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Does Childhood Bipolar I Disorder Persist?

It did for a large proportion of participants in this longitudinal study, and morbidity was high.

Many adults with bipolar disorders report that they had symptoms in childhood, but no prospective studies have determined how often childhood bipolar disorder continues into adulthood. These investigators followed 115 children (mean age at baseline, 11 years) with a first episode of pure or mixed mania.

The researchers used a stringent definition of childhood bipolar I disorder: Diagnosis of mania required elation, grandiosity, or both. Most subjects (94%) completed all assessments during the 8-year follow-up (every 6 months for 2 years, yearly for 4 years, and a final assessment 2 years later). About half of the participants were 18 or older at the final assessment.

Of the group, 88% recovered from the index manic episode (mean time to recovery, 55.6 weeks); 73% of these subjects relapsed to mania, on average 99 weeks later. Although significantly shorter than the index episode, later manic episodes were lengthy (mean duration: second episode, 55 weeks; third episode, 40 weeks) and were marked by psychosis and ultradian cycling. Participants younger than 18 years were ill 66% of the time; the percentage dropped to 49% among patients 18 or older. Low maternal warmth and earlier age at onset predicted longer time ill with manic episodes. At age 18 or older, 44% of participants had manic episodes, and 35% developed a substance-use disorder.

Comment: In this study, bipolar I disorder persisted into adulthood among 44% of participants, but this percentage probably understates the phenomenon, for several reasons: The authors followed only half of the subjects past age 18 and none into their mid-20s, they did not analyze subsyndromal and bipolar II disorders, and they did not use irritability as a diagnostic criterion for mania. Researchers have not yet demonstrated that treating bipolar disorder in childhood reduces later morbidity. Still, early recognition and appropriate treatment seem indicated, as does research into the border between these disorders and other conditions involving hyperactivity and irritability.

— Steven Dubovsky, MD

Published in Journal Watch Psychiatry October 27, 2008

Citation(s):

Geller B et al. Childhood bipolar I disorder: Prospective continuity with adult bipolar I disorder; characteristics of second and third episodes; predictors of 8-year outcome. Arch Gen Psychiatry 2008 Oct; 65:1125.

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