A case series of Turkish children and adolescents with bipolar spectrum disorder: a naturalistic clinical phenomenological follow-up

Abstract

Aim: The main objectives of this a naturalistic, prospective follow-up study were to describe the clinical presentation and predictors of treatment response in Turkish children and adolescents with bipolar disorder (BD) and to document their response to available treatment regimes.

Methods: The study sample consisted of 27 consecutive admissions to the Child and Adolescent Psychiatry Clinic between 2002 and 2006. Washington University at St. Louis -Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) was administered to mothers for an assessment of the problem of their children and to children about themselves. Subjects were phenomenologically re-examined to ascertain whether they met the Leibenluft criteria for the narrow, intermediate, or broad phenotypes of juvenile mania. All patients were also rated with Children Global Assessment Scale (CGAS) and Young Mania Rating Scale (YMRS). Treatment response was documented using the Clinical Global Impression (CGI) and the YMRS.

Results: The mean age was 12.95+/-3.8 years and the mean follow-up period was 24+/-9.2 months. Nineteen (70.3%) patients continued their treatment for 20.6+/-12.47 months. A large number of patients responded to mood stabilizers and antipsychotic agents (89.5%). When treatment endpoint scores of CGAS were compared between patients with age at onset =or>13 and <13, functionality of group with age at onset =or>13 was significantly greater than early onset group at the end of the treatment(z:-2.014, P=0.044).

Conclusion: Compared to non-episodic patients, episodic patients were more likely to have psychotic features and to have a later age of onset. Mood stabilizers and atypical antipsychotic combination was required in many cases (73.7%). Long term follow-up clinical phenomenological and treatment efficacy studies are needed in the future.