Vol 3 - Iss 1 - Article - BIPOLAR SPECTRUM DISORDERS IN CHILDREN AND ADOLESCENTS: POSSIBLE CLINICAL PHENOTYPES #93

BIPOLAR SPECTRUM DISORDERS IN CHILDREN AND ADOLESCENTS: POSSIBLE CLINICAL PHENOTYPES Gabriele Masia, Stefania Millepiedia, Maria Muccia, Cinzia Paria , Chiara Pfannera, Stefano Berloffaa, Giulio Perugib,c, Cristina Tonic a IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone (Pisa), Italy b Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, Psychiatry Section, University of Pisa, Pisa, Italy cInstitute of Behavioral Sciences "G. De Lisio", Carrara-Pisa, Italy Address all correspondence to: Gabriele Masi, MD IRCCS Stella Maris, Via dei Giacinti 2 56018 Calambrone (Pisa) Italy Phone: +39 050 886111 Fax: +39 050 32214 E-mail: gabriele.masi@inpe.unipi.it Running title : Juvenile Bipolar Disorder Key-words: bipolar disorder, children, adolescents, subgrouping, course, phenotype. Financial support: none SUMMARY Background: Recent research has addressed the issue of subtyping juvenile bipolar disorder (BD). Accordingly, we set out to find out, in a naturalistic sample of bipolar children and adolescents with mania and mixed mania, whether useful subtyping should be based on clinical features, such as the DSM IV subtyping (BD type I, BD type II, BD type not otherwise specified (NOS)), the chronic versus episodic course, the irritable versus euphoric mood, the prepubertal versus adolescent onset, and the ADHD comorbidity. Methods: We report on some of our recent studies including partly overlapping large samples of children and adolescents with BD, meeting the DSM-IV diagnosis of BD, according to historical information, prolonged observations, and a structured clinical interview (K-SADS-PL). Results: These studies seem to support a convergent model of early-onset BD, according to which two broad phenotypes can be grossly described. The first phenotype presents the following features: early-onset, very frequent ADHD comorbidity, chronic course, irritable mood, higher superimposed comorbidity with ODD/CD, greater functional impairment, less improvement during the follow-up, clinical features fitting the DSM-IV definition of BD-NOS. The second phenotype presents the following features: later-onset, lower ADHD comorbidity, more frequent episodic course, lower externalizing comorbidity, but increasing internalizing (anxiety) comorbidity, higher sensitivity to treatments, clinical features fitting diagnostic criteria for BD-I or BD-II. Conclusions: These findings suggest that more comprehensive phenotypes can be described according to the selected specifiers. Further validation of such a distinction would require prospective studies, exploring whether these subtypes represent different disorders, or whether they are part of a unique spectrum of related and partially overlapping illnesses. The stability of the two phenotypes is still unclear, but preliminary clinical suggestions indicate that part of the patients with the first phenotype may change their phenomenology during the course of the disorder. Key words: Bipolar disorder; mania; children; adolescents; phenotype; course Details   Price: €10.00 Options   Quantity 1 (this product is downloadable)  Add to cart

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