Prognosis worse with childhood bipolar disorder

When bipolar disorder arises in childhood, it may take far longer to diagnose and have a worse prognosis, a new study suggests.

Bipolar disorder is a mental illness marked by severe mood swings from depression to mania. In adults, the depression may manifest as persistent sadness, sleep problems or suicidal thoughts, while mania symptoms include unusual energy, euphoria and greatly inflated self-esteem.
These symptoms are often different in children and teenagers, however. When manic, for instance, a child may become overly irritable or destructive, whereas depression episodes often manifest as physical symptoms like stomach problems and headaches.

Because of such differences, bipolar disorder is considered tougher to diagnose in children. It may in some cases be mislabeled as simple depression or attention-deficit hyperactivity disorder (ADHD), for instance.

In the new study, researchers found that adults whose first bipolar symptoms arose in childhood typically waited years for a diagnosis -- and far longer than those whose symptoms began in late adolescence or early adulthood.

What's more, they tended to be in poorer mental health as adults, according to the researchers, led by Gabriele S. Leverich of U.S. National Institute of Mental Health.

Writing in the Journal of Pediatrics, they urge doctors to be "particularly alert" to the possibility of bipolar disorder in children who have signs of conditions like depression and

ADHD

The findings are based on a one-year follow-up of 480 U.S. and European adults being treated for bipolar disorder. At the start of the study, the patients were interviewed about the history of their illness, including the age at which they first had symptoms. They were then followed for one year to chart the current severity of their illness.

Overall, Leverich's team found, half of the patients said their symptoms first arose in childhood or adolescence. These patients tended to have a far longer delay until they started treatment.

Those whose symptoms arose before age 12 waited an average of 17 years before starting therapy; those who developed symptoms as teenagers waited nearly 12 years for treatment.

In contrast, men and women who developed bipolar symptoms after the age of 18 typically waited 2 to 4 years before receiving treatment.

Moreover, the delay in diagnosis seemed to affect the study participants' long-term prognosis. Men and women who developed bipolar signs before the age of 18 often suffered more severe symptoms of both depression and mania, and reported fewer symptom-free days.

The results highlight the importance of recognizing bipolar symptoms in children, rather than quickly attributing their problems to disorders like depression and ADHD, according to Leverich and her colleagues.

"Such vigilance may begin to shorten what were the extraordinary long delays to first treatment some 20 years ago," the researchers write.

SOURCE: Journal of Pediatrics, May 2007.