Stephen J Hirneth1, Philip L Hazell2, Tanya L Hanstock3, Terry J Lewin4. 1. Hunter New England Local Health District, Child and Adolescent Mental Health Service, Newcastle, NSW, Australia; University of Sydney, Sydney Medical School, Discipline of Psychiatry, Sydney, NSW, Australia. Electronic address: Stephen.Hirneth@hnehealth.nsw.gov.au. 2. University of Sydney, Sydney Medical School, Discipline of Psychiatry, Sydney, NSW, Australia; Sydney and South Western Sydney Local Health Districts, Infant Child and Adolescent Mental Health Services, Sydney, NSW, Australia. 3. School of Psychology, University of Newcastle, Callaghan, NSW, Australia. 4. University of Newcastle and Hunter New England Mental Health Services, Centre for Translational Neuroscience and Mental Health, Newcastle, NSW, Australia.
Abstract
BACKGROUND: Bipolar disorder (BD) phenomenology in children and adolescents remains contentious. The study investigated Australian children and adolescents with bipolar I disorder (BD-I), bipolar II disorder (BD-II), or BD not otherwise specified (BD-NOS). METHODS: Index episode demographics, symptomatology, functioning and diagnostic data were compared for 88 participants (63 female) aged 8-18 years (M=14.8, SD=2.5) meeting DSM-IV-TR criteria for BD-I (n=24), BD-II (n=13) or BD-NOS (n=51). RESULTS: BD-I had higher rates of previous episodes, psychotropic medication (compared to BD-II but not BD-NOS), rates of inpatient admissions (compared to BD-NOS), and number of inpatient admissions (compared to BD-II). BD-II had lower rates of lifetime depression and anxiety disorders, higher frequency of hypomania, shorter duration of illness, and fewer previous episodes. BD-NOS had younger age of onset, chronic course, irritability and mixed presentation. All BD subtypes had high rates of self-harm (69.3%), suicidal ideation (73.9%), suicide attempts (36.4%), psychiatric admission (55.7%), and psychosis (36.4%). LIMITATIONS: There were relatively small numbers of BD-I and BD-II. Diagnoses were based on retrospective recall. CONCLUSIONS: All BD subtypes had high levels of acuity and clinical risk. In accord with previous results, BD-I and BD-II participants' phenomenology was consistent with classical descriptions of these subtypes. BD-NOS participants were younger, with less euphoric mania but otherwise phenomenologically on a continuum with BD-I, suggesting that child and adolescent BD-NOS may be an early and less differentiated phase of illness of BD-I or BD-II and hence a target for early intervention.
BACKGROUND:Bipolar disorder (BD) phenomenology in children and adolescents remains contentious. The study investigated Australian children and adolescents with bipolar I disorder (BD-I), bipolar II disorder (BD-II), or BD not otherwise specified (BD-NOS). METHODS: Index episode demographics, symptomatology, functioning and diagnostic data were compared for 88 participants (63 female) aged 8-18 years (M=14.8, SD=2.5) meeting DSM-IV-TR criteria for BD-I (n=24), BD-II (n=13) or BD-NOS (n=51). RESULTS: BD-I had higher rates of previous episodes, psychotropic medication (compared to BD-II but not BD-NOS), rates of inpatient admissions (compared to BD-NOS), and number of inpatient admissions (compared to BD-II). BD-II had lower rates of lifetime depression and anxiety disorders, higher frequency of hypomania, shorter duration of illness, and fewer previous episodes. BD-NOS had younger age of onset, chronic course, irritability and mixed presentation. All BD subtypes had high rates of self-harm (69.3%), suicidal ideation (73.9%), suicide attempts (36.4%), psychiatric admission (55.7%), and psychosis (36.4%). LIMITATIONS: There were relatively small numbers of BD-I and BD-II. Diagnoses were based on retrospective recall. CONCLUSIONS: All BD subtypes had high levels of acuity and clinical risk. In accord with previous results, BD-I and BD-II participants' phenomenology was consistent with classical descriptions of these subtypes. BD-NOS participants were younger, with less euphoric mania but otherwise phenomenologically on a continuum with BD-I, suggesting that child and adolescent BD-NOS may be an early and less differentiated phase of illness of BD-I or BD-II and hence a target for early intervention.
Authors: Xavier Estrada-Prat; Anna R Van Meter; Ester Camprodon-Rosanas; Santiago Batlle-Vila; Benjamin I Goldstein; Boris Birmaher Journal: Bipolar Disord Date: 2019-05-15 Impact factor: 6.744