Mania With and Without Depression in a Community Sample of US Adolescents

University of North Carolina at Chapel Hill (Dr Youngstrom)
Archives of general psychiatry (Impact Factor: 14.48). 05/2012; 69(9). DOI: 10.1001/archgenpsychiatry.2012.38
Source: PubMed


CONTEXT: There are limited data on the manifestations of mania in general community samples of adolescents. OBJECTIVE: To present the prevalence and clinical correlates of mania with and without depressive episodes in a representative sample of US adolescents. DESIGN: Cross-sectional survey of adolescents using a modified version of the Composite International Diagnostic Interview. PARTICIPANTS: Ten thousand one hundred twenty-three adolescents aged 13 to 18 years identified in household and school settings. MAIN OUTCOME MEASURES: Mania/hypomania with or without depression among those who met DSM-IV criteria for bipolar I or II disorder or major depressive disorder. RESULTS: Two and a half percent of youth met criteria for lifetime bipolar I or II disorder and 1.7%, for mania only. Twelve-month rates of mania with and without depression were 2.2% and 1.3%, respectively. There was a nearly 2-fold increase in rates of mania from ages 13-14 to 17-18 years. Mania with depression was associated with a greater number of all indictors of clinical severity including symptom number and severity, role disability, severe impairment, comorbidity, and treatment compared with depression alone, whereas correlates of mania were similar among those with mania with or without depression. CONCLUSIONS: The increasing prevalence of bipolar disorder with increasing age and the comparable rate of bipolar disorder with those of adult samples highlight adolescence as the peak period of onset of mania. The clinical significance of mania plus depression as demonstrated by a 1 in 5 suicide attempt rate and nearly 2 months per year of role impairment in adolescence has important implications for early intervention. The evidence for independence of mania from depression warrants additional scrutiny in the diagnostic nomenclature and etiologic dissection of bipolar disorder.

