Pediatric bipolar disorder versus severe mood dysregulation: risk for manic episodes on follow-up.
OBJECTIVE
An important question in pediatric bipolar research is whether marked nonepisodic irritability is a manifestation of bipolar disorder in youth. This study tests the hypothesis that youth with severe mood dysregulation (SMD), a category created for the purpose of studying children presenting with severe nonepisodic irritability, will be significantly less likely to develop (hypo-)manic or mixed episodes over time than will youth with bipolar disorder (BD).


METHODS
Patients with SMD (N = 84) and narrowly defined BD (N = 93) at baseline were followed up in 6-monthly intervals using the relevant K-SADS modules to ascertain (hypo-)manic or mixed episodes.


RESULTS
Only one of 84 SMD subjects (1/84 [1.2%]; 95% confidence interval CI = 0.0003 to 0.064) experienced a (hypo-)manic or mixed episode during the study (median follow-up = 28.7 months). The frequency of such episodes was more than 50 times higher in those with narrowly defined BD (58/93 [62.4%]; 95% CI 0.52 to 0.72).


CONCLUSIONS
These data suggest that, over an approximately 2-year follow-up period, youth with SMD are unlikely to develop (hypo-)manic or mixed episodes.
Stringaris
Argyris
A
National Institute of Mental Health, Bethesda, MD, USA. argyris.stringaris@kcl.ac.uk
Baroni
Argelinda
A
Haimm
Caroline
C
Brotman
Melissa
M
Lowe
Catherine H
CH
Myers
Frances
F
Rustgi
Eileen
E
Wheeler
Wanda
W
Kayser
Reilly
R
Towbin
Kenneth
K
Leibenluft
Ellen
E
D000293:Adolescent; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007508:Irritable Mood; D010372:Pediatrics
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