The Health Care Crisis of Childhood-Onset Bipolar Illness: Some Recommendations for Its Amelioration
J Clin Psychiatry 2006;67(1):115-125
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Objective: To describe new data on the
incidence and impact of childhood- and adolescent-onset bipolar illness and make
recommendations to help accelerate the acquisition of knowledge
in this area.
Data Sources: Two large, multicenter
outpatient studies in adults with DSM-IV bipolar disorder- the Systematic Treatment
Enhancement Program for Bipolar Disorder and the
Bipolar Collaborative Network- were the primary
sources of retrospective data on age at onset.
Study Selection: We focused on the 2
retrospective studies because they supplied more
immediate data on age at onset and long-term prognosis than current prospective studies.
Data Synthesis: The 2 studies revealed
that 15% to 28% of adults experienced an onset of their illness prior to age 13 years. Those
with childhood versus adult onset had a more
severe, complicated, and adverse course of bipolar
illness, assessed retrospectively and confirmed
prospectively during naturalistic treatment. The
time lag from onset of first symptoms to first
treatment was strongly inversely related to age at onset
and averaged 16.8 ± 10 years in those with
childhood onset. Recommendations include defining
temporary consensus threshold criteria for each
bipolar subtype and their prodromes; conducting
studies using less onerous than traditional designs,
including randomized open comparisons to acquire preliminary data in this age cohort; and
forming clinical and academic treatment outcome
networks to more quickly acquire treatment outcome data in this understudied population.
Conclusions: The data reveal a very
substantial rate of childhood-onset bipolar
illness, extraordinary delays in onset to first
treatment, and a very adverse long-term outcome.
Several approaches to accelerating the rate of
acquisition of treatment outcome data in this cohort are