Get access

A prospective 4–5 year follow-up of juvenile onset bipolar disorder

Authors

  • Rajeev Jairam,

    1. Child and Adolescent Psychiatry Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
    2. Infant, Child and Adolescent Mental Health Services, South Western Sydney Area Health Service, Liverpool, NSW, Australia
    Search for more papers by this author
  • Shoba Srinath,

    1. Child and Adolescent Psychiatry Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
    Search for more papers by this author
  • Satish C Girimaji,

    1. Child and Adolescent Psychiatry Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
    Search for more papers by this author
  • Shekhar P Seshadri

    1. Child and Adolescent Psychiatry Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
    Search for more papers by this author

  • None of the authors have any commercial associations and there is no conflict of interest in connection with this manuscript.

Rajeev Jairam, MD, Staff Specialist, Infant, Child and Adolescent Mental Health Services, South Western Sydney Area Health Service, Level 1, 13 Elizabeth Street, Liverpool, NSW 2170, Australia. Fax: +61 2 9827 8010; e-mail: rajeev.jairam@swsahs.nsw.gov.au.

Abstract

Objective:  Data on outcome of juvenile onset bipolar disorder is limited. This study examined the course and outcome of bipolar disorder and assessed the rate and predictors of recovery and relapse in a sample of children and adolescents over a 4–5 year period.

Method:  Twenty-five consecutively ascertained subjects (9–16 years) with a diagnosis of mania (mean duration at intake of 4.6 ± 3.9 weeks), were comprehensively assessed at baseline and at 6-month intervals using the Diagnostic Interview for Children and Adolescents (revised) (DICA-R), the Missouri Assessment for Genetic Interview in Children (MAGIC), the Young's Mania Rating Scale (YMRS) and the Children's Global Assessment (CGAS). The study phenotype required DSM-IV criteria of mania with elation and/or grandiosity as a criterion to distinguish them from those with attention deficit hyperactivity disorder. Subjects received the standard treatment as prescribed by their primary treating team.

Results:  During the course of the study period, all 25 subjects (100%) recovered from the index episode. The mean time to recovery was 44 ± 46 days. The mean duration of follow-up was 51.6 ± 4.1 months. Sixteen subjects (64%) relapsed after a mean period of 18 ± 16.4 months. A majority of the relapses (72.4%) were while the subjects were on treatment.

Conclusions:  Acute juvenile onset mania has a high rate of recovery and low chronicity. The relapse rate was high and most of these occurred in the first 3 years despite aggressive prophylactic treatment. The effectiveness of currently used thymoleptics, in particular lithium, in the prophylaxis of juvenile bipolar disorder needs to be evaluated in controlled studies.

Ancillary