Longitudinal course and risk factors associated with psychosis in bipolar youths

Abstract

Objectives To compare the longitudinal clinical course of youths with bipolar disorder (BD) spectrum with lifetime (past, intake, and/or follow‐up) psychosis (BDP+) to youths with BD without lifetime psychosis (BDP−). Also, to identify risk factors associated with increased risk of first onset of psychosis during prospective follow‐up. Method Bipolar disorder youths (BDP+ = 137, BDP− = 233), aged 7‐17 years old, were followed on average every 7 months for 11.7 years and were evaluated using standardized instruments. Data were analyzed using linear and generalized linear models for the full sample, as well as for youths who developed first period of psychosis (n = 55). Results After adjusting for confounders, BDP+ youths with one, and in particular ≥2 lifetime psychotic episodes, had higher rates and more severe mood and anxiety symptoms, higher rates of suicidality, psychiatric hospitalizations, and sexual/physical abuse, and poorer psychosocial functioning than BDP− youths. Even before the first onset of psychosis during follow‐up, BDP+ youths showed more psychopathology and had more family history of psychiatric illness than those who never developed psychosis. First‐onset psychosis was associated with low socioeconomic status (SES), living with one parent, bipolar disorder type one and type two, comorbid anxiety, history of hospitalizations, and family history of mania and suicidality. Conclusion BDP+ is associated with poor prognosis and worse clinical picture, even before the onset of psychosis, indicating the need for prompt identification and treatment of these youths. Studies aimed to treat acute symptoms of psychosis, as well as prevent the onset of psychosis, including risk factors amenable to change, are warranted.

<p>The Impact of Childhood Trauma on Developing Bipolar Disorder: Current Understanding and Ensuring Continued Progress</p>

“… 83 Further support for the effect of CT during development on functional outcome in adults with first-episode psychosis and BD has been presented by several studies. 84 , 85 Specifically, physical and sexual abuse has a devastating long-term effect, in addition to short-term consequences of greater severity of subclinical symptoms. 85 In contrast, another study in adults with BD did not find a significant relationship between sexual trauma and either of the used chronicity measures of duration of illness or severity of symptoms.…”

“… 84 , 85 Specifically, physical and sexual abuse has a devastating long-term effect, in addition to short-term consequences of greater severity of subclinical symptoms. 85 In contrast, another study in adults with BD did not find a significant relationship between sexual trauma and either of the used chronicity measures of duration of illness or severity of symptoms. 86 However, the authors showed an increased probability of poor long-term outcome based on childhood family problems, which encompassed family history of mood disorder.…”

What Do We Know about the Long-Term Course of Early Onset Bipolar Disorder? A Review of the Current Evidence

“…Early age at onset was found to predict a more severe course of illness [ 13 , 27 , 31 , 38 , 54 ]. Other negative prognostic predictors were family history of BD or substance abuse, sexual abuse, suicidality, more severe mood symptoms, and presence of psychotic symptoms [ 14 , 38 , 46 ]. Rates of psychosis of 40% and 61% were reported [ 28 , 53 ].…”

“…Rates of psychosis of 40% and 61% were reported [ 28 , 53 ]. Psychosis was associated with a more severe symptomatic course and higher rates of suicide attempt and hospitalization [ 46 ].…”

“…Patients with lifetime psychosis had more severe mood and anxiety symptoms, higher suicidality, higher rates of psychiatric hospitalization and sexual/physical abuse, and worse psychosocial functioning [ 46 ].…”