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Course and outcome of bipolar spectrum disorder in children and adolescents: A review of the existing literature

Published online by Cambridge University Press:  25 October 2006

BORIS BIRMAHER  and
DAVID AXELSON
BORIS BIRMAHER
Affiliation:
University of Pittsburgh Medical Center
DAVID AXELSON
Affiliation:
University of Pittsburgh Medical Center
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Abstract

The longitudinal course of children and adolescents with bipolar disorder (BP) is manifested by frequent changes in symptom polarity with a fluctuating course showing a dimensional continuum of bipolar symptom severity from subsyndromal to mood syndromes meeting full Diagnostic and Statistical Manual of Mental Disorders criteria. These rapid fluctuations in mood appear to be more accentuated than in adults with BP, and combined with the high rate of comorbid disorders and the child's cognitive and emotional developmental stage, may explain the difficulties encountered diagnosing and treating BP youth. Children and adolescents with early-onset, low socioeconomic status, subsyndromal mood symptoms, long duration of illness, rapid mood fluctuation, mixed presentations, psychosis, comorbid disorders, and family psychopathology appear to have worse longitudinal outcome. BP in children and adolescents is associated with high rates of hospitalizations, psychosis, suicidal behaviors, substance abuse, family and legal problems, as well as poor psychosocial functioning. These factors, in addition to the enduring and rapid changeability of symptoms of this illness from very early in life, and at crucial stages in their lives, deprive BP children of the opportunity for normal psychosocial development. Thus, early recognition and treatment of BP in children and adolescents is of utmost importance.This work was supported in part by grant MH59929 from the National Institute of Mental Health. The authors thank Carol Kostek for her assistance with manuscript preparation and Editha Nottelmann, PhD, and Regina James, MD, for their continued support.

Type
Research Article
Information
Development and Psychopathology , Volume 18 , Issue 4 , December 2006 , pp. 1023 - 1035
Copyright
© 2006 Cambridge University Press

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References

REFERENCES

Akiskal, H. S., Bourgeois, M. L., Angst, J., Post, R., Moller, H., & Hirschfeld, R. (2000). Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. Journal of Affective Disorders, 59(Suppl. 1), S5–S30.Google Scholar
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., revised). Washington, DC: Author.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Angst, J., Gerber-Werder, R., Zuberbühler, H. U., & Gamma, A. (2004). Is bipolar I disorder heterogeneous? European Archives of Psychiatry and Clinical Neuroscience, 254, 82–91.Google Scholar
Axelson, D. A., Birmaher, B., Strober, M., Gill, M. K., Valeri, S., Chiappetta, L., et al. (in press). Phenomenology of children and adolescents with bipolar spectrum disorders. Archives of General Psychiatry.
Bashir, M., Russell, J., & Johnson, G. (1987). Bipolar affective disorder in adolescence: A 10-year study. Australian and New Zealand Journal of Psychiatry, 21, 36–43.Google Scholar
Biederman, J., Faraone, S. V., Wozniak, J., Mick, E., Kwon, A., & Aleardi, M. (2004). Further evidence of unique developmental phenotypic correlates of pediatric bipolar disorder: Findings from a large sample of clinically referred preadolescent children assessed over the last 7 years. Journal of Affective Disorders, 82S, S45–S58.Google Scholar
Birmaher, B. (2004). Bipolare und Depressive Storungen im Kindes—und Jugendalter. In A. Maneros (Ed.), Das Neue Handbuch der Bipolaren und Depressiven Erkrankungen (pp. 573–590). Stuttgart: George Thieme Verlag.
