High level of persistence of pediatric bipolar-I disorder from childhood onto adolescent years: A four year prospective longitudinal follow-up study

Abstract

Objective To examine the longitudinal course of pediatric bipolar (BP)-I disorder in youth transitioning from childhood into adolescence. Methods We conducted a four-year prospective follow-up study of 78 youth with BP-I disorder 6-17 years old at ascertainment followed up into adolescent years (13.4±3.9 years). All subjects were comprehensively assessed with structured diagnostic interviews, neuropsychological testing, psychosocial, educational and treatment history assessments. BP disorder was considered persistent if subjects met full criteria for DSM-IV BP-I disorder at follow-up. Results Of 78 BP-I participating youth subjects, 57 (73.1%), continued to meet full diagnostic criteria for BP-I Disorder. Of those with a non-persistent course, only 6.4% (n=5) were euthymic (i.e., syndromatic and symptomatic remission) at the 4-year follow-up and were not receiving pharmacotherapy for the disorder. The other non-persistent cases either continued to have subthreshold BP-I disorder (n=5, 6.4%), met full (n=3, 3.8%) or subthreshold (n=1, 1.3%) criteria for major depression, or were euthymic but were treated for the disorder (n=7, 9.0%). Full persistence was associated with higher rates of major depression and disruptive behavior disorders at the follow-up assessment and higher use of stimulant medicines at the baseline assessment. Non-Peristent BP-I was also characterized by high levels of dysfunction and morbidity. Conclusions This four-year follow-up shows that the majority of BP-I disorder youth continue to experience persistent disorder into their mid and late adolescent years and its persistence is associated with high levels of morbidity and disability. Persistence of subsyndromal forms of bipolar disorder was also associated with dysfunction and morbidity.

Increases in multiple psychiatric disorders in parents and grandparents of patients with bipolar disorder from the USA compared with The Netherlands and Germany

“…Rather than a perpetual focus on possible diagnostic ambiguities that has occupied many in the field (Carlson, 2011;Axelson, 2013), the widely agreed on high prevalence of childhood and adolescent onsets of bipolar disorder in the USA from epidemiological studies (Merikangas et al, 2010), clinical samples (Delbello et al, 2007;Birmaher et al, 2009;Geller et al, 2010;Wozniak et al, 2011), comparative studies ( Etain et al, 2012), and the multiple high-risk studies (described above), as well as the contribution from cohort and anticipation effects (Lange and McInnis, 2002) deserves heightened recognition, intensive study, and better attempts at treatment and prevention. The delay from first onset of illness to first treatment is an additional risk factor for a poor outcome (Post et al, 2010b;Drancourt et al, 2013), and is longer in the USA than in Europe (Post et al, 2014c).…”

A Comparison of American and English Hospital Discharge Rates for Pediatric Bipolar Disorder, 2000 to 2010

“…Furthermore, descriptions of US youth meeting criteria for BD typically describe them as having multiple and frequent episodes. 23,24 Therefore, it is unlikely that the high rates in the United States are due to youth receiving the diagnosis of BD based on a single episode. We also found cross-national differences not only in the rates of overall PBD, BP-I, and BP-II, but also BP-NOS.…”

The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research

“…Consistent findings include (i) high rates of progression from BD-NOS or CycD to BD-I or BD-II (eg, 43%), 64 particularly in youth with a family history of BD; (ii) high rates of recovery from episodes, particularly with treatment (eg, 81.5%); 87,88 (iii) high rates of recurrence of depression, hypomania, or mania (eg, 62.5%); 64,87,89,90 and (iv) patterns of comorbidity 91 and treatment response congruent with adult BD. 92 The prodrome of BD-I or BD-II, often identified retrospectively in adult studies, commonly involves attenuated mood symptoms; and sleep disturbance may be a marker clinically (see reference for detailed discussion of prodrome).…”