Bipolar Kids Suffer as Adults, Too

Study Shows Symptoms of Bipolar Disorder May Continue in Adulthood

By Robynne Boyd
WebMD Health News

Reviewed By Louise Chang, MD

Oct. 6, 2008 -- Children who are diagnosed with bipolar disorder can continue to suffer from the disease as they develop into young adults.

That's according to a new study by researchers at Washington University in St. Louis, which was published in the October issue of Archives of General Psychiatry.

The study appears amid an ongoing controversy about diagnosing bipolar disorder in children. Much of the debate stems from an exponential surge in the number of children being diagnosed with bipolar disorder. Some experts believe it is uncommon and becoming over-diagnosed, while others think just the opposite.

More articles on the condition were published in January 2008 than in the decade between 1986 and 1996, highlighting many researchers' hope of better understanding bipolar disorder.

Barbara Geller, MD, and her colleagues at Washington University followed a sample of children diagnosed with pediatric bipolar disorder into adulthood.

Beginning in 1995 to 1998, the researchers examined 115 children diagnosed with bipolar disorder with an average age of 11. At the beginning of the study and again during nine follow-up visits conducted over eight years, the children and their parents were interviewed separately about their symptoms, diagnoses, daily cycles of mania and depression, and interactions with others.

Ninety-four percent of the children completed the study, with 54 of these patients turning 18 or older at the end of the follow-up period.

During the eight-year follow-up, the researchers found that the children's first, second, and third episodes of mania included psychosis and daily cycling between mania and depression for long periods of time. Many of them recovered from these episodes, but about 73% of them relapsed.

After the follow-up period, Geller and her colleagues found that about 44% of those who had bipolar disorder as children and who turned 18 by the end of the study period continue to have manic episodes as young adults. Thirty-five percent of them had substance use disorders, a rate similar to those diagnosed with bipolar disorder as adults.

It is not yet understood why some patients did not experience manic episodes as they matured, since that particular data has not been studied, says Geller. However, she notes that it's unlikely to be due to a misdiagnosis.

"The study provides validation that the illness continues into adulthood in a very large proportion of the children, and unfortunately like adults with the disease, they have a high rate of substance dependence," says Geller.

"This is important for clinicians giving data to parents," continues Geller. "The first question parents ask when their children are diagnosed is if their children will have the illness as adults. Now we can say we have to keep being very vigilant and keep following the children."

The study concluded that the severity and chronic nature of this disorder highlights the need for a greater effort toward understanding the neurobiology behind the disease and for developing prevention and intervention strategies.

Gary Sachs, MD, the director of the Bipolar Clinic and Research Program at Massachusetts General Hospital, agrees that the study provides vital information for moving the conversation about childhood bipolar disorder forward.

"The article is important because it suggests that there are a fair number of detectable cases in children and that a number of them continue to express the illness after adulthood," says Sachs. "We all have to recognize that these kids are out there, and now that we say they exist, let's identify them appropriately with a formal diagnostic process."

The study also provides an important foundation for future research, writes Ellen Leibenluft, MD, of the National Institute of Mental Health, in an editorial that accompanied the study.

"The publication reflects our field's continuing efforts to nurture development conceptualizations of psychiatric illnesses," she writes. "Such conceptualizations hold the hope of fostering work that will allow us to treat youth with bipolar disorder more effectively and eventually give us the knowledge base needed to prevent the onset of bipolar disorder in youth at risk."

SOURCES: Archives of General Psychiatry, October 2008; vol 65: pp 1125-1133. News release, JAMA/Archives.

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