1. Home>
2. Specialties>
3. Pediatrics and Adolescent Medicine>
4. Summary and Comment

Does Age of Onset Predict Outcomes in Bipolar Disease?

Childhood onset of illness was associated with long treatment delay and more severe disease than adult onset.

Bipolar disorder affects about 1% to 3% of adults; in many cases, the illness starts in childhood or adolescence. Investigators examined whether age of onset predicted the severity of bipolar disorder in 480 carefully diagnosed adult outpatients (mean age, 42) who had been ill for an average of more than 20 years.

Data on self-reported age of onset of manic or depressive symptoms and age of first pharmacologic treatment were available for 420 patients. Overall, 14% of patients experienced onset of illness before age 13 (childhood onset), and 36% experienced onset between ages 13 and 18 (adolescent onset). Among the childhood-onset group, the average time before first treatment was more than 16 years. Compared with adult-onset patients, those who had onset in childhood and adolescence reported more affective episodes, comorbidities, and rapid ultradian cycling (days during which both mania and depression occurred).

Comment: Early onset of bipolar disorder is associated with treatment delay that might contribute to more affective episodes and treatment-resistant illness, as well as comorbidities such as substance use and anxiety. The diagnosis of bipolar disorder is difficult and often is complicated by episodic, fragmented care and physicians’ reluctance to label a child or adolescent with the disorder. Coordination of care for affected youth remains a challenge. The lack of available mental health care often results in visits to primary-care providers who tend to view symptoms in isolation. As a result, some bipolar children are treated with stimulants for ADHD or antidepressants for depression, which can prolong the time to diagnosis of bipolar disorder and to treatment with mood stabilizers or antipsychotics, as recommended in treatment guidelines (see J Am Acad Child Adolesc Psychiatry 2005; 44:213). Early detection, diagnosis, and treatment remain key to improved quality of life for those affected with bipolar disorder.

— M. Susan Jay, MD

Published in Journal Watch Pediatrics and Adolescent Medicine July 3, 2007

Citation(s):

Leverich GS et al. The poor prognosis of childhood-onset bipolar disorder. J Pediatr 2007 May; 150:485-90.

• Medline abstract (Free)

Scheffer RE. Childhood onset bipolar disorder: A role for early recognition and treatment. J Pediatr 2007 May; 150:459-60.

• Medline abstract (Free)