Mania With and Without Depression in a Community Sample of US Adolescents

University of North Carolina at Chapel Hill (Dr Youngstrom)
Archives of general psychiatry (Impact Factor: 13.75). 05/2012; 69(9). DOI: 10.1001/archgenpsychiatry.2012.38
Source: PubMed

ABSTRACT CONTEXT: There are limited data on the manifestations of mania in general community samples of adolescents. OBJECTIVE: To present the prevalence and clinical correlates of mania with and without depressive episodes in a representative sample of US adolescents. DESIGN: Cross-sectional survey of adolescents using a modified version of the Composite International Diagnostic Interview. PARTICIPANTS: Ten thousand one hundred twenty-three adolescents aged 13 to 18 years identified in household and school settings. MAIN OUTCOME MEASURES: Mania/hypomania with or without depression among those who met DSM-IV criteria for bipolar I or II disorder or major depressive disorder. RESULTS: Two and a half percent of youth met criteria for lifetime bipolar I or II disorder and 1.7%, for mania only. Twelve-month rates of mania with and without depression were 2.2% and 1.3%, respectively. There was a nearly 2-fold increase in rates of mania from ages 13-14 to 17-18 years. Mania with depression was associated with a greater number of all indictors of clinical severity including symptom number and severity, role disability, severe impairment, comorbidity, and treatment compared with depression alone, whereas correlates of mania were similar among those with mania with or without depression. CONCLUSIONS: The increasing prevalence of bipolar disorder with increasing age and the comparable rate of bipolar disorder with those of adult samples highlight adolescence as the peak period of onset of mania. The clinical significance of mania plus depression as demonstrated by a 1 in 5 suicide attempt rate and nearly 2 months per year of role impairment in adolescence has important implications for early intervention. The evidence for independence of mania from depression warrants additional scrutiny in the diagnostic nomenclature and etiologic dissection of bipolar disorder.

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    • "Our finding confirms those of prior studies regarding the increased recognition and treatment of mania in males (Duax et al. 2007) and depression in females (Duax et al. 2007; Olfson et al. 2009). These differences may be attributable to referral bias as well as to sex differences in the prominence of symptoms that lead to referral for bipolar disorder, such as externalizing symptoms exhibited by males and internalizing symptoms exhibited by females (Duax et al. 2007; Merikangas et al. 2010, 2012). Analyses of other health services used by adolescents with bipolar disorder revealed that those treated for depression or mania utilized general medical, human services, and school services more than those who had not received treatment, and human services and medications more than adolescents treated for other disorders. "
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    ABSTRACT: Despite growing evidence that bipolar disorder often emerges in adolescence, there are limited data regarding treatment patterns of youth with bipolar disorder in community samples. Our objective was to present the prevalence and clinical correlates of treatment utilization for a nationally representative sample of US adolescents with bipolar disorder. Analyses are based on data from the National Comorbidity Survey-Adolescent Supplement, a face-to-face survey of 10,123 adolescents (ages 13-18) identified in household and school settings. We found that of adolescents meeting DSM-IV criteria for bipolar I or II disorder (N = 250), 49 % were treated for depression or mania, 13 % were treated for conditions other than depression or mania, and 38 % did not report receiving treatment. Treatment for depression or mania was associated with increased rates of suicide attempts, as well as greater role disability and more comorbid alcohol use relative to those who had not received treatment. Treated adolescents had triple the rate of ADHD and double the rates of behavior disorders than those without treatment. Our findings demonstrate that a substantial proportion of youth with bipolar disorder do not receive treatment, and of those who do, many receive treatment for comorbid conditions rather than for their mood-related symptoms. Treatment was more common among youth with severe manifestations and consequences of bipolar disorder and those with behavior problems. These trends highlight the need to identify barriers to treatment for adolescents with bipolar disorder and demonstrate that those in treatment are not representative of youth with bipolar disorder in the general population.
    Journal of Abnormal Child Psychology 06/2014; 43(2). DOI:10.1007/s10802-014-9885-6 · 3.09 Impact Factor
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    • "Rising rates of pediatric BD are also evident in outpatient mental health settings, with a 40-fold increase in office visits by youth with BD to all mental health providers over the same time period (Moreno et al., 2007). In fact, recent evidence from a large community sample suggests that the prevalence of BD in adolescents approaches that of adults (Merikangas et al., 2012). Among the factors potentially implicated in this rise is the overlap between Diagnostic and Statistical Manual Fourth Edition (DSM-IV) symptoms of mania and symptoms of other psychiatric diagnoses, including attention-deficit/hyperactivity Disorder (ADHD). "
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    ABSTRACT: Background: Rates of diagnosis and treatment for bipolar disorder (BD) in youth continue torise. Researchers and clinicians experience difficulty differentiating between BD in youth andother conditions that are commonly comorbid or share similar clinical features with BD,especially attention-deficit/hyperactivity disorder (ADHD). Comparative studies of thephenomenology and psychosocial correlates of these conditions help to address this. Familyfunctioning is an important topic for both BD and ADHD since both are associated withnumerous family-related deficits. One previous study suggested that manic/hypomanic youths'family functioning differed from ADHD and typically developing control (TDC) groups.However, many family functioning studies with BD and ADHD youth have methodologicallimitations or fail to use comprehensive, validated measures. Methods: This investigation usedadolescent report on the Family Assessment Device (FAD), based on the McMaster Model offamily functioning. Youth were recruited in BD (n=30), ADHD (n=36), and TDC (n=41)groups. Results: Groups were similar on most demographic variables, but The TDC groupscored somewhat higher than the others on IQ and socioeconomic status. FAD results indicatedthat BD and ADHD groups scored worse than TDC on the General Functioning and Roles scalesof the FAD. In addition, the BD group showed impairment on the Problem Solving scale relativeto TDC. Limitations: sample size, lack of parent report, ADHD comorbidity in BD group.Conclusions: Family functioning deficits distinguish both clinical groups from TDC, andproblem-solving dysfunction may be specific to BD. These findings may apply to treatmentmodels for both conditions.
    Journal of Affective Disorders 05/2013; 150(3). DOI:10.1016/j.jad.2013.04.027 · 3.71 Impact Factor
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    • "Assoc. 1994) with diagnostic information from teens only (Merikangas et al. 2012). Rates of ADHD in youths with bipolar disorder varied from 18% to 24%, depending on whether the sample included both unipolar mania and mania plus depression, or only the latter. "
    Journal of child and adolescent psychopharmacology 04/2013; 23(3):144-7. DOI:10.1089/cap.2013.2331 · 3.07 Impact Factor
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