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. 2018 Aug 15:236:199-206.
doi: 10.1016/j.jad.2018.04.021. Epub 2018 Apr 9.

Mood instability as a predictor of clinical and functional outcomes in adolescents with bipolar I and bipolar II disorder

Lisa A O'Donnell  1 , Alissa J Ellis  2 , Margaret M Van de Loo  2 , Jonathan P Stange  3 , David A Axelson  4 , Robert A Kowatch  4 , Christopher D Schneck  5 , David J Miklowitz  2
Affiliations

Mood instability as a predictor of clinical and functional outcomes in adolescents with bipolar I and bipolar II disorder

Lisa A O'Donnell et al. J Affect Disord. .

Abstract

Background: Traditional assessment and treatment of bipolar disorder (BD) often overlooks an important feature of the illness, mood instability (MI). MI - the presence of intense, rapidly shifting emotional states - is associated with a number of poor prognostic outcomes. This study examined whether MI among adolescents with BD was cross-sectionally related to bipolar subtype (I vs. II) and prognostically associated with symptoms and functioning over 3 months.

Methods: Participants included 145 adolescents (mean age: 15.6 years ± 1.4) with BD I or II with a mood episode in the previous 3 months. Depression and (hypo)mania instability were computed using the root mean square successive difference (rMSSD) score, reflecting both the size and temporal order of changes in weekly depression and (hypo)mania scores (over 12 weeks) from the Adolescent Longitudinal Interval Follow-Up Evaluation.

Results: Greater depression instability was associated with BD II, whereas greater (hypo)mania instability was associated with BD I. Baseline MI, particularly depression, predicted more instability, a higher percentage of weeks in a clinical mood state, and poorer global functioning over 3 months, even when covarying concurrent mood severity scores.

Limitations: The clinical measure of symptoms used retrospective reports of clinically significant symptoms only. We were unable to standardize medication use or adherence.

Conclusions: MI differs by diagnostic subtype, is relatively stable over time, and predicts clinical and functional outcomes. Targeting MI should be considered a clinical focus to augment traditional methods of assessing and treating BD during adolescence to enhance clinical and functional outcomes.

Keywords: Adolescence; Affective instability; Childhood-onset bipolar disorder; Mood disorders; Psychosocial functioning.

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Conflict of interest statement

Conflicts of Interest

Drs. O’Donnell, Ellis, and Axelson have no conflicts of interest to declare. Dr. Stange is supported by the National Institute of Mental Health (K23MH112769) and has received research funding from the Brain and Behavior Research Foundation. Dr. Schneck has received research support from NIMH, the Crown Family Philanthropies, and the Ryan White HIV/AIDS Treatment Extension Act. Dr. Miklowitz has received research funding from the National Institute of Mental Health, Brain and Behavior Research Foundation, Attias Family Foundation, Danny Alberts Foundation, Carl and Roberta Deutsch Foundation, Kayne Family Foundation, and the American Foundation for Suicide Prevention and book royalties from Guilford Press and John Wiley & Sons.

Figures

Figure 1
Figure 1
Comparison between overall 3-month mean depression Psychiatric Status Ratings (PSRs; sum of 12 weekly PSRs divided by 12 weeks) and actual weekly PSR scores, calculated across adolescents with bipolar disorder. 12 Weeks Prior to Initial Assessment Psychiatric Status Ratings (PSRs) for Depression
Figure 2
Figure 2
Comparison between overall 3-month mean (hypo)mania Psychiatric Status Ratings (PSRs; sum of 12 weekly PSRs divided by 12 weeks) and actual weekly PSR scores, calculated across adolescents with bipolar disorder. 12 Weeks Prior to Initial Assessment Psychiatric Status Ratings (PSRs) for (Hypo) mania
See this image and copyright information in PMC

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