Comorbidity in Pediatric Bipolar Disorder

Pervasive Developmental Disorders Program, Clinical and Research Programs in Pediatric Psychopharmacology, Massachusetts General Hospital, Harvard Medical School, 32 Fruit Street, Boston, MA 02114, USA.
Child and adolescent psychiatric clinics of North America (Impact Factor: 2.88). 05/2009; 18(2):291-319, vii-viii. DOI: 10.1016/j.chc.2008.12.005
Source: PubMed


The growing literature shows the pervasiveness and importance of comorbidity in youth with bipolar disorder (BPD). For instance, up to 90% of youth with BPD have been described to manifest comorbidity with attention-deficit hyperactivity disorder. Multiple anxiety, substance use, and disruptive behavior disorders are the other most commonly reported comorbidities with BPD. Moreover, important recent data highlight the importance of obsessive-compulsive and pervasive developmental illness in the context of BPD. Data suggest that not only special developmental relationships are operant in the context of comorbidity but also that the presence of comorbid disorders with BPD results in a more severe clinical condition. Moreover, the presence of comorbidity has therapeutic implications for the treatment response for both BPD and the associated comorbid disorder. Future longitudinal studies to address the relationship and the impact of comorbid disorders on course and therapeutic response over time are required in youth with BPD.

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    • "This case series illustrates the intricacy of treatment decision making when managing patients with major depressive disorder and bipolar disorders.8,9) In the quest of achieving remission and relieving patients of their symptoms, the treating physician has to keep a number of things in his mind. "
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    ABSTRACT: Major depressive disorder and bipolar disorders are among the commonest neuropsychiatric conditions, affecting persons of both sexes which belong to all age groups. Comorbidity is the rule rather than the exception; anxiety spectrum disorders, somatoform disorders, eating disorders and substance use disorders frequently co-exist with mood disorders. Catatonia is a serious complication of the latter and every patient with a severe affective exacerbation should be assessed for the presence of catatonic signs and symptoms. In a significant minority of patients, symptoms show treatment resistance; many patients experience severe hopelessness and suicidal ideation, causing high rates of morbidity and mortality in afflicted individuals. Pharmacological management is challenging and currently available psychotropic agents often fall short of inducing remission. Second generation antipsychotics have been shown in a number of studies as having an antidepressant and mood stabilizing effect. Aripiprazole is a novel antipsychotic which is being increasingly used in difficult to treat mood disorders patients. Several controlled and uncontrolled studies have shown the efficacy and safety of this medication in subjects of all ages. Here a case series of three patients is presented who suffered from refractory mood disorders but responded to aripiprazole with complete remission of affective symptoms.
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    ABSTRACT: Pediatric bipolar disorder differs from the adult form of the disorder, marked by longer episodes, rapid cycling, prominent irritability, and high rates of comorbid attention-deficit/hyperactivity disorder and anxiety disorders. A careful assessment by families of children's symptoms, including their duration and intensity, helps with accurate diagnosis. After the diagnosis is made and careful psychopharmacological intervention is initiated, psychiatric nursing treatment of children and adolescents with pediatric bipolar disorder should involve child-and family-focused cognitive-behavioral therapies, family support, and psychoeducation.
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    ABSTRACT: The onset of bipolar disorder (BD) most commonly occurs in adolescence; about 60% of bipolar adults exhibit their first mood symptoms before 19 years. The worldwide prevalence rate of BD in youth varies by report from 0% in the United Kingdom to 4% in India and Spain. In the United States, an overall lifetime prevalence rate for bipolar disorders, including bipolar I disorder (BD-I), bipolar II disorder (BD-II), and cyclothymia was reported to be 1% in a community sample of adolescents. Differences in methodology, diagnostic criteria used, and varying levels of access to mental health professionals may account for this disparity in prevalence rates. Children and adolescents with BD have significantly high rates of psychosocial morbidity and mortality. Youth with BD reportedly have a 10-fold increased risk of suicide, compared with the general population. Moreover, children and adolescents with BD demonstrate high rates of mixed episodes, rapid cycling, psychosis, and co-occurring illnesses. They also exhibit low rates of recovery and high rates of recurrences. Overall, the presentation of early-onset BD is associated with a poor prognosis. Typically, there is a lag period of about 8 to 10 years before BD is diagnosed and treatment is initiated. There is a 10% lower likelihood of recovery for each year of untreated illness. Therefore, it is important to recognize and treat BD early in the illness course.
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