Early stages of pediatric bipolar disorder: retrospective analysis of a Czech inpatient sample

Abstract

BackgroundApproximately 30%–60% of adults diagnosed with bipolar disorder (BD) report onset between the ages 15 and 19 years; however, a correct diagnosis is often delayed by several years. Therefore, investigations of the early features of BD are important for adequately understanding the prodromal stages of the illness.MethodsA complete review of the medical records of 46 children and adolescents who were hospitalized for BD at two psychiatric teaching centers in Prague, Czech Republic was performed. Frequency of BD in all inpatients, age of symptom onset, phenomenology of mood episodes, lifetime psychiatric comorbidity, differences between very-early-onset (<13 years of age) and early-onset patients (13–18 years), and differences between the offspring of parents with and without BD were analyzed.ResultsThe sample represents 0.83% of the total number of inpatients (n=5,483) admitted during the study period at both centers. BD often started with depression (56%), followed by hypomania (24%) and mixed episodes (20%). The average age during the first mood episode was 14.9 years (14.6 years for depression and 15.6 years for hypomania). Seven children (15%) experienced their first mood episode before age 13 years (very early onset). Traumatic events, first-degree relatives with mood disorders, and attention deficit hyperactivity disorder were significantly more frequent in the very-early-onset group vs the early-onset group (13–18 years) (P≤0.05). The offspring of bipolar parents were significantly younger at the onset of the first mood episode (13.2 vs 15.4 years; P=0.02) and when experiencing the first mania compared to the offspring of non-BD parents (14.3 vs 15.9 years; P=0.03). Anxiety disorders, substance abuse, specific learning disabilities, and attention deficit hyperactivity disorder were the most frequent lifetime comorbid conditions.ConclusionClinicians must be aware of the potential for childhood BD onset in patients who suffer from recurrent depression, who have first-degree relatives with BD, and who have experienced severe psychosocial stressors.

The geography of a controversial diagnosis: A bibliographic analysis of published academic perspectives on ‘paediatric bipolar disorder’

“…Rates for the 10 to 14 years age group were 134 (USA), 3.9 (Australia), 1.3 (New Zealand), 0.48 (England) and 0.46 (Germany). Similar low rates for inpatient diagnoses were found in the Czech Republic (Goetz et al, 2015) and for both inpatient and outpatient children and youth in Denmark (Kessing, Vradi, & Andersen, 2014). These recent studies of diagnosis rates in Europe and Australasia show little to no deviation from older British, European and Australasian studies that found mania/hypomania/bipolar disorder to be rare in adolescence and exceedingly rare or not detected in prepubertal children (Barton-Hall, 1952; Räsänen, Tiihonen, & Hakko, 1998; Sigurdsson, Fombonne, Kapil, & Checkley, 1999; Sourander, 2004; Thomsen, Moller, Dehlholm, & Brask, 1992; Werry & McClellan, 1992).…”

“…The influence of the traditional perspective on BD among academics in non-US countries may also be reflected in clinical practice with hospital discharge diagnosis rates for BD in the paediatric age range. Rates were found to be orders of magnitude lower in other nations compared to the United States (Clacey et al, 2015; Goetz et al, 2015; Kessing et al, 2014). This influence may also account for scepticism of PBD in surveys among child and adolescent psychiatrists in Germany (Meyer, Koßmann-Böhm, & Schlottke, 2004), Australia and New Zealand (Parry, Furber, & Allison, 2009), and the previously mentioned clinical vignette studies showing British child and adolescent psychiatrists having more conservative diagnostic practices compared to their US counterparts (Dubicka et al, 2008).…”

Challenges and developments in research of the early stages of bipolar disorder

“…28,29 Several studies have recognized mood lability, major depressive episodes, subsyndromal manic symptoms, a diagnosis of a bipolar spectrum disorder (such as cyclothymia or BD not otherwise specified), and mood-congruent psychotic symptoms as precursors of BD. [30][31][32] On the other hand, in clinical practice, identification of a symptomatic high-risk BD phase is complicated by the complex nature of dimensions of this disorder, by potentially different symptom presentations in children and adolescents, 5,21,33 and by the blurred lines between the prodrome and the disease itself. 34 Retrospective and prospective studies have revealed a pattern of putative prodromal symptoms, of which mood lability/mood swings/cyclothymic features, depressive mood, racing thoughts, irritability, and physical agitation are most commonly reported.…”

‘Pediatric Bipolar Disorder’ Rates are Still Lower than Claimed – A Re-examination of Eight Epidemiological Surveys used by an Updated Meta-analysis

“…In contrast, apart from a small number of academic units in other countries (Parry et al 2019b), the classical view held sway internationally. This was re ected in inpatient discharge diagnosis rates where the US had several-hundred-fold higher rates of BD diagnosis than in England, Australia, New Zealand, Germany, Czech Republic, Denmark and Finland (Clacey et al 2015;Goetz et al 2015;Kessing et al 2014;Sourander 2004). It is also re ected in six longitudinal highrisk offspring of parents with BD studies, where only the Pittsburgh study that employs the PBD hypothesis found "50% had mania prior to age 12 (compared to 0% in other studies)" (Duffy et al 2017).…”