Clinical Course of Children and Adolescents With Bipolar Spectrum Disorders

Birmaher, Boris; Axelson, David; Strober, Michael; Gill, Mary Kay; Valeri, Sylvia; Chiappetta, Laurel; Ryan, Neal D.; Leonard, Henrietta L.; Hunt, Jeffrey; Iyengar, Satish; Keller, Martin B.

doi:10.1001/archpsyc.63.2.175

Cited by 585 publications

(592 citation statements)

References 76 publications

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“…This distinction between these different presentations is important, given its potential implications for pathophysiology treatment, and nosologic classification. Youth with the short-duration episodes were followed longitudinally in the COBY study, in which approximately 25% of the BD-NOS subjects experienced a full-duration hypomanic or manic episode over the course of a 3-year follow-up 18 In contrast, in the present study, 1.2% of SMD subjects converted from SMD to BD-I or BD-II within an approximate 2-year follow-up. Of note, the AACAP guidelines for BD recommend considering both the "short episode" and the "nonepisodic" phenotypes to be BD-NOS presentations.…”

Section: Nih-pa Author Manuscriptcontrasting

confidence: 58%

“…18 The diagnosis of BD-NOS is poorly specified in DSM-IV; in child psychiatry, it is frequently assigned to two distinct clinical presentations: youth with severe, nonepisodic irritability (a presentation that we operationalized as SMD), and those with distinct (hypo-)manic episodes that are shorter than 4 days in duration. This distinction between these different presentations is important, given its potential implications for pathophysiology treatment, and nosologic classification.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric Bipolar Disorder Versus Severe Mood Dysregulation: Risk for Manic Episodes on Follow-Up

Stringaris

Baroni

Haimm

et al. 2010

Journal of the American Academy of Child & Adolescent Psych

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Objective-An important question in pediatric bipolar research is whether marked nonepisodic irritability is a manifestation of bipolar disorder in youth. This study tests the hypothesis that youth with severe mood dysregulation (SMD), a category created for the purpose of studying children presenting with severe nonepisodic irritability, will be significantly less likely to develop (hypo-)manic or mixed episodes over time than will youth with bipolar disorder (BD). Method-Patients with SMD (N = 84) and narrowly defined BD (N = 93) at baseline were followed up in 6-monthly intervals using the relevant K-SADS modules to ascertain (hypo-)manic or mixed episodes.Results-Only one of 84 SMD subjects (1/84 [1.2%]; 95% confidence interval CI = 0.0003 to 0.064) experienced a (hypo-)manic or mixed episode during the study (median follow-up = 28.7 months). The frequency of such episodes was more than 50 times higher in those with narrowly defined BD (58/93 [62.4%]; 95% CI 0.52 to 0.72).Conclusions-These data suggest that, over an approximately 2-year follow-up period, youth with SMD are unlikely to develop (hypo-)manic or mixed episodes. Keywords bipolar disorder; pediatric; severe mood dysregulation; irritability; ADHD In American psychiatric clinics and inpatient settings, dramatic increases in the rates of diagnosis of pediatric bipolar disorder (BD) have been documented over the past decade, 1,2 with a concomitant increase in prescription rates for antipsychotic medication. 3 This rapid increase in the diagnosis of pediatric BD has coincided with the contention that the clinical presentation of BD differs between children and adults. 4,5 The debate regarding the pediatric presentation of BD is complex. One important aspect of it has been the suggestion that marked irritability, even when it does not constitute an episodic change from baseline, is a manifestation of BD in youth. 4,6,7 To provide a framework for research on whether irritable children without distinct manic episodes have a developmental presentation of BD, we operationalized 8 a clinical syndrome, severe mood dysregulation (SMD), designed to capture chronically irritable children whose diagnostic status is in doubt. This paper uses a longitudinal sample to investigate the extent to which subjects with SMD develop episodes of (hypo-)mania, compared to youth with narrowly defined BD.The criteria for SMD require a persistent, nonepisodic clinical presentation of negatively valenced mood with frequent and impairing anger outbursts, combined with at least three of the "B" criteria of mania (pressured speech, agitation, insomnia, and flight of ideas/racing thoughts) and one (distractibility) that is also common to ADHD. 8 A community-based follow-up study suggests that SMD is common, with a lifetime prevalence of 3.3% in youth 9 to 19 years of age. 9 Furthermore, in that sample SMD predicted depressive disorder at 7-year follow-up in youths who were 9 to 19 years old at baseline. 9 Consistent with this finding, another community-based study of nonepisod...