Birmaher, B., Axelson, D., Strober, M., Gill, M. K., Valeri, S., Chiappetta, L., et al. (2006). Clinical course of children and adolescents with bipolar spectrum disorders. Archives of General Psychiatry, 63, 175–183.Google Scholar
Brent, D. A., Holder, D., Kolko, D., Birmaher, B., Baugher, M., Roth, C., et al. (1997). A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy. Archives of General Psychiatry, 54, 877–885.Google Scholar
Brent, D. A., Perper, J. A., Goldstein, C. E., Kolko, D. J., Allan, M. J., Allman, C. J., et al. (1988). Risk factors for adolescent suicide: A comparison of adolescent suicide victims with suicidal inpatients. Archives of General Psychiatry, 45, 581–588.Google Scholar
Carlson, G., Davenport, Y., & Jamison, K. (1977). A comparison of outcome in adolescent- and late-onset bipolar manic-depressive illness. American Journal of Psychiatry, 134, 919–922.Google Scholar
Carlson, G. A., Bromet, E. J., Driessens, C., Mojtabai, R., & Schwartz, J. E. (2002). Age at onset, childhood psychopathology, and 2-year outcome in psychotic bipolar disorder. American Journal of Psychiatry, 159, 307–309.Google Scholar
Chambers, W. J., Puig-Antich, J., Hirsch, M., Paez, P., Ambrosini, P. J., Tabrizi, M. A., et al. (1985). The assessment of affective disorders in children and adolescents by semi-structured interview test-retest reliability. Archives of General Psychiatry, 42, 696–702.Google Scholar
Chengappa, K. N., Kupfer, D. J., Frank, E., Houck, P. R., Grochocinski, V. J., Cluss, P. A., et al. (2003). Relationship of birth cohort and early age at onset of illness in a bipolar disorder case registry. American Journal of Psychiatry, 160, 1636–1642.Google Scholar
Coryell, W., Endicott, J., & Keller, M. (1990). Outcome of patients with chronic affective disorder: A five-year follow-up. American Journal of Psychiatry, 147, 1627–1633.Google Scholar
Coryell, W., Endicott, J., Maser, J. D., Keller, M. B., Leon, A. C., & Akiskal, H. S. (1995). Long-term stability of polarity distinctions in the affective disorders. American Journal of Psychiatry, 152, 385–390.Google Scholar
Coryell, W., Keller, M., Lavori, P., & Endicott, J. (1990). Affective syndromes, psychotic features, and prognosis. II. Mania. Archives of General Psychiatry, 47, 658–662.Google Scholar
Coryell, W., Scheftner, W., Keller, M., & Endicott, J. (1993). The enduring psychosocial consequences of mania and depression. American Journal of Psychiatry, 150, 720–727.Google Scholar
Coryell, W., Turvey, C., Endicott, J., Leon, A., Mueller, T., & Solomon, D. (1998). Bipolar I affective disorder: Predictors of outcome after 15 years. Journal of Affective Disorders, 50, 109–116.Google Scholar
Coryell, W., Winokur, G., Solomon, D., Shea, T., Leon, A., & Keller, M. (1997). Lithium and recurrence in a long-term follow-up of bipolar affective disorder. Psychological Medicine, 27, 281–289.Google Scholar
Dunner, D. L., & Fieve, R. R. (1974). Clinical factors in lithium carbonate prophylaxis failure. Archives of General Psychiatry, 30, 229–233.Google Scholar
Findling, R. L., Gracious, B. L., McNamara, N. K., Youngstrom, E. A., Demeter, C. A., & Calabrese, J. R. (2001). Rapid, continuous cycling and psychiatric co-morbidity in pediatric bipolar I disorder. Bipolar Disorders, 3, 202–210.Google Scholar
Fristad, M. A., Goldberg-Arnold, J. S., & Gavazzi, S. M. (2002). Multifamily psychoeducation groups (MFPG) for families of children with bipolar disorder. Bipolar Disorders, 4, 254–262.Google Scholar
Geller, B., Tillman, R., Craney, J., & Bolhofner, K. (2004). Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Archives of General Psychiatry, 61, 459–467.Google Scholar
Geller, B., Zimerman, B., Williams, M., Bolhofner, K., Craney, J. L., DelBello, M. P., et al. (2001). Reliability of the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-K-SADS) mania and rapid cycling sections. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 450–455.Google Scholar
Gershon, E. S., Hamovit, J. H., Guroff, J. J., & Nurnberger, J. I. (1987). Birth cohort changes in manic and depressive disorders in relatives of bipolar and schizoaffective patients. Archives of General Psychiatry, 44, 314–319.Google Scholar
Goodwin, F., & Jamison, K. (1990). Manic depressive illness. New York: Oxford University Press.
