A prospective 4–5 year follow-up of juvenile bipolar disorder

Child and Adolescent Psychiatry Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
Bipolar Disorders (Impact Factor: 4.97). 11/2004; 6(5):386-94. DOI: 10.1111/j.1399-5618.2004.00149.x
Source: PubMed


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.

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    • "Very few studies evaluated maintenance therapy in PBD. Some studies have commented on the efficacy of lithium in preventing relapse [26, 51]. Findling et al. noted that both lithium and valproate were good maintenance agents but noted that, in both trials, symptoms returned subsequently in about 16 weeks [52]. "
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    • "Several prospective studies have been conducted on the course of illness and long-term prognosis of a manic episode in adolescents, but few exhibit results on the determinants of short-term outcome. To summarize, mixed polarity, low socioeconomic status (SES), young age at onset, previous affective episode , psychosis and female sex were associated, at least in one study, with a poorer outcome (Strober et al., 1995; Geller et al., 2002a; Jairam et al., 2004; Birmaher et al., 2006; DelBello et al., 2007a). However, none reported transition risk to schizophrenia spectrum disorder. "
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