The Poor Prognosis of Childhood-Onset Bipolar Disorder
Received 3 March 2006; received in revised form 3 August 2006; accepted 27 October 2006.
Refers to article:
Childhood Onset Bipolar Disorder: A Role for Early Recognition and Treatment
Russell E. Scheffer
The Journal of Pediatrics
May 2007 (Vol. 150, Issue 5, Pages 459-460) Full Text |
Full-Text PDF (53 KB)
Objective
We examined age of onset of bipolar disorder as a potential course-of-illness modifier with the hypothesis that early onset will engender more severe illness.
Study design
A total of 480 carefully diagnosed adult outpatients with bipolar disorder (mean age, 42.5 ± 11.6 years) were retrospectively rated for age of illness onset, time to first pharmacotherapy, and course of illness. Clinicians prospectively rated daily mood fluctuations over 1 year.
Results
Of the 480 patients, 14% experienced onset in childhood (12 years or younger); 36% in adolescence (13 to 18 years); 32% in early adulthood (19 to 29 years); and 19% in late adulthood (after 30 years). Childhood-onset bipolar illness was associated with long delays to first treatment, averaging more than 16 years. The patients with childhood or adolescent onset reported more episodes, more comorbidities, and rapid cycling retrospectively; prospectively, they demonstrated more severe mania, depression, and fewer days well.
Conclusions
This study demonstrates that childhood onset of bipolar disorder is common and is associated with long delays to first treatment. Physicians and clinicians should be alert to a possible bipolar diagnosis in children in hopes of shortening the time to initiating treatment and perhaps ameliorating the otherwise adverse course of illness.
Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health, Biological Psychiatry Branch, Bethesda, MD; Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH; Mental Health Care Line and General Clinical Research Center, Cincinnati VA Medical Center, Cincinnati, OH; Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California Los Angeles and West Los Angeles VA Medical Center, Los Angeles, CA; Altrecht Institute for Mental Health Care, Utrecht, The Netherlands; Department of Psychiatry, University Hospital, Groningen, The Netherlands; University of Texas-Southwestern Medical Center, Dallas; and Psychiatrische Klinik der LMU, Munich, Germany.
ABSTRACT