Symptoms Persist as Bipolar Children Grow Up

Follow-up Study Confirms Continuity of Child and Adult Forms

October 27, 2008 • Science Update

Bipolar disorder (BD) identified in childhood often persisted into adulthood in the first large follow-up study of its kind. Forty-four percent of children diagnosed with BD continued to have manic episodes as adults, in the study by NIMH grantee Barbara Geller, M.D., and colleagues at Washington University in St. Louis. They report on their findings in the October issue of the Archives of General Psychiatry.

“Serious mental illnesses do not emerge de novo (anew) when individuals reach adulthood, but rather reflect early developmental processes,” explained NIMH’s Ellen Leibenluft, M.D., in an accompanying editorial entitled “Pediatric Bipolar Disorder Comes of Age.”

Background
The rates of youth diagnosed with BD have soared over the past decade, amid debate over whether the diagnosis is used excessively. To learn more about the course of the disorder and what affects it, Geller and colleagues separately interviewed 108 children diagnosed with BD at about age 11 and their parents, periodically over eight years, by which time half of the patients had become adults.

Results of This Study
Among these 54 young adult patients, 44 percent had at least one manic episode after age 18. This was 13 to 44 times the population average. Thirty-five percent had substance use disorders. These rates are comparable to those seen in studies of adults with the disorder, according to the researchers. During the eight years, 88 percent of all patients experienced periods of recovery from mania, but 73 percent of these relapsed. Children with BD were ill with mania or depression about 60 percent of the time.

Significance
The study adds to mounting evidence for the legitimacy of the diagnosis of BD in children, and reflects the “field’s continuing efforts to nurture developmental conceptualizations of psychiatric illnesses,” notes Leibenluft. The results are consistent with a 2006 study by Geller and colleagues, which found that child and adult forms of BD occurred within the same families. In taking stock of what has been learned about pediatric BP over the past couple of decades, Leibenluft points to a growing consensus that “unequivocal,” classic BD occurs in youth – albeit with continuing debate about whether children with persistent, severe irritability, but without distinct episodes of mania, should be assigned the BD diagnosis. There is also consensus that children with BD are severely impaired, with frequent relapses and other apparent psychopathology.

What’s Next?
Neuroimaging and genetics studies hold hope for development of biomarkers that will refine diagnosis, speed development of more specific treatments – and someday even “prevent the onset of BD in youth at risk,” says Leibenluft.

References:

Geller B, Tillman R, Bolhofner K, Zimerman B.  Child 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(10):1125-33.
PMID: 18838629

Leibenluft E.  Pediatric bipolar disorder comes of age.
Arch Gen Psychiatry. 2008 Oct;65(10):1122-4. No abstract available. PMID: 18838628

Geller B, Tillman R, Bolhofner K, Zimerman B, Strauss NA, Kaufmann P.  Controlled, blindly rated, direct-interview family study of a prepubertal and early-adolescent bipolar I disorder phenotype: morbid risk, age at onset, and comorbidity.
Arch Gen Psychiatry. 2006 Oct;63(10):1130-8. PMID: 17015815