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Section: Nih-pa Author Manuscriptcontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Pediatric Bipolar Disorder Versus Severe Mood Dysregulation: Risk for Manic Episodes on Follow-Up

Stringaris

Baroni

Haimm

et al. 2010

Journal of the American Academy of Child & Adolescent Psych

View full text Add to dashboard Cite

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“…[42][43][44] In naturalistic studies of BD among children and adolescents, the recovery rates are high (70 to 100%), but the recurrence rate in 2 to 5 years is up to 80%. [45][46][47] Moreover, most of the time these patients experienced subsyndromal and syndromal mood symptomatology and frequent mood fluctuations, as reported in the Course and Outcome of Bipolar Youth (COBY, n=263) 2-year followup study. 48 This may explain the fact that 80% of children and adolescents suffering from BD do not reach functional remission.…”

Section: Epidemiologymentioning

confidence: 99%

“…[50][51][52][53] The main factors associated with poor BD prognosis are the following: earlier age of onset, duration of symptoms, rapid cycling, mixed episodes, psychotic symptoms, comorbidities such as ADHD and anxiety disorders, low socioeconomic status, negative life events, presence of psychiatric disorders in the family, absence of psychotherapy, low adherence to pharmacological treatment, use of antidepressants and alcohol. [45][46][47][48][54][55][56] …”

Section: Epidemiologymentioning

confidence: 99%

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Mood disorders in childhood and adolescence

Rocha

Zeni

Caetano

et al. 2013

Rev. Bras. Psiquiatr.

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The identification and treatment of mood disorders in children and adolescents has grown over the last decades. Major depression is one of the most common and debilitating disorders worldwide, imposing a massive burden to the youth population. Bipolar disorder is being increasingly recognized as having its roots early in life, and its presentation during childhood and adolescence has been submitted to extensive research. This review aims to highlight clinical aspects of the current knowledge on mood disorders in the pediatric population, presenting updated information on epidemiology, diagnostic procedures, and management strategies. Limitations of available evidence and future directions of research in the field are also discussed.

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Lifetime Psychiatric Disorders in School-aged Offspring of Parents With Bipolar Disorder

Birmaher¹,

Axelson²,

Monk³

et al. 2009

Arch Gen Psychiatry

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334

311

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Context: Whether offspring of parents with bipolar disorder (BP) are at specifically high risk to develop BP and other psychiatric disorders has not been adequately studied. Objective: To evaluate lifetime prevalence and specificity of psychiatric disorders in offspring of parents with BP-I and BP-II. Design: Offspring aged 6 to 18 years who have parents with BP and community control subjects were interviewed with standardized instruments. All research staff except the statistician were blind to parental diagnoses. Setting: Parents with BP were recruited primarily through advertisement and outpatient clinics. Control parents were ascertained by random-digit dialing and were group matched for age, sex, and neighborhood to parents with BP. Participants: Three hundred eighty-eight offspring of 233 parents with BP and 251 offspring of 143 demographically matched control parents. Main Outcome Measures: Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) Axis I disorders. Results: Adjusting for demographic factors, living with 1 vs both biological parents, both biological parents' non-BP psychopathology, and within-family correlations, offspring of parents with BP showed high risk for BP spectrum disorders (odds ratio [OR]=13.4; 95% confidence interval [CI], 2.9-61.6) and any mood (OR=5.2; 95% CI, 2.3-11.4), anxiety (OR=2.3; 95% CI, 1.3-4.0), and Axis I (OR=2.2; 95% CI, 1.5-3.3) disorders. Off-spring of parents with BP with high socioeconomic status showed more disruptive behavior disorders and any Axis I disorders than offspring of control parents with high socioeconomic status. Families in which both parents had BP had more offspring with BP than families with only 1 parent with BP (OR=3.6; 95% CI, 1.1-12.2). More than 75.0% of offspring who developed BP had their first mood episode before age 12 years, with most of these episodes meeting criteria for BP not otherwise specified and, to a lesser degree, major depression. Conclusions: Offspring of parents with BP are at high risk for psychiatric disorders and specifically for early-onset BP spectrum disorders. These findings further support the familiality and validity of BP in youth and indicate a need for early identification and treatment.

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Clinical Course of Children and Adolescents With Bipolar Spectrum Disorders

Abstract: Youths with BP spectrum disorders showed a continuum of BP symptom severity from subsyndromal to full syndromal with frequent mood fluctuations. Results of this study provide preliminary validation for BP-NOS.

Cited by 585 publications

References 76 publications

Pediatric Bipolar Disorder Versus Severe Mood Dysregulation: Risk for Manic Episodes on Follow-Up

Pediatric Bipolar Disorder Versus Severe Mood Dysregulation: Risk for Manic Episodes on Follow-Up

Mood disorders in childhood and adolescence

Lifetime Psychiatric Disorders in School-aged Offspring of Parents With Bipolar Disorder

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