A systematic review of the frequency and severity of manic symptoms reported in studies that compare phenomenology across children, adolescents and adults with bipolar disorders.
BACKGROUND
In the last two decades, there has been a significant increase in the diagnosis of Bipolar Disorder (BD) in children. The notion of prepubertal onsets of BD is not without controversy, with researchers debating whether paediatric cases have a distinct symptom profile or follow a different illness trajectory from other forms of BD. The latter issue is difficult to address without long-term prospective follow-up studies. However, in the interim, it is useful to consider the phenomenology observed in groups of cases with different ages of onset and particularly to compare manic symptoms in children diagnosed with BD compared to cases presenting with BD in adolescence and adulthood. This review systematically explores the phenomenology of manic or hypomanic episodes in groups defined by age at onset of BD (children, adolescents and adults; or combined age groups e.g. children and adolescents versus adults).


METHODS
Literature reviews of PubMed and Scopus were conducted to identify publications which directly compared the frequency or severity of manic symptoms in individuals with BD presenting with a first episode of mania in childhood, adolescence or adulthood.


RESULTS
Of 304 studies identified, 55 texts warranted detailed review, but only nine studies met eligibility criteria for inclusion. Comparison of manic symptoms across age groups suggested that irritability is a key feature of BD with an onset in childhood, activity is the most prominent in adolescent-onset BD and pressure of speech is more characteristic of adult-onset BD. However, none of the eligible studies made a direct comparison of phenomenology in children versus adults. Assessment procedures varied in quality and undermined the reliability of cross-study comparisons. Other limitations were: the scarcity of comparative studies, the geographic bias (most studies originated in the USA), the failure to fully consider the impact of psychiatric comorbidities on recorded symptoms and methodological heterogeneity.


CONCLUSIONS
Despite frequent discussion of similarities and differences in phenomenology of mania presenting in different age groups, systematic research is lacking and studies are still required to reliably establish whether the frequency and severity of manic symptoms varies. Such information has implications for clinical practice and the classification of mental disorders.
Early Intervention in Psychiatry Hub, NTW NHS Trust, Newcastle upon Tyne, UK.
Faye
F
Ryles
Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, TX, USA.
Thomas D
TD
Meyer
Department of Psychiatry, La Princesa Hospital, Madrid, Spain.
Jaime
J
Adan-Manes
Early Intervention in Psychiatry Hub, NTW NHS Trust, Newcastle upon Tyne, UK.
Iain
I
MacMillan
Academic Psychiatry, Wolfson Unit, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK. jan.scott@newcastle.ac.uk.
Jan
http://orcid.org/0000-0002-7203-8601
J
Scott
Activity; Adolescents; Adults; Children; Cognition; Irritability; Mania; Manic symptoms; Phenomenology; Systematic review