Early-onset bipolar disorder linked to poorer outcomes

MedWire News: People who develop bipolar disorder in childhood or adolescence tend to have a more severe course of illness than those who develop the mood disorder in adulthood, US study results suggest.

“Symptoms of bipolar disorder are increasingly recognised among children and adolescents,” explain Roy Perlis (Massachusetts General Hospital and Harvard Medical School, Boston, USA), and colleagues.

But they add: “Little is known about the course of bipolar disorder among adults who experience childhood onset of symptoms.”

To investigate, the researchers examined data on 3658 adult patients with bipolar I or II disorder who were participating in a multicentre study of the mood condition.

The participants were divided into three groups based on age at disease onset of less than 13 years (childhood or prepubertal onset), 13–18 years (adolescent onset) and over 18 years (adult onset).

Baseline features and outcomes over 2 years of follow up were compared among the three groups.

The team found that, compared with the 1187 patients with adult onset bipolar disorder, the 1068 patients with childhood or prepubertal onset disease experienced, on average, an earlier recurrence of depression and mania episodes after initial remission, fewer days spent in a ‘normal’ mood, and greater impairment in functioning and quality of life over a 2-year monitoring period.

The 1403 patients with adolescent onset bipolar disorder also had poorer outcomes than those with adult-onset disease, but better outcomes than those with childhood or prepubertal onset bipolar disorder.

Writing in the journal Bipolar Disorders, Dr Perlic and team conclude: “These results… suggest that individuals with earlier onset [bipolar disorder] may be at risk for a more chronic as well as recurrent course in adulthood, with poorer functioning and quality of life.”

They add that the findings “underscore the need to develop better strategies for early identification and early interventions” that achieve and maintain remission and improve functioning in patients with early onset bipolar disorder.