High level of persistence of pediatric bipolar-I disorder from childhood onto adolescent years: A four year prospective longitudinal follow-up study (original) (raw)
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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.
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.
Journal of the American Academy of Child & Adolescent Psychiatry, 2011
Objective-To determine the rate of diagnostic conversion from an operationalized diagnosis of Bipolar Disorder Not Otherwise Specified (BP-NOS) to Bipolar I or Bipolar II Disorders (BP-I/II) in youth over prospective follow-up and to identify factors associated with conversion. Method-Subjects were 140 children and adolescents recruited from clinical referrals or advertisement who met operationalized criteria for BP-NOS at intake and participated in at least one follow-up evaluation (91% of initial cohort). Diagnoses were assessed at follow-up interviews using the Longitudinal Interval Follow-Up Evaluation. The mean duration of follow-up was 5 years and the mean interval between assessments was 8.2 months. Results-Diagnostic conversion to BP-I/II occurred in 63 subjects (45%): 32 (23%) to BP-I (9 of whom had initially converted to BP-II) and 31 to only BP-II (22%). Median time from intake to
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.
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...
Pediatric-Onset Bipolar Disorder: A Neglected Clinical and Public Health Problem Gianni
Harvard Review of Psychiatry, 1995
disorder (BPD), probably the most prevalent psychotic disorder in adults, has been relatively neglected or controversial in children and adolescents over the past century. We reviewed the literature on early-onset BPD.* Estimates of prevalence, particularly before puberty, are limited by historical biases against pediatric mood disorders and by formidable diagnostic complexity and comorbidity. Although clinical features of pediatric and adult BPD have similarities, pediatric cases probably cannot be defined solely by features characteristic of adult cases. Onset was before age 20 years in at least 25% of reported BPD cases, with some increase in this incidence over the past century. Pediatric BPD is familial more often than is adult-onset BPD, may be associated with a premorbid cyclothymic or hyperthymic temperament, and can be precipitated by antidepressant treatment. Pediatric BPD episodes frequently include irritability, dysphoria, or psychotic symptoms; they are commonly chronic and carry high risks of substance abuse and suicide. BPD is often recognized in adolescents, but the syndrome or its antecedents are almost certainly underrecognized and undertreated in children. Controlled studies of shortand long-term treatment, course, and outcome in this disorder remain strikingly limited, and the syndrome urgently requires increased clinical and scientific interest. (HARVARD REV PSYCHIATRY 1995;3:171-95.) From the International Consortium on Bipolar Disorders Research (Drs.
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 children and adolescents: an update on diagnosis
Clinical Practice, 2014
Practice points • Despite converging evidence validating pediatric bipolar disorder (PBD), it is still challenging to diagnose PBD accurately. • Consideration of the developmental course and common comorbidities will help improve the diagnostic accuracy of PBD. • Clinical triggers such as family history, early-onset depression, antidepressant-coincident mania, episodic mood lability, episodic aggressive behavior, psychotic features and sleep disturbance should trigger a thorough evaluation of possible PBD. • Semistructured interviews remain the gold standard for assessing for PBD. • Understanding cultural dynamics such as training, class/race issues, stigma and lifestylerelated factors may help bridge the gap between research and practice. Converging evidence from both community and clinical settings shows that pediatric bipolar disorder is a valid diagnosis and a debilitating condition. While the field has evolved considerably, there remain gaps in diagnosis, assessment, research and practice. This article critically appraises: advances in understanding of the phenomenology of pediatric bipolar disorder; changes in diagnostic criteria from the Diagnostic and Statistical Manual (DSM)-IV to DSM-5 and corresponding controversies; the epidemiology of pediatric bipolar disorder; current assessment and diagnostic practices; and cultural factors influencing treatment seeking and diagnosis. We recommend using an evidence-based framework for bridging the gap between research and clinical practice.