Early-Onset Bipolar Disorder and Treatment Delay Are Risk Factors for Poor Outcome in Adulthood

Abstract

These data converge with other evidence that onset of bipolar disorder in childhood is common and often associated with extraordinarily long delays to first pharmacologic treatment. Both childhood onset and treatment delay were associated with a persistently more adverse course of illness rated prospectively in adults. These data should help foster efforts to ensure earlier and more effective treatment of bipolar illness in children and adolescents. It is hoped that appropriate early intervention would result in a more benign illness and a better prognosis in adulthood.

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

“…While the concepts of “over‐diagnosis” and “over‐treatment” in pediatric BD have received substantial attention,565 representative population studies demonstrate that adolescent BD is characterized by low rates of treatment, alongside high rates of suicidality and comorbidity 566, 567. Risks of incorrectly diagnosing and treating BD in a child or adolescent should thus be carefully weighed against the risk of incorrectly or not diagnosing or treating,568 keeping in mind that the duration of treatment delay has been shown to be an independent risk factor for a poor outcome in adulthood 569…”

Excellence in psychiatry: hopes and hubris

“…The risk of recurrence increases with every new episode 2 2. Delay to first treatment is associated with more time depressed, greater severity of depression, greater number of episodes and more days of ultrarapid cycling 3 3. Response to lithium monotherapy decreases with the occurrence of multiple prior episodes 4 4.…”

This issue: Differentiating Pediatric Bipolar Disorder from Attention-Deficit/Hyperactivity Disorder

“…4 However, most prospective data in those with P-BP show a considerable burden of illness in a high percentage of patients, and these observations converge with those from adults with BP that onset of illness in childhood carries a more difficult prognosis than those with adult onset. 6,7 Compounding this difficulty is the finding that independent of the early onset, the duration of the delay to first treatment for either mania or depression is a separate and additional predictor of more time and severity of depression in adulthood. 7 Even when the illness in children is carefully diagnosed by experts, 8-year follow-up of naturalistic treatment in the community left children symptomatic two-thirds of the time, and regretfully 37% of the children never guest editorial received any of the recommended treatments for P-BP.…”

“…6,7 Compounding this difficulty is the finding that independent of the early onset, the duration of the delay to first treatment for either mania or depression is a separate and additional predictor of more time and severity of depression in adulthood. 7 Even when the illness in children is carefully diagnosed by experts, 8-year follow-up of naturalistic treatment in the community left children symptomatic two-thirds of the time, and regretfully 37% of the children never guest editorial received any of the recommended treatments for P-BP. 8 Parenthetically, those who did receive treatment with lithium had the highest rate of remission.…”