600mg/d in a variety of combinations, but several drugs had to be discontinued or changed the dose due to intolerance (e.g. risperidone – postural hypotension; olanzapine plus lithium – 10-kilos weight gain and secondary nocturnal enuresis; lithium at 900mg/d – TSH alteration; oxcarbazepine – rash). Currently, he is taking olanzapine 2,5mg/d, lithium 600mg/d (0,75mEq/L) and aripiprazole 15mg/d with a better control of appetite and improvement of mood oscillations. Until now, he has not showed euthymic periods longer than 60 days.