Bipolar Disorders in Children and Adolescents

Naomi A. Schapiro, RN, MS, CPNP

Disclosures

J Pediatr Health Care. 2005;19(3):131-141. 

In This Article

Long-term Prognosis

Adults with bipolar I disorder had episodes of mania lasting, on average, 9 weeks and were symptomatic for less than half the time, in one 12-year longitudinal study (Judd, Aksiskal, Schettler, Endicott, Maser, et al., 2002). In contrast, prepubertal and early adolescent children with bipolar I disorder, in a 4-year study, had manic episodes lasting more than a year, with relapse rates up to 70% (Geller et al., 2004). Psychotic symptoms were found to be an indicator of poor functioning between episodes and poor recovery (Geller et al., 2004). Children and adults with bipolar I disorder might be expected to have a severe course, and longitudinal studies of bipolar II disorder and BPD-NOS are indicated.

Up to 25% of children and adults with BPD attempt suicide, especially during depressive episodes (Dalton, Cate-Carter, Mundo, Parikh, & Kennedy, 2003), and persons with substance abuse or rapid cycling are at increased risk. Poor adjustment in childhood or adolescence has been associated with alcohol and drug use (Goldberg & Ernst, 2004).

Papolos and Papolos (2002), summarizing the concerns of parents of children with BPD children posted on a listserv over a 1-year period, note that parents want more outcomes research, more outreach and education for families struggling to help their children, more inpatient and outpatient mental health services, and screening for depression in schools. Parents particularly expressed concern that their children with periodic explosive outbursts might end up in adolescent detention centers instead of psychiatric hospitals. Their concerns are supported by a U.S. Government Accounting Office (GAO) report that children are being placed in both the child welfare and juvenile justice systems solely to obtain needed mental health services (2003).

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