title: Longitudinal trajectories and associated baseline predictors in youths with bipolar spectrum disorders.
abstract: OBJECTIVE
  The authors sought to identify and evaluate longitudinal mood trajectories and associated baseline predictors in youths with bipolar disorder.
  
  
  METHODS
  A total of 367 outpatient youths (mean age, 12.6 years) with bipolar disorder with at least 4 years of follow-up were included. After intake, participants were interviewed on average 10 times (SD=3.2) over a mean of 93 months (SD=8.3). Youths and parents were interviewed for psychopathology, functioning, treatment, and familial psychopathology and functioning.
  
  
  RESULTS
  Latent class growth analysis showed four different longitudinal mood trajectories: "predominantly euthymic" (24.0%), "moderately euthymic" (34.6%), "ill with improving course" (19.1%), and "predominantly ill" (22.3%). Within each class, youths were euthymic on average 84.4%, 47.3%, 42.8%, and 11.5% of the follow-up time, respectively. Multivariate analyses showed that better course was associated with higher age at onset of mood symptoms, less lifetime family history of bipolar disorder and substance abuse, and less history at baseline of severe depression, manic symptoms, suicidality, subsyndromal mood episodes, and sexual abuse. Most of these factors were more noticeable in the "predominantly euthymic" class. The effects of age at onset were attenuated in youths with lower socioeconomic status, and the effects of depression severity were absent in those with the highest socioeconomic status.
  
  
  CONCLUSIONS
  A substantial proportion of youths with bipolar disorder, especially those with adolescent onset and the above-noted factors, appear to be euthymic over extended periods. Nonetheless, continued syndromal and subsyndromal mood symptoms in all four classes underscore the need to optimize treatment.
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Gill
authors.forename: David A
authors.initials: DA
authors.lastname: Axelson
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Goldstein
authors.forename: Tina R
authors.initials: TR
authors.lastname: Goldstein
authors.forename: Haifeng
authors.initials: H
authors.lastname: Yu
authors.forename: Fangzi
authors.initials: F
authors.lastname: Liao
authors.forename: Satish
authors.initials: S
authors.lastname: Iyengar
authors.forename: Rasim S
authors.initials: RS
authors.lastname: Diler
authors.forename: Michael
authors.initials: M
authors.lastname: Strober
authors.forename: Heather
authors.initials: H
authors.lastname: Hower
authors.forename: Shirley
authors.initials: S
authors.lastname: Yen
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hunt
authors.forename: John A
authors.initials: JA
authors.lastname: Merranko
authors.forename: Neal D
authors.initials: ND
authors.lastname: Ryan
authors.forename: Martin B
authors.initials: MB
authors.lastname: Keller
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000339:Affect; D017668:Age of Onset; D001526:Behavioral Symptoms / Q000453:epidemiology / Q000209:etiology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D002648:Child; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011599:Psychopathology; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D012923:Social Class; D014481:United States / Q000453:epidemiology; D000092864:Suicide Prevention
chemical_list: D011619:Psychotropic Drugs