title: Childhood-compared to adolescent-onset bipolar disorder has more statistically significant clinical correlates.
abstract: BACKGROUND
  The strengths and limitations of considering childhood-and adolescent-onset bipolar disorder (BD) separately versus together remain to be established. We assessed this issue.
  
  
  METHODS
  BD patients referred to the Stanford Bipolar Disorder Clinic during 2000-2011 were assessed with the Systematic Treatment Enhancement Program for BD Affective Disorders Evaluation. Patients with childhood- and adolescent-onset were compared to those with adult-onset for 7 unfavorable bipolar illness characteristics with replicated associations with early-onset patients.
  
  
  RESULTS
  Among 502 BD outpatients, those with childhood- (<13 years, N=110) and adolescent- (13-18 years, N=218) onset had significantly higher rates for 4/7 unfavorable illness characteristics, including lifetime comorbid anxiety disorder, at least ten lifetime mood episodes, lifetime alcohol use disorder, and prior suicide attempt, than those with adult-onset (>18 years, N=174). Childhood- but not adolescent-onset BD patients also had significantly higher rates of first-degree relative with mood disorder, lifetime substance use disorder, and rapid cycling in the prior year. Patients with pooled childhood/adolescent - compared to adult-onset had significantly higher rates for 5/7 of these unfavorable illness characteristics, while patients with childhood- compared to adolescent-onset had significantly higher rates for 4/7 of these unfavorable illness characteristics.
  
  
  CONCLUSIONS
  Caucasian, insured, suburban, low substance abuse, American specialty clinic-referred sample limits generalizability. Onset age is based on retrospective recall.
  
  
  CONCLUSIONS
  Childhood- compared to adolescent-onset BD was more robustly related to unfavorable bipolar illness characteristics, so pooling these groups attenuated such relationships. Further study is warranted to determine the extent to which adolescent-onset BD represents an intermediate phenotype between childhood- and adult-onset BD.
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA.
authors: Jessica N
authors: JN
authors: Holtzman
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA.
authors: Shefali
authors: S
authors: Miller
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA.
authors: Farnaz
authors: F
authors: Hooshmand
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA.
authors: Po W
authors: PW
authors: Wang
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA.
authors: Kiki D
authors: KD
authors: Chang
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA.
authors: Shelley J
authors: SJ
authors: Hill
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA.
authors: Natalie L
authors: NL
authors: Rasgon
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA. Electronic address: tketter@stanford.edu.
authors: Terence A
authors: TA
authors: Ketter
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D019973:Alcohol-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology*; D002140:California / Q000453:epidemiology; D002648:Child; D015897:Comorbidity; D005192:Family Health; D005260:Female; D006801:Humans; D008297:Male; D019964:Mood Disorders / Q000453:epidemiology* / Q000523:psychology; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Bipolar disorder; Childhood onset; Early onset; Onset age