Dr Barbara Geller and colleagues from Washington University School of Medicine found that pre-pubescent and adolescent bipolar disorder carries a lower rate of mania recovery and higher relapse rate than usual adult-onset disease and is more similar phenotypically to treatment resistant or mixed/cycling bipolar disorder. The findings of the study raise the question of whether a new approach to both psychosocial and pharmacological treatment needs to be considered for young sufferers of bipolar disorder. In a two-year prospective follow-up study of 89 childhood sufferers of mania, 65.2 per cent of the children recovered from mania and 55.2 relapsed after recovery from mania. Family setting appeared to affect recovery ability. Children who were living in an intact biological family were 2.2 times more likely to recover from mania, while children with "low maternal warmth" were 4.1 times more likely to relapse after recovery. Drug treatment, however, did not appear to predict recovery or relapse, and this is consistent with previous studies that suggest children and adolescents tend to respond poorly to treatments such as lithium. However, it is not clear whether this is due to the nature of young-onset disorder or whether children have a poorer response to mood stabilisers than adults. The researchers said the finding that childhood bipolar disorder has a strong similarity to the severe adult form of the disease raises the question of whether these children will grow up having mixed mania and continuous cycles like the severe adult group, or whether their pathology will develop into that of the majority of adult sufferers who have intermittent periods of mania followed by relatively symptom-free periods. The team said that further research into expressed emotion and psychosocial intervention and longitudinal studies of subjects with prepubertal and adolescent bipolar disorder is warranted. Reference: Geller et al, American Journal of Psychiatry 2002;159:927-933

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Last updated: 07/31/2002 - 02:21 PM