Article

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: 13.75). 11/2008; 65(10):1125-33. DOI: 10.1001/archpsyc.65.10.1125
Source: PubMed

ABSTRACT 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.

0 Followers
 · 
151 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Rating scales and diagnostic instruments have become increasingly important tools in psychiatric care over the past several decades. Using these standardized tools to collect information and evaluate patients enables streamlined evidence-based diagnosis and assessments of functioning. This thesis revolves around the Children’s Global Assessment Scale (CGAS), a widely used rating scale designed to measure how a child functions psychosocially in daily life. In Paper I, the inter-rater reliability (IRR) and accuracy of CGAS ratings among untrained raters (n=703) were assessed in a large clinical setting. The untrained raters scored case vignettes significantly higher than the gold standard established by experts. The IRR in terms of intra-class correlation coefficient (ICC) was 0.73. Social workers and psychologists were significantly more likely to have overall aberrant ratings than medical doctors. The results suggest that reliability and accuracy is moderate when CGAS is used in a clinical setting with untrained raters. In Paper II, two training methods to improve CGAS ratings were evaluated. Untrained raters (n=648) were randomised to training either by a CD-ROM or in a seminar. In addition, 55 raters formed a non-randomised comparison group. There was no significant difference between the two training groups at the 12-month follow-up. The untrained comparison group improved at the same order of magnitude as the training groups. The ICCs at baseline and at end-of-study were 0.71/0.78 (seminar), 0.76/0.78 (CD-ROM), and 0.67/0.79 (comparison). These results speak in favour of using the less resourcedemanding computer-based training. However, the overall training effect was too small to be clinically relevant. Future evaluations of training methods should include a control group to control for unspecific learning effects. Registration of CGAS ratings in the clinical database Pastill was initiated at the completion of the training activity carried out for Paper II. This enabled a study on the effectiveness of child psychiatric treatment by examining the change in psychosocial functioning as measured by CGAS described in Paper III. The change in CGAS ratings between intake and case closure was investigated for 12,613 patients. CGAS improved during the course of treatment across all diagnostic groups. In the mood disorder group, several psychotherapies were associated with improved outcome whereas medication was not. In the Attention-Deficit Hyperactivity Disorder (ADHD) group, medication with central stimulants was not associated with improvement. Treatment-as-usual was found to be less effective than clinical trials have indicated, particularly for the ADHD group, suggesting that results from clinical trials cannot be extrapolated to routine child psychiatric care. Hence, more studies of ADHD and mood disorders are needed to investigate the effectiveness of medication/psychotherapy in regular treatment. In Paper IV, the Pastill data were linked to Swedish national registers to see whether CGAS ratings at end-of-treatment predict long-term negative outcomes in young adults. To do this, 4,876 patients were followed up prospectively. Patients with CGAS≤60 at end-of-treatment had a moderately increased risk of a criminal conviction and a substantially increased risk for bipolar disorder and borderline personality disorder during follow-up compared to patients with CGAS>60. Low CGAS ratings were not associated with depression, suicide attempt, or substance misuse. Hence, CGAS ratings provide specific long-term prognostic information, and adolescents with CGAS scores below 60 at end-of-treatment should be considered for intensified follow-up.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Research on pediatric bipolar disorder (PBD) is providing a plethora of empirical findings regarding its comorbidity. We addressed this question through a systematic review concerning the prevalence, clinical impact, etiology and treatment of main comorbid disorders involved. A comprehensive database search was performed from 1990 to August 2014. Overall, 167 studies fulfilled the inclusion criteria. Bipolar youth tend to suffer from comorbid disorders, with highest weighted mean prevalence rate arising from anxiety disorders (54%), followed by attention deficit hyperactivity disorder (ADHD) (48%), disruptive behavior disorders (31%), and substance use disorders (SUD) (31%). Furthermore, evidence indicates that ADHD and anxiety disorders negatively affect the symptomatology, neurocognitive profile, clinical course and the global functioning of PBD. Likewise, several theories have been posited to explain comorbidity rates in PBD, specifically common risk factors, one disorder being a risk factor for the other and nosological artefacts. Lastly, randomized controlled trials highlight a stronger therapeutic response to stimulants and atomoxetine (vs. placebo) as adjunctive interventions for comorbid ADHD symptoms. In addition, research focused on the treatment of other comorbid disorders postulates some benefits from mood stabilizers and/or SGA. Epidemiologic follow-up studies are needed to avoid the risk of nosological artefacts. Likewise, more research is needed on pervasive developmental disorders and anxiety disorders, especially regarding their etiology and treatment. Psychiatric comorbidity is highly prevalent and is associated with a deleterious clinical effect on pediatric bipolarity. Different etiological pathways may explain the presence of these comorbid disorders among bipolar youth. Standardized treatments are providing ongoing data regarding their effectiveness for these comorbidities among bipolar youth. Copyright © 2014 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 12/2014; 174C:378-389. DOI:10.1016/j.jad.2014.12.008 · 3.71 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Dramatically increasing prevalence rates of bipolar disorder in children and adolescents in the United States have provoked controversy regarding the boundaries of manic symptoms in child and adolescent psychiatry. The serious impact of this ongoing debate on the treatment of affected children is reflected in the concomitant increase in prescription rates for antipsychotic medication. A key question in the debate is whether this increase in bipolar disorder in children and adolescents is based on a better detection of early-onset bipolar disorder-which can present differently in children and adolescents-or whether it is caused by an incorrect assignment of symptoms which overlap with other widely known disorders. So far, most findings suggest that the suspected symptoms, in particular chronic, non-episodic irritability (a mood symptom presenting with easy annoyance, temper tantrums and anger) do not constitute a developmental presentation of childhood bipolar disorder. Additional research based on prospective, longitudinal studies is needed to further clarify the developmental trajectories of bipolar disorder and the diagnostic status of chronic, non-episodic irritability.
    12/2014; 6:111. DOI:10.12703/P6-111

Preview

Download
0 Downloads
Available from