Bipolar disorder in kids focus of several studies presented at international meeting

PITTSBURGH, June 14 – Nearly one out of 100 children and teenagers worldwide have bipolar disorder, a mental illness characterized by swings between mania, or euphoric mood, and depression. Despite the number of young people affected, doctors still have limited resources when it comes to helping them because very few long-term studies to determine safe and effective treatments have been performed.

The few researchers who have focused on such studies presented new findings today at the Fourth International Conference on Bipolar Disorder in Pittsburgh, as well as highlighted areas where more work needs to be done.

While the disorder is better understood in adults, research into bipolar disorder in children and adolescents has been gaining ground. Some of the studies presented today suggest adolescents are more prone to a form known as “rapid cycling,” where swings from mania to depression occur faster and more frequently than the standard form; children with bipolar disorder continue to have difficulties in relationships and school, even when treatment is successful; and bipolar disorder in adolescents is often accompanied by attention-deficit hyperactivity disorder (ADHD), anxiety disorders or conduct disorders, which complicates diagnosis and treatment.

Highlights of the presentations include:

• Nearly Half of Bipolar Children Require Multiple Medications

  Despite doctors’ best efforts to avoid treating patients with more than one medication, up to 40 percent required at least three different drugs to control their symptoms, according to Boris Birmaher, M.D., of the University of Pittsburgh School of Medicine. In addition, while 70 to 80 percent of the 73 adolescents in the study recovered from their initial bout with the illness, 80 percent relapsed.

• Bipolar Disorder is Often More Severe in Children than Adults

  Bipolar Disorder in children is often similar to severe, treatment-resistant, continually cycling bipolar disease in adults, according to Barbara Geller, M.D., of Washington University in St. Louis. In that study, Dr. Geller compared patients with prepubertal and early adolescent bipolar disorder (PEA-BP) with patients with ADHD and normal controls and also learned that discreet episodes of mania and depression, with clear sudden onsets and offsets, are not the norm for kids with bipolar as they are in adults. Children with PEA-BP have low recovery and high relapse rates as well, and suffer from significantly worse psychosocial functioning than those with ADHD and healthy kids.

• Recent Advances in Psychological Measurements May Shed Light on Brain Changes

  Young people with bipolar disorder suffer an apparent loss of connections between the emotional and the thinking brain that cause problems with mood regulation. Ian M. Goodyear, M.D. F.Med.Sci., Cambridge University, U.K., presented findings showing how diagnostic advances could impact the future of diagnosis and treatment for the neural, chemical and psychological processes behind bipolar disorder in adolescents.

• Drug Shows Promise for Effective Treatment

  The drug divalproex showed early promise for fulfilling doctors’ wishes of being able to use just one medication for safe and effective treatment of children with bipolar disorder. In a study of divalproex conducted by Robert A. Kowatch, M.D., of the University of Cincinnati, 21 of 30 subjects with bipolar disorder showed improvement without having to be put on additional medications.

• Certain Drugs May Trigger Bipolar Disorder in Genetically Susceptible Kids

Doctors should be careful in prescribing stimulants and antidepressants to hyperactive children, according to Catrien G. Reichart, M.D., of Academisch Ziekenhuis Rotterdam, The Netherlands.

Dr. Reichart and colleagues studied children in the United States and The Netherlands who had a parent with bipolar disorder. Their results show that the prevalence of bipolar disorder in these at-risk adolescents is much greater for American children (39 percent) than for Dutch children (4 percent). In The Netherlands there were very few cases of bipolar disorder found in children younger than 20, while in the U.S., children younger than 12 had been diagnosed.

The difference, according to Dr. Reichart, may be due to the use of stimulants and antidepressants to treat American children with hyperactivity, while doctors in The Netherlands rely more on psychosocial approaches.

NOTE TO EDITORS: To schedule interviews or for more information to attend the conference, please contact Craig Dunhoff at the UPMC News Bureau, (412) 624-2607.