title: Early stages of pediatric bipolar disorder: retrospective analysis of a Czech inpatient sample.
abstract: BACKGROUND
  Approximately 30%-60% of adults diagnosed with bipolar disorder (BD) report onset between the ages 15 and 19 years; however, a correct diagnosis is often delayed by several years. Therefore, investigations of the early features of BD are important for adequately understanding the prodromal stages of the illness.
  
  
  METHODS
  A complete review of the medical records of 46 children and adolescents who were hospitalized for BD at two psychiatric teaching centers in Prague, Czech Republic was performed. Frequency of BD in all inpatients, age of symptom onset, phenomenology of mood episodes, lifetime psychiatric comorbidity, differences between very-early-onset (<13 years of age) and early-onset patients (13-18 years), and differences between the offspring of parents with and without BD were analyzed.
  
  
  RESULTS
  The sample represents 0.83% of the total number of inpatients (n=5,483) admitted during the study period at both centers. BD often started with depression (56%), followed by hypomania (24%) and mixed episodes (20%). The average age during the first mood episode was 14.9 years (14.6 years for depression and 15.6 years for hypomania). Seven children (15%) experienced their first mood episode before age 13 years (very early onset). Traumatic events, first-degree relatives with mood disorders, and attention deficit hyperactivity disorder were significantly more frequent in the very-early-onset group vs the early-onset group (13-18 years) (P≤0.05). The offspring of bipolar parents were significantly younger at the onset of the first mood episode (13.2 vs 15.4 years; P=0.02) and when experiencing the first mania compared to the offspring of non-BD parents (14.3 vs 15.9 years; P=0.03). Anxiety disorders, substance abuse, specific learning disabilities, and attention deficit hyperactivity disorder were the most frequent lifetime comorbid conditions.
  
  
  CONCLUSIONS
  Clinicians must be aware of the potential for childhood BD onset in patients who suffer from recurrent depression, who have first-degree relatives with BD, and who have experienced severe psychosocial stressors.
authors.affiliation: Department of Child Psychiatry, Second Faculty of Medicine, Motol University Hospital, Charles University in Prague, Prague, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Goetz
authors.affiliation: National Institute of Mental Health, Klecany and Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Novak
authors.affiliation: Department of Child Psychiatry, Second Faculty of Medicine, Motol University Hospital, Charles University in Prague, Prague, Czech Republic.
authors.forename: Marie
authors.initials: M
authors.lastname: Vesela
authors.affiliation: Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic.
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Hlavka
authors.affiliation: National Institute of Mental Health, Klecany and Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Brunovsky
authors.affiliation: Children's Department, Bohnice Psychiatric Hospital, Prague, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Povazan
authors.affiliation: Department of Psychiatry, First Faculty of Medicine, General Teaching Hospital, Charles University in Prague, Czech Republic.
authors.forename: Radek
authors.initials: R
authors.lastname: Ptacek
authors.affiliation: National Institute of Mental Health, Klecany and Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors.forename: Antonin
authors.initials: A
authors.lastname: Sebela
keywords: adolescents; children; inpatients