Peanut WA
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Posts: 208
(9/23/00 1:43 am)
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Facts & Statistics
* Not until 1995 was bipolar disorder considered to be a viable diagnostic entity in childhood. None of the major epidemiological studies, until 1995 included it as a diagnosis, therefore there is little research to guide our understanding of the condition. Recently, reports of the effects of early childhood psychiatric disorders on personality are being published in the psychiatric literature (American Journal of Psychiatry, Oct. 1999). Again, there is no mention of bipolar disorder.
* Adult BP vs. Childhood BP - How it differs:
Adults seem to experience abnormally intense moods for weeks or months at a time, but children appear to experience such rapid shifts of mood that they commonly cycle many times within the day. This cycling pattern is called ultra-ultra rapid or ultradian cycling and it is most often associated with low arousal states in the mornings (these children find it almost impossible to get up in the morning) followed by afternoons and evenings of increased energy.
* ADHD, ODD vs. Childhood Onset BP:
Several studies have reported that over 80 percent of children who have early-onset bipolar disorder will meet full criteria for ADHD. It is possible that the disorders are co-morbid--appearing together--or that ADHD-like symptoms are a part of the bipolar picture. Also, the ADHD symptoms may simply appear first on the continuum of a developing disorder.
Children with bipolar disorder exhibit much more irritability, labile mood, grandiose behavior, and sleep disturbances-- often accompanied by night terrors (nightmares filled with gore and life-threatening content)--than do children with ADHD.
Because stimulant medications may exacerbate a bipolar disorder and induce an episode or negatively influence the cycling pattern of a bipolar disorder, bipolar disorder should be ruled out first, before a stimulant is prescribed.
* As yet, no national or international epidemiological study of bipolar disorder (BP) during the pediatric years is available. However, data from Carlson and Kashani (1988) and Lewinsohn et al. (1995) suggest that prevalence during the adolescent years is at least that of the adult population.
* Co-Morbid Dx's/Conditions
When subjects are seen initially because of bipolar symptomatology, approximately 90% of prepubertal and 30% of adolescent bipolars have ADHD (Geller et al., 1995). Even with the relatively conservative DSM-IV criteria, conduct disorder occurs in approximately 22% of bipolar children and 18% of bipolar adolescents (Geller et al., 1995). Substance abuse begins to be an important comorbid condition during the teenage years and is an important differential (Horowitz, 1975; 1977). Similar to the multiple comorbid anxiety conditions seen with MDD, bipolar patients also manifest multiple comorbid anxiety conditions (approximately 33% of bipolar prepubertal patients and 12% of bipolar adolescent patients) (Geller et al., 1995).
* Prognosis
Adolescents with bipolar disorder may have a more prolonged early course and less responsiveness to treatment (McGlashan, 1988; Strober et al., 1995). This may be due to the fact that adolescents with bipolar disorder frequently present with either mixed features, psychotic symptoms, and/or comorbid behavior/substance abuse problems, all of which predict a more refractory response to lithium therapy. However, the few available studies suggest that the long-term prognosis of early-onset bipolar disorder is similar to that of adult onset; with approximately one half of patients showing significant functional impairment compared with their premorbid state (McClellan et al., 1993; McGlashan, 1988; Werry et al., 1991). Premorbid characteristics, including intellectual functioning, also strongly influence outcome (Werry et al., 1992). Further research is needed to examine how bipolar disorder affects evolving developmental processes, given the disruptive impact of the episodes on academic, social, and family functioning.
Adolescents with bipolar disorder are at increased risk for completed suicides (Brent et al., 1988, 1993, 1994; Welner et al., 1979). Strober et al. (1995) found that 20% of their adolescent patients made at least one medically significant suicide attempt. In the adult literature, a large review of studies examining depressive and manic depressive disorders found the mean rate of completed suicides to be 19% (Goodwin and Jamison, 1990). Patients who are male or who are in the depressed phase of their illness are at the highest risk.
Edited by: Peanut WA  at: 6/2/01 1:21:36 pm
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