Retrospective age at onset of bipolar disorder and outcome during two‐year follow‐up: results from the STEP‐BD study

Abstract

Objective Symptoms of bipolar disorder are increasingly recognized among children and adolescents, but little is known about the course of bipolar disorder among adults who experience childhood onset of symptoms. Methods We examined prospective outcomes during up to two years of naturalistic treatment among 3,658 adult bipolar I and II outpatients participating in a multicenter clinical effectiveness study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Age at illness onset was identified retrospectively by clinician assessment at study entry. Results Compared to patients with onset of mood symptoms after age 18 years (n = 1,187), those with onset before age 13 years (n = 1,068) experienced earlier recurrence of mood episodes after initial remission, fewer days of euthymia, and greater impairment in functioning and quality of life over the two-year follow-up. Outcomes for those with onset between age 13 and 18 years (n = 1,403) were generally intermediate between these two groups. Conclusion Consistent with previous reports in smaller cohorts, adults with retrospectively obtained early-onset bipolar disorder appear to be at greater risk for recurrence, chronicity of mood symptoms, and functional impairment during prospective observation.

A Randomized Controlled Trial of Individual Family Psychoeducational Psychotherapy and Omega-3 Fatty Acids in Youth with Subsyndromal Bipolar Disorder

“…C hildhood-onset bipolar disorder (BP) can lead to greater impairment later in life than adult-onset BP (Perlis et al 2009). It is important to develop/identify efficacious treatments for BP in children.…”

Efficacy and Safety of Extended-Release Quetiapine Fumarate in Youth with Bipolar Depression: An 8 Week, Double-Blind, Placebo-Controlled Trial

“…Early recognition of the symptoms of bipolar disorder and prompt initiation of effective treatment are key to reducing the disease burden in these youth, with the potential for associated improvements in both short-and long-term outcomes (Perlis et al 2009). Although there is growing evidence to characterize the efficacy and safety of interventions in pediatric bipolar mania and/or mixed states, there are to date no large, multisite, placebo-controlled studies published for any pharmacologic intervention in pediatric bipolar depression (Kowatch et al 2005;Liu et al 2011).…”

Paradigm Shift: Preliminary Clinical Categorization of Ultrahigh Risk for Childhood Bipolar Disorder to Facilitate Studies on Prevention

“…Childhood-onset illness is associated with a more adverse outcome in adulthood than adult-onset illness. 3,4,21,22 In addition, the duration of the time lag to first treatment is an independent risk factor for a poor outcome in adulthood. 3 More specifically, acute response rates to the gold standard mood stabilizer lithium are reduced with increased prior episode burden, suggesting that undiagnosed or poorly treated adolescent bipolar disorder reduces the response for successful outcome for adults treated with lithium.…”