Skip to main content

Advertisement

SpringerLink
Log in

Phenomenology, socio-demographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents

A chart review

  • BRIEF REPORT
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Background

The existence of bipolar disorder type I (BD-I) during adolescence is now clearly established whereas there are still some controversies on BD-II and BD-NOS diagnosis, mainly in Europe (O’Dowd in Br Med J 29, 2006). Little is known on the phenomenology and potential short-term prognosis factors of bipolar episodes in this age population. In particular, very few studies examine this issue on inpatients in the European context of free access to care.

Objective

To describe the phenomenology of acute manic and mixed episodes in hospitalized adolescents and to analyse potential predictive factors associated with clinical improvement at discharge and length of hospitalization.

Methods

A total of 80 subjects, aged 12–20 years, consecutively hospitalized for a manic or mixed episode. Socio-demographic and clinical data were extracted by reviewing patients’ charts. We used a multivariate analysis to evaluate short-term outcome predictors.

Results

The sample was characterized by severe impairment, high rates of psychotic features (N = 50, 62.5%), a long duration of stay (mean 80.4 days), and an overall good improvement (86% very much or much improved). Thirty-three (41.3 %) patients had a history of depressive episodes, 13 (16.3%) had manic or brief psychotic episodes but only 3 (3.7%) had a history of attention deficit/hyperactivity disorders. More manic episodes than mixed episodes were identified in subjects with mental retardation (MR) and in subjects from migrant and/or low socio-economic families. Overall severity and female gender predicted better improvement in GAF scores. Poor insight and the existence of psychotic features predicted longer duration of stay.

Conclusion

These results suggest that severe manic and mixed episodes in adolescents with BD-I need prolonged inpatient care to improve and that socio-cultural factors and MR should be examined more closely in youth with BD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Akiskal HS (1995) Developmental pathways to bipolarity: are juvenile-onset depressions pre-bipolar? J Am Acad Child Adolesc Psychiatry 34:754–763

    Article  PubMed  CAS  Google Scholar 

  2. Axelson D, Birmaher B, Strober M, Kay M, Valeri S, Chiappetta L, Ryan N, Leonard H, Hunt J, Iyengar S, Bridge J, Keller M (2006) Phenomenology of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry 63:1139–1148

    Article  PubMed  Google Scholar 

  3. Bashir M, Russell J, Johnson G (1987) Bipolar affective disorder in adolescence: a 10-year study. Aust N Z J Psychiatry 21:36–43

    Article  PubMed  CAS  Google Scholar 

  4. Biederman J, Faraone S, Mick E et al (1996) Attention-deficit hyperactivity disorder and juvenile mania: an overlooked comorbidity? J Am Acad Child Adolesc Psychiatry 35:997–1008

    PubMed  CAS  Google Scholar 

  5. Birmaher B, Axelson D, Strober M et al (2006) Clinical course of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry 63:175–183

    Article  PubMed  Google Scholar 

  6. Brief Psychiatric Rating Scale (BPRS) Overoll JE, Gorham DR (1962); traduction française Pichot, 1973

  7. Calderoni D, Wudarsky M, Bhangoo R et al (2001) Differentiating childhood-onset schizophrenia from psychotic moood disorders. J Am Acad Child Adolesc Psychiatry 40:1190–1196

    Article  PubMed  CAS  Google Scholar 

  8. Carlson GA, Strober M (1978) Manic depressive illness in early adolescence: a study of clinical and diagnostic characteristics in six cases. J Am Acad Child Psychiatry 17:138–153

    Article  PubMed  CAS  Google Scholar 

  9. Carlson GA, Fennig S, Bromet EJ (1994) The confusion between bipolar disorder and schizophrenia in youth: where does it stand in the 1990s? J Am Acad Child Adolesc Psychiatry 33:453–460

    Article  PubMed  CAS  Google Scholar 

  10. Carlson GA, Bromet EJ, Sievers S (2000) Phenomenology and outcome of subjects with early- and adult-onset psychotic mania. American Journal of Psychiatry 157:213–219

    Article  PubMed  CAS  Google Scholar 

  11. Carlson GA (2005) Early onset bipolar disorder: clinical and research considerations. J Clin Child Adolesc Psychol 34:335–345

