Rasim S Diler1, John A Merranko2, Danella Hafeman2, Tina R Goldstein2, Benjamin I Goldstein3, Heather Hower4, Mary Kay Gill2, David A Axelson5, Neal Ryan2, Michael Strober6, Martin B Keller7, Shirley Yen8, Jeffrey I Hunt9, Lauren M Weinstock10, Satish Iyengar2, Boris B Birmaher2. 1. Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, United States of America. Electronic address: dilerrs@upmc.edu. 2. Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, United States of America. 3. Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, 2075 Bayview Ave., FG-53, Toronto, ON M4N-3M5, Canada. 4. Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States of America; Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, United States of America; Department of Psychiatry, University of California San Diego, 4510 Executive Drive, Suite 315, San Diego, CA 92121, United States of America. 5. Department of Psychiatry, Nationwide Children's Hospital, Ohio State College of Medicine, 700 Children's Drive, Columbus, OH 43205, United States of America. 6. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America. 7. Department of Psychiatry, University of California San Diego, 4510 Executive Drive, Suite 315, San Diego, CA 92121, United States of America; Department of Psychiatry, University of Miami, 1120 NW 14th St., Miami, FL 33136, United States of America. 8. Departments of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States of America. 9. Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, United States of America; Department of Psychiatry, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, United States of America. 10. Department of Psychiatry, University of California San Diego, 4510 Executive Drive, Suite 315, San Diego, CA 92121, United States of America.
Abstract
BACKGROUND: To identify prospectively ascertained individual and family factors that are associated with improvement in Bipolar Disorder (BD) among youths who initially presented with poor course. METHODS: 82 youths with BD with persistent poor mood symptomatology ("predominantly ill course") were compared to 70 youths with BD who at intake had poor course, but showed improvement during the follow-up ("ill with improving course"), (ages 12.3 ± 3.3, vs. 11.7 ± 3.3 years old, at intake). Improvement was measured by the percentage of time euthymic during a mean follow-up of 12.8 years. Youths and parents were interviewed to assess psychopathology, functioning, treatment, and familial functioning and psychopathology. RESULTS: Compared to the ill group, since intake, the improving group showed significantly lower subthreshold depression and hypo/mania, Attention Deficit Hyperactivity Disorder, and Disruptive Behavior Disorders. Parental Socioeconomic Status (SES) remained unchanged over time in the ill group, but progressively increased in the improving group. Importantly, the change in SES predated the improvement in the mood trajectory. The most influential variables that predicted improvement were higher SES, and absence of parental BD and Substance Use Disorder (SUD). Parental SUD also negatively affected the parental SES, which was directly associated with worse mood course. LIMITATIONS: Predominantly self-reported White samples may limit generalizability; other factors potentially associated with outcome (e.g., treatment adherence), were not ascertained. CONCLUSIONS: In addition to treating mood/comorbid psychopathology in symptomatic BD youths, to improve their prognosis, it is crucial to address their parent's BD and SUD and promote parental education/employment.
BACKGROUND: To identify prospectively ascertained individual and family factors that are associated with improvement in Bipolar Disorder (BD) among youths who initially presented with poor course. METHODS: 82 youths with BD with persistent poor mood symptomatology ("predominantly ill course") were compared to 70 youths with BD who at intake had poor course, but showed improvement during the follow-up ("ill with improving course"), (ages 12.3 ± 3.3, vs. 11.7 ± 3.3 years old, at intake). Improvement was measured by the percentage of time euthymic during a mean follow-up of 12.8 years. Youths and parents were interviewed to assess psychopathology, functioning, treatment, and familial functioning and psychopathology. RESULTS: Compared to the ill group, since intake, the improving group showed significantly lower subthreshold depression and hypo/mania, Attention Deficit Hyperactivity Disorder, and Disruptive Behavior Disorders. Parental Socioeconomic Status (SES) remained unchanged over time in the ill group, but progressively increased in the improving group. Importantly, the change in SES predated the improvement in the mood trajectory. The most influential variables that predicted improvement were higher SES, and absence of parental BD and Substance Use Disorder (SUD). Parental SUD also negatively affected the parental SES, which was directly associated with worse mood course. LIMITATIONS: Predominantly self-reported White samples may limit generalizability; other factors potentially associated with outcome (e.g., treatment adherence), were not ascertained. CONCLUSIONS: In addition to treating mood/comorbid psychopathology in symptomatic BD youths, to improve their prognosis, it is crucial to address their parent's BD and SUD and promote parental education/employment.
Authors: S Yen; R Stout; H Hower; M A Killam; L M Weinstock; D R Topor; D P Dickstein; J I Hunt; M K Gill; T R Goldstein; B I Goldstein; N D Ryan; M Strober; R Sala; D A Axelson; B Birmaher; M B Keller Journal: Acta Psychiatr Scand Date: 2015-10-17 Impact factor: 6.392
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Authors: Regina Sala; Michael A Strober; David A Axelson; Mary Kay Gill; Josefina Castro-Fornieles; Tina R Goldstein; Benjamin I Goldstein; Wonho Ha; Fangzi Liao; Satish Iyengar; Shirley Yen; Heather Hower; Jeffrey Hunt; Daniel P Dickstein; Neal D Ryan; Martin B Keller; Boris Birmaher Journal: J Am Acad Child Adolesc Psychiatry Date: 2013-10-17 Impact factor: 8.829