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Mode of Onset and Prospective Course

Hagop S. Akiskal, MD; John Downs, MD; Patti Jordan, PharmD; Sally Watson, RN; David Daugherty, MD; David B. Pruitt, MD

Arch Gen Psychiatry. 1985;42(10):996-1003.

Abstract
• We studied 68 referred juvenile offspring or siblings of adult bipolar patients. Mean age at onset of affective and related disturbances was 15.9 years (range, 6 to 24 years). Although four of the ten prepubertal children had hypomanic features, full-blown manic psychosis did not appear before puberty. In the sample at large, 12 were classified as dysthymic and ten as cyclothymic. Eleven additional subjects with polysubstance abuse, who at onset did not meet criteria for affective disorder, were reclassified as having either a dysthymic or a cyclothymic disorder during follow-up. Of the remaining patients—24 depressive, eight manic, and three mixed state—71% experienced recurrences; mood-incongruent features, present in four cases at onset, recurred in only one patient during subsequent episodes. Overall, half the sample evidenced signs of bipolarity during a mean prospective follow-up period of three years.

Author Affiliations
From the Affective Disorders Program, the Departments of Psychiatry and Pharmacology (Dr Akiskal), and the Child and Adolescent Division (Drs Daugherty and Pruitt), the University of Tennessee College of Medicine, Memphis; and the Mood Clinic, Northeast Mental Health Center, Memphis (Drs Akiskal, Downs, and Jordan, and Ms Watson).

Footnotes
Accepted for publication Feb 25, 1985.

Reprint requests to Department of Psychiatry, University of Tennessee, 66 N Pauline St, Suite 633, Memphis, TN 38163 (Dr Akiskal).

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