    Google Scholar 

  12. Case BG, Olfson M, Marcus SC, Siegel C (2007) Trends in the inpatient mental health treatment of children and adolescents in US community hospitals between 1990 and 2000. Arch Gen Psychiatry 64:89–96

    Article  PubMed  Google Scholar 

  13. Charfi F, Cohen D (2005) Trouble hyperactif avec déficit de l’attention et trouble bipolaire sont-ils liés? Neuropsychiatrie de l’enfance et de l’adolescence 53:121–127

    Article  Google Scholar 

  14. Chen YW, Dilsaver SC (1995) Comorbidity of panic disorder in bipolar illness: evidence from the Epidemiologic Catchment Area Survey. Am J Psychiatry 152:280–282

    PubMed  CAS  Google Scholar 

  15. Clinical Global Impressions (CGI ) In: Guy W, Bonato RR (eds) (1970) Manual for the ECDEU Assessment Battery, 2nd Rev edn. National Institute of Mental Health, Chevy Chase, pp 12-1–12-6

  16. Compton MT, Kaslow NJ, Walker EF (2004) Observations on parent/family factors that may influence the duration of untreated psychosis among African American first-episode schizophrenia-spectrum patients. Schizophr Res 68:373–385

    Article  PubMed  Google Scholar 

  17. Consoli A, Soultanian C, Tanguy ML, Laurent C, Perisse D, Luque R, Berrios GE, Cohen D (2007) Cotard’s syndrome in adolescents and young adults is associated with an increased risk of bipolar disorder. Bipolar Disord 9:1–4

    Article  Google Scholar 

  18. Delbello MP, Hanseman D, Adler CM et al (2007) Twelve-month outcome of adolescents with bipolar disorder following first hospitalization for a manic or mixed episode. Am J Psychiatry 164:582–590

    Article  PubMed  Google Scholar 

  19. Diagnostic Inteview for Genetic Studies (DIGS) Nurnberger et al (1994); traduction française C. Laurent (French translation Claudine Laurent)

  20. Ernst CL, Goldberg JF (2004) Clinical features related to age at onset in bipolar disorder. J Affect Disord 82:21–27

    Article  PubMed  Google Scholar 

  21. Global Assessment of functioning Scale (GAF) Endicott J, Spitzer RL, Fleiss J et al (1976); traduction française J. D. Guelfi et al (1989)

  22. Geller B, Fox LW, Clark KA (1994) Rate and predictors of prepubertal bipolarity during follow-up of 6 to 12-year old depressed children. J Am Acad Child Adolesc Psychiatry 33:461–468

    Article  PubMed  CAS  Google Scholar 

  23. Geller B, Williams M, Zimmerman B, Frazier J, Beringer L, Warner KL (1998) Prepubertal and early adolescent bipolarity differentiate from ADHA by manic symptoms, grandiose delusions, ultra-rapid or ultraradian cycling. J Affect Disord 51:81–91

    Article  PubMed  CAS  Google Scholar 

  24. Geller B, Zimerman B, Williams M, Delbello MP, Bolhofner K, Craney JL, Frazier J, Beringer L, Nickelsburg MJ (2002) DSM-IV mania symptoms in a prepubertal and early adolescent bipolar disorder phenotype compared to attention-deficit hyperactive and normal controls. J Child Adolesc Psychopharmacol 12:11–25

    Article  PubMed  Google Scholar 

  25. Geller B, Sun K, Zimerman B, Luby J, Frazier J, Williams M (1995) Complex and rapid-cycling in bipolar children and adolescents: a preliminary study. J Affect Disord 34:259–268

    Article  PubMed  CAS  Google Scholar 

  26. Geller B, Tillman R, Craney JL, Bolhofner K (2004) Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Arch Gen Psychiatry 61:459–467

    Article  PubMed  Google Scholar 

  27. Geller B et al (2002) Two-year prospective follow-up of children with prepubertal and early adolescent bipolar phenotype. Am J Psychiatry 159:927–933

    Article  PubMed  Google Scholar 

  28. Harrington R, Myatt T (2003) Is preadolescent mania the same condition as adult mania? A british perspective. Biol Psychiatry 53:961–969

    Article  PubMed  Google Scholar 

  29. Jairam R, Srinath S, Girimaji SC, Seshadri SP (2004) A prospective 4–5 year follow-up of juvenile onset bipolar disorder. Bipolar Disord 6:386–394

