A Naturalistic Study of Youth Referred to a Tertiary Care Facility for Acute Hypomanic or Manic Episode

Abstract

Background: Bipolar Disorders (BD) in youth are a heterogeneous condition with different phenomenology, patterns of comorbidity and outcomes. Our aim was to explore the effects of gender; age at onset (prepubertal- vs. adolescent-onset) of BD; and elements associated with attention deficit hyperactivity disorder (ADHD) and Substance Use Disorder (SUD) comorbidities, severe suicidal ideation or attempts, and poorer response to pharmacological treatments. Method: 117 youth (69 males and 57 females, age range 7 to 18 years, mean age 14.5 ± 2.6 years) consecutively referred for (hypo)manic episodes according to the Diagnostic and Statistical Manual of Mental Disorders, 54th ed (DSM 5) were included. Results: Gender differences were not evident for any of the selected features. Prepubertal-onset BD was associated with higher rates of ADHD and externalizing disorders. SUD was higher in adolescent-onset BD and was associated with externalizing comorbidities and lower response to treatments. None of the selected measures differentiated patients with or without suicidality. At a 6-month follow up, 51.3% of the patients were responders to treatments, without difference between those receiving and not receiving a psychotherapy. Clinical severity at baseline and comorbidity with Conduct Disorder (CD) and SUD were associated with poorer response. Logistic regression indicated that baseline severity and number of externalizing disorders were associated with a poorer outcome. Conclusions: Disentangling broader clinical conditions in more specific phenotypes can help timely and focused preventative and therapeutic interventions.

Co-occurring Mental Disorders in Transitional Aged Youth With Substance Use Disorders – A Narrative Review

“…Literature also indicates a link between SUDs and bipolar disorder in youth. In an Italian sample of 117 children and adolescents (aged between 7 and 18 years) with bipolar disorder, 27.4% also fit the criteria for SUDs (age M = 15.6; SD = 1.93) ( 78 ). This finding is consistent with earlier studies that found elevated prevalence rates of SUDs in youth with a history of mania and that the emergence of SUDs tended to Post-date the onset of bipolar disorder ( 79 ).…”

Psychiatric comorbidity in patients with pediatric bipolar disorder – A systematic review

“…Current comorbid anxiety disorders (not specified) occurred in 14.4%–28% (weighted mean prevalence = 19%) of patients in remission 15,33 . Multiple anxiety disorders (defined as two or more) occurred in 17.4%–65.7% (weighted mean prevalence = 43.8%) of patients with PBD 15,27,30,35,40 …”

“…Six of the included studies reported the prevalence of tics or Tourette's in patients with PBD 26,27,35,38–40 . Two of the six studies reported the prevalence of tics alone 26,36 and one study reported the prevalence of Tourette's alone 39 .…”

“…One of the included studies reported the prevalence of comorbid mental retardation to be 10.3% in patients with PBD 29 . Mental retardation (defined as an IQ < 70) was an exclusion criterion in 12 of the included studies 14,15,26,28,31,33–36,38–40 . No studies reported the current prevalence of mental retardation in patients in remission.…”

“…Sixteen of the included studies reported the prevalence of ADHD in patients with PBD. 14,15,[27][28][29][30][31][32][33][34][35][36][37][38][39][40] The studies showed that comorbid ADHD occurred in 0%-87.1% (weighted mean prevalence = 59.5%) of patients with PBD. Current comorbid ADHD occurred in 15%-70% (weighted mean prevalence = 51.4%) of patients in remission.…”