Delayed treatment of childhood-onset bipolar disorder results in negative outcome in adults

In bipolar disorder, also called manic-depressive disorder, a person experiences mood changes that fluctuate between periods of abnormally high energy and extreme depression. Bipolar disorder is estimated to affect approximately 1-3% of adults, but also can affect children and adolescents. Untreated, this disorder is associated with greater risk of drug and alcohol addiction, of interpersonal relationship difficulties, of school and, later, work problems, of engaging in risky behaviors, and of suicide. A study published in the May issue of The Journal of Pediatrics shows that childhood-onset bipolar disorder is more common than believed and often goes unrecognized and untreated for long periods of time, leading to lower quality of life and greater difficulty in treatment.

480 adults in the United States who were diagnosed with bipolar disorder completed questionnaires and were interviewed about their courses of illness. These adults were studied at an average age of 42 and had been ill for an average time of more than 20 years. Researchers from the National Institute of Mental Health of the National Institutes of Health and from other institutions determined the age of onset of manic or depressive symptoms and the age of first treatment in this group. The duration of time from onset of illness to first pharmacological treatment for depression or mania was available for 420 patients. For those who experienced the onset of bipolar disorder in childhood (under 13 years old), the average time before first treatment was more than 16 years (Figure). They experienced more days depressed, more days in which both mania and depression occurred within a 24-hour period (ultradian cycling), and greater number of manic and depressive episodes throughout their lives. The patients also had an increased risk of substance abuse, a greater lifetime risk of suicide attempts, higher prevalence of lifetime anxiety disorders, and greater resistance to treatment.

22% to 28% of the adults studied experienced the onset of bipolar disorder prior to the age of 13. In the interval between onset of illness and initial treatment, patients are at risk of disability and comorbid conditions such as anxiety and substance abuse. Moreover, some children with bipolar disorder are diagnosed with ADHD or depression and receive treatment for long periods of time with only stimulants or antidepressants, rather than combination medications such as mood stabilizers or atypical antipsychotics, as recommended in most treatment guidelines for bipolar disorder. As stated by Dr. Russell Scheffer from the Medical College of Wisconsin in an editorial that accompanies the study, “The information contained in this report and additional mounting evidence suggest that early detection, diagnosis, and treatment are essential for determining effective treatment outcomes and, subsequently, quality of life for those affected with bipolar disorder.” Earlier recognition and treatment of bipolar disorder in children and adolescents could positively impact the course of illness.

The study is reported in “The Poor Prognosis of Childhood Onset Bipolar Disorder” by Gabriele Simon Leverich, Robert M Post, M.D., Paul E Keck Jr., M.D., Lori L Altshuler, M.D., Mark A Frye, M.D., Ralph W Kupka, M.D., Ph.D., Willem A Nolen, M.D., Ph.D., Trisha Suppes, M.D., Ph.D., Susan L McElroy, M.D., Heinz Grunze, M.D., Kirk D Denicoff, M.D., Maria KM Moravec, B.S., David Luckenbaugh, M.A. from the National Institute of Mental Health, National Institutes of Health, Maryland, University of Cincinnati College of Medicine, Ohio, Altrecht Institute for Mental Health Care and University Hospital Groningen, The Netherlands, University of Texas-Southwestern Medical Center, Texas, and Psychiatrische Klinik der LMU, Germany. The editorial is titled “Childhood Onset Bipolar Disorder: A Role for Early Recognition and Treatment” by Russell E. Scheffer, M.D. from the Medical College of Wisconsin, Milwaukee, Wisconsin. The article and editorial appear in The Journal of Pediatrics, Volume 150, Issue 5 (May 2007), published by Elsevier.

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