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Transient manic symptoms (TMS) are associated with an increased risk for conversion to bipolar spectrum disorder (BPSD) in children with depressive spectrum disorders (DSD), study results show.
The findings also suggest that early multi-family psycho-educational psychotherapy may protect against conversion to BPSD in such children.
Writing in the journal Bipolar Disorders, Mary Fristad (Ohio State University, Columbus, USA) and colleagues explain: “No studies to date have longitudinally assessed the clinical importance of TMS in children with DSD to determine whether these transient subthreshold manifestations later progress to a recognized BPSD.”
To address this, the team studied 165 children, aged an average of 9.9 years, with mood disorders who participated in the Multi-Family Psychoeducational Psychotherapy (MF-PEP) treatment study. Of these, 37 had DSD plus TMS, 13 had DSD alone, and 115 had BPSD.
At baseline, 78 children were randomly assigned to immediately receive MF-PEP while 87 were assigned to a 1-year waiting list for the intervention (controls).
All of the children were assessed using the Children’s Interview for Psychiatric Syndromes-Child, the Mania Rating Scale, and the Children’s Depression Rating Scale-Revised on four occasions over the 18-month study period.
In total, 13 children converted to BPSD during the study period, with the DSD+TMS group having a significantly higher conversion rate (48.0%) than the DSD-alone group (12.5%).
Conversion rates were also significantly higher in the control group (60.0%) than in the intervention group (16.0%).
The researchers note that children who converted to BPSD had greater levels of functional impairment at baseline than those who did not, but there were no significant differences between converters and non-converters regarding clinical presentation, family environment, and family history of mental health disorders.
Also, the use of antidepressants, stimulants, mood stabilizers, antipsychotics, and other medications were not associated with conversion rates.
“TMS are a risk factor for eventual conversion to BPSD,” Fristad and team conclude.
“An additional intriguing finding, which clearly warrants additional investigation, is the suggestion that psycho-educational psychotherapy may be protective for depressed children in staving off potential conversion to BPSD,” they add.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
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People who develop bipolar disorder in childhood or adolescence are at greater risk for recurrence, chronicity of mood symptoms, and functional impairment than those who develop the mood disorder in adulthood, US study results confirm.
“Symptoms of bipolar disorder are increasingly recognized among children and adolescents,” explain Roy Perlis (Massachusetts General Hospital and Harvard Medical School, Boston, USA), and colleagues.
But they add: “Little is known about the course of bipolar disorder among adults who experience childhood onset of symptoms.”
To investigate, the researchers studied data on 3658 adult patients with bipolar I and II disorder who were participating the Systematic Treatment Enhancement Program for Bipolar Disorder ??” a multicenter clinical effectiveness study.
The participants were divided into three groups based on age at disease onset of less than 13 years (childhood or prepubertal onset), 13??”18 years (adolescent onset) and over 18 years (adult onset).
Baseline features and outcomes over 2 years of follow-up were compared among the three groups.
The team found that, compared with the 1187 patients with adult onset bipolar disorder, the 1068 patients with childhood or prepubertal onset of disease experienced, on average, an earlier recurrence of mood episodes after initial remission, fewer days of euthymia, and greater impairment in functioning and quality of life over follow-up.
Patients with adolescent onset bipolar disorder (n=1403) also had poorer outcomes than those with adult-onset disease, but better outcomes than those with childhood or prepubertal onset bipolar disorder.
Writing in the journal Bipolar Disorders, Perlic and team conclude: “These results… suggest that individuals with earlier onset [bipolar disorder] may be at risk for a more chronic as well as recurrent course in adulthood, with poorer functioning and quality of life.”
They add that the findings “underscore the need to develop better strategies for early identification and early interventions which achieve and maintain symptomatic remission and enhance functioning over the course of development.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
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