title: Diagnostic transition towards schizophrenia in adolescents with severe bipolar disorder type I: an 8-year follow-up study.
abstract: BACKGROUND
  The diagnosis of bipolar disorder-I (BD-I) is currently well-established. However, more studies exploring diagnostic stability and psychosocial adaptation during follow-up in adulthood are needed.
  
  
  OBJECTIVE
  We assessed factors at follow-up (FU): (1) the diagnostic stability of manic/mixed episodes from adolescence to adulthood, (2) psychosocial adaptation, and (3) factors associated with psychosocial adaptation.
  
  
  METHODS
  A sample of 80 adolescents hospitalized in a university hospital between 1993 and 2004 for a manic or mixed episode were contacted for an FU assessment on average 8 years after the index episode. Assessments included socio-demographic data, mortality, lifetime psychiatric diagnosis, the Social Adaptation Scale, negative life events and insight.
  
  
  RESULTS
  Of the 64 patients with available information, one patient died from a heart attack. Of the 55 patients available for an FU assessment, 35 (63.6%) still presented a diagnosis of BD-I at FU, whereas 20 (36.4%) had changed diagnosis towards a schizophrenia spectrum disorder. Psychosocial adaptation was moderate to poor for most patients, and 91% of the patients had at least one relapse. A low socio-economic status, intellectual disability, negative life events, a history of sexual abuse, and treatment with classical antipsychotics at FU were significantly associated with poorer psychosocial adaptation. In contrast, better insight, a family history of depression and a diagnosis of BD-I at FU were associated with better psychosocial adaptation.
  
  
  CONCLUSIONS
  BD-I in adolescent inpatients can lead to important morbidity and mortality during outcome. Diagnostic stability is high, but a high proportion of patients also show a transition towards a schizophrenia spectrum disorder.
authors.affiliation: Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; INSERM U-669, PSIGIAM, Paris F-75679, France. Electronic address: angele.consoli@psl.aphp.fr.
authors.forename: Angèle
authors.initials: A
authors.lastname: Consoli
authors.affiliation: Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; CRICM-CNRS, Institut du Cerveau et de la Moelle, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Brunelle
authors.affiliation: Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bodeau
authors.affiliation: Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Laboratoire de Psychopathologie clinique de l'adolescent, Université Paris V, Paris, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Louët
authors.affiliation: Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Deniau
authors.affiliation: Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Perisse
authors.affiliation: Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; CRICM-CNRS, Institut du Cerveau et de la Moelle, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Claudine
authors.initials: C
authors.lastname: Laurent
authors.affiliation: Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001714:Bipolar Disorder / Q000209:etiology*; D002648:Child; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012559:Schizophrenia / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D012565:Schizophrenic Psychology; D018709:Statistics, Nonparametric; D013405:Suicide / Q000523:psychology; D013997:Time Factors; D055815:Young Adult
keywords: Adolescent; Bipolar disorder; Follow-up; Schizo-affective disorder; Schizophrenia