title: Early-onset bipolar disorder and treatment delay are risk factors for poor outcome in adulthood.
abstract: OBJECTIVE
  We examined the influence of age at onset of illness and the delay in time to first treatment on morbidity in adulthood.
  
  
  METHODS
  529 adult outpatients with a mean age of 42 years, who entered our research network from 1996 through 2001 and who were diagnosed with bipolar disorder according to DSM-IV criteria, were rated prospectively on a daily basis with the National Institute of Mental Health-Life Chart Method during naturalistic treatment for up to 4 years.
  
  
  RESULTS
  Fifty percent of patients had illness onset in childhood (<13 years of age) or adolescence (13-18 years of age). In year 1 of follow-up, these patients, compared to those with adult onset, showed significantly (P<.05) greater severity of depression and mania, greater number of episodes, more days depressed, more days of ultradian cycling, and fewer days euthymic. After 4 years, the mean severity and duration of depression remained greater and the number of days euthymic fewer in those with childhood compared to adult onset (P<.05). The delays to first treatment correlated inversely with age at onset of illness. Independently, delay to first treatment was associated with more time depressed, greater severity of depression, greater number of episodes, more days of ultradian cycling, and fewer days euthymic (all P<.05).
  
  
  CONCLUSIONS
  These data converge with other evidence that onset of bipolar disorder in childhood is common and often associated with extraordinarily long delays to first pharmacologic treatment. Both childhood onset and treatment delay were associated with a persistently more adverse course of illness rated prospectively in adults. These data should help foster efforts to ensure earlier and more effective treatment of bipolar illness in children and adolescents. It is hoped that appropriate early intervention would result in a more benign illness and a better prognosis in adulthood.
authors.affiliation: Bipolar Collaborative Network, 5415 W Cedar Lane, Bethesda, MD 20814, USA. robert.post@speakeasy.net
authors.forename: Robert M
authors.initials: RM
authors.lastname: Post
authors.forename: Gabriele S
authors.initials: GS
authors.lastname: Leverich
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Kupka
authors.forename: Paul E
authors.initials: PE
authors.lastname: Keck
authors.forename: Susan L
authors.initials: SL
authors.lastname: McElroy
authors.forename: Lori L
authors.initials: LL
authors.lastname: Altshuler
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frye
authors.forename: David A
authors.initials: DA
authors.lastname: Luckenbaugh
authors.forename: Michael
authors.initials: M
authors.lastname: Rowe
authors.forename: Heinz
authors.initials: H
authors.lastname: Grunze
authors.forename: Trisha
authors.initials: T
authors.lastname: Suppes
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D055502:Secondary Prevention; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018692:Antimanic Agents