Classifying Mood Symptom Trajectories in Adolescents With Bipolar Disorder

Abstract

Objective: The Course and Outcome of Bipolar Youth study found that children and adolescents with bipolar spectrum disorders followed 1 of 4 distinct mood trajectories over 8 years of follow-up, with as many as 25% of participants showing a predominantly euthymic course. We evaluated whether similar patterns of illness course are observed in adolescents with bipolar I and II disorder who participated in a 2-year clinical trial. Method: A total of 144 adolescents with bipolar I or II disorder, identified shortly after a mood episode, were assessed over a 2-year period. Participants were randomly assigned to one of 2 psychosocial family treatments during the first 9 months of the study, and pharmacotherapy was provided throughout the 2 years. Using latent class growth analyses, we classified participants into distinct courses of illness based on mood ratings collected over the 2 years. We examined demographic and illness variables as predictors of these course classifications. Results: Latent class growth analyses indicated four mood trajectories: "predominantly euthymic" (29.9% of sample), "ill with significantly improving course" (11.1%), "moderately euthymic" (26.4%), and "ill with moderately improving course" (32.6%). Adolescents in these classes were euthymic 77.7%, 53.6%, 44.1%, and 18.6% of the weeks of follow-up, respectively. Psychosocial treatment condition and baseline medication exposure were not associated with trajectories. However, youth with more severe baseline depressive symptoms, suicidality, lower quality of life scores, and minority race/ ethnicity had more symptomatic courses of illness over time. Conclusion: A substantial proportion (25%À30%) of youth with bipolar I or II disorder maintain euthymic states over extended periods of follow-up. Identifying youth who are more and less likely to remain stable over time may help guide psychosocial and pharmacological treatments after an illness episode.

Effects of family-focused therapy on suicidal ideation and behavior in youth at high risk for bipolar disorder

“…Less recognized are the high rates of suicidal ideation (SI) and attempts associated with early-onset BD and subthreshold "high-risk" conditions (Goldstein et al, 2012;Melhem et al, 2019). High levels of SI are associated with a more deteriorative course of illness in youth with BD (Birmaher et al, 2014;Weintraub et al, 2020). The present study examined whether a brief course of family-focused therapy (FFT) is effective in reducing levels of suicidal thinking and behavior in youth at high risk for BD.…”

What Do We Know about the Long-Term Course of Early Onset Bipolar Disorder? A Review of the Current Evidence

“…Four cohorts were based on reviews of medical records from naturalistically treated patients, with a total of 363 patients and a period of observation between 1.5 and 15 years [ 29 , 30 , 53 , 55 ]. Two cohorts consisted of follow-up of clinical trial samples, for a total of 220 patients and a period of observation of two years [ 56 , 60 ]. One was a large managed care insurance database, which included 8129 patients and a period of observation of 1.4 years [ 52 ], and one was a nationwide population registry in Denmark, which included up to 519 patients over a 10-year period ( Table 1 ) [ 59 ].…”

“…In a medical record review on a Spanish sample, children with BD had a chronic course with little inter-episodic recovery [ 54 ]. However, in a prospective follow-up of a clinical trial sample, a substantial proportion (25–30%) of youth with bipolar I or II disorder maintained euthymic states over extended periods [ 60 ].…”

Research Status in Clinical Practice Regarding Pediatric and Adolescent Bipolar Disorders

“…Weintraub et al ( 97 ) divided mood symptom trajectories of adolescent BD patients after FFT into the following four types: Apparent euthymia (initially responded to treatment well and maintained euthymia), accounting for 29.9% of cases; morbid but apparently improved (poor initial treatment effect but later improved and then maintained euthymia), accounting for 11.1%; mild euthymia (improved initially but symptoms reappeared and residual symptoms remained), accounting for 26.4%; and morbid with mild improvement (had severe symptoms initially and presented with mild euthymia after treatment), accounting for 32.6%; participants in these four groups spent, respectively, 77.7, 53.6, 44.1, and 18.6% of the follow-up weeks in euthymia states. Groups 1 and 2 showed fewer severe depression symptoms at baseline than Groups 3 and 4, and Groups 1 and 2 also showed less suicidal ideation, which meant that the prognosis of BD with more severe depression symptoms and suicidal ideation was poorer ( 97 ). Meanwhile, life stage and the level of therapy at baseline also predicted the division whereby patients in Groups 1 and 2 presented with higher life quality scores than patients in Group 4; patients in Group 2 presented with the highest family happiness levels at baseline and higher school happiness than patients in Groups 3 and 4, which indicated that life quality was related to mood symptoms of patients with BD ( 97 ).…”