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08-07-2013 | Mental health | Article

Autistic comorbidities take toll in pediatric bipolar disorder


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medwireNews: Autistic spectrum disorders (ASD) may be present in nearly a third of children with bipolar I disorder, further impairing their social functioning, say researchers.

Gagan Joshi (Massachusetts General Hospital, Boston, USA) and team report a "striking similarity in the clinical features of mania" among the study participants, regardless of whether or not they also had ASD. In addition, the risk for bipolar I disorder in first-degree relatives was elevated in both groups and unaffected by the presence of ASD.

This suggests genuine co-occurrence of bipolar I disorder and ASD, rather than symptoms of one disorder being misattributed to the other, say Joshi et al.

"Although our findings require confirmation, they draw attention to the importance of clinicians taking into consideration the possibility of comorbid bipolar disorder in ASD youth with mood dysregulation who meet diagnostic threshold for bipolar disorder and, upon recognition of this diagnosis, providing appropriate interventions specific to the disorder," they write in TheJournal of Clinical Psychiatry.

In all, 30.3% of the 155 patients (aged 6-17 years) with bipolar I disorder had ASD. These patients, as well as those without ASD, had a mania symptom profile dominated by irritability, distractibility, poor judgment, and an increase in activity. The only difference was that patients with ASD were significantly more likely to exhibit grandiosity.

"This observation raises questions about the unique quality of grandiosity in individuals with ASD as well as the utility of grandiosity as a cardinal symptom of mania," say Joshi et al, speculating that it could occur in some form in autistic children without bipolar disorder.

Comorbid ASD was associated with more severe psychopathology. Patients with comorbid ASD were significantly younger at bipolar disorder onset, at 4.7 years versus 6.3 years in those with bipolar disorder alone, and had significantly poorer Global Assessment of Functioning scores, at 39.5 versus 41.1.

Also, parents of children with comorbid ASD reported significantly worse scores for all sections of the Child Behavior Checklist than parents of children with bipolar disorder alone, "suggesting that ASD complicates the already compromised course of youth with bipolar I disorder."

Both disorders, whether alone or combined, "exerted a severe toll on educational and family functions," with affected children having worse scores on the Family Environment Scale, relative to 136 control children, and doing poorly on various educational measures.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Eleanor McDermid, Senior medwireNews Reporter

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