Abstract
Background: Bipolar Disorders (BD) in youth are a heterogeneous condition with different phenomenology, patterns of comorbidity and outcomes. Our aim was to explore the effects of gender; age at onset (prepubertal- vs. adolescent-onset) of BD; and elements associated with attention deficit hyperactivity disorder (ADHD) and Substance Use Disorder (SUD) comorbidities, severe suicidal ideation or attempts, and poorer response to pharmacological treatments. Method: 117 youth (69 males and 57 females, age range 7 to 18 years, mean age 14.5 ± 2.6 years) consecutively referred for (hypo)manic episodes according to the Diagnostic and Statistical Manual of Mental Disorders, 54th ed (DSM 5) were included. Results: Gender differences were not evident for any of the selected features. Prepubertal-onset BD was associated with higher rates of ADHD and externalizing disorders. SUD was higher in adolescent-onset BD and was associated with externalizing comorbidities and lower response to treatments. None of the selected measures differentiated patients with or without suicidality. At a 6-month follow up, 51.3% of the patients were responders to treatments, without difference between those receiving and not receiving a psychotherapy. Clinical severity at baseline and comorbidity with Conduct Disorder (CD) and SUD were associated with poorer response. Logistic regression indicated that baseline severity and number of externalizing disorders were associated with a poorer outcome. Conclusions: Disentangling broader clinical conditions in more specific phenotypes can help timely and focused preventative and therapeutic interventions.
Highlights
Even if bipolar disorder (BD) is a well-established clinical picture in adults, its presentation in children and early adolescents is frequently “atypical”, compared to adult-onset presentation [1,2,3].Formal systematic studies have led to a definition of clinical subtypes and early signs, but clinical phenotypes and boundaries of Bipolar Disorders (BD) in youths are still debated, given the possible developmentally different presentations of the early-onset form [4,5] as well as the high rate of comorbidities [2,3]
This was a naturalistic study based on a clinical database of youth with BD consecutively referred during a 2-year period (2016–2018) for manic or hypomanic symptoms to our third-level Department of Child and Adolescent Psychiatry and Psychopharmacology, with nation-wide catchment, followed for at least 6 months and not included in previous studies
Thirty-one patients (26.5%) had attention deficit hyperactivity disorder (ADHD), and about 45% had oppositional-defiant disorder (ODD)/Conduct Disorder (CD). This was a sample of severely impaired patients, as evidenced by the baseline Clinical Global Impression Scale (CGI-S) and Children’s Global Assessment Scale (CGAS)
Summary
Even if bipolar disorder (BD) is a well-established clinical picture in adults, its presentation in children and early adolescents is frequently “atypical”, compared to adult-onset presentation [1,2,3].Formal systematic studies have led to a definition of clinical subtypes and early signs, but clinical phenotypes and boundaries of BD in youths are still debated, given the possible developmentally different presentations of the early-onset form [4,5] as well as the high rate of comorbidities [2,3]. A first clinical differentiation in manic children was between a “narrow” and a “broad” phenotype, according to the degree of fit to the full Diagnostic and Statistical Manual of Mental Disorders, 54th ed (DSM 5). Valuable clinical information can be derived from rigorous, controlled studies, with an experimental design, controlled variables, strict exclusion criteria (i.e, severe comorbidities, substance abuse and suicidal behavior), specific and focused outcome measures, and selected treatments, limiting the generalizability of findings to broader clinical populations. Observational studies in realistic, nonexperimental conditions, including larger samples of unselected, consecutively referred patients with all comorbidities assessed with global measures of outcome and treated as usual with adjunctive treatments, preclude solid conclusions and may be less innovative in terms of aims and findings but are more informative in terms of generalization of results to everyday clinical practice. Clinical severity at baseline and comorbidity with Conduct Disorder (CD) and SUD were associated with poorer response
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