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    • "Bipolar disorder is a severe and disabling neuropsychiatric disorder affecting approximately 1–2% of youths in the general population (Jonas et al., 2003; Kupfer, 2005; Merikangas et al., 2012). There is converging evidence that early onset bipolar disorder follows a more severe course leading to poorer long-term clinical outcomes with nearly a third of these patients attempting suicide (Goldstein et al., 2005; Post et al., 2010). "
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    ABSTRACT: Previous studies have reported abnormalities of white-matter diffusivity in pediatric bipolar disorder. However, it has not been established whether these abnormalities are able to distinguish individual subjects with pediatric bipolar disorder from healthy controls with a high specificity and sensitivity. Diffusion-weighted imaging scans were acquired from 16 youths diagnosed with DSM-IV bipolar disorder and 16 demographically matched healthy controls. Regional white matter tissue microstructural measurements such as fractional anisotropy, axial diffusivity and radial diffusivity were computed using an atlas-based approach. These measurements were used to 'train' a support vector machine (SVM) algorithm to predict new or 'unseen' subjects' diagnostic labels. The SVM algorithm predicted individual subjects with specificity=87.5%, sensitivity=68.75%, accuracy=78.12%, positive predictive value=84.62%, negative predictive value=73.68%, area under receiver operating characteristic curve (AUROC)=0.7812 and chi-square p-value=0.0012. A pattern of reduced regional white matter fractional anisotropy was observed in pediatric bipolar disorder patients. These results suggest that atlas-based diffusion weighted imaging measurements can distinguish individual pediatric bipolar disorder patients from healthy controls. Notably, from a clinical perspective these findings will contribute to the pathophysiological understanding of pediatric bipolar disorder.
    Full-text · Article · Oct 2015 · Psychiatry Research: Neuroimaging
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    • "It is most likely that the majority of the 346 patients in the present study suffered from bipolar disorder, type I, as patients were included via their contact to hospital psychiatric settings. It is most likely that patients with bipolar disorder, type II were not included as also reflected in the low incidence rates of 0.001% to 0.004% compared with 12-month prevalence rates for mania with and without depression of 2.2% and 1.3% from a recent population-based US survey of 13–18-year-old adolescents (Merikangas et al. 2012). In this way, our findings may be generalized to patients with bipolar disorder, type I, but not to bipolar disorder, type II. "
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    ABSTRACT: Studies from the USA suggest that rates of pediatric bipolar disorder have increased since the mid-90s, but no study outside the USA has been published on the rates of pediatric bipolar disorder. Further, it is unclear whether an increase in rates reflects a true increase in the illness or more diagnostic attention. Using nationwide registers of all inpatients and outpatients contacts to all psychiatric hospitals in Denmark, we investigated (1) gender-specific rates of incident pediatric mania/bipolar disorder during a period from 1995 to 2012, (2) whether age and other characteristics for pediatric mania/bipolar disorder changed during the calendar period (1995 to 2003 versus 2004 to 2012), and (3) whether the diagnosis is more often made at first psychiatric contact in recent time compared to earlier according to gender. Totally, 346 patients got a main diagnosis of a manic episode (F30) or bipolar affective disorder (F31) at least once during the study period from 1995 to 2012. For both sexes, annual rates of mania/bipolar disorder two to four doubled during the study period (0.001% before year 2004 to 0.002%-0.004% in 2010). Median age at the index diagnosis was very similar during the two calendar periods (17.2, quartiles, 16.2-18.3 versus 17.4, quartiles, 16.1-18.2) indicating that the diagnosis of mania/bipolar disorder was not made earlier in the recent calendar period. Similarly, there were no differences between early versus late in the study period in the fractions of first contact diagnosis of mania/bipolar disorder diagnoses, the contact number at which patients got the diagnosis or the duration from first psychiatric contact to the diagnosis of mania/bipolar disorder. The rate of diagnosis of mania/bipolar disorder increased from 1995 to 2014, which did not seem to be explained by more diagnostic attention.
    Full-text · Article · Sep 2014
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    • "Our finding confirms those of prior studies regarding the increased recognition and treatment of mania in males (Duax et al. 2007) and depression in females (Duax et al. 2007; Olfson et al. 2009). These differences may be attributable to referral bias as well as to sex differences in the prominence of symptoms that lead to referral for bipolar disorder, such as externalizing symptoms exhibited by males and internalizing symptoms exhibited by females (Duax et al. 2007; Merikangas et al. 2010, 2012). Analyses of other health services used by adolescents with bipolar disorder revealed that those treated for depression or mania utilized general medical, human services, and school services more than those who had not received treatment, and human services and medications more than adolescents treated for other disorders. "
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    ABSTRACT: Despite growing evidence that bipolar disorder often emerges in adolescence, there are limited data regarding treatment patterns of youth with bipolar disorder in community samples. Our objective was to present the prevalence and clinical correlates of treatment utilization for a nationally representative sample of US adolescents with bipolar disorder. Analyses are based on data from the National Comorbidity Survey-Adolescent Supplement, a face-to-face survey of 10,123 adolescents (ages 13-18) identified in household and school settings. We found that of adolescents meeting DSM-IV criteria for bipolar I or II disorder (N = 250), 49 % were treated for depression or mania, 13 % were treated for conditions other than depression or mania, and 38 % did not report receiving treatment. Treatment for depression or mania was associated with increased rates of suicide attempts, as well as greater role disability and more comorbid alcohol use relative to those who had not received treatment. Treated adolescents had triple the rate of ADHD and double the rates of behavior disorders than those without treatment. Our findings demonstrate that a substantial proportion of youth with bipolar disorder do not receive treatment, and of those who do, many receive treatment for comorbid conditions rather than for their mood-related symptoms. Treatment was more common among youth with severe manifestations and consequences of bipolar disorder and those with behavior problems. These trends highlight the need to identify barriers to treatment for adolescents with bipolar disorder and demonstrate that those in treatment are not representative of youth with bipolar disorder in the general population.
    Full-text · Article · Jun 2014 · Journal of Abnormal Child Psychology
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