A prospective 4-5 year follow-up of juvenile onset bipolar disorder.
ABSTRACT Data on outcome of juvenile onset bipolar disorder is limited. This study examined the course and outcome of bipolar disorder and assessed the rate and predictors of recovery and relapse in a sample of children and adolescents over a 4-5 year period.
Twenty-five consecutively ascertained subjects (9-16 years) with a diagnosis of mania (mean duration at intake of 4.6 +/- 3.9 weeks), were comprehensively assessed at baseline and at 6-month intervals using the Diagnostic Interview for Children and Adolescents (revised) (DICA-R), the Missouri Assessment for Genetic Interview in Children (MAGIC), the Young's Mania Rating Scale (YMRS) and the Children's Global Assessment (CGAS). The study phenotype required DSM-IV criteria of mania with elation and/or grandiosity as a criterion to distinguish them from those with attention deficit hyperactivity disorder. Subjects received the standard treatment as prescribed by their primary treating team.
During the course of the study period, all 25 subjects (100%) recovered from the index episode. The mean time to recovery was 44 +/- 46 days. The mean duration of follow-up was 51.6 +/- 4.1 months. Sixteen subjects (64%) relapsed after a mean period of 18 +/- 16.4 months. A majority of the relapses (72.4%) were while the subjects were on treatment.
Acute juvenile onset mania has a high rate of recovery and low chronicity. The relapse rate was high and most of these occurred in the first 3 years despite aggressive prophylactic treatment. The effectiveness of currently used thymoleptics, in particular lithium, in the prophylaxis of juvenile bipolar disorder needs to be evaluated in controlled studies.
SourceAvailable from: Pawan Gupta[Show abstract] [Hide abstract]
ABSTRACT: Considerable controversy exist regarding clinical presentation, diagnosis, and comorbidities specially Attention Deficit Hyperactivity Disorder (ADHD), in paediatric BPD.Objectives To describe phenomenology and comorbidities of paediatric BPD.AimsTo clinically study the Phenomenology and Comorbidity of Pediatric BPD and to clinically study the comorbidity of ADHD in Pediatric BPD.Method78 Subjects (6–16 years) attending child and adolescent psychiatry services of C.S.M.M.U. Lucknow, who fulfilled DSM-IV-TR 2000 criteria for BPD were assessed using K-SADS-PL, child mania rating scale (CMRS),child depression rating scale (CDRS) ADHD-RS and C-GAS.ResultsAll the subjects were diagnosed as BPD-I. Their mean chronological age was 13.4 ± 2.1 years. The mean age at onset of BPD was 12.2 ± 2.3 years. The most common symptoms found in manic subjects were increased goal directed activities (100%), distractibility (100%), elation (98.7%), grandiosity (90.5%), physical restlessnesss (82.4%), poor judgment (82.4%) and decreased need for sleep (81.1%). 19 (24.5%) cases of BPD had other current comorbid disorders. The commonest comorbidities were MR (10.26%) and ADHD (10.26%), accompanied by Seizure disorders (2.56%), Oppositional Defiant Disorder (6.41%), substance abuse (3.85%), Anxiety Disorders (2.56%), and Enuresis (1.28).Conclusions In children and adolescents elation/grandiosity is more common presentation than Irritability. Comorbidities are rare in paediatric BPD-I. Differentiation of comorbid disruptive behaviour disorders especially ADHD from BPD is possible with respect to age of onset, quality of the disturbed mood, and the course of each disorder.European Psychiatry 01/2012; 27:1. DOI:10.1016/S0924-9338(12)74463-2 · 3.21 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Background The diagnosis of bipolar disorder-I (BD-I) is currently well-established. However, more studies exploring diagnostic stability and psychosocial adaptation during follow-up in adulthood are needed. Objectives We assessed factors at follow-up (FU): (1) the diagnostic stability of manic/mixed episodes from adolescence to adulthood, (2) psychosocial adaptation, and (3) factors associated with psychosocial adaptation. Methods A sample of 80 adolescents hospitalized in a university hospital between 1993 and 2004 for a manic or mixed episode were contacted for an FU assessment on average 8 years after the index episode. Assessments included socio-demographic data, mortality, lifetime psychiatric diagnosis, the Social Adaptation Scale, negative life events and insight. Results Of the 64 patients with available information, one patient died from a heart attack. Of the 55 patients available for an FU assessment, 35 (63.6%) still presented a diagnosis of BD-I at FU, whereas 20 (36.4%) had changed diagnosis towards a schizophrenia spectrum disorder. Psychosocial adaptation was moderate to poor for most patients, and 91% of the patients had at least one relapse. A low socio-economic status, intellectual disability, negative life events, a history of sexual abuse, and treatment with classical antipsychotics at FU were significantly associated with poorer psychosocial adaptation. In contrast, better insight, a family history of depression and a diagnosis of BD-I at FU were associated with better psychosocial adaptation. Conclusion BD-I in adolescent inpatients can lead to important morbidity and mortality during outcome. Diagnostic stability is high, but a high proportion of patients also show a transition towards a schizophrenia spectrum disorder.Schizophrenia Research 09/2014; 159(2-3). DOI:10.1016/j.schres.2014.08.010 · 4.43 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: First episode mania (FEM) cohorts provide an opportunity to identify windows for intervention to potentially alter the course of bipolar disorder (BD). Despite several efforts to prospectively characterize first episode patients, follow-up of such cohorts has seldom exceeded 1 year. We present 4-year outcomes from the STOP-EM FEM cohort. Of 101 identified FEM patients, 81 had longitudinal follow-up. Clinical evaluations including substance misuse, sociodemographics and family history were characterized using semi-structured instruments. Clinical reassessments occurred every 6 months. Within one year, all patients had remitted and 95% recovered. Recurrence following remission occurred in 58% of patients by 1 year and 74% by 4 years (60% depressive, 28% manic and 12% hypomanic). Recurrence within one year was associated with a higher rate of recurrence thereafter. Older age was associated with a shorter time to remission. Substance misuse was associated with delayed recovery and earlier recurrence. This prospective multiwave longitudinal design employed may be limited by the assessment schedule and associated recall bias. The influences of attrition of this sample should be considered when attempting to generalize our findings. Best practices in FEM result in remission and recovery. While recurrence is common, minimizing recurrence within the first year through risk factor modification may alter the course of the BD. Copyright © 2015 Elsevier B.V. All rights reserved.Journal of Affective Disorders 01/2015; 175C:411-417. DOI:10.1016/j.jad.2015.01.032 · 3.71 Impact Factor