Pediatric mania rarely persists
medwireNews: Most children with symptoms of mania improve rapidly and are unlikely to be diagnosed with a bipolar spectrum disorder, research shows.
The study authors identified four different trajectories for symptoms in children monitored for 2 years. These were: high and falling; low and falling; high and rising; and unstable.
Most (85.7%) of the 703 children fell into the first two categories. Rates of diagnostic progression were low among these children with decreasing symptoms, with 6.6% and 1.8% of those with initially high and low symptoms, respectively, progressing from no diagnosis to any form of bipolar disorder during follow up, and a corresponding 10.3% and 2.4% having any diagnostic progression.
"The improvement in this large majority of patients is reassuring, reinforcing the point that what may appear to be manic symptoms at a given time point may reflect a variety of underlying diagnoses, and can follow several different longitudinal trajectories," say study author Robert Findling (Johns Hopkins University, Baltimore, Maryland, USA) and colleagues.
In the overall cohort, symptoms improved most rapidly during the first year of follow up, with slower reductions thereafter. After just 6 months of follow up, the average score was below 12 on the Parent General Behavior Inventory-10-item Mania Form, which was the researchers' definition of elevated mania.
This rapid overall reduction occurred despite the presence of a subgroup of children - 8.3% in all - whose initially elevated symptoms continued to increase during follow up (high and rising trajectory). Of these children, 15.5% progressed to a first bipolar diagnosis and 29.3% had any diagnostic progression.
Notably, children in this category had the highest proportion of caregivers with self-reported mania or depression, at respective rates of 18.1% and 31.5%.
Findling et al caution that this association is not necessarily causal, but add that "the possibility that higher degrees of parental self-reported affective symptoms may be associated with worse outcomes in their children is a consideration that seems plausible both genetically and environmentally, thus deserving further evaluation."
A further 6.0% of children had unstable manic symptoms, which dropped abruptly but recurred before the end of follow up. During this time, 21.4% received a new bipolar diagnosis and 26.2% had any diagnostic progression.
Writing in Bipolar Disorders, the researchers comment that if children with unfavorable symptom trajectories can be identified early, they could "be specifically targeted for more intensive therapeutic attention."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Eleanor McDermid, Senior medwireNews Reporter