Differences of Clinical Characteristics and Phenotypes between Prepubertal- and Adolescent-Onset Bipolar Disorders

Abstract

The aim of this study is to describe the clinical characteristics of prepubertal- and adolescent-onset bipolar disorder (BD) and to identify any clinical differences between patients with prepubertal- and adolescent-onset BD. We analyzed the clinical records of 53 inpatients with BD. These patients were divided into prepubertal-onset and adolescent-onset groups. We also divided the subjects into narrow, intermediate, and broad phenotypes according to the definitions proposed by Leibenluft and colleagues. Of the total sample, 16 patients (30.2%) were in the prepubertal-onset group and 37 (69.8%) were in the adolescent-onset group. Patients with prepubertal-onset BD were more likely to display an insidious clinical presentation, atypical features, and comorbid psychopathology. And the majority of the subjects, especially in the prepubertal-onset group, were classified under the intermediate and broad phenotypes. These results suggest that the clinical presentation of BD with prepubertal-onset is different from that of adolescent-onset BD. It is inferred that a significant number of patients with prepubertal- and adolescent-onset BD do not meet DSM-IV criteria for mania or hypomania from the results of this study.

A systematic review of the frequency and severity of manic symptoms reported in studies that compare phenomenology across children, adolescents and adults with bipolar disorders

“…1 , nine studies met eligibility criteria for inclusion in the review. The CASP assessment revealed that three studies achieved good-to-high-quality ratings (Findling et al 2001 ; Birmaher et al 2009 ; Chan et al 2011 ), three were rated as good-to-modest (McElroy et al 1997 ; Lazaro et al 2007 ; Safer et al 2012 ), whilst three studies achieved lower scores, suggesting some methodological weaknesses (Ballenger et al 1982 ; Jerrell and Shugart 2004 ; Song et al 2010 ).…”

“…Fifty-six percent of the studies (5 out of 9) compared the symptoms of (hypo)mania in children versus adolescents (Findling et al 2001 ; Lazaro et al 2007 ; Birmaher et al 2009 ; Song et al 2010 ; Chan et al 2011 ). Two studies combined children and adolescents into one group (minimum age 7 years; maximum age 17 years) and compared the younger group with adults (Jerrell and Shugart 2004 ; Safer et al 2012 ).…”

“…Four of seven studies identified irritability or irritability and aggression as the highest ranking symptom in the youngest age group assessed (either children alone or a group comprising children and adolescents). The two highest ranking symptoms in the seven studies that included an adolescent group were increased activity/energy, closely followed by elated/euphoric mood (Ballenger et al 1982 ; McElroy et al 1997 ; Findling et al 2001 ; Lazaro et al 2007 ; Birmaher et al 2009 ; Song et al 2010 ; Chan et al 2011 ). One study (Ballenger et al 1982 ) compared adolescents and adults and found that grandiosity was more common in the adolescent group and pressured speech was ranked highest in the adult group; decreased sleep was a frequent symptom for both age groups.…”

“…Others included ratings of additional symptoms of BD, such as depression (e.g. Song et al 2010 ), without specifying if these occurred within a manic episode (suggesting the possibility of mixed states) or outside the manic phase. Also, studies of the frequency of manic symptoms often used different tools, some of which did not even include symptoms that are deemed core features of mania.…”

Comparison of Serum Uric Acid in Major Depressive Disorder and Bipolar Disorder: a Retrospective Chart Review Study

“… 2 In particular, diagnosis is challenging in pre-pubertal and adolescent patients, as their symptoms may not meet the DSM-IV criteria. 3 Also, studies suggest that even during the euthymic state of BD, cognitive and functional abnormalities can persist. 4 Thus, biomarkers for BD would be very useful in early diagnosis, disease control, measuring treatment response, and developing new therapeutic methods.…”