A prospective 4-5 year follow-up of juvenile onset bipolar disorder (original) (raw)
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American Journal of Psychiatry, 2009
Objective-To assess the longitudinal course of youth with bipolar spectrum disorders. Methods-413 youth (7-17 years) with bipolar-I (n=244), bipolar-II (n=28), and bipolar Not-Otherwise-Specified (NOS) (n=141) were recruited mainly from outpatient clinics at the University of Pittsburgh, Brown, and UCLA. Symptoms were ascertained retrospectively on average every 9.4 months for 4 years using the Longitudinal Interval Follow-up Evaluation. Rates and time to recovery and recurrence and week-by-week symptomatic status were analyzed. Results-Approximately 2.5 years after onset of their index episode, 81.5% of subjects fully recovered, but 1.5 years later 62.5% had a syndromal recurrence, particularly depression. One-third of the subjects had one syndromal recurrence and 30% ≥ 2 syndromal recurrences. The polarity of the index episode predicted the polarity of subsequent episodes. Subjects were symptomatic during 60% of follow-up time, particularly with subsyndromal symptoms of depression and mixed-polarity, with numerous changes in mood polarity. Manic symptomatology, especially syndromal, was less frequent and bipolar-II was mainly manifested by depressive symptoms. Forty-percent of subjects had syndromal and/or subsyndromal symptoms during 75% of follow-up period. During 17% of follow-up time subjects, especially those with bipolar-I, experienced psychosis. Twenty-five percent of bipolar-II subjects converted into bipolar-I and 38% of bipolar-NOS converted into bipolar-I/II. Early-onset, bipolar-NOS, long duration, low socioeconomic status, and family history of mood disorders were associated with poorer outcomes. Conclusions-Bipolar spectrum disorder in youth is an episodic disorder characterized by subsyndromal and, less frequently, syndromal episodes with mainly depressive and mixed symptoms and rapid mood changes.
Bipolar disorders across the lifespan
Journal of Clinical Psychology, 2008
For several decades, psychological research on bipolar disorder languished. The robust heritability of the disorder , coupled with the great gains provided by lithium , led to a biological zeitgeist. Few psychologists considered the disorder as a target for their work, and the portfolio of NIMH grants for the disorder was quite small. In 1988, an NIH task force was convened to evaluate the state of findings, and their recommendations led to a significant change in the field (Prien & Potter, 1988). Acknowledging the high relapse rates on medications alone, they pushed for more basic research on the predictors of symptoms, as well as more research on psychosocial treatments to supplement medication approaches. Within a few years, a set of psychological treatment outcome trials were funded. These trials did more than supply a set of treatment outcome findings; they increased the visibility of the disorder in psychology departments and at psychology conferences. Within the last 10 years, this visibility has paid off in a new generation of trainees who are entering the field and tackling a broader and broader array of topics.
Bipolar disorder in young people. description, assessment and evidence-based treatment
Objective. The literature on bipolar in children and adolescents was reviewed to provide an update for clinicians. Review process. Literature of particular relevance to evidence-based practice was selected for critical review. Outcomes. An up-to-date overview of clinical features, epidemiology, prognosis, aetiology, assessment and intervention was provided. Conclusions. Bipolar disorder in children and adolescence is a relatively common, multifactorially determined, and recurring problem which persists into adulthood. Psychometrically robust screening questionnaires and structured interviews facilitate reliable assessment. Multimodal chronic care programmes involving medication (notably lithium) and family oriented psychotherapy are currently the treatment of choice.
