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Bipolar Disorder and Comorbid Conduct Disorder in Childhood and Adolescence

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ABSTRACT

Objective

To report on the rate and associated features of comorbid conduct disorder (CD) in 26 bipolar (BP) youths and examine whether comorbidity affects clinical course.

Method

The clinically referred subjects, 8 to 13 years old at study entry, were participating in a longitudinal investigation of childhood-onset psychiatric disorders. They were repeatedly examined during an interval of up to 12 years, and diagnosed by DSM-III criteria.

Results

There was a 69% rate of lifetime comorbidity and 54% rate of episode comorbidity with CD. CD predated the first BP episode for 11 youths and postdated it for 7. Only 12% of the 26 children had primary uncomplicated affective illness. Youngsters without CD comorbidity had a higher rate of primary affective illness, a somewhat greater number of BP episodes, but slightly better overall clinical course. They also had a greatly elevated rate of maternal mania, whereas BP youths with CD were notable for the rate of paternal substance abuse.

Conclusions

Comorbid CD may exist in a large portion of young patients with BP disorder, confusing its clinical presentation and possibly accounting for some of the documented failure to detect BP disorder. Comorbid CD in bipolar youths appears to be associated with a somewhat worse clinical course. The overall indications are that comorbid CD may identify a subtype of very early onset BP disorder. J. Am. Acad. Child Adolesc. Psychiatry, 1995, 34, 6:715–723.

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  • Cited by (0)

    An earlier version of this article was delivered at the NIMH Workshop, Bipolar Disorder in Children and Adolescents: Phenomenology and Course from a Life-Span Perspective, Bethesda, MD, January 19-20, 1993.

    This project has been supported by grant MH33990 from the National Institute of Mental Health. We thank Lucy P. Parrone, M.S., for programming tasks and Protap Mukerji, M.S., for statistical analyses.

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