Trouble bipolaire à début précoce : considérations cliniques et de recherche

[Bipolar disorder: Continuity from child to adult?]

Early onset (pediatric) bipolar disorders are still an issue of much controversy due to several clinical particularities of the thymic episodes at this age. To date, there is indeed no consensus regarding the prevalence of bipolar disorders before puberty. Diagnosis criteria in children and young adolescents remain thus elusive. The purpose of this review is to provide an overview of this issue. The idea of continuity, from childhood to adulthood, in bipolar disorders also raises important questions regarding predictive factors of bipolar disorders in adults. Studies on the childhood of bipolar adults, as well as studies on the children of bipolar parents will be reviewed, in an attempt to identify the psychopathological substrates of bipolar disorders.

[Bipolar episodes in adolescents: diagnostic issues and follow-up in adulthood]

BACKGROUND

Little is known on the phenomenology and potential prognosis factors of bipolar episodes in adolescents. In particular, very few studies examine this issue on inpatients in the European context of free access to care.

OBJECTIVE

To assess the follow-up in adulthood of acute manic and mixed episodes in hospitalized adolescents and the predictive value of psychological testing.

METHODS

80 subjects, aged 12 to 20 years, consecutively hospitalized for a manic or mixed episode between 1994 and 2003, were contacted in 2005-2006 for a follow-up assessment. 5 patients refused, 20 were lost, 55 patients were assessed by direct and complete interview (67%) or by phone and treating psychiatrist (33%).

RESULTS

At index episode, 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 at discharge from hospital (86% very much or much improved). Half had a psychological testing before discharge. At follow-up (mean average 5 years), 35 patients still had a diagnosis of bipolar disorder. Eight changed life-time diagnosis for schizoaffective disorder and 11 for schizophrenia. Mortality and morbidity were severe with one subject who died from cardiac failure, and 91% of patients who had at least one relapse. Patients without relapse (N = 5) and patients showing a good social functioning (N = 19) remained with a diagnosis of bipolar disorder. Using a clinical global impression method, psychological testing (blind with follow-up status) was significantly correlated with transition to schizophrenia spectrum disorder.

CONCLUSION

Contrarily to what is seen in less severe sample of bipolar disorder, changes in life time diagnosis can occur during follow-up after a manic or mixed episode in adolescence, as many patients are in the schizophrenia spectrum in adulthood.