Interventions for Youth at Risk of Bipolar Disorder
Current Treatment Options in Psychiatry, 2014
With the recognition that bipolar disorder (BD) develops in a series of predictable clinical stages, clinical and research focus has shifted increasingly into early intervention and prevention. The heritability of BD is estimated to be around 85 %; therefore, children of affected parents are an identifiable and important high-risk group. Lessons from early psychosis and other areas of medicine suggest that education for high-risk families regarding recognizable clinical stages and modifiable risk factors are a reasonable starting place. Specifically, reinforcing the importance of healthy nutrition, cardiovascular exercise, maintaining normal body mass index, and healthy coping strategies are important topics to cover. Early risk syndromes include sleep and anxiety disorders, which should be addressed with low-risk treatments, including sleep hygiene and individual psychotherapy. Typically, adolescence marks the age of onset of depressive disorders related to the bipolar diathesis. This is also the time when poor coping through substance abuse emerges. It is very important when assessing a depressed adolescent to understand the familial risk of psychiatric disorders. While psychotherapy is typically effective for mild non-psychotic depression, the acute treatment of moderate-severe major depression in adolescents and young adults with a confirmed family history of BD is a topic of considerable debate. The treatment decision should be taken together with the patient and family, with full discussion of the risks and potential benefits. Options include a closely monitored trial of low-dose antidepressant, discontinued immediately upon resolution of the depressive episode, or mood stabilizer that fits the patient profile, or a combination of these two, in addition to psychotherapy and reducing modifiable risk factors. When a high-risk subject manifests a diagnosable manic or hypomanic episode (typically years after the first depressive episode in late adolescence or adulthood) the question arises of whether to initiate prophylactic treatment. Potential candidates are those with a high recurrence risk and/or concern about the recurrence of a severe episode. Research has shown that most patients can be stabilized, with selected monotherapy individualized on the basis of the nature of the clinical course (episodic vs. non-episodic), quality of the spontaneous remission, and family history of psychiatric disorders and treatment response.
Bipolar Disorders, 2006
Aim and Methods-Findings from recent long-term, prospective longitudinal studies of the course, outcome, and naturalistic treatment of adults with bipolar illness are highlighted as background for long-term developmental study of pediatric bipolar illness. Results-Accumulating knowledge of bipolar illness in adults underscores a high risk for multiple recurrences through the lifespan, significant medical morbidity, high rates of self-harm, economic and social burden, and frequent treatment resistance with residual symptoms between major episodes. At present, there is no empirical foundation to support any assumption about the long-term course or outcome of bipolar illness when it arises in childhood or adolescence, or the effects of conventional pharmacotherapies in altering its course and limiting potentially adverse outcomes. The proposed research articulates specific descriptive aims that draw on adult findings, and outlines core methodological requirements for such an endeavor. Conclusions-Innovations in the description and quantitative analysis of prospective longitudinal clinical data must now be extended to large, systematically ascertained pediatric cohorts recruited through multi-center studies if there is to be a meaningful scientific advance in our knowledge of the enduring effects of bipolar illness and the potential value of contemporary approaches to its management.
The Poor Prognosis of Childhood-Onset Bipolar Disorder
The Journal of Pediatrics, 2007
We examined age of onset of bipolar disorder as a potential course-of-illness modifier with the hypothesis that early onset will engender more severe illness. Study design A total of 480 carefully diagnosed adult outpatients with bipolar disorder (mean age, 42.5 ؎ 11.6 years) were retrospectively rated for age of illness onset, time to first pharmacotherapy, and course of illness. Clinicians prospectively rated daily mood fluctuations over 1 year. Results Of the 480 patients, 14% experienced onset in childhood (12 years or younger); 36% in adolescence (13 to 18 years); 32% in early adulthood (19 to 29 years); and 19% in late adulthood (after 30 years). Childhood-onset bipolar illness was associated with long delays to first treatment, averaging more than 16 years. The patients with childhood or adolescent onset reported more episodes, more comorbidities, and rapid cycling retrospectively; prospectively, they demonstrated more severe mania, depression, and fewer days well. Conclusions This study demonstrates that childhood onset of bipolar disorder is common and is associated with long delays to first treatment. Physicians and clinicians should be alert to a possible bipolar diagnosis in children in hopes of shortening the time to initiating treatment and perhaps ameliorating the otherwise adverse course of illness.
