title: Clinical course of children and adolescents with bipolar spectrum disorders.
abstract: BACKGROUND
  Despite the high morbidity associated with bipolar disorder (BP), few studies have prospectively studied the course of this illness in youth.
  
  
  OBJECTIVE
  To assess the longitudinal course of BP spectrum disorders (BP-I, BP-II, and not otherwise specified [BP-NOS]) in children and adolescents.
  
  
  METHODS
  Subjects were interviewed, on average, every 9 months for an average of 2 years using the Longitudinal Interval Follow-up Evaluation.
  
  
  METHODS
  Outpatient and inpatient units at 3 university centers.
  
  
  METHODS
  Two hundred sixty-three children and adolescents (mean age, 13 years) with BP-I (n = 152), BP-II (n = 19), and BP-NOS (n = 92).
  
  
  METHODS
  Rates of recovery and recurrence, weeks with syndromal or subsyndromal mood symptoms, changes in symptoms and polarity, and predictors of outcome.
  
  
  RESULTS
  Approximately 70% of subjects with BP recovered from their index episode, and 50% had at least 1 syndromal recurrence, particularly depressive episodes. Analyses of weekly mood symptoms showed that 60% of the follow-up time, subjects had syndromal or subsyndromal symptoms with numerous changes in symptoms and shifts of polarity, and 3% of the time, psychosis. Twenty percent of BP-II subjects converted to BP-I, and 25% of BP-NOS subjects converted to BP-I or BP-II. Early-onset BP, BP-NOS, long duration of mood symptoms, low socioeconomic status, and psychosis were associated with poorer outcomes and rapid mood changes. Secondary analyses comparing BP-I youths with BP-I adults showed that youths significantly more time symptomatic and had more mixed/cycling episodes, mood symptom changes, and polarity switches.
  
  
  CONCLUSIONS
  Youths with BP spectrum disorders showed a continuum of BP symptom severity from subsyndromal to full syndromal with frequent mood fluctuations. Results of this study provide preliminary validation for BP-NOS.
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15213, USA. birmaherb@upmc.edu
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: David
authors.initials: D
authors.lastname: Axelson
authors.forename: Michael
authors.initials: M
authors.lastname: Strober
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Gill
authors.forename: Sylvia
authors.initials: S
authors.lastname: Valeri
authors.forename: Laurel
authors.initials: L
authors.lastname: Chiappetta
authors.forename: Neal
authors.initials: N
authors.lastname: Ryan
authors.forename: Henrietta
authors.initials: H
authors.lastname: Leonard
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hunt
authors.forename: Satish
authors.initials: S
authors.lastname: Iyengar
authors.forename: Martin
authors.initials: M
authors.lastname: Keller
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001714:Bipolar Disorder / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012008:Recurrence; D012720:Severity of Illness Index; D012923:Social Class