Further Evidence for a Developmental Subtype of Bipolar Disorder Defined by Age at Onset: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
American Journal of Psychiatry (Impact Factor: 12.3). 10/2006; 163(9):1633-6. DOI: 10.1176/appi.ajp.163.9.1633
Source: PubMed


This study examines the relationship between age at onset of bipolar I disorder and illness characteristics among adults in a community sample.
The National Epidemiologic Survey on Alcohol and Related Conditions identified 1,411 adults with bipolar disorder. For analyses, bipolar disorder subjects were divided into three age at onset groups: childhood (less than 13 years old, N=113), adolescence (13-18 years old, N=339), and adulthood (19 years or older, N=959).
Nonremitting bipolar disorder was most prevalent among childhood-onset subjects, and childhood-onset subjects were most likely to experience prolonged episodes. Antisocial personality disorder was most prevalent among childhood-onset subjects. Drug use disorders were more prevalent among childhood-onset and adolescent-onset, as compared with adult-onset, subjects. Prevalence of mixed episodes or irritability did not differ significantly between groups.
Findings corroborate clinical studies: illness characteristics among adults with childhood-onset bipolar disorder are similar to those described in children with bipolar disorder.

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Available from: Benjamin I Goldstein
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    • "The high score of dimension (for example depressive) means, that most items generating domain ratings exceeding 0. It is not identical with severe depression identified by clinical terms.For BD, we built five models, basing on information collected: (1) affective disorders in a family, bipolar disorder in the family and other disorders in a family (first and second degree relatives); (2) premorbid personality disorder, marital status, employment at onset, work adjustment, premorbid social adjustment and definite psychological stressor prior onset; (3) age at onset: early (childhood and adolescence) and late (adulthood) and sex. Similar to Goldstein, we treated onset when 19 and more as adulthood and called it late[24]. In case of schizophrenia sample we checked following models: (1) gender and age at onset. "
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    • "The relationship between substance abuse and AAO in BD is poorly understood. The risk for substance abuse (especially of illicit substances) appears to be increased for patients with childhood- and adolescent onset compared with adult onset [13, 17–21], and it has been hypothesized that AAO and substance abuse may share a common genetic etiology [13]. These studies, however, did not differentiate between the types of substances used. "
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    • "The comorbidity of BD and substance use disorders (SUD; i.e., abuse or dependence of alcohol or drugs) has been well documented in the adult BD literature, and is associated with markedly increased illness severity across a broad spectrum of parameters (Cassidy, Ahearn, & Carroll, 2001). Both clinical and epidemiologic data indicate that the lifetime prevalence of SUD among child-and adolescent-onset subjects is significantly greater than among adult-onset subjects (Goldstein & Levitt, 2006; Perlis et al., 2004). Indeed, SUDs (most commonly alcohol and cannabis disorders) are prevalent among approximately 20% of adolescents with BD in large-scale clinical studies (Biederman et al., 2005; Goldstein et al., 2008). "
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