Hazell, P. L., Carr, V., Lewin, T. J., & Sly, K. (2003). Manic symptoms in young males with ADHD predict functioning but not diagnosis after 6 years. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 552–560.Google Scholar
Herjanic, B., & Reich, W. (1982). Development of a structural interview for children: Agreement between parent and child on individual symptoms. Journal of Abnormal Child Psychology, 10, 307–324.Google Scholar
Himmelhoch, J. M., & Garfinkel, M. E. (1986). Sources of lithium resistance in mixed mania. Psychopharmacology Bulletin, 22, 613–620.Google Scholar
Hlastala, S. A., Frank, E., Kowalski, J., Sherrill, J. T., Tu, X. M., Anderson, B., et al. (2000). Stressful life events, bipolar disorder, and the “kindling model.” Journal of Abnormal Psychology, 109, 777–786.Google Scholar
Jairam, R., Srinath, S., Girimaji, S. C., & Seshadri, S. P. (2004). A prospective 4–5 year follow-up of juvenile onset bipolar disorder. Bipolar Disorders, 6, 386–394.Google Scholar
Jarbin, H., Ott, Y., & Von Knorring, A. L. (2003). Adult outcome of social function in adolescent-onset schizophrenia and affective psychosis. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 176–183.Google Scholar
Joyce, P. R. (1984). Illness behavior and rehospitalization in bipolar affective disorder. Psychological Medicine, 15, 521–525.Google Scholar
Judd, L. L., Akiskal, H. S., Schettler, P. J., Coryell, W., Endicott, J., Maser, J. D., et al. (2003). A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Archives of General Psychiatry, 60, 261–269.Google Scholar
Judd, L. L., Akiskal, H. S., Schettler, P. J., & Endicott, J. (2002). The long-term natural history of the weekly symptomatic status of bipolar I disorder. Archives of General Psychiatry, 59, 530–537.Google Scholar
Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 980–988.Google Scholar
Keitner, G. I., Solomon, D. A., Ryan, C. E., Miller, I. W., Mallinger, A., Kupfer, D. J., et al. (1996). Prodromal and residual symptoms in bipolar I disorder. Comprehensive Psychiatry, 37, 362–367.Google Scholar
Keller, M., Lavori, P., Coryell, W., Andreasen, J., Endicott, J., Clayton, P., et al. (1986). Differential outcome of episodes of illness in bipolar patients. Pure manic, mixed/cycling, and pure depressive. Journal of the American Medical Association, 255, 3138–3142.Google Scholar
Keller, M. B., Lavori, P. W., Coryell, W., Endicott, J., & Mueller, T. I. (1993). Bipolar I: A five-year prospective follow-up. Journal of Nervous and Mental Disease, 181, 238–245.Google Scholar
Keller, M., Lavori, P., Friedman, B., Nielsen, E., Endicott, J., McDonald-Scott, P., et al. (1987). The longitudinal interval follow-up evaluation: A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 44, 540–548.Google Scholar
Klerman, G. L., Lavori, P. W., Rice, J. P., Reich, T., Endicott, J., Andreasen, N. C., et al. (1985). Birth-cohort trends in rates of major depressive disorder among relatives of patients with affective disorder. Archives of General Psychiatry, 42, 689–693.Google Scholar
Klerman, G. L., Olfson, M., Leon, A., & Weissman, M. (1992). Measuring the need for mental health care. Health Affairs, 11, 23–33.Google Scholar
Kowatch, R. A., Fristad, M. A., Birmaher, B., Wagner, K. D., Findling, R. L., Hellander, M., et al. (2005). Treatment guidelines for children and adolescents with bipolar disorder: Child Psychiatric Workgroup on Bipolar Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 213–235.Google Scholar
Kowatch, R. A., Youngstrom, E. A., Danielyan, A., & Findling, R. L. (2005). Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescents. Bipolar Disorders, 7, 483–496.Google Scholar
Kraepelin, E. (1921). Manic depressive insanity and paranoia. London: E & S Livingstone.
