A prospective study of bipolar disorder in children and adolescents from India

Abstract

Bipolar disorder in adults is known to run an episodic course. However, little information exists on the long-term naturalistic course of bipolar disorder in juvenile populations. The present study was undertaken with the objectives of (i) documenting the rates of recovery and relapse, (ii) identifying the predictors of recovery and relapse and (iii) assessing the rates of comorbid conditions. A total of 30 subjects with onset of bipolar illness (according to DSM-III-R criteria) in childhood and adolescence were assessed systematically at baseline and 4 to 5 years later. All 30 subjects (100%) had recovered from their index episodes and none had exhibited chronicity. Twenty of the 30 subjects (67%) had relapsed, with most relapses occurring within 2 years of recovery from index episodes. No predictors of recovery and relapse could be identified. Conduct disorder was the only comorbid diagnosis in two subjects (7%). The main implication of our study, in view of the high rates of relapse in the crucial developmental phase of a young individual, is that long-term maintenance medication should be considered in juvenile bipolar patients, even if it is a first episode.

Twelve-Month Outcome of Adolescents With Bipolar Disorder Following First Hospitalization for a Manic or Mixed Episode

“…First, previous studies have not reported information regarding medication adherence, despite the strong association between treatment adherence and high recovery rates in studies of bipolar adults (12). Second, although most outcome studies of bipolar youth include a subset of adolescents close to their illness onset (3)(4)(5)(6)(7)(8)(9)(10)(11), no study, to our knowledge, has examined the outcome exclusively of adolescents hospitalized for their first manic episode. Studying patients early in their illness course permits identification of factors associated with recovery that may be difficult to detect in patients who have had multiple affective episodes, where illness chronicity may become the most significant predictor of outcome (3,12,13).…”

“…Al though the onset of bipolar disorder most commonly occurs during adolescence (1,2), there have been relatively few naturalistic outcome studies of children and adolescents with bipolar disorder (3)(4)(5)(6)(7)(8)(9)(10)(11). Prospective studies of clinical cohorts of bipolar youth have reported recovery and recurrence rates that range from 14%-100% and 35%-70%, respectively, during follow-up periods of 6 months to 4 years.…”

Twelve-Month Outcome of Adolescents With Bipolar Disorder Following First Hospitalization for a Manic or Mixed Episode

“…(Am J Psychiatry 2007; 164: [582][583][584][585][586][587][588][589][590] Al though the onset of bipolar disorder most commonly occurs during adolescence (1,2), there have been relatively few naturalistic outcome studies of children and adolescents with bipolar disorder (3)(4)(5)(6)(7)(8)(9)(10)(11). Prospective studies of clinical cohorts of bipolar youth have reported recovery and recurrence rates that range from 14%-100% and 35%-70%, respectively, during follow-up periods of 6 months to 4 years.…”

History of suicide attempts in pediatric bipolar disorder: factors associated with increased risk

“…Furthermore, reports from two longitudinal studies support significant mortality from suicide among pediatric BP patients. Srinath et al (8) reported a 3% suicide rate among pediatric BPI patients 5 years after index episode hospitalization, whereas Welner et al (9) documented a 25% suicide completion rate among a BP adolescent inpatient sample (when compared with 6% among unipolar patients) at 10-year follow up.…”