Bipolar disorder in children and adolescents: a rocky road

Bipolar disorder in children and adolescents typically follows a tumultuous course with periods of apparent euthymia interrupted by numerous changes in mood state and a high frequency of subsyndromal symptoms, a new study has shown. The Course and Outcomes of Bipolar Youth (COBY) study previously reported on the first two years of illness in 263 young patients aged from seven to 17 years at the time of diagnosis. This latest report has described 413 patients followed for four years. There were 62% who had a syndromal recurrence, most often depression, of whom half had two or more recurrences. The polarity of the index episode predicted the polarity of subsequent episodes. Participants were assessed as symptomatic for 60% of the total follow-up period, usually with depression or mixed polarity, but there were numerous changes in mood state. Overt mania was quite uncommon. “The course of bipolar disorder, the relative infrequency of syndromal DSM manic episodes, the effects of development in symptom manifestation, and the high prevalence of comorbid disorders may account...for the difficulties in recognising and managing this illness in youths,” the report concluded. The high recurrence rate, chronicity and psychosocial morbidity made it vital to encourage early diagnosis and effective treatment, it stated. American Journal of Psychiatry 2009; 166: 795-804....