Bipolar Disorder in Adolescents: Q & A

bipolar disorderBipolar disorder tends to emerge in adolescence or early adulthood; however, sometimes it has an earlier onset.[1] In fact, 2.5 percent of youth meet the criteria for bipolar disorder in their lifetime.1 It leaves many questions for families, but recently there have been several studies that have provided answers to some clinically important questions about bipolar disorder in children and adolescents.2

Q: Do children with manic symptoms continue to experience mania over time?[2]

A: Seven-hundred and seven children who were between six and 12 years-of-age when participating in the Longitudinal Assessment of Manic Symptoms study were followed-up by Findling and colleagues for 24-months.2 At baseline, these children showed elevated symptoms of mania; however, most did not meet the criteria for bipolar spectrum disorder.2 In fact, they were more likely to have depression, ADHD, oppositional defiant disorder, or conduct disorder.2

However, over the 24-month period, distinct trajectories of manic symptoms were found in these children.2 Approximately 85 percent had a reduction in manic symptoms over time, no matter if they had high or low manic symptom levels initially.2 The other 15 percent had a pattern of high manic symptoms that worsened over time, decreased sharply, and returned to high baseline levels.2

The finding that manic symptoms did not progress to bipolar disorder in most children is significant.2 Further studies of prognostic factors is warranted for early identification of children whose manic symptoms do progress.2

Q: How common are suicidal ideation and suicide attempts in children and adolescents with bipolar disorder?2

A: A study of 1,595 youths with bipolar disorder were investigated to find the rates of suicidal ideation and suicide attempts.2 It was found that suicidal ideation was found 50.4 percent of the time and suicide attempts were common, with a rate of 25.5 percent.2 Unfortunately, the prevalence of suicidal ideation was higher than that found in adults with bipolar disorder.2

Factors that were associated with suicide attempts were older age, female sex, early illness onset, more severe illness, more mixed episodes, more comorbid disorders, past self-injurious behavior, physical/sexual abuse, family history of suicidality, poor family functioning, and parental depression.2

Q: How severe is bipolar disorder in children and adolescents?2

A: Van Meter and colleagues compared the impact of depressive symptoms with that of manic symptoms in functioning youths with bipolar disorder,, using a sample of 54 children with bipolar disorder.2 Clinician and parent ratings were obtained using a wide range of scales that assess depressive and manic symptoms, behavior, and quality of life.2

The clinician ratings revealed that depressive symptoms in children increased the risk of psychiatric illness, hopelessness, suicidal ideation, and lower quality of life.2 Parental ratings showed an association between depressive symptoms and problem behaviors.2 On the other hand, manic symptoms were associated with greater psychiatric illness and physical well-being by both parents and clinicians.2

Overall, bipolar disorder in youths is usually more severe and calls for a need for more effective treatment.2

Q: Are there any new medicine studies for acute treatment of bipolar disorder in youths?2

A: Yes. Paliperidone has been evaluated in an eight-week open-label study for the treatment of 15 youths aged six to 15 with bipolar disorder.2 Only 11 youths completed the study, with the other four being unable to swallow the pills, finding a lack of efficacy, and experiencing adverse effects.2 Upon study completion, participants were rated as much improved or very much improved when assessed with the Clinical Global Impression-Improvement Scale.2 Still, further studies are needed for this medicine.2

Adverse effects were decreased energy, increased appetite, cold symptoms, headache, and insomnia.2 There was also a statistically significant increase in weight, from 0 to 12.5 pounds.2

Q: Are there any new long-term studies on mood stabilizers for the treatment of bipolar disorders in youths?2

The long-term effectiveness of lithium treatment for children and adolescents with bipolar disorder was recently investigated by Findling and colleagues.2 Sixty-one participants took part in an eight-week monotherapy trial of lithium.2 At the end of the study, 68 percent of participants met the criteria for response, and 50 percent had a significant reduction in symptoms.2 It was found that the addition of adjunctive psychotropic medicine helped patients maintain mood stabilization, as well.2 Still, more effective treatments are needed for bipolar disorder in youths.2

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