    Article  PubMed  Google Scholar 

  30. Joyce PR (1984) Age of onset in bipolar affective disorder and misdiagnosis as schizophrenia. Psychol Med 14:145–149

    Article  PubMed  CAS  Google Scholar 

  31. Judd L, Akiskal H, Schettler P, Endicott J (2002) The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 59:530–537

    Article  PubMed  Google Scholar 

  32. Judd L, Akiskal H, Schettler P et al (2003) The comparative clinical phenotype and long-term longitudinal episode course of bipolar I and II: a clinical spectrum or distinct disorders? J Affect Disord 73:19–32

    Article  PubMed  Google Scholar 

  33. Kennedy N, Boydell J, van Os J, Murray RM (2004) Ethnic differences in first clinical presentation of bipolar disorder: results from an epidemiological study. J Affect Disord 83:161–168

    Article  PubMed  CAS  Google Scholar 

  34. Kim-Cohen J, Caspi A, Moffitt T et al (2003) Prior juvenile diagnoses in adults with mental disorder. Arch Gen Psychiatry 60:709–717

    Article  PubMed  Google Scholar 

  35. Kirov G, Murray RM (1999) Ethnic differences in the presentation of bipolar affective disorder. Eur Psychiatry 14:199–204

    Article  PubMed  CAS  Google Scholar 

  36. Klein R, Pine DS, Klein DF (1998) Resolved: mania is mistaken for ADHD in prepubertal children. Negative. J Am Acad Child Adolesc Psychiatry 37:1093–1096

    Google Scholar 

  37. Kraepelin E (1921) Manic depressive insanity and paranoia. E & S Livingstone, Edinburgh

    Google Scholar 

  38. Kramlinger KG, Post RM (1996) Ultra-rapid and ultradian cycling in bipolar affective illness. Br J Psychiatry 168:314–323

    Article  PubMed  CAS  Google Scholar 

  39. Lewinsohn PM, Klein DN, Seeley JR (1995) Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. J Am Acad Child Adolesc Psychiatry 34:454–463

    Article  PubMed  CAS  Google Scholar 

  40. Leibenluft E, Charney DS, Towbin KE, Bhangoo RK, Pine DS (2003) Defining clinical phenotypes of juvenile mania. Am J Psychiatry 160:430–437

    Article  PubMed  Google Scholar 

  41. Lish JD, Dime-Meenan S, Whybrow PC, Price RA, Hirschfeld RM (1994) The National Depressive and Manic-depressive Association (DMDA) survey of bipolar members. J Affect Disord 31:281–294

    Article  PubMed  CAS  Google Scholar 

  42. Luckasson R, Borthwick-Duffy S, Buntix W et al (2002) Mental retardation: definition, classification, and systems of supports, 10th edn. AAMR, Washington, DC

    Google Scholar 

  43. McElroy SL, Strakowski SM, West SA, Keck PE Jr, Mc Conville BJ (1997) Phenomenology of adolescent and adult mania in hospitalized patients with bipolar disorder. Am J Psychiatry 154:44–49

    PubMed  CAS  Google Scholar 

  44. O’Dowd A (2006) NICE issues new guidance to improve the treatment of bipolar disorder. Br Med J 29

  45. Patel NC, Delbello MP, Keck PE, Strakowski SM (2005) Ethnic differences in maintenance antipsychotic prescription among adolescents with bipolar disorder. J Child Adolesc Psychopharmacol 15:938–946

    Article  PubMed  Google Scholar 

  46. Patel NC, Delbello MP, Keck PE, Strakowski SM (2006) Phenomenology associated with age at onset in patient with bipolar disorder at their first psychiatric hospitalization. Bipolar Disord 8:91–94

    Article  PubMed  Google Scholar 

  47. Pavuluri MN, Birmaher B, Naylor MW (2005) Pediatric bipolar disorder: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 44:846–871

    Article  PubMed  Google Scholar 

  48. Perlis RH, Miyahara S, Marangell LB, Wisniewski SR, Ostacher M, Delbello MP, Bowden CL, Sachs GS, Nierenberg AA (2004) Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry 55:875–881

    Article  PubMed  Google Scholar 

  49. Schurhoff F, Bellivier F, Jouvent R, Mouren-Simeoni MC, Bouvard M, Allilaire JF, Leboyer M (2000) Early and late onset bipolar disorders: two different forms of manic-depressive illness? J Affect Disord 58:215–221

