Do young adults with bipolar disorder benefit from early intervention?

It is unknown whether young adults with bipolar disorder are able to benefit from early intervention combining optimised pharmacological treatment and group psychoeducation. The aim of the present report was to compare the effects of early intervention among patients with bipolar disorder aged 18-25 years to that of patients aged 26 years or older.

Patients were randomised to early treatment in a specialised outpatient mood disorder clinic versus standard care. The primary outcome was risk of psychiatric re-hospitalisation.

A total of 158 patients with mania/bipolar disorder were included among whom 29 (18.4%) were between 18 and 25 years and 129 patients were 26 years or older. For both age groups, the point estimate of the hazard ratio of re-hospitalisation was insignificantly decreased for patients treated in the mood disorder clinic versus standard treatment but more so for patients between 18 and 25 years (HR 0.33, 95% CI 0.10-1.07; p=0.064) than for patients 26 years or older (HR 0.68, 95% CI 0.40-1.14, p=0.14). Younger adults treated in the mood disorder clinic used mood stabilisers and antipsychotics more in contrast to those treated in standard care. The differences between the estimates of effects did not reach significance in tests of interactions (p>0.2).

The study was based on a post hoc subgroup analysis and due to the small number of patients aged 18-25 years, type II errors cannot be excluded.

Although not statistically different, the observed differences of the point estimates was surprisingly larger for young adults suggesting that young adults with bipolar disorder may benefit even more than older adults from early intervention combining pharmacological treatment and group psychoeducation.