Child-onset bipolar disorder carries poor outcome in adulthood
MedWire News: Bipolar disorder patients whose first symptoms appear in childhood or adolescent often have poorer illness outcomes than those whose symptoms appear in later life, study results show.
Patients with early onset bipolar symptoms also tended to experience a long delay to treatment, which was also linked to poor outcomes in adulthood.
The findings emphasize the importance of early intervention in bipolar disorder, say Robert Post (Bipolar Collaborative Network, Bethesda, Maryland, USA) and colleagues.
The researchers recruited 529 adult outpatients with bipolar disorder aged an average of 42 years.
Patients were assessed over a 4-year period with the National Institute of Mental Health-Life Chart Method and completed questionnaires regarding their prior course of illness.
In all, 15% of patients reported onset of illness symptoms before the age of 13 years and 35% reported onset between 13 and 18 years - thus 50% of the patients had their first episode of illness in childhood or adolescence.
Patients with early onset disease showed greater severity of depression and mania, a greater number of episodes, more days depressed, more days of ultradian cycling, and fewer days euthymic compared with those who had a later onset.
Notably, the early onset patients continued to show poorer outcomes throughout the 4-year follow-up period despite intensive monitoring and treatment.
Perhaps not surprisingly those with earlier age at onset displayed a significantly longer delay to first treatment than those with adulthood onset symptoms.
In turn, delay to first treatment was independently associated with greater depression, greater number of episodes, more days of ultradian cycling, and fewer days euthymic.
"Whether early intervention to shorten the delays to first treatment could alter this adverse course of illness in adulthood, or whether early onset is harbinger of worse course regardless of intervention, remains to be studied," Post and colleagues comment in the Journal of Clinical Psychiatry.
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By Andrew Czyzewski