The clinical phenotypes of juvenile bipolar disorder: toward a validation of the episodic-chronic-distinction.
BACKGROUND
Recent research has addressed the issue of subtyping juvenile bipolar disorder (JBD). Accordingly, we set out to find out, in a naturalistic sample of bipolar children and adolescents with mania and mixed mania, whether the most useful subtyping should be based on clinical features (elated vs. irritable) or course (episodic vs. chronic).


METHODS
We studied 136 patients, 81 male patients (59.6%) and 55 female patients (40.4%), mean age 13.5 +/- 2.9 years, meeting the DSM-IV diagnosis of bipolar disorder, assessed by a structured clinical interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version [K-SADS-PL]).


RESULTS
Regarding course, 77 patients (56.6%) had an episodic course and 59 patients (43.4%) had a chronic course. Patients with chronic course were significantly younger, had an earlier onset of JBD, and presented a more frequent comorbidity with disruptive behavior disorders. According to the prevalent mood disturbance, 75 patients (55.1%) showed an elated and 61 patients (44.9%) showed an irritable mood. Elated mood was more frequent in patients with episodic course, whereas irritable mood was more frequent in the patients with chronic course.


CONCLUSIONS
These findings suggest that chronic versus episodic course may be a putative differential feature. Further validation of such a distinction would require prospective studies, temperament evaluation, gender and neurobiologic approaches, and differential psychopharmacologic assignment and response.
IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone (Pisa), Italy. gabriele.masi@inpe.unipi.it
Gabriele
G
Masi
Giulio
G
Perugi
Cristina
C
Toni
Stefania
S
Millepiedi
Maria
M
Mucci
Nicoletta
N
Bertini
Hagop S
HS
Akiskal
D000293:Adolescent; D000339:Affect; D001714:Bipolar Disorder / Q000145:classification* / Q000175:diagnosis / Q000523:psychology*; D002648:Child; D002908:Chronic Disease; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D010641:Phenotype; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires