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Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype.
Arch Gen Psychiatry. 2004 May; 61(5):459-67.AG

Abstract

BACKGROUND

Diagnosis of child mania has been contentious.

OBJECTIVE

To investigate natural history and prospective validation of the existence and long-episode duration of mania in children.

DESIGN

Four-year prospective longitudinal study of 86 subjects with intake episode mania who were all assessed at 6, 12, 18, 24, 36, and 48 months. The phenotype was defined as DSM-IV bipolar I disorder (manic or mixed) with at least 1 cardinal symptom (elation and/or grandiosity) to ensure differentiation from attention-deficit/hyperactivity disorder. Parent and child informants were separately interviewed, by highly experienced research nurses, using the Washington University in St Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS). A Children's Global Assessment Scale score of 60 or less was needed to establish definite impairment. Treatment was by subjects' community practitioners.

SETTING

Research unit in a university medical school.

PARTICIPANTS

Subjects were obtained from psychiatric and pediatric sites by consecutive new case ascertainment, and their baseline age was 10.8 +/- 2.7 years. Onset of the baseline episode was 7.4 +/- 3.5 years. (Data are given as mean +/- SD.)

MAIN OUTCOME MEASURES

Episode duration, weeks ill, recovery/relapse rates, and outcome predictors.

RESULTS

Prospective episode duration of manic diagnoses, using onset of mania as baseline date, was 79.2 +/- 66.7 consecutive weeks. Any bipolar disorder diagnosis occurred during 67.1% +/- 28.5% of total weeks, during the 209.4 +/- 3.3 weeks of follow-up. Subjects spent 56.9% +/- 28.8% of total weeks with mania or hypomania (unipolar or mixed), and 38.7% +/- 28.8% of these were with mania. Major or minor depression and dysthymia (unipolar or mixed) occurred during 47.1% +/- 30.4% of total weeks. Polarity switches occurred 1.1 +/- 0.7 times per year. Low maternal warmth predicted faster relapse after recovery from mania (chi(2) = 13.6, P =.0002), and psychosis predicted more weeks ill with mania or hypomania (F(1,80) = 12.2, P =.0008). Pubertal status and sex were not predictive. (Data are given as mean +/- SD.)

CONCLUSIONS

These findings validate the existence, long-episode duration, and chronicity of child mania. Differences from the natural history of adult bipolar disorder are discussed.

Authors+Show Affiliations

Department of Psychiatry, Washington University in St Louis, MO 63110, USA. gellerb@medicine.wustl.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15123490

Citation

Geller, Barbara, et al. "Four-year Prospective Outcome and Natural History of Mania in Children With a Prepubertal and Early Adolescent Bipolar Disorder Phenotype." Archives of General Psychiatry, vol. 61, no. 5, 2004, pp. 459-67.
Geller B, Tillman R, Craney JL, et al. Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Arch Gen Psychiatry. 2004;61(5):459-67.
Geller, B., Tillman, R., Craney, J. L., & Bolhofner, K. (2004). Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Archives of General Psychiatry, 61(5), 459-67.
Geller B, et al. Four-year Prospective Outcome and Natural History of Mania in Children With a Prepubertal and Early Adolescent Bipolar Disorder Phenotype. Arch Gen Psychiatry. 2004;61(5):459-67. PubMed PMID: 15123490.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. AU - Geller,Barbara, AU - Tillman,Rebecca, AU - Craney,James L, AU - Bolhofner,Kristine, PY - 2004/5/5/pubmed PY - 2004/5/27/medline PY - 2004/5/5/entrez SP - 459 EP - 67 JF - Archives of general psychiatry JO - Arch Gen Psychiatry VL - 61 IS - 5 N2 - BACKGROUND: Diagnosis of child mania has been contentious. OBJECTIVE: To investigate natural history and prospective validation of the existence and long-episode duration of mania in children. DESIGN: Four-year prospective longitudinal study of 86 subjects with intake episode mania who were all assessed at 6, 12, 18, 24, 36, and 48 months. The phenotype was defined as DSM-IV bipolar I disorder (manic or mixed) with at least 1 cardinal symptom (elation and/or grandiosity) to ensure differentiation from attention-deficit/hyperactivity disorder. Parent and child informants were separately interviewed, by highly experienced research nurses, using the Washington University in St Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS). A Children's Global Assessment Scale score of 60 or less was needed to establish definite impairment. Treatment was by subjects' community practitioners. SETTING: Research unit in a university medical school. PARTICIPANTS: Subjects were obtained from psychiatric and pediatric sites by consecutive new case ascertainment, and their baseline age was 10.8 +/- 2.7 years. Onset of the baseline episode was 7.4 +/- 3.5 years. (Data are given as mean +/- SD.) MAIN OUTCOME MEASURES: Episode duration, weeks ill, recovery/relapse rates, and outcome predictors. RESULTS: Prospective episode duration of manic diagnoses, using onset of mania as baseline date, was 79.2 +/- 66.7 consecutive weeks. Any bipolar disorder diagnosis occurred during 67.1% +/- 28.5% of total weeks, during the 209.4 +/- 3.3 weeks of follow-up. Subjects spent 56.9% +/- 28.8% of total weeks with mania or hypomania (unipolar or mixed), and 38.7% +/- 28.8% of these were with mania. Major or minor depression and dysthymia (unipolar or mixed) occurred during 47.1% +/- 30.4% of total weeks. Polarity switches occurred 1.1 +/- 0.7 times per year. Low maternal warmth predicted faster relapse after recovery from mania (chi(2) = 13.6, P =.0002), and psychosis predicted more weeks ill with mania or hypomania (F(1,80) = 12.2, P =.0008). Pubertal status and sex were not predictive. (Data are given as mean +/- SD.) CONCLUSIONS: These findings validate the existence, long-episode duration, and chronicity of child mania. Differences from the natural history of adult bipolar disorder are discussed. SN - 0003-990X UR - https://www.unboundmedicine.com/medline/citation/15123490/Four_year_prospective_outcome_and_natural_history_of_mania_in_children_with_a_prepubertal_and_early_adolescent_bipolar_disorder_phenotype_ L2 - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/archpsyc.61.5.459 DB - PRIME DP - Unbound Medicine ER -