Further Evidence for a Developmental Subtype of Bipolar Disorder Defined by Age at Onset: Results From the National Epidemiologic Survey on Alcohol and Related Conditions
ABSTRACT This study examines the relationship between age at onset of bipolar I disorder and illness characteristics among adults in a community sample.
The National Epidemiologic Survey on Alcohol and Related Conditions identified 1,411 adults with bipolar disorder. For analyses, bipolar disorder subjects were divided into three age at onset groups: childhood (less than 13 years old, N=113), adolescence (13-18 years old, N=339), and adulthood (19 years or older, N=959).
Nonremitting bipolar disorder was most prevalent among childhood-onset subjects, and childhood-onset subjects were most likely to experience prolonged episodes. Antisocial personality disorder was most prevalent among childhood-onset subjects. Drug use disorders were more prevalent among childhood-onset and adolescent-onset, as compared with adult-onset, subjects. Prevalence of mixed episodes or irritability did not differ significantly between groups.
Findings corroborate clinical studies: illness characteristics among adults with childhood-onset bipolar disorder are similar to those described in children with bipolar disorder.
Full-textDOI: · Available from: Benjamin I Goldstein, Aug 30, 2015
- SourceAvailable from: Akiah Ottesen Berg
[Show abstract] [Hide abstract]
- "The relationship between substance abuse and AAO in BD is poorly understood. The risk for substance abuse (especially of illicit substances) appears to be increased for patients with childhood- and adolescent onset compared with adult onset [13, 17–21], and it has been hypothesized that AAO and substance abuse may share a common genetic etiology . These studies, however, did not differentiate between the types of substances used. "
ABSTRACT: The aim of the study was to investigate which factors are associated with age at onset in bipolar disorder with a specific focus on excessive alcohol and cannabis use, and the sequence of the onsets of excessive substance use and bipolar disorder. We investigated a naturalistic sample of 151 patients with bipolar I and II disorder receiving psychiatric treatment. Whether the presence of excessive substance use prior to bipolar disorder onset or the type of substance used (alcohol or cannabis) was associated with differences in age at onset was investigated using hierarchical and multiple linear regression analyses, adjusting for potential confounders. Patients with excessive alcohol use had a significantly later onset compared with patients with excessive cannabis use. Excessive general substance use prior to bipolar disorder onset was associated with a later onset. However, excessive cannabis use was associated with an earlier onset whether it preceded or followed bipolar disorder onset, also after adjusting for possible confounders. Excessive use of alcohol or other substances was not independently associated with age at onset in multivariate analyses. Alcohol use was associated with a later onset compared with cannabis use, suggesting different relationships to the onset of bipolar disorder. Lifetime use of cannabis predicted an earlier onset, independent of the sequence of onsets. This indicates that an early onset may increase the risk of cannabis use and that cannabis use may trigger bipolar disorder in vulnerable individuals.European Archives of Psychiatry and Clinical Neuroscience 09/2011; 261(6):397-405. DOI:10.1007/s00406-011-0188-4 · 3.36 Impact Factor
[Show abstract] [Hide abstract]
- "The comorbidity of BD and substance use disorders (SUD; i.e., abuse or dependence of alcohol or drugs) has been well documented in the adult BD literature, and is associated with markedly increased illness severity across a broad spectrum of parameters (Cassidy, Ahearn, & Carroll, 2001). Both clinical and epidemiologic data indicate that the lifetime prevalence of SUD among child-and adolescent-onset subjects is significantly greater than among adult-onset subjects (Goldstein & Levitt, 2006; Perlis et al., 2004). Indeed, SUDs (most commonly alcohol and cannabis disorders) are prevalent among approximately 20% of adolescents with BD in large-scale clinical studies (Biederman et al., 2005; Goldstein et al., 2008). "
ABSTRACT: This paper examines obstacles and challenges encountered in the manualized Family Focused Therapy–A of an adolescent with bipolar disorder. We begin by describing adolescent bipolar disorder and some of the many complications that frequently accompany it. We summarize Family Focused Therapy (FFT-A), an empirically validated treatment approach for bipolar disorder, originally applied to the treatment of adults with bipolar disorder and modified for use with adolescents and their families. We present the details of a difficult treatment case, and examine the factors that led to its suboptimal outcome. We elaborate on ways in which this case would inform future iterations of FFT-A, and suggest future directions for research in this area.Cognitive and Behavioral Practice 08/2011; DOI:10.1016/j.cbpra.2010.05.007 · 1.33 Impact Factor
[Show abstract] [Hide abstract]
- "There is a strong comorbidity of ASPD and bipolar disorder (Fan & Hassell, 2008). Onset of bipolar disorder is earlier in individuals with both disorders (Goldstein & Levitt, 2006). In one report, 55% of newly diagnosed adolescents with bipolar disorder already had histories of antisocial behavior (Barzman et al., 2007). "
ABSTRACT: Bipolar disorder and antisocial personality disorder (ASPD) overlap in clinical characteristics and behavioral consequences. Impulsivity is prominent in both, but there is little information on how specific mechanisms of impulsivity differentiate, bridge, or underlie the disorders. Subjects, all males, were controls (n = 46), bipolar disorder without cluster B personality disorder (n = 21), ASPD without bipolar disorder (n = 50), and bipolar disorder with ASPD (n = 16). Impulsivity measures were the Immediate Memory Task (IMT), a continuous performance test of response inhibition measuring ability to evaluate a stimulus before responding, and the Two-Choice Impulsivity Paradigm (TCIP), a choice between smaller-sooner and larger-later reward. Data were analyzed using general linear models analysis. Subjects with bipolar disorder had fewer IMT correct detections and slower reaction times than controls. Reaction times were faster with combined diagnoses than in bipolar disorder alone. TCIP responding in either diagnosis alone resembled controls, but was more impulsive in combined disorders. These differences persisted after correction for age and education, which had significant independent effects. In combined ASPD and bipolar disorder, increased reaction speed, impulsive response bias, and reward-delay impulsivity occurred independent of substance-use disorder history. Impulsivity was increased in the combined disorders over either disorder alone. Results were consistent with at least partially distinct mechanisms of impulsivity in ASPD and bipolar disorder. Compensatory mechanisms for impulsivity in uncomplicated ASPD or bipolar disorder appear to be compromised or lost when the disorders are combined.Journal of Psychiatric Research 06/2011; 45(11):1477-82. DOI:10.1016/j.jpsychires.2011.06.009 · 4.09 Impact Factor