Abstract
Childhood onset bipolar disorder (CO-BD) presents a panoply of difficulties associated with early recognition and treatment. CO-BD is associated with a variety of precursors and comorbidities that have been inadequately studied, so treatment remains obscure. The earlier the onset, the longer is the delay to first treatment, and both early onset and treatment delay are associated with more depressive episodes and a poor prognosis in adulthood. Ultra-rapid and ultradian cycling, consistent with a diagnosis of BP-NOS, are highly prevalent in the youngest children and take long periods of time and complex treatment regimens to achieve euthymia. Lithium and atypical antipsychotics are effective in mania, but treatment of depression remains obscure, with the exception of lurasidone, for children ages 10-17. Treatment of the common comorbid anxiety disorders, oppositional defiant disorders, pathological habits, and substance abuse are all poorly studied and are off-label. Cognitive dysfunction after a first manic hospitalization improves over the next year only on the condition that no further episodes occur. Yet comprehensive expert treatment after an initial manic hospitalization results in many fewer relapses than traditional treatment as usual, emphasizing the need for combined pharmacological, psychosocial, and psycho-educational approaches to this difficult and highly recurrent illness.
Highlights
Epidemiological data by Merikangas et al, (2010) indicated that 2.2% of adolescents in the US have a bipolar spectrum disorder, including BP-NOS, but disappointedly only 20% are in any kind of treatment [1]
Childhood onsets of bipolar disorders are more common in the US than in many European countries with one quarter of onsets in adults with bipolar disorder occurring before age 13 and two thirds before age 19 [2,3,4,5] Multiple factors account for this; among the most prominent are an increased incidence of a positive family history of mood disorders and substance abuse disorders in patients’ parents and grandparents [6,7,8] and an increased incidence of multiple psychosocial adversities in childhood [9]
The data are convergent with those of Axelson et al [4], indicating that upon a systematic 8 years of follow up, children of a bipolar parent compared to a control parent in the community are at increased risk for an anxiety disorder, depression, disruptive behavioral disorder, ADHD, and substance abuse, each more than the approximately 20% who will develop a bipolar disorder diagnosis
Summary
Epidemiological data by Merikangas et al, (2010) indicated that 2.2% of adolescents in the US have a bipolar spectrum disorder, including BP-NOS, but disappointedly only 20% are in any kind of treatment [1]. Other data indicate a similar percentage of bipolar I children in other countries, but if those with BP-NOS are considered, the incidence may be considerably higher, perhaps around 5%. Childhood onsets of bipolar disorders are more common in the US than in many European countries with one quarter of onsets in adults with bipolar disorder occurring before age 13 and two thirds before age 19 [2,3,4,5] Multiple factors account for this; among the most prominent are an increased incidence of a positive family history of mood disorders and substance abuse disorders in patients’ parents and grandparents [6,7,8] and an increased incidence of multiple psychosocial adversities (different types of abuse) in childhood [9]. Other risk factors in the US include obesity, an inflammatory diet, and poor access to health care yielding longer delays to diagnosis and first treatment
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