Childhood Bipolar Disorder Could Extend Into Young Adulthood

Young adults who had bipolar disorder as children are likely to suffer
from manic episodes, according to an article released on October 6,
2008 in Archives of General Psychiatry, one of the
JAMA/Archives journals.



Bipolar disorder is a severe mood disorder that involves episodes of
mania and depression. There is significant debate about how pediatric
bipolar disorder, which affects children, should be diagnosed.
According to the authors, recent increased media attention to this
disorder, it is important to explore diagnosis of the disease and any
potential ramifications later in life.



In order to explore these issues, Barbara Geller, M.D., and colleagues
at Washington University in St. Louis examined 115 children diagnosed
with bipolar disorder (according to the DSM-IV scale BP-1) between 1995
and 1998. Visits were performed at the start of the study and for 9
follow up visits over eight years, separately interviewing children and
their parents about the child's symptoms, diagnoses, daily cycles of
mania and depression, and interactions with others. The study was
completed by 108 of the children. The average age at baseline was 11.1
and the average age at final follow-up was 18.1 years.



In the 8 years of follow-up, as a whole, the children spent 60.2% of
their weeks with some number of mood episodes, and 39.6% of the weeks
with some episodes of mania. In total, 87.8% of the patients recovered
from mania, but 73.3% relapsed. In examination of second and third
episodes of mania, the researchers found that they included psychosis,
cycling between mania and depression, and a long duration. The average
length of a second manic episode was 55.2 weeks and the average length
of a third episode was 40 weeks.



Of the 54 patients who were 18 years or older at the end of follow-up,
44.4% continued to have manic episodes, a proportion much higher than
in the general population. Of this adult group, 35.2% of them had
substance use disorders -- this rate is similar to that in adults
diagnosed with bipolar disorder. According to the authors, this
indicates that there may be significant continuity between childhood
and adult bipolar disorder.



“In grown-up subjects with child bipolar disorder I, the 44.4
percent frequency of manic episodes was 13 to 44 times higher than
population prevalences, strongly supporting continuity between child
and adult bipolar disorder I,” write the authors.
“Subjects with child bipolar disorder I who were grown up at
the eight-year follow-up constituted approximately half the sample.
However, even if all subjects younger than 18 years at the eight-year
follow-up never had episodes of bipolar disorder I as adults, the
overall significance of the findings would be similar, because the rate
would still be six to 22 times higher than population
prevalences.”



The authors finally emphasize the need for further efforts exploring
and addressing the issue of pediatric bipolar disorde: “In
conclusion, mounting data support the existence of child bipolar
disorder I, and the severity and chronicity of this disorder argue
strongly for large efforts toward understanding the neurobiology and
for developing prevention and intervention strategies.”



Child Bipolar I Disorder: Prospective Continuity With Adult
Bipolar I Disorder; Characteristics of Second and Third Episodes;
Predictors of 8-Year Outcome

Barbara Geller; Rebecca Tillman; Kristine Bolhofner; Betsy Zimerman

Arch Gen Psychiatry. 2008;65(10):1125-1133.

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Written by Anna Sophia McKenney