title: Retrospective age at onset of bipolar disorder and outcome during two-year follow-up: results from the STEP-BD study.
abstract: OBJECTIVE
  Symptoms of bipolar disorder are increasingly recognized among children and adolescents, but little is known about the course of bipolar disorder among adults who experience childhood onset of symptoms.
  
  
  METHODS
  We examined prospective outcomes during up to two years of naturalistic treatment among 3,658 adult bipolar I and II outpatients participating in a multicenter clinical effectiveness study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Age at illness onset was identified retrospectively by clinician assessment at study entry.
  
  
  RESULTS
  Compared to patients with onset of mood symptoms after age 18 years (n = 1,187), those with onset before age 13 years (n = 1,068) experienced earlier recurrence of mood episodes after initial remission, fewer days of euthymia, and greater impairment in functioning and quality of life over the two-year follow-up. Outcomes for those with onset between age 13 and 18 years (n = 1,403) were generally intermediate between these two groups.
  
  
  CONCLUSIONS
  Consistent with previous reports in smaller cohorts, adults with retrospectively obtained early-onset bipolar disorder appear to be at greater risk for recurrence, chronicity of mood symptoms, and functional impairment during prospective observation.
authors.affiliation: Bipolar Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, ACC 812 15 Parkman Street, Boston, MA 02114, USA. rperlis@partners.org
authors.forename: Roy H
authors.initials: RH
authors.lastname: Perlis
authors.forename: Ellen B
authors.initials: EB
authors.lastname: Dennehy
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
authors.forename: Melissa P
authors.initials: MP
authors.lastname: Delbello
authors.forename: Michael
authors.initials: M
authors.lastname: Ostacher
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Ametrano
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bowden
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: Gary
authors.initials: G
authors.lastname: Sachs
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D001714:Bipolar Disorder / Q000145:classification / Q000523:psychology* / Q000628:therapy*; D002648:Child; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome