Phenomenology of Children and Adolescents With Bipolar Spectrum Disorders

Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA.
Archives of General Psychiatry (Impact Factor: 14.48). 11/2006; 63(10):1139-48. DOI: 10.1001/archpsyc.63.10.1139
Source: PubMed


Children and adolescents who present with manic symptoms frequently do not meet the full DSM-IV criteria for bipolar I disorder (BP-I).
To assess the clinical presentation and family history of children and adolescents with BP-I, bipolar II disorder (BP-II), and bipolar disorder not otherwise specified (BP-NOS).
Subjects and their primary caretaker were assessed by semistructured interview, and family psychiatric history was obtained from interview of the primary caretaker.
Outpatient and inpatient units at 3 university centers.
A total of 438 children and adolescents (mean +/- SD age, 12.7 +/- 3.2 years) with BP-I (n = 255), BP-II (n = 30), or BP-NOS (n = 153).
Lifetime psychiatric history and family history of psychiatric disorders.
Youth with BP-NOS were not diagnosed as having BP-I primarily because they did not meet the DSM-IV duration criteria for a manic or mixed episode. There were no significant differences among the BP-I and BP-NOS groups in age of onset, duration of illness, lifetime rates of comorbid diagnoses, suicidal ideation and major depression, family history, and the types of manic symptoms that were present during the most serious lifetime episode. Compared with youth with BP-NOS, subjects with BP-I had more severe manic symptoms, greater overall functional impairment, and higher rates of hospitalization, psychosis, and suicide attempts. Elevated mood was present in 81.9% of subjects with BP-NOS and 91.8% of subjects with BP-I. Subjects with BP-II had higher rates of comorbid anxiety disorders compared with the other 2 groups and had less functional impairment and lower rates of psychiatric hospitalization than the subjects with BP-I.
Children and adolescents with BP-II and BP-NOS have a phenotype that is on a continuum with that of youth with BP-I. Elevated mood is a common feature of youth with BP-spectrum illness.

Download full-text


Available from: Jeffrey A Bridge, May 28, 2015
16 Reads
  • Source
    • "of Pittsburgh Medical Center, Brown University, and University of California Los Angeles). At intake, participants met the following criteria: (1) age 7-17 years; (2) DSM-IV bipolar I (BP-I), bipolar II (BP-II), or study-operationalized bipolar disorder not otherwise specified (BP-NOS) (Axelson et al., 2006 "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study examined the longitudinal association between mood episode severity and relationships in youth with bipolar (BP) disorder. Participants were 413 Course and Outcome of Bipolar Youth study youth, aged 12.6 ± 3.3 years. Monthly ratings of relationships (parents, siblings, and friends) and mood episode severity were assessed by the Adolescent Longitudinal Interval Follow-up Evaluation Psychosocial Functioning Schedule and Psychiatric Rating Scales, on average, every 8.2 months over 5.1 years. Correlations examined whether participants with increased episode severity also reported poorer relationships and whether fluctuations in episode severity predicted fluctuations in relationships, and vice versa. Results indicated that participants with greater mood episode severity also had worse relationships. Longitudinally, participants had largely stable relationships. To the extent that there were associations, changes in parental relationships may precede changes in episode severity, although the magnitude of this finding was small. Findings have implications for relationship interventions in BP youth.
    Journal of Nervous & Mental Disease 02/2015; 203(3). DOI:10.1097/NMD.0000000000000261 · 1.69 Impact Factor
  • Source
    • "Given that SI is less likely to be reported in clinical interviews than in self-report measures (Kaplan et al., 1994), it is possible that SI was under-reported among participants in our study. However, SI also may be somewhat less common among individuals with lesssevere bipolar spectrum disorders (e.g., Axelson et al., 2006) as is true for our sample. Thus, our results should be considered within the context of rates of SI that are lower than would be expected in treatment-seeking individuals with bipolar I and II disorders. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Rates of suicidal ideation and behavior are extremely high in Bipolar Spectrum Disorders (BSDs). However, relatively little work has evaluated potentially synergistic relationships between cognitive and emotion-regulatory processes proposed by theoretical models of suicidality in BSDs. The present study evaluated whether negative cognitive style and subtypes of rumination would exacerbate the impact of self-criticism on suicidal ideation in a prospective study of individuals with BSDs. Seventy-two young adults with BSDs (bipolar II, bipolar NOS, or cyclothymia) completed diagnostic interviews and trait measures of self-criticism, negative cognitive style, and brooding and reflective rumination at a baseline assessment. The occurrence of suicidal ideation was assessed as part of diagnostic interviews completed every four months for an average of three years of follow-up. Negative cognitive style and reflective rumination strengthened the association between self-criticism and the prospective occurrence of suicidal ideation across follow-up. Individuals with high levels of self-criticism in conjunction with negative cognitive style or reflective rumination were most likely to experience the onset of suicidal ideation. Self-criticism may work synergistically with negative cognitive style and rumination to confer risk for suicidal ideation in bipolar spectrum disorders. These results support theoretical models of suicidality in BSDs and indicate that evaluating and understanding negative cognitive styles may help to identify individuals who are at risk for suicide.
    Psychiatry Research 01/2015; DOI:10.1016/j.psychres.2014.12.042 · 2.47 Impact Factor
  • Source
    • "BD was categorized as BD–I (DSM–IV 296–7), BD–II (DSM–IV 296.89) or BD–NOS. BD– NOS was defined according to the Course of Bipolar Youth Study criteria: 'A distinct period of abnormally elevated, expansive, or irritable mood plus the following: (1) 2 DSM–IV manic symptoms (3 if the mood is irritability only) that were clearly associated with the onset of abnormal mood, (2) a clear change in functioning, (3) mood and symptom duration of a minimum of 4 hours within a 24-hour period for a day to be considered meeting the diagnostic threshold and (4) a minimum of 4 days (not necessarily consecutive) meeting the mood, symptom, duration, and functional change criteria over the subject's lifetime, which could be two 2-day episodes, four 1-day episodes, or another variation' (Axelson et al., 2006; Birmaher et al., 2006). "

Show more