Kupfer, D. J. (2005). The increasing medical burden of bipolar disorder. Journal of the American Medical Association, 293, 2528–2530.Google Scholar
Lam, D. H., Hayward, P., Watkins, E. R., Wright, K., & Sham, P. (2005). Relapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years. American Journal of Psychiatry, 162, 324–329.Google Scholar
Lam, D. H., Watkins, E. R., Hayward, P., Bright, J., Wright, K., Kerr, N., et al. (2003). A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: Outcome of the first year. Archives of General Psychiatry, 60, 145–152.Google Scholar
Landlot, A. B. (1957). Follow-up studies on circular manic-depressive reactions occurring in the young. Bulletin of the New York Academy of Medicine, 33, 65–73.Google Scholar
Lewinsohn, P., Klein, D., & Seeley, J. (1995). Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. Journal of the American Academy of Child & Adolescent Psychiatry, 34, 454–463.Google Scholar
Lewinsohn, P. M., Klein, D. N., & Seeley, J. R. (2000). Bipolar disorder during adolescence and young adulthood in a community sample. Bipolar Disorders, 2, 281–293.Google Scholar
Lish, J. D., Dime-Meenan, S., Whybrow, P. C., Price, R. A., & Hirshfield, R. M. (1994). The National Depressive and Manic-Depressive Association (DMDA) survey of bipolar members. Journal of Affective Disorders, 31, 281–294.Google Scholar
Lucas, C. P., Rigby, J. C., & Lucas, S. B. (1989). The occurrence of depression following mania. A method of predicting vulnerable cases. British Journal of Psychiatry, 154, 705–708.Google Scholar
McGlashan, T. H. (1988). Adolescent versus adult onset of mania. American Journal of Psychiatry, 145, 221–223.Google Scholar
Miklowitz, D. J., George, E. L., Axelson, D. A., Kim, E. Y., Birmaher, B., Schneck, C., et al. (2004). Family-focused treatment for adolescents with bipolar disorder. Journal of Affective Disorders, 82, S113–S128.Google Scholar
Miklowitz, D. J., Goldstein, M. J., Nuechterlein, K. H., Snyder, K. S., & Mintz, J. (1988). Family factors and the course of bipolar affective disorder. Archives of General Psychiatry, 45, 225–231.Google Scholar
Mufson, L., Weissman, M. M., Moreau, D., & Garfinkel, R. (1999). Efficacy of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 56, 573–579.Google Scholar
O'Connell, R. A., Mayo, J., Flatow, L., Cuthbertson, B., & O'Brien, B. (1991). Outcome of bipolar disorder on long-term treatment with lithium. British Journal of Psychiatry, 159, 123–129.Google Scholar
Otto, U. (1972). Suicidal acts by children and adolescents: A follow-up study. Acta Psychiatrica Scandinavica, 233(Suppl.), 1–123.Google Scholar
Pavuluri, M. N., Birmaher, B., & Naylor, M. (2005). Pediatric Bipolar Disorder: Ten year review. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 846–871.Google Scholar
Perlis, R. H., Miyahara, S., Marangell, L. B., Wisniewski, S. R., Ostacher, M., DelBello, M. P., et al. (2004). Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (SEP-BD). Biological Psychiatry, 55, 875–881.Google Scholar
Post, R. M. (1992). Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. American Journal of Psychiatry, 149, 999–1010Google Scholar
Post, R. M., Denicoff, K. D., Leverich, G. S., Altshuler, L. L., Frye, M. A., Suppes, T. M., et al. (2003). Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH life chart method. Journal of Clinical Psychiatry, 64, 680–690.Google Scholar
Post, R. M., Rubinow, D. R., Uhde, T. W., Roy-Byrne, P. P., Linnoila, M., Rosoff, A., et al. (1989). Dysphoric mania: Clinical and biological correlates. Archives of General Psychiatry, 46, 353–358.Google Scholar
Quackenbush, D., Kutcher, S., Robertson, H. A., Boulos, C., & Chaban, P. (1996). Premorbid and postmorbid school functioning in bipolar adolescents: Description and suggested academic interventions. Canadian Journal of Psychiatry—Revue Canadienne de Psychiatrie, 41, 16–22.Google Scholar
Rajeev, J., Srinath, S., Reddy, Y., Shashikiran, M., Girimaji, S. C., Seshadri, S. P., et al. (2003). The index manic episode in juvenile-onset bipolar disorder: The pattern of recovery. Canadian Journal of Psychiatry, 48, 52–55.Google Scholar
Rosen, L. N., Rosenthel, N. E., Dunner, D., & Fieve, R. R. (1983). Social outcome compared in psychotic and non-psychotic bipolar I patients. Journal of Nervous and Mental Disorders, 171, 272–275.Google Scholar
Rosen, L. N., Rosenthel, N. E., VanDusen, P. H., Dunner, D. L., & Fieve, R. R. (1983). Age at onset and number of psychotic symptoms in bipolar I and schizoaffective disorder. American Journal of Psychiatry, 140, 1523–1524.Google Scholar
Ryan, N., Williamson, D. E., Iyengar, S., Orvaschel, H., Reich, T., Dahl, R. E., et al. (1992). A secular increase in child and adolescent onset affective disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 31, 600–605.Google Scholar
Schaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., et al. (1983). A children's global assessment scale (CGAS). Archives of General Psychiatry, 40, 1228–1231.Google Scholar
Schneck, C. D., Miklowitz, D. J., Calabrese, J. R., Allen, M. H., Thomas, M. R., Wisniewski, S. R., et al. (2004). Phenomenology of rapid-cycling bipolar disorder: data from the first 500 participants in the systematic treatment enhancement program. American Journal of Psychiatry, 161, 1902–1908.Google Scholar
Shaw, J. A., Egeland, J. A., Endicott, J., Allen, C. R., & Hostetter, A. M. (2005). A 10-year prospective study of prodromal patterns for bipolar disorder among Amish youth. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 1104–1111.Google Scholar
Srinath, S., Janarolha, N., Reddy, Y. C., Girimani, S. R., Seshadri, S. R., & Subbakrishna, D. K. (1998). A prospective study of bipolar disorder in children and adolescents from India. Acta Psychiatrica Scandinavica, 98, 437–442.Google Scholar
Strober, M., Freeman, R., Bower, S., Lampert, C., & DeAntonio, M. (1995). Recovery and relapse in adolescents with bipolar affective illness: A five-year naturalistic, prospective follow-up. Journal of the American Academy of Child & Adolescent Psychiatry, 34, 724–731.Google Scholar
Tohen, M., Waternaux, C., Tsuang, M., & Hunt, A. (1990). Four-year follow-up of twenty-four first-episode manic patients. Journal of Affective Disorders, 19, 79–86.Google Scholar
Tohen, M., Zarate, C. A., Jr., Hennen, J., Khalsa, H., Strakowski, S. M., Gebre-Medhin, P., et al. (2003). The McLean-Harvard first-episode mania study: prediction of recovery and first recurrence. American Journal of Psychiatry, 160, 2099–2107.Google Scholar
Tsuang, M., Woolson, R., & Fleming, J. (1979). Long-term outcome of major psychoses. Archives of General Psychiatry, 36, 1295–1301.Google Scholar
Turvey, C. L., Coryell, W. H., Arndt, S., Solomon, D. A., Leon, A. C., Endicott, J., et al. (1999). Polarity sequence, depression, and chronicity in bipolar I disorder. Journal of Nervous and Mental Disease, 187, 181–187.Google Scholar
Turvey, C., Coryell, W., Solomon, D., Leon, A. C., Endicott, J., Keller, M. B., et al. (1999). Long-term prognosis of bipolar I disorder. Acta Psychiatrica Scandinavica, 99, 110–119.Google Scholar
Welner, A., Welner, Z., & Fishman, R. (1979). Psychiatric adolescent inpatients: Eight- to ten-year follow-up. Archives of General Psychiatry, 36, 698–700.Google Scholar
Werry, J. S., & McClellan, J. M. (1992). Predicting outcome in child and adolescent (early onset) schizophrenia and bipolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 31, 147–150.Google Scholar
Winokur, G., Coryell, W., Akiskal, H., & Endicott, J. (1994). Manic-depressive (bipolar) disorder: The course in light of a prospective ten-year follow-up of 131 patients. Acta Psychiatrica Scandinavica, 89, 102–110.Google Scholar
Winokur, G., Coryell, W., Keller, M., Endicott, J., & Akiskal, H. (1993). A prospective follow-up of patients with bipolar and primary unipolar affective disorder. Archives of General Psychiatry, 50, 457–465.Google Scholar