Child bipolar I disorder - Prospective continuity with adult bipolar I disorder; Characteristics of second and third episodes; Predictors of 8-year outcome

Department of Psychiatry, Washington University in St Louis, 660 S Euclid Ave, St Louis, MO 63110-1093, USA.
Archives of general psychiatry (Impact Factor: 14.48). 11/2008; 65(10):1125-33. DOI: 10.1001/archpsyc.65.10.1125
Source: PubMed


Child bipolar I disorder (BP-I) is a contentious diagnosis.
To investigate continuity of child and adult BP-I and characteristics of later episodes.
Inception cohort longitudinal study. Prospective, blinded, controlled, consecutive new case ascertainment.
University medical school research unit. Subjects There were 115 children, enrolled from 1995 through 1998, aged 11.1 (SD, 2.6) years with first episode DSM-IV BP-I, mixed or manic phase, with 1 or both cardinal symptoms (elation or grandiosity) and score of 60 or less on the Children's Global Assessment Scale (CGAS). All DSM-IV severity and duration criteria were fulfilled. Separate interviews were conducted of parents about their children and of children about themselves.
Washington University in St Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS); Psychosocial Schedule for School Age Children-Revised; CGAS.
Retention was 93.9% (n = 108) for completing assessments at every one of the 9 follow-up visits. Subjects spent 60.2% of weeks with any mood episodes and 39.6% of weeks with mania episodes, during 8-year follow-up. During follow-up, 87.8% recovered from mania, but 73.3% relapsed to mania. Even accounting for family psychopathology, low maternal warmth predicted relapse to mania, and more weeks ill with manic episodes was predicted by low maternal warmth and younger baseline age. Largely similar to first episodes, second and third episodes of mania were characterized by psychosis, daily (ultradian) cycling, and long duration (55.2 and 40.0 weeks, respectively), but significantly shorter than first episodes. At 8-year follow-up, 54 subjects were 18.0 years or older. Among subjects 18.0 years or older, 44.4% had manic episodes and 35.2% had substance use disorders.
In grown-up subjects with child BP-I, the 44.4% frequency of manic episodes was 13 to 44 times higher than population prevalences, strongly supporting continuity. The rate of substance use disorders in grown-up child BP-I was similar to that in adult BP-I.