Lithium treatment in bipolar adolescents: a follow-up naturalistic study
Neuropsychiatric Disease and Treatment
Background: Although lithium is currently approved for the treatment of bipolar disorders in youth, long term data, are still scant. The aim of this study was to describe the safety and efficacy of lithium in referred bipolar adolescents, who were followed up at the 4th (T1) and 8th (T2) month of treatment. Methods: The design was naturalistic and retrospective, based on a clinical database, including 30 patients (18 males, mean age 14.2±2.1 years). Results: Mean blood level of lithium was 0.69±0.20 mEq/L at T1 and 0.70±0.18 mEq/L at T2. Both Clinical Global Impression-Severity (CGI-S) and Children Global Assessment Scale (C-GAS) scores improved from baseline (CGI-S 5.7±0.5, C-GAS 35.1±3.7) to T1 (CGI-S 4.2±0.70, C-GAS 46.4±6.5; P,0.001), without significant differences from T1 to T2. Thyroid-stimulating hormone significantly increased from 2.16±1.8 mU/mL at baseline to 3.9±2.7 mU/mL at T2, remaining within the normal range, without changes in T3/T4 levels; two patients needed a thyroid hormone supplementation. Creatinine blood level did not change. No cardiac symptoms and electrocardiogram QTc changes occurred. White blood cell count significantly increased from 6.93±1.68 10 3 /mmc at baseline to 7.94±1.94 10 3 /mmc at T2, and serum calcium significantly increased from 9.68±0.3 mg/dL at baseline to 9.97±0.29 mg/dL at T2, both remaining within the normal range; all the other electrolyte levels were stable and normal during the follow-up. The treatment with lithium was well tolerated, probably due to the relatively low lithium blood levels. Gastrointestinal symptoms (16.7%), sedation (9.7%) and tremor (6.4%) were the most frequently reported side effects. Conclusion: Lithium was effective and safe in adolescent bipolar patients followed-up for eight months.
Bipolar disorder in children and adolescents
Child and Adolescent Mental Health, 2013
BackgroundThe existence of bipolar disorder (BP) in youth is controversial.MethodsThe current evidence regarding the diagnosis of BP in youth was reviewed.ResultsBP is a recurrent familial disorder that occurs in 1–3% of youth, particularly in adolescents. Except for subsyndromal BP, the prevalence of BP‐I is similar across most countries. Due to the child's immaturity, the presence of comorbid disorders, and divergent interpretations of manic symptomatology, it is difficult to diagnose BP in youth. Youth with subsyndromal mania and family history of BP, are at high risk to develop BP‐I and BP‐II. Both the full‐syndromal BP and subsyndromal BP are associated with significant psychosocial difficulties and increased risk for use of substances, suicidality, legal problems, and services utilization.ConclusionBipolar disorder exists in youth, but it is difficult to diagnose. The recurrent nature and psychosocial morbidity associated with this illness during critical developmental sta...
Clinical Course of Children and Adolescents With Bipolar Spectrum Disorders
Archives of General Psychiatry, 2006
Context: Despite the high morbidity associated with bipolar disorder (BP), few studies have prospectively studied the course of this illness in youth. Objective: To assess the longitudinal course of BP spectrum disorders (BP-I, BP-II, and not otherwise specified [BP-NOS]) in children and adolescents. Design: Subjects were interviewed, on average, every 9 months for an average of 2 years using the Longitudinal Interval Follow-up Evaluation. Setting: Outpatient and inpatient units at 3 university centers. Participants: Two hundred sixty-three children and adolescents (mean age, 13 years) with BP-I (n = 152), BP-II (n=19), and BP-NOS (n = 92). Main Outcome Measures: Rates of recovery and recurrence, weeks with syndromal or subsyndromal mood symptoms, changes in symptoms and polarity, and predictors of outcome.