 |
|
Clinical Course of Children and Adolescents With Bipolar Spectrum Disorders
Boris Birmaher, MD;
David Axelson, MD;
Michael Strober, PhD;
Mary Kay Gill, MSN;
Sylvia Valeri, PhD;
Laurel Chiappetta, MS;
Neal Ryan, MD;
Henrietta Leonard, MD;
Jeffrey Hunt, MD;
Satish Iyengar, PhD;
Martin Keller, MD
Arch Gen Psychiatry. 2006;63:175-183.
Context Despite the high morbidity associated with bipolar disorder (BP), few studies have prospectively studied the course of this illness in youth.
Objective To assess the longitudinal course of BP spectrum disorders (BP-I, BP-II, and not otherwise specified [BP-NOS]) in children and adolescents.
Design Subjects were interviewed, on average, every 9 months for an average of 2 years using the Longitudinal Interval Follow-up Evaluation.
Setting Outpatient and inpatient units at 3 university centers.
Participants Two hundred sixty-three children and adolescents (mean age, 13 years) with BP-I (n = 152), BP-II (n = 19), and BP-NOS (n = 92).
Main Outcome Measures Rates of recovery and recurrence, weeks with syndromal or subsyndromal mood symptoms, changes in symptoms and polarity, and predictors of outcome.
Results Approximately 70% of subjects with BP recovered from their index episode, and 50% had at least 1 syndromal recurrence, particularly depressive episodes. Analyses of weekly mood symptoms showed that 60% of the follow-up time, subjects had syndromal or subsyndromal symptoms with numerous changes in symptoms and shifts of polarity, and 3% of the time, psychosis. Twenty percent of BP-II subjects converted to BP-I, and 25% of BP-NOS subjects converted to BP-I or BP-II. Early-onset BP, BP-NOS, long duration of mood symptoms, low socioeconomic status, and psychosis were associated with poorer outcomes and rapid mood changes. Secondary analyses comparing BP-I youths with BP-I adults showed that youths significantly more time symptomatic and had more mixed/cycling episodes, mood symptom changes, and polarity switches.
Conclusions Youths with BP spectrum disorders showed a continuum of BP symptom severity from subsyndromal to full syndromal with frequent mood fluctuations. Results of this study provide preliminary validation for BP-NOS.
Author Affiliations: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center (Drs Birmaher, Axelson, and Ryan and Mss Gill and Chiappetta), and Department of Statistics, University of Pittsburgh (Dr Iyengar), Pittsburgh, Pa; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles (Dr Strober); and Department of Psychiatry and Butler Hospital, Brown University School of Medicine, Providence, RI (Drs Valeri, Leonard, Hunt, and Keller).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Pediatric Bipolar Disorder Comes of Age
Leibenluft
Arch Gen Psychiatry 2008;65:1122-1124.
FULL TEXT
Child Bipolar I Disorder: Prospective Continuity With Adult Bipolar I Disorder; Characteristics of Second and Third Episodes; Predictors of 8-Year Outcome
Geller et al.
Arch Gen Psychiatry 2008;65:1125-1133.
ABSTRACT
| FULL TEXT
Family-Focused Treatment for Adolescents With Bipolar Disorder: Results of a 2-Year Randomized Trial
Miklowitz et al.
Arch Gen Psychiatry 2008;65:1053-1061.
ABSTRACT
| FULL TEXT
Early-Onset Bipolar Disorder
Meyer and Carlson
Focus 2008;6:271-283.
ABSTRACT
| FULL TEXT
Bibliography for Child and Adolescent Psychiatry
Focus 2008;6:314-316.
FULL TEXT
Pediatric Bipolar Disorder
Leibenluft and Rich
Focus 2008;6:331-347.
ABSTRACT
| FULL TEXT
National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth
Moreno et al.
Arch Gen Psychiatry 2007;64:1032-1039.
ABSTRACT
| FULL TEXT
Parental Diagnoses in Youth With Narrow Phenotype Bipolar Disorder or Severe Mood Dysregulation
Brotman et al.
Am. J. Psychiatry 2007;164:1238-1241.
ABSTRACT
| FULL TEXT
Differentiation in the Preonset Phases of Schizophrenia and Mood Disorders: Evidence in Support of a Bipolar Mania Prodrome
Correll et al.
Schizophr Bull 2007;0:sbm028v1-1.
ABSTRACT
| FULL TEXT
Longitudinal Course of Pediatric Bipolar Disorder
Birmaher
Am. J. Psychiatry 2007;164:537-539.
FULL TEXT
Twelve-Month Outcome of Adolescents With Bipolar Disorder Following First Hospitalization for a Manic or Mixed Episode
DelBello et al.
Am. J. Psychiatry 2007;164:582-590.
ABSTRACT
| FULL TEXT
Different Psychophysiological and Behavioral Responses Elicited by Frustration in Pediatric Bipolar Disorder and Severe Mood Dysregulation
Rich et al.
Am. J. Psychiatry 2007;164:309-317.
ABSTRACT
| FULL TEXT
Bibliography BIPOLAR DISORDER
Focus 2007;5:40-43.
FULL TEXT
Abstracts FOR BIPOLAR DISORDER
Focus 2007;5:44-58.
FULL TEXT
The Role of Psychosocial Stress in the Onset and Progression of Bipolar Disorder and its Comorbidities: The Need for Earlier and Alternative Modes of Therapeutic Intervention
Post and Leverich
Focus 2007;5:73-97.
ABSTRACT
| FULL TEXT
Controlled, blindly rated, direct-interview family study of a prepubertal and early-adolescent bipolar I disorder phenotype: morbid risk, age at onset, and comorbidity.
Geller et al.
Arch Gen Psychiatry 2006;63:1130-1138.
ABSTRACT
| FULL TEXT
Phenomenology of children and adolescents with bipolar spectrum disorders.
Axelson et al.
Arch Gen Psychiatry 2006;63:1139-1148.
ABSTRACT
| FULL TEXT
Flying Almost Blind
Leibenluft
Am. J. Psychiatry 2006;163:1129-1131.
FULL TEXT
Limbic hyperactivation during processing of neutral facial expressions in children with bipolar disorder
Rich et al.
Proc. Natl. Acad. Sci. USA 2006;103:8900-8905.
ABSTRACT
| FULL TEXT
|
