Young adults who had bipolar disorder as children are likely to suffer from manic episodes, according to an article released on October 6, 2008 in Archives of General Psychiatry, one of the JAMA/Archives journals.

Bipolar disorder is a severe mood disorder that involves episodes of mania and depression. There is significant debate about how pediatric bipolar disorder, which affects children, should be diagnosed. According to the authors, recent increased media attention to this disorder, it is important to explore diagnosis of the disease and any potential ramifications later in life.

In order to explore these issues, Barbara Geller, M.D., and colleagues at Washington University in St. Louis examined 115 children diagnosed with bipolar disorder (according to the DSM-IV scale BP-1) between 1995 and 1998. Visits were performed at the start of the study and for 9 follow up visits over eight years, separately interviewing children and their parents about the child’s symptoms, diagnoses, daily cycles of mania and depression, and interactions with others. The study was completed by 108 of the children. The average age at baseline was 11.1 and the average age at final follow-up was 18.1 years.

In the 8 years of follow-up, as a whole, the children spent 60.2% of their weeks with some number of mood episodes, and 39.6% of the weeks with some episodes of mania. In total, 87.8% of the patients recovered from mania, but 73.3% relapsed. In examination of second and third episodes of mania, the researchers found that they included psychosis, cycling between mania and depression, and a long duration. The average length of a second manic episode was 55.2 weeks and the average length of a third episode was 40 weeks.

Of the 54 patients who were 18 years or older at the end of follow-up, 44.4% continued to have manic episodes, a proportion much higher than in the general population. Of this adult group, 35.2% of them had substance use disorders — this rate is similar to that in adults diagnosed with bipolar disorder. According to the authors, this indicates that there may be significant continuity between childhood and adult bipolar disorder.

“In grown-up subjects with child bipolar disorder I, the 44.4 percent frequency of manic episodes was 13 to 44 times higher than population prevalences, strongly supporting continuity between child and adult bipolar disorder I,” write the authors. “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.”

The authors finally emphasize the need for further efforts exploring and addressing the issue of pediatric bipolar disorde: “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.”

Child Bipolar I Disorder: Prospective Continuity With Adult Bipolar I Disorder; Characteristics of Second and Third Episodes; Predictors of 8-Year Outcome
Barbara Geller; Rebecca Tillman; Kristine Bolhofner; Betsy Zimerman
Arch Gen Psychiatry. 2008;65(10):1125-1133.
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Written by Anna Sophia McKenney