    Article  PubMed  CAS  Google Scholar 

  50. Srinath S, Janarolha N, Reddy YC, Girimani SR, Seshadri SR, Subbakrishna DK (1998) A prospective study of bipolar disorder in children and adolescents from India. Acta Psychiatr Scand 98:437–442

    Article  PubMed  CAS  Google Scholar 

  51. Strober M, Carlson G (1982) Bipolar illness in adolescents with major depression. Arch Gen Psychiatry 39:549–555

    PubMed  CAS  Google Scholar 

  52. Strober M, Schmidt-Lackner S, Freeman R, Bower S, Lampert C, DeAntonio M (1995) Recovery and relapse in adolescents with bipolar affective illness: a five-year naturalistic, prospective follow-up. J Am Acad Child Adolesc Psychiatry 34:724–731

    Article  PubMed  CAS  Google Scholar 

  53. Strober M, Birmaher B, Ryan N et al (2006) Pediatric bipolar disease: current and future perspectives for study of its long-term course and treatment. Bipolar Disord 8:311–321

    Article  PubMed  Google Scholar 

  54. Swanson JM, Sergeant JA, Taylor E et al (1998) Attention-deficit hyperactivity disorder and hyperkinetic disorder. Lancet 351:429–433

    Article  PubMed  CAS  Google Scholar 

  55. Taieb O, Flament M, Chevret S, Jeammet P, Allilaire J-F, Mazet P, Cohen D (2002) Clinical relevance of electroconvulsive therapy (ECT) in adolescents with severe mood disorder:evidence from a follow-up study. Eur Psychiatry 17:206–212

    Article  PubMed  CAS  Google Scholar 

  56. Young RC, Biggs JT, Ziegler VE, Meyer DA (1978) A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 133:429–435

    Article  PubMed  CAS  Google Scholar 

  57. Yung AR, Mc Gorry PD (1996) The initial prodrome in psychosis: description and qualitative aspects. Aust N Z J Psychiatry 30:587–599

    Article  PubMed  CAS  Google Scholar 

  58. Zammit S, Allebeck P, David A, Dalman C et al (2004) A longitudinal study of premorbid IQ score and risk of developing schizophrenia, bipolar disorder, severe depression and other nonaffective psychoses. Arch Gen Psychiatry 61:354–360

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded by grants from the French Ministry of Health (Programme Hospitalier de Recherche Clinique AOM 06-088) and the Fondation Wyeth pour la Santé de l’Enfant et de l’Adolescent. AC was partly supported by Sanofi-Synthélabo France through a grant awarded for her PhD research on the outcome of bipolar type 1 disorder in adolescents. We thank Professor Boris Birmaher from Pittsburg University for his helpful comments on an earlier version of the manuscript.

Author information

Authors and Affiliations

  1. Service de Psychiatrie de l’Enfant et de l’Adolescent, Groupe Hospitalier Pitié-Salpétrière, 47 Bd de l’Hôpital, 75651, PARIS cedex 13, France

    Julie Brunelle MD, Angèle Consoli, Didier Perisse, Emmanuelle Deniau &  David Cohen

  2. Laboratoire "Psychologie et Neurosciences Cognitives", CNRS FRE 2987, Paris, France

    Julie Brunelle MD, Angèle Consoli, Jean-Marc Guilé &  David Cohen

  3. Department of Biostatistics, AP-HP, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France

    Marie-Laure Tanguy

  4. Department of Child and Adolescent Psychiatry, Université de Montreal, Montreal, Canada

    Christophe Huynh & Jean-Marc Guilé

  5. Department of Child and Adolescent Psychiatry, Hôpital C.Nicolle, Rouen, France

    Priscille Gérardin

Authors
  1. Julie Brunelle MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Angèle Consoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marie-Laure Tanguy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christophe Huynh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Didier Perisse
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emmanuelle Deniau
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean-Marc Guilé
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Priscille Gérardin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. David Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Cohen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brunelle, J., Consoli, A., Tanguy, ML. et al. Phenomenology, socio-demographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents. Eur Child Adolesc Psychiatry 18, 185–193 (2009). https://doi.org/10.1007/s00787-008-0715-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-008-0715-7

Keywords

Search

Navigation