About 44% of individuals who had bipolar disorder as children continue to have manic episodes as young adults.
Recent data has demonstrated an enormous increase in the diagnosis of pediatric bipolar disorder, a severe mood disorder involving episodes of mania and depression. However, skepticism continues to exist regarding the existence of the condition in children. Given increased media attention to the issue, there is a need to further increase the validity of childhood diagnoses.
Barbara Geller, and colleagues at Washington University in St. Louis studied 115 children ( average age 11.1 ) diagnosed with bipolar disorder beginning in 1995 to 1998. At the beginning of the study and again during nine follow-up visits conducted over eight years, the children and their parents were interviewed separately about their symptoms, diagnoses, daily cycles of mania and depression and interactions with others.
A total of 108 ( 93.9% ) of the children completed the study ( average age at follow-up, 18.1 years ). During the eight-year follow-up, they spent 60.2% of weeks with any mood episodes and 39.6% of weeks with episodes of mania. Although 87.8% recovered from mania, 73.3% relapsed. The researchers also examined the characteristics of children's second and third episodes of mania and found that like the first episodes, they were characterized by psychosis, daily cycling between mania and depression and a long duration ( 55.2 weeks for the second and 40 weeks for the third episode ).
At the end of the follow-up period, 54 patients were age 18 or older. Of those, 44.4% continued to have manic episodes and 35.2% had substance use disorders, a rate similar to those diagnosed with bipolar disorder as adults.
In grown-up subjects with child bipolar disorder I, the 44.4% frequency of manic episodes was 13 to 44 times higher than population prevalences, strongly supporting continuity between child and adult bipolar disorder I.
Subjects with child bipolar disorder I who were grown up at the eight-year follow-up constituted approximately half the sample. However, even if all subjects younger than 18 years at the eight-year follow-up never had episodes of bipolar disorder I as adults, the overall significance of the findings would be similar, because the rate would still be six to 22 times higher than population prevalences.
In conclusion, mounting data support the existence of child bipolar disorder I, and 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, 2008