A new study published in the Journal of Clinical Psychiatry suggests that people with bipolar disorder whose symptoms began in childhood have a worse prognosis with their bipolar as adults.  It also suggests that the earlier in life a person's bipolar symptoms appear, and the longer the disorder goes untreated and undiagnosed, the more severe the disorder seems to be throughout their life.

According to a study performed by Dr. Robert M. Post, from the Bipolar Collaborative Network in Bethesda, Maryland, “Both childhood onset and treatment delay were associated with a persistently more adverse course of illness rated prospectively in adults.”

Bipolar disorder usually presents in the late teens and early twenties; however, in recent years, more attention has been given to early recognition and diagnosis in children – as early as toddlerhood.  However, bipolar disorder in children often presents differently than it does in adults and can be difficult to diagnose.  It can also be misdiagnosed as other disorders such as Attention Deficit Hyperactivity Disorder (ADHD).

Post and his colleagues followed 529 adult outpatients with bipolar disorder over a period of four years.  The average age of the patients was 42. The participants were rated daily using the National Institute of Mental Health (NIMH) Life Chart Method.  The study participants also completed questionnaires regarding the history of their illness and symptoms.

15 percent of the participants had symptoms before the age of 13 and 35 percent between the ages of 13-18.  During the first year of follow-up, compared to the patients whose symptoms developed as an adult, those with childhood onset had more manic and depressive episodes (and more severe episodes), more depressed days, more rapid cycling, and fewer days of normal mood.

After following the participants for four years, those with onset during childhood, compared to those with adult onset, continued to have on average longer and more severe periods of depression, and fewer days of normal mood.

On average, the earlier the age at which symptoms first appeared, the longer it took for the patients to be diagnosed.  In addition, the longer the delay in diagnosis, the more time patients spent depressed, the more episodes of depression they had, the worse the episodes were, and the more rapid the cycling of episodes.

Unfortunately there is still a great deal of controversy regarding the increasing awareness and diagnosis of bipolar disorder in children.  That's why this study is significant – it might help to encourage parents to seek earlier diagnosis and treatment if they suspect that their child might have bipolar disorder.  These results may also encourage pediatricians to refer the child earlier to a psychiatrist for diagnosis, and more aggressive treatment by those psychiatrists.

Post says, ”These data should help foster efforts to ensure earlier and more effective treatment of bipolar illness in children and adolescents…The findings emphasize the importance of early intervention in bipolar disorder.  Whether early intervention to shorten the delays to first treatment could alter this adverse course of illness in adulthood, or whether early onset is harbinger of worse course regardless of intervention, remains to be studied.”

Dr. Post’s results are published in the July edition of the Journal of Clinical Psychiatry.

Source: Journal of Clinical Psychiatry