Twelve-Month Outcome of Adolescents With Bipolar Disorder Following First Hospitalization for a Manic or Mixed Episode

Abstract

Most bipolar adolescents experienced syndromic recovery following their first hospitalization. However, rates of symptomatic and functional recoveries were much lower. Future studies examining effective pharmacological and nonpharmacological treatment strategies for bipolar youth with co-occurring disorders and investigating factors that contribute to the development of substance use disorders and treatment adherence in bipolar youth are necessary to improve outcome.

Mood disorders in childhood and adolescence

“…[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.…”

“…[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] …”

Cannabis e humor

“…De um modo geral, parece que o uso de substâncias psicoativas em bipolares pode estar associado a uma série de características negativas, como dificuldade na recuperação dos sintomas afetivos, maior número de internações, piora na adesão ao tratamento, risco aumentado de suicídio, agressividade e a uma pobre resposta ao lítio 13,[19][20][21][22][23] . No estudo de van Rossum et al, no qual mais de três mil sujeitos foram acompanhados por um período de um ano, os prejuízos clínicos foram bem mais evidentes do que os prejuízos sociais 20 .…”

Phenomenology, socio-demographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents

“…The sample was composed of 45 females and 35 males with a mean age of 15.7 (±1.9) years (range [12][13][14][15][16][17][18][19]. The socio-demographic and clinical characteristics of the sample are summarized in Table 1.…”

“…To summarize, mixed polarity, low socioeconomic status (SES), young age at onset, previous affective episode, psychosis and female sex were associated at least in one study with a poorer outcome [5,18,27,29,52]. Furthermore, in the US, inpatient treatment tends to be shorter and shorter (median lenght of stay for BD in 2000 is 5.6 days) due to economic pressures [12], which leads to a bias in short-term prognosis studies.…”