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

ArticleinArchives of general psychiatry 69(9) · May 2012with38 Reads
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.
    • "In addition, a cross-sectional study of 10,123 adolescents (13–18) were examined for bipolar and MDD diagnoses. 2.5% met criteria for lifetime BP I or II diagnosis, 1.7% met criteria for mania only, and rates for mania with and without depression were 2.2% and 1.3% respectively [62]. A nearly 2-fold increase in rates of mania from ages 13–14 and 17–18 was found and highlights adolescence as a peak age of onset for mania/bipolar disorder. "
    [Show abstract] [Hide abstract] ABSTRACT: Mood is the changing expression of emotion and can be described as a spectrum. The outermost ends of this spectrum highlight two states, the lowest low, melancholia, and the highest high, mania. These mood extremes have been documented repeatedly in human history, being first systematically described by Hippocrates. Nineteenth century contemporaries Falret and Baillarger described two forms of an extreme mood disorder, with the validity and accuracy of both debated. Regardless, the concept of a cycling mood disease was accepted before the end of the 19th century. Kraepelin then described "manic depressive insanity" and presented his description of a full spectrum of mood dysfunction which could be exhibited through single episodes of mania or depression or a complement of many episodes of each. It was this concept which was incorporated into the first DSM and carried out until DSM-III, in which the description of episodic mood dysfunction was used to build a diagnosis of bipolar disorder. Criticism of this approach is explored through discussion of the bipolar spectrum concept and some recent examinations of the clinical validity of these DSM diagnoses are presented. The concept of bipolar disorder in children is also explored.
    Full-text · Article · Jul 2016
    • "Bipolar Disorder manifests early, in adolescence and early adulthood. The US National Comorbidity Survey (NCS-A) of a representative sample (N ¼10,123) aged 14–24 found Major Depressive Disorder (MDD) in 7.6%, Bipolar Disorder in 2.5%, Unipolar Mania in 1.7% and unipolar hypomania in an additional 3.6% of the sample (Merikangas et al., 2012). Prospective epidemiological studies are even more conclusive. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Bipolar disorder (BD) is a public health issue; it is one of the leading causes of disability and its late diagnosis heightens the impact of the condition. Screening tools for early detection could be extremely useful. Methods: Narrative review on screening of BD. Results: Screening questionnaires have high sensitivity but relatively low specificity if DSM diagnoses are taken as the "gold standard". Critics maintain that an excess of false positives makes such tools unnecessary for identifying cases and of little use in screening studies consisting of two phases. However, "positive" screening was frequently homogeneous with BD in terms of gender, age, level of distress, low social functioning and employment rate, comorbidity with alcohol and substance abuse, heavy recourse to health care, use of mood stabilizers and antidepressants, risk of suicide attempts, and high recurrence of depressive episodes. While none of these components is pathognomonic of BD, their co-occurrence could identify subthreshold "cases". The studies reviewed found positivity at screening to be associated with impaired quality of life, even without BD and independently of comorbidity. Patients with a neurological disease and positive at screening show homogenous brain lesions, different from those of patients screening negative. Conclusions: The results are coherent with the hypothesis that positivity identifies a bipolar spectrum of clinical and public health interest, including sub-threshold bipolar cases, which do not fulfil the diagnostic criteria for BD.
    Full-text · Article · Jun 2016
    • "The scale has demonstrated high internal consistency and satisfactory test-retest reliability [18]. It was also reported to show both convergent [70] and divergent [18] validity. "
    [Show abstract] [Hide abstract] ABSTRACT: Evidence suggests that current treatments cannot fully alleviate the burden of disease associated with depression but that prevention approaches offer a promising opportunity to further reduce this burden. Adolescence is a critical period in the development of mental illness, and final school examinations are a significant and nearly universal stressor that may act as a trigger for mental health difficulties such as depression. The aim of the present trial is to investigate the impact of SPARX-R, an online, gamified intervention based on cognitive behavioural principles, on the prevention of depression in secondary school students before their final examinations. Government, independent and Catholic secondary schools in New South Wales, Australia, will be recruited to participate in the trial. All students enrolled in their final year of high school (year 12) in participating schools will be invited to participate. To account for possible attrition, the target sample size was set at 1600 participants across 30 schools. Participating schools will be cluster randomised at the school level to receive either SPARX-R or lifeSTYLE, an attention-controlled placebo comparator. The control intervention is an online program aimed at maintaining a healthy lifestyle. The primary outcome will be symptoms of depression, and secondary outcomes will include symptoms of anxiety, suicidal ideation and behaviours, stigma and academic performance. Additional measures of cost-effectiveness, as well as process variables (e.g., adherence, acceptability) and potential predictors of response to treatment, will be collected. Consenting parents will be invited to complete measures regarding their own mental health and expectations for their child. Assessments will be conducted pre- and post-intervention and at 6- and 18-month follow-up. Primary analyses will compare changes in levels of depressive symptomatology for the intervention group relative to the attention control condition using mixed-effects model repeated-measures analyses to account for clustering within schools. This is the first trial of a universal depression prevention intervention delivered to school students in advance of a specific, significant stressor. If found to be effective, this program may offer schools a new approach to preparing students for their final year of schooling. Trial registration Australian New Zealand Clinical Trials Registry identifier: ACTRN12614000316606. Registered 25 March 2014.
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