Psychiatric comorbidity in patients with pediatric bipolar disorder – A systematic review

Abstract

Background: A growing body of evidence suggests that pediatric bipolar disorder (PBD) frequently co-occurs with comorbid psychiatric disorders that may impact functioning.Objective: To review existing literature on the prevalence of psychiatric comorbidity and general functioning in patients with a primary diagnosis of PBD. Methods:We performed a systematic literature search on the PubMed, Embase and PsycInfo databases on November 16th, 2022. We included original papers on patients ≤18 years with primary PBD and any comorbid psychiatric disorder, diagnosed according to a validated diagnostic tool. Risk of bias of the individual studies was assessed using the STROBE checklist. We calculated weighted means to assess the comorbidity prevalence. The review complied with PRISMA statement guidelines.Results: Twenty studies with a total study population of 2722 patients with PBD were included (mean age = 12.2 years). We found an overall high prevalence of comorbidity in patients with PBD. The most common comorbidities were attention-deficit-hyperactivity disorder (ADHD) (60%) and oppositional defiant disorder (ODD) (47%). Anxiety disorders, obsessive-compulsive disorder, conduct disorder, tic disorders and substance-related disorders affected between 13.2% and 29% of patients, while one in 10 had comorbid mental retardation or autism spectrum disorder (ASD). The prevalence of comorbid disorders was lower in studies that assessed the current prevalence in patients in full or partial remission. General functioning was overall not specifically decreased in patients with comorbidity. Conclusions: Comorbidity across a broad range of disorders was high in children diagnosed with PBD, especially regarding ADHD, ASD, behavioral and anxiety disorders including OCD. Future original studies should assess current prevalence of comorbidities in patients with PBD who are in remission to obtain more reliable estimates of psychiatric comorbidity in this patient group. The review highlights the clinical and scientific importance of comorbidity in PBD.

Comorbid Obsessive-Compulsive Disorder and Bipolar Disorder in the Pediatric Population — Clinical and Therapeutic Challenges

“…Pediatric population: Studies of BD in children and adolescents have documented a 1.3%-46.9% rate of comorbid OCD. [5,[8][9][10][11] These results are similar to the 27-45% rate of manic symptoms in OCD both in pediatric and adult populations, [8,10,[12][13][14] but significantly higher when compared to the adult BD population alone, in which much smaller rates of OCD-BD comorbidity are described, only 10-16%. [9,14,15] In a retrospective study with a sample of 207 children and adolescents, the overlap between BD and OCD was bidirectional and symmetrical, with reciprocal comorbidity present in 21% of the youth with BPD and 15% of those diagnosed with OCD.…”

Does Screening for Bipolar Disorders Identify a “Dysregulation of Mood, Energy, and Social Rhythms Syndrome” (DYMERS)? A Heuristic Working Hypothesis

“…The diagnoses (different from those of bipolar disorder) affecting MDQ positives were conditions well known to be frequently associated with BD [4] and notoriously clinically identified about ten years before the onset of the co-occurring BD [33]. There is a vast literature that focuses on co-morbidity with BD and, often, on the temporal sequence (according to the late recognition of diagnoses of BD) with the mental health disorders indicated by the research on the inefficacy of the screeners, specifically post-traumatic stress disorder [34][35][36], borderline personality disorders [37][38][39], specific phobia [40][41][42], attention deficit disorder [43][44][45], alcohol use disorders [46][47][48], substance use disorders [49][50][51], eating disorders [52][53][54], and impulse control disorder [55][56][57].…”

Aberrant Neurofunctional Responses During Emotional and Attentional Processing Differentiate ADHD Youth With and Without a Family History of Bipolar I Disorder

“…Prevalence rates of attention-deficit/hyperactivity disorder (ADHD) in youth with bipolar I disorder (BD) are substantially higher than the general population (Fahrendorff et al, 2023), and ADHD commonly precedes the initial onset of BD (Axelson et al, 2015;Meier et al 2018;Singh et al, 2006). Having a first-degree relative with BD is a robust risk factor for both BD (Mortensen et al, 2003;Birmaher et al, 2022) and ADHD (Lau et al, 2018;Propper et al, 2023), and youth with ADHD and a first-degree relative with BD present with more severe mood and externalizing symptoms compared to youth with ADHD and no familiy history of BD (Chen et al, 2022;Kim et al, 2015).…”