What Do We Know about the Long-Term Course of Early Onset Bipolar Disorder? A Review of the Current Evidence

Abstract

Aim: Early onset of psychopathology is often an index of a more severe clinical course and worse prognosis. This review examined the course of bipolar disorder (BD) with onset in childhood and adolescence, with a focus on persistence of symptoms, severity of illness, comorbidity, and functional impairment. Methods: The databases of PubMed, Embase, and PsycInfo were systematically searched for publications since 1990 reporting on long-term (12 months or longer) assessments of patients with early onset BD. Results: Forty-two relevant publications were identified, which reported on data derived from 15 different patient cohorts, including 7 prospective research psychopathology studies, 4 medical record reviews, 2 follow-ups of clinical trial samples, 1 managed care database, and 1 nationwide registry, for a total of 10,187 patients. The length of follow-ups ranged from 1.0 to 15 years. Diagnostic stability of BD ranged from 73% to 100% over ten years. Recovery rate from an index episode was 81.5–100% and recurrence rate was 35–67%. Suicide attempt cumulative prevalence in five years was 18–20%. Earlier age at the first episode predicted a more severe clinical course. Conclusions: Early onset BD persists over time through adolescence, with homotypic diagnostic continuity over the years, but heterogeneity in the severity of the clinical course. Whether early identification and treatment improves distal prognosis remains to be further investigated.

Composite immune marker scores associated with severe mental disorders and illness course

“…Severity of illness course is often described quantitatively by number of illness episodes ( Coulon et al, 2020 ; Immonen et al, 2017 ; Kennedy et al, 2015 ) together with qualitative markers of comorbid substance use disorder ( Kendler et al, 2019 ; Messer et al, 2017 ), history of suicidality ( Yates et al, 2019 ), and in bipolar disorders, presence of psychotic episodes ( Burton et al, 2018 ; Keck et al, 2003 ). A more severe illness course also seems to be related to an earlier age at onset ( Cirone et al, 2021 ; Coulon et al, 2020 ; Hanssen et al, 2015 ). To address the complex patterns of the immune system, the current study uses Principal Component Analysis (PCA) of immune markers.…”

Paediatric bipolar disorder and its controversy

“…The study, however, accepted bipolar diagnoses across time points based on ultradian cycling, arguably indicating persistence of affective lability, rather than true transition to bipolar disorder (Parry, 2021). Nevertheless, other studies report that around 45% of children with subthreshold symptoms, including ultradian cycling, develop bipolar disorder after five years (Axelson et al, 2011), and around 60% of children meeting DSM criteria for bipolar disorder have a recurrence of depression or mania within two-to-four years (Birmaher et al, 2006;Birmaher et al, 2009;Stringaris et al, 2010;Cirone et al, 2021). Whilst providing stronger support for continuity, the findings also potentially undermine the initial diagnosis in around half of patients without further follow-up.…”

Machine Learning Models for the Prediction of Early-Onset Bipolar Using Electronic Health Records

“…Earlier age of onset of BD has been associated with a more severe course, heightened suicidal risk, and poorer functional outcomes 53 , and early intervention has been reported to improve prognosis 54,55 . However, there are currently no well-established tools to stratify risk of BD onset.…”