Abstract
Aim: Early onset of psychopathology is often an index of a more severe clinical course and worse prognosis. This review examined the course of bipolar disorder (BD) with onset in childhood and adolescence, with a focus on persistence of symptoms, severity of illness, comorbidity, and functional impairment. Methods: The databases of PubMed, Embase, and PsycInfo were systematically searched for publications since 1990 reporting on long-term (12 months or longer) assessments of patients with early onset BD. Results: Forty-two relevant publications were identified, which reported on data derived from 15 different patient cohorts, including 7 prospective research psychopathology studies, 4 medical record reviews, 2 follow-ups of clinical trial samples, 1 managed care database, and 1 nationwide registry, for a total of 10,187 patients. The length of follow-ups ranged from 1.0 to 15 years. Diagnostic stability of BD ranged from 73% to 100% over ten years. Recovery rate from an index episode was 81.5–100% and recurrence rate was 35–67%. Suicide attempt cumulative prevalence in five years was 18–20%. Earlier age at the first episode predicted a more severe clinical course. Conclusions: Early onset BD persists over time through adolescence, with homotypic diagnostic continuity over the years, but heterogeneity in the severity of the clinical course. Whether early identification and treatment improves distal prognosis remains to be further investigated.
Highlights
Bipolar disorder (BD) is a chronic condition and a leading cause of morbidity and mortality, being associated with reduced life expectancy primarily due to cardiovascular disease and suicide [1]
Even though effective treatments exist and extended remission is possible, BD is a lifelong condition for which a definitive cure is not yet available
When considering that a depressive episode can precede mania as the initial manifestation, it should be noted that onset of BD in adolescence is not uncommon
Summary
Bipolar disorder (BD) is a chronic condition and a leading cause of morbidity and mortality, being associated with reduced life expectancy primarily due to cardiovascular disease and suicide [1]. Lifetime prevalence is estimated to be about 1% worldwide [2], but rates up to 2.6% have been reported [3,4]. The mean age of onset of BD type I (BD-I) is around 18 years [5], with a peak in the incidence of the first manic episode between 21 and 23 years [3,6]. One study identified three peaks of onset in life, at 17, 26, and 35 years, respectively [7]. When considering that a depressive episode can precede mania as the initial manifestation, it should be noted that onset of BD in adolescence is not uncommon
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