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Comparative Study
. 2006 Feb;63(2):175-83.
doi: 10.1001/archpsyc.63.2.175.

Clinical course of children and adolescents with bipolar spectrum disorders

Boris Birmaher  1 , David Axelson, Michael Strober, Mary Kay Gill, Sylvia Valeri, Laurel Chiappetta, Neal Ryan, Henrietta Leonard, Jeffrey Hunt, Satish Iyengar, Martin Keller
Affiliations
Comparative Study

Clinical course of children and adolescents with bipolar spectrum disorders

Boris Birmaher et al. Arch Gen Psychiatry. 2006 Feb.

Abstract

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.

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Figures

Figure 1
Figure 1
Recovery stratified by bipolar subtype. The index episode was defined as the most recent or current episode from the date of intake. To ascertain the real duration of illness, time to recovery was calculated from the onset of the index episode. Therefore, for some subjects the duration of episode exceeded the length of prospective follow-up. BP-I indicates bipolar I disorder; BP-II, bipolar II disorder; BP-NOS, bipolar disorder not otherwise specified.
Figure 2
Figure 2
Recurrence stratified by bipolar subtype. Time to recurrence was calculated from the time subjects fulfilled criteria for recovery until they met full criteria for a new mood episode. Abbreviations are explained in the legend to Figure 1.
See this image and copyright information in PMC

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