title: Risk for substance use disorders in youths with child- and adolescent-onset bipolar disorder.
abstract: OBJECTIVE
  Previous work in adults has suggested that early-onset bipolar disorder (BPD) is associated with an elevated risk for substance use disorders (SUD). To this end, the authors assessed the risk for SUD in child- versus adolescent-onset BPD with attention to comorbid psychopathology.
  
  
  METHODS
  All youths (aged 13-18 years) with available structured psychiatric interviews were studied systematically. From clinic subjects (N = 333), 86 subjects with DSM-III-R BPD were identified. To evaluate the risk for SUD and BPD while attending to developmental issues, the authors stratified the BPD sample into those with child-onset BPD (< or = 12 years of age, n = 50) and those with adolescent-onset BPD (13-18 years of age, n = 36).
  
  
  RESULTS
  In mid-adolescence, youths with adolescent-onset BPD were at significantly increased risk for SUD relative to those with child-onset BPD (39% versus 8%; p = .001). Compared with those with child-onset BPD, those with adolescent-onset BPD had 8.8 times the risk for SUD (95% confidence interval = 2.2-34.7; chi 7(2) = 9.7, p = .002). The presence of conduct disorder or other comorbid psychopathology within BPD did not account for the risk for SUD.
  
  
  CONCLUSIONS
  Adolescent-onset BPD is associated with a much higher risk for SUD than child-onset BPD, which was not accounted for by conduct disorder or other comorbid psychopathology. Youths with adolescent-onset BPD should be monitored and educated about SUD risk. The identification and treatment of manic symptomatology may offer therapeutic opportunities to decrease the risk for SUD in these high-risk youths.
authors.affiliation: Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: T E
authors.initials: TE
authors.lastname: Wilens
authors.forename: J
authors.initials: J
authors.lastname: Biederman
authors.forename: R B
authors.initials: RB
authors.lastname: Millstein
authors.forename: J
authors.initials: J
authors.lastname: Wozniak
authors.forename: A L
authors.initials: AL
authors.lastname: Hahesy
authors.forename: T J
authors.initials: TJ
authors.lastname: Spencer
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001714:Bipolar Disorder / Q000453:epidemiology*; D002648:Child; D015897:Comorbidity; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D019966:Substance-Related Disorders / Q000453:epidemiology*