Bipolar disorder in children and adolescents: International perspective on epidemiology and phenomenology

Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, Clínica Universitaria, University of Navarra, Pamplona, Spain.
Bipolar Disorders (Impact Factor: 4.97). 12/2005; 7(6):497-506. DOI: 10.1111/j.1399-5618.2005.00262.x
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There is considerable skepticism outside the US over the prevalence of pediatric bipolar disorder (BD). We wished to evaluate the epidemiology of BD in children and adolescents in non-US samples.
We reviewed studies on the prevalence of BD in children and adolescents in international samples. We also describe our sample of 27 children with BD at the University of Navarra.
There are important and frequently overlooked differences in the definition of BD between the International Classification of Diseases 10th edition (ICD-10) and DSM-IV and methodological differences in epidemiological studies that may partially explain international differences in prevalence of pediatric BD. The prevalence of bipolar spectrum disorder in young adults in Switzerland is 11%. In Holland the 6-month prevalence of mania in adolescents was 1.9% and of hypomania 0.9%. Only 1.2% of hospitalized youth (<15 years) in Denmark and 1.7% of adolescents in Finland had BD. In our clinic, the prevalence of DSM-IV BD in children 5-18 years old is 4%, and of any mood disorders 27%. There are also data from Brazil, India and Turkey with varying results.
Relative lack of data, ICD-10 and DSM-IV differences in diagnostic criteria, different levels of recognition of Child and Adolescent Psychiatry as a true specialty in Europe, clinician bias against BD, an overdiagnosis of the disorder in USA and/or a true higher prevalence of pediatric BD in USA may explain these results. US-International differences may be a methodological artifact and research is needed in this field.

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Available from: Felipe Ortuno, Oct 01, 2015
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    • "Bipolar disorder is a severe and enduring condition that affects a significant portion of the population globally (Weissman et al. 1996). Though specific annual rates of occurrence can vary by geographic region of the world (Soutullo et al. 2005), a large, international study of ten countries revealed consistent lifetime rates of bipolar disorder (Weissman et al. 1996). Such studies of the Americas, Europe, and Asia have revealed a 2.4% lifetime prevalence of bipolar spectrum disorders (Merikangas et al. 2011). "
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    ABSTRACT: Bipolar disorder presents with diverse clinical manifestations. Numerous investigators have sought to identify variables that may predict a more severe illness course. With the objective of studying the clinical characteristics of bipolar patients between South and North America, a comparison was performed between a sample from Argentina (n = 449) and a sample from the United States (n = 503) with respect to demographics and clinical characteristics, including presence of comorbidities. The Argentinian sample had more unfavorable demographics and higher rates of prior psychiatric hospitalization and prior suicide attempt but a better social outcome. However, the sample from the United States had a higher rate of prior year rapid cycling, as well as younger bipolar disorder onset age (mean ± SD, 17.9 ± 8.4 vs. 27.1 ± 11.4 years) and more severe clinical morbidity, though there was no significant difference in terms of the total duration of the illness. Argentinian compared to American patients were taking more mood stabilizers and benzodiazepines/hypnotics, but fewer antipsychotics and other psychotropic medications, when considering patients in aggregate as well as when stratifying by illness subtype (bipolar I versus bipolar II) and by illness onset age (≤21 vs. >21 years). However, there was no significant difference in rate of antidepressant prescription between the two samples considered in aggregate. Although possessing similar illness durations, these samples presented significant clinical differences and distinctive prescription patterns. Thus, though the Argentinian compared to North American patients had more unfavorable demographics, they presented a better social outcome and, in several substantive ways, more favorable illness characteristics. In both samples, early onset (age ≤ 21 years) was a marker for poor prognosis throughout the illness course, although this phenomenon appeared more robust in North America.
    04/2015; 3(1):3-8. DOI:10.1186/s40345-015-0027-z
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    • "We have used European as an abbreviation of convenience for patients located at the Netherlands and German sites, and readily acknowledge that substantial differences in age of onset and other course of illness variables may differ considerably among different European countries (Soutullo et al., 2005). A similar caveat exists for different locales in the US. "
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    ABSTRACT: Background There is some controversy but growing evidence that childhood onset bipolar disorder may be more prevalent and run a more difficult course in the United States than some European countries. Methods We update and synthesize course of illness data from more than 960 outpatients with bipolar disorder (average age 40) from 4 sites in the U.S. and 3 sites in Netherlands and Germany. After giving informed consent, patients reported on parental history, childhood and lifetime stressors, comorbidities, and illness characteristics. Results Almost all aspects of bipolar disorder were more adverse in patients from the US compared with Europe, including a significantly higher prevalence of: bipolar disorder in one parent and a mood disorder in both parents; childhood verbal, physical, or sexual abuse; stressors in the year prior to illness onset and the last episode; childhood onsets of bipolar illness; delay to first treatment; anxiety disorder, substance abuse, and medical comorbidity; mood episodes and rapid cycling; and nonresponse to prospective naturalistic treatment. Limitations Selection bias in the recruit of patients cannot be ruled out, but convergent data in the literature suggest that this does not account for the findings. Potential mechanisms for the early onset and more adverse course in the U.S. have not been adequately delineated and require further investigation. Conclusions The data suggest the need for earlier and more effective long-term treatment intervention in an attempt to ameliorate this adverse course and its associated heavy burden of psychiatric and medical morbidity.
    Journal of Affective Disorders 05/2014; 160:27–33. DOI:10.1016/j.jad.2014.02.006 · 3.38 Impact Factor
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    • "). Umgekehrt erhalten Kinder in anderen Ländern vergleichsweise selten die Diagnose einer bipolaren Störung (Soutullo et al., 2005). Auffällig sind vor allem deutliche Unterschiede hinsichtlich der Prävalenz von bipolaren Störungen in klinischen Populationen: Während Studien aus den USA z. "
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    ABSTRACT: One of the goals of epidemiological research is to describe the frequency and patterns in the distribution of diseases among certain groups of a statistical population. According to the literature available, mental disorders in children and adolescents are a common phenomenon worldwide. This article provides a review of the most important and recent international studies on the magnitude, on patterns of distribution, on the course and on gender differences of psychiatric disorders in children and adolescents. Additional data from scientific textbooks are added to the original articles.
    Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 01/2013; 41(1):45-57. DOI:10.1024/1422-4917/a000209 · 0.99 Impact Factor
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