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    • "Nonetheless, childhood-onset bipolar disorder now is recognized and does share features with adult-onset bipolar disorder. For example, researchers suggested that there is continuity in symptoms across adolescence [41] and into adulthood [79]. Further support for the continuity of symptoms over the course of development was supported by family studies comparing children with bipolar disorder to their parents who had bipolar disorder via neuroimaging [61] and with genetic studies [80]. "
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    ABSTRACT: Although bipolar disorder historically was thought to only occur rarely in children and adolescents, there has been a significant increase in children and adolescents who are receiving this diagnosis more recently (Carlson, 2005). Nonetheless, the applicability of the current bipolar disorder diagnostic criteria for children, particularly preschool children, remains unclear, even though much work has been focused on this area. As a result, more work needs to be done to further the understanding of bipolar symptoms in children. It is hoped that this paper can assist psychologists and other health service providers in gleaning a snapshot of the literature in this area so that they can gain an understanding of the diagnostic criteria and other behaviors that may be relevant and be informed about potential approaches for assessment and treatment with children who meet bipolar disorder criteria. First, the history of bipolar symptoms and current diagnostic criteria will be discussed. Next, assessment strategies that may prove helpful for identifying bipolar disorder will be discussed. Then, treatments that may have relevance to children and their families will be discussed. Finally, conclusions regarding work with children who may have a bipolar disorder diagnosis will be offered.
    02/2014; 2014(4):928685. DOI:10.1155/2014/928685
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    • "The reason for this definition was that elevated mood and/or grandiosity can be considered as the “cardinal features” of mania and have been proposed as required symptoms in children and adolescents with hypomania [51]. Thus, only irritable mood was not sufficient as the core symptom unless grandiosity and/or elevated mood were also present [4,51]. This approach was adopted to avoid overlap with dimensional irritability/aggression, which is present across different child and adolescent mental disorders (e.g., ADHD, CD, ODD, MDD, PTSD, and disruptive mood dysregulation disorder). "
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    ABSTRACT: We investigated whether adolescents with hypomania spectrum episodes have an excess risk of mental and physical morbidity in adulthood, as compared with adolescents exclusively reporting major depressive disorder (MDD) and controls without a history of adolescent mood disorders. A community sample of adolescents (N = 2 300) in the town of Uppsala, Sweden, was screened for depressive symptoms. Both participants with positive screening and matched controls (in total 631) were diagnostically interviewed. Ninety participants reported hypomania spectrum episodes (40 full-syndromal, 18 with brief episode, and 32 subsyndromal), while another 197 fulfilled the criteria for MDD without a history of a hypomania spectrum episode. A follow up after 15 years included a blinded diagnostic interview, a self-assessment of personality disorders, and national register data on prescription drugs and health services use. The participation rate at the follow-up interview was 71 % (64/90) for the hypomania spectrum group, and 65.9 % (130/197) for the MDD group. Multiple imputation was used to handle missing data. The outcomes of the hypomania spectrum group and the MDD group were similar regarding subsequent non-mood Axis I disorders in adulthood (present in 53 vs. 57 %). A personality disorder was reported by 29 % of the hypomania spectrum group and by 20 % of the MDD group, but a statistically significant difference was reached only for obsessive-compulsive personality disorder (24 vs. 14 %). In both groups, the risk of Axis I disorders and personality disorders in adulthood correlated with continuation of mood disorder. Prescription drugs and health service use in adulthood was similar in the two groups. Compared with adolescents without mood disorders, both groups had a higher subsequent risk of psychiatric morbidity, used more mental health care, and received more psychotropic drugs. Although adolescents with hypomania spectrum episodes and adolescents with MDD do not differ substantially in health outcomes, both groups are at increased risk for subsequent mental health problems. Thus, it is important to identify and treat children and adolescents with mood disorders, and carefully follow the continuing course.
    BMC Psychiatry 01/2014; 14(1):9. DOI:10.1186/1471-244X-14-9 · 2.21 Impact Factor
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    • "The age and sex distributions of the patients included in this study were similar to those in previous studies.17-19) The number of male patients treated for PBD was more than double that of female patients, and the mean age of male patients was younger than that of female patients.20) "
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    ABSTRACT: This study compared the efficacy and tolerability of aripiprazole with that of other atypical antipsychotics by examining patients with pediatric bipolar disorder (PBD) at a child and adolescent psychiatric clinic in a university hospital in Korea. We reviewed the medical records of 127 pediatric patients with bipolar disorder aged 4-18 years treated at Department of Child and Adolescent Psychiatric, Yonsei University Severance Hospital between January 2010 and October 2011 to collect demographic and clinical data. Using the Clinical Global Impression (CGI) scales, we evaluated levels of severity of and improvements in symptoms at the first, second, third, fourth, and fifth hospital visits. The mean age of patients was 12.29±3.47 years. The sample included 91 (71.7%) male and 36 (28.3%) female patients. Aripiprazole was prescribed to 62 (48.8%) patients, risperidone to 52 (40.9%), quetiapine to 11 (8.7%), and paliperidone to two (1.6%). Patients treated with aripiprazole had lower CGI-Severity (CGI-S) scores than did patients treated with other atypical antipsychotics at the second and third visits. The CGI-Improvement (CGI-I) scores of patients treated with aripiprazole were lower at the second visit. Treatment with atypical antipsychotics was well tolerated, and no serious or fatal side effects were observed. The present retrospective chart review suggests that atypical antipsychotics may be effective and safe for the treatment of patients with PBD. In particular, treatment with aripiprazole may be more effective than treatment with other atypical antipsychotics in the early phase. These results should be verified in future multi-center controlled studies.
    Clinical Psychopharmacology and Neuroscience 08/2013; 11(2):72-9. DOI:10.9758/cpn.2013.11.2.72
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