Early bipolar disorder often persists to adulthood

By Karla Gale

NEW YORK (Reuters Health) - New study findings show that close to half of children diagnosed with bipolar I disorder continued to have manic episodes as young adults and also have a high rate of substance abuse.

"Our findings support that children with bipolar I disorder become adults with bipolar I disorder, thus adding validation for the existence of the child bipolar I disorder diagnosis," lead author Dr. Barbara Geller noted in correspondence with Reuters Health. "Families frequently ask about prognosis, and these findings allow clinicians to have a database for informing families of the poor prognosis."

Bipolar I disorder, the "classic" form of the illness, involves recurrent episodes of mania and depression that usually recur across the lifespan, according to the National Institute of Mental Health. Between episodes, most people with bipolar disorder are free of symptoms However, up to 33 percent may have residual symptoms and a small percentage will have chronic unremitting symptoms, despite treatment.

The research team, from Washington University in St. Louis, studied the 8-year outcomes of participants a study called the "Phenomenology and Course of Pediatric Bipolar Disorders." Funded by the NIMH, the study included 115 children between 7 and 16 years old (the average age was 11 years) who enrolled between 1995 and 1998 during a first manic or mixed symptom episode.

As reported in the Archives of General Psychiatry, the children had an average of two episodes of mania or mixed-mania during follow-up. Of 54 patients who were 18 years old or older at the 8-year follow-up, 24 had at least one documented episode of mania, which is about to 44 times higher that the rate in the general population.

Characteristics of second or third mania episodes, including a long episode duration, psychosis and daily "cycling" from mania to depression, showed that the children still had significant illness, the investigators report. In addition, about 35 percent were also substance abusers.

Geller noted that there still is skepticism about the existence of pediatric bipolar I disorder. What is needed is a balance between "healthy skepticism," so children aren't overdiagnosed, and "vigilance" so the condition is not underdiagnosed, she said.

"In addition to the need for clinicians to follow these children for their bipolar I disorder, there needs to be high vigilance for the onset of substance use disorders."

The authors conclude: "The severity and chronicity of this disorder argue strongly for large efforts toward understanding the neurobiology and for developing prevention and intervention strategies."

SOURCE: Archives of General Psychiatry, October 2008.