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Phenomenology and diagnostic stability of paediatric bipolar disorder in a Spanish sample
María Ribeiro-Fernández1, Azucena Díez-Suárez2, César Soutullo2
1Child and Adolescent Psychiatry Unit, Psychiatry and Clinical Psychology Department, University of Navarra Clinic, Pamplona, Spain; Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA: Navarra Institute for Health Research, Pamplona, Spain.
Insights
Most children diagnosed with bipolar disorder (BD) maintain their diagnosis long-term, with many initially diagnosed with BD-NOS converting to BD-I. This highlights the stability of pediatric BD.
Area of Science:
- Child and Adolescent Psychiatry
- Neurodevelopmental Disorders
- Mental Health Research
Background:
- Paediatric bipolar disorder (BD) is increasingly recognized, yet data on its long-term stability and presentation are still needed.
- Previous research has addressed the controversy surrounding paediatric BD, but further investigation into its prevalence and phenomenology is required.
Purpose of the Study:
- To assess the diagnostic stability and subtype changes of paediatric bipolar disorder over time.
- To analyze the prevalence of different bipolar disorder subtypes (BD-I, BD-II, BD-NOS) at diagnosis and during follow-up in a paediatric population.
Main Methods:
- A retrospective review of medical records for 72 patients diagnosed with DSM-IV Bipolar Disorder (BD) over 15 years.
- Assessment of presenting symptoms, diagnostic stability, and subtype changes (BD-I, BD-II, BD-NOS) during a median follow-up of 3.86 years.
Main Results:
- The majority of paediatric patients (95.8%) retained a BD diagnosis at follow-up.
- Initially diagnosed with BD-Not Otherwise Specified (NOS), half maintained this subtype, while the other half converted to Bipolar I Disorder (BD-I).
- A small percentage (4.2%) of patients initially diagnosed with BD-NOS no longer met BD criteria at follow-up and remained stable.
Conclusions:
- Paediatric bipolar disorder demonstrates significant diagnostic stability over a median follow-up of 3.86 years.
- Conversion from BD-NOS to BD-I is common, indicating the dynamic nature of the disorder in youth.
- While most retain a diagnosis, a small subset may remit, suggesting the need for ongoing monitoring and individualized treatment approaches.
Background:
Paediatric bipolar disorder (BD) has gained validity, and substantial research in the last 20 years has dissipated the controversy surrounding it. However, data on the prevalence, prodromes, phenomenology, and longitudinal stability of paediatric BD are still required.
Methods:
We reviewed the medical records of all patients (n = 72) with DSM-IV BD evaluated over a 15-year period. We assessed the most frequently present symptoms prior to and at the time of diagnosis, the diagnostic stability of the disorder and its subtypes (I, II and NOS).
Results:
Patients [75% boys, median age (interquartile range, IQR) at diagnosis 12.6 (9.6-15.7) years] underwent follow up for a median period of 3.86 (1.8-5.9) years. There was a median delay from symptom onset to diagnosis of 2.3 (1.2-4.8) years. At the time of diagnosis, 37.5% had BD-I, 8.3% BD-II, and 54.2% BD-NOS. At follow-up, 62.5% had BD-I, 8.3% had BD-II, and 23.6% had BD-NOS, whereas 4.2% no longer met the DSM-IV criteria for BD.
Limitations:
Our sample size limited the BD subtype analyses. Some of information was collected retrospectively.
Conclusion:
95.8% of our sample retained a BD diagnosis after a median follow-up period of 3.86 years. BD-I patients maintained their diagnosis and subtype of BD. Half of all patients with baseline BD-NOS maintained their BD subtype, but most of the other half showed conversion to BP-I at follow up. Only 4.2% of the sample (all with BD-NOS at baseline) did not meet criteria for BD at follow up, and these patients were stable.
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