MedWire News: Children and adolescents with bipolar disorder have a chronic course with a low rate of remission, say US and Spanish researchers who found that early age at onset and attention-deficit hyperactivity disorder (ADHD) predicted a worse prognosis.
The prevalence of bipolar disorder among children and adolescents is reported to be lower outside than in the USA, but recent research in Spain indicated that the profile of pediatric bipolar disorder is similar in both countries.
Hypothesizing that the distinct pattern of bipolar disorder among pediatric patients may be leading to under- or misdiagnosis, Inmaculada Escamilla (Clínica Universidad de Navarra, Madrid, Spain) and colleagues examined the records of all 38 children and adolescents diagnosed with bipolar disorder according to DSM-IV criteria between 1999 and 2005.
The clinical course of the patients, of whom 79% were boys, was assessed using the National Institute of Mental Health Lifetime Mood Chart and the Clinical Global Impression-Severity Scale, the team notes in the Journal of Affective Disorders.
Bipolar I disorder was identified in 44.7% of patients, bipolar II disorder in 5.3% of patients, and bipolar disorder not otherwise specified in 50% of patients. The median age at diagnosis was 13.9 years, and the median follow-up period was 2.6 years.
The proportion of time from the onset of bipolar disorder spent in an episode was, on average, 46.2%, and was significantly longer in children aged under 12 years than in older children, at 50.0% versus 44.6%. Just 2.5% of patients had rapid cycling, defined as four or more episodes per year.
Comorbid ADHD was diagnosed in 21.1% of patients. All children with ADHD required hospitalization during follow-up, compared with 53.0% of children without ADHD.
In all, 18.4% of patients recovered, defined as at least 9 months without symptoms, and 21.0% achieved remission (≥3 months symptom-free), but 60.5% continued to have persistent symptoms with impairment. A poor treatment response was significantly more common in younger than older patients and those who did not receive antidepressants.
The team writes: "The results of our study closely resemble those found in samples from the USA. In our sample, children and adolescents [with bipolar disorder] had a chronic course with a low frequency of rapid cycling and low interepisodic recovery."
They add: "An early age of onset and ADHD comorbidity are risk factors for worse prognosis."
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