A prospective 4-5 year follow-up of juvenile onset bipolar disorder.
OBJECTIVE
Data on outcome of juvenile onset bipolar disorder is limited. This study examined the course and outcome of bipolar disorder and assessed the rate and predictors of recovery and relapse in a sample of children and adolescents over a 4-5 year period.


METHODS
Twenty-five consecutively ascertained subjects (9-16 years) with a diagnosis of mania (mean duration at intake of 4.6 +/- 3.9 weeks), were comprehensively assessed at baseline and at 6-month intervals using the Diagnostic Interview for Children and Adolescents (revised) (DICA-R), the Missouri Assessment for Genetic Interview in Children (MAGIC), the Young's Mania Rating Scale (YMRS) and the Children's Global Assessment (CGAS). The study phenotype required DSM-IV criteria of mania with elation and/or grandiosity as a criterion to distinguish them from those with attention deficit hyperactivity disorder. Subjects received the standard treatment as prescribed by their primary treating team.


RESULTS
During the course of the study period, all 25 subjects (100%) recovered from the index episode. The mean time to recovery was 44 +/- 46 days. The mean duration of follow-up was 51.6 +/- 4.1 months. Sixteen subjects (64%) relapsed after a mean period of 18 +/- 16.4 months. A majority of the relapses (72.4%) were while the subjects were on treatment.


CONCLUSIONS
Acute juvenile onset mania has a high rate of recovery and low chronicity. The relapse rate was high and most of these occurred in the first 3 years despite aggressive prophylactic treatment. The effectiveness of currently used thymoleptics, in particular lithium, in the prophylaxis of juvenile bipolar disorder needs to be evaluated in controlled studies.
Jairam
Rajeev
R
Child and Adolescent Psychiatry Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India. rajeev.jairam@swsahs.nsw.gov.au
Srinath
Shoba
S
Girimaji
Satish C
SC
Seshadri
Shekhar P
SP
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D002220:Carbamazepine / Q000627:therapeutic use; D002746:Chlorpromazine / Q000627:therapeutic use; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use; D016651:Lithium Carbonate / Q000627:therapeutic use; D008297:Male; D010641:Phenotype; D011446:Prospective Studies; D020127:Recovery of Function; D018967:Risperidone / Q000627:therapeutic use; D055502:Secondary Prevention; D012720:Severity of Illness Index; D014635:Valproic Acid / Q000627:therapeutic use*
D000927:Anticonvulsants; D014150:Antipsychotic Agents; D016651:Lithium Carbonate; D002220:Carbamazepine; D014635:Valproic Acid; D006220:Haloperidol; D018967:Risperidone; D007099:Imipramine; D002746:Chlorpromazine