Retrospective age at onset of bipolar disorder and outcome during two-year follow-up: results from the STEP-BD study.
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.
Perlis
Roy H
RH
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
Dennehy
Ellen B
EB
Miklowitz
David J
DJ
Delbello
Melissa P
MP
Ostacher
Michael
M
Calabrese
Joseph R
JR
Ametrano
Rebecca M
RM
Wisniewski
Stephen R
SR
Bowden
Charles L
CL
Thase
Michael E
ME
Nierenberg
Andrew A
AA
Sachs
Gary
G
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