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Child Bipolar Disorder Is Similar to Severe Adult Bipolar Disorder

Manic children appear to remain ill longer and relapse sooner than manic adults.

Kraepelin distinguished between manic-depressive insanity and dementia praecox on the grounds that patients with the first disorder had better outcomes and that studies of adult bipolar illness showed high rates of recovery from an index episode of mania. This carefully done, 4-year, prospective study of 86 pediatric bipolar patients (mean age, 11 years), 81% of whom were experiencing first manic episodes, suggests worse outcomes in child patients.

Patients and their parents were interviewed seven times over 4 years. To minimize confusion with attention deficit hyperactivity disorder, which can have similar symptoms, the presence of elation or grandiosity was required to diagnose pediatric mania or hypomania.

Eighty-seven percent of patients eventually recovered (average time to recovery, 60 weeks), but 70% subsequently relapsed. During the 4 years, participants had a bipolar diagnosis 67% of the time; measured prospectively after baseline assessment, the index episode of mania lasted a mean of 79 weeks. Psychosis predicted more weeks with mania, and low maternal warmth predicted earlier relapse after recovery.

Comment: Compared with manic adults, manic children appear to remain ill longer and relapse sooner. The bipolar children in this study appeared to spend more time in manic or hypomanic states, compared with the predominantly depressive states of bipolar adults; however, the children were assessed by experienced research nurses and by dual informants, whereas not all adult studies have employed that methodology. Pediatric patients with elation or grandiosity seem clearly distinguishable from those with ADHD, but the same may not be true of bipolar patients with predominant irritability, which could represent a different subtype.

— Steven Dubovsky, MD

Published in Journal Watch Psychiatry July 7, 2004

Citation(s):

Geller B et al. Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Arch Gen Psychiatry 2004 May; 61:459-67.

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