WebMD Medical News
Louise Chang, MD
Oct. 6, 2008 -- Children who are diagnosed with
bipolar disorder can continue to suffer from the disease as they develop
into young adults.
That's according to a new study by researchers at Washington University in
St. Louis, which was published in the October issue of Archives of General
The study appears amid an ongoing controversy about
diagnosing bipolar disorder in children. Much of the debate stems from an
exponential surge in the number of children being diagnosed with bipolar
disorder. Some experts believe it is uncommon and becoming over-diagnosed,
while others think just the opposite.
More articles on the condition were published in January 2008 than in the
decade between 1986 and 1996, highlighting many researchers' hope of better
understanding bipolar disorder.
Barbara Geller, MD, and her colleagues at Washington University followed a
sample of children diagnosed with pediatric bipolar disorder into
Beginning in 1995 to 1998, the researchers examined 115 children diagnosed
with bipolar disorder with an average age of 11. At the beginning of the study
and again during nine follow-up visits conducted over eight years, the children
and their parents were interviewed separately about their symptoms, diagnoses,
daily cycles of
depression, and interactions with others.
Ninety-four percent of the children completed the study, with 54 of these
patients turning 18 or older at the end of the follow-up period.
During the eight-year follow-up, the researchers found that the children's
first, second, and third episodes of mania included psychosis and daily cycling
between mania and depression for long periods of time. Many of them recovered
from these episodes, but about 73% of them relapsed.
After the follow-up period, Geller and her colleagues found that about 44%
of those who had bipolar disorder as children and who turned 18 by the end of
the study period continue to have manic episodes as young adults. Thirty-five
percent of them had substance use disorders, a rate similar to those diagnosed
with bipolar disorder as adults.
It is not yet understood why some patients did not experience manic episodes
as they matured, since that particular data has not been studied, says Geller.
However, she notes that it's unlikely to be due to a misdiagnosis.
"The study provides validation that the illness continues into adulthood
in a very large proportion of the children, and unfortunately like adults with
the disease, they have a high rate of substance dependence," says
"This is important for clinicians giving data to parents," continues
Geller. "The first question parents ask when their children are diagnosed
is if their children will have the illness as adults. Now we can say we have to
keep being very vigilant and keep following the children."
The study concluded that the severity and chronic nature of this disorder
highlights the need for a greater effort toward understanding the neurobiology
behind the disease and for developing prevention and intervention
Gary Sachs, MD, the director of the Bipolar Clinic and Research Program at
Massachusetts General Hospital, agrees that the study provides vital
information for moving the conversation about
childhood bipolar disorder forward.
"The article is important because it suggests that there are a fair
number of detectable cases in children and that a number of them continue to
express the illness after adulthood," says Sachs. "We all have to
recognize that these kids are out there, and now that we say they exist, let's
identify them appropriately with a formal diagnostic process."
The study also provides an important foundation for future research, writes
Ellen Leibenluft, MD, of the National Institute of Mental Health, in an
editorial that accompanied the study.
"The publication reflects our field's continuing efforts to nurture
development conceptualizations of psychiatric illnesses," she writes.
"Such conceptualizations hold the hope of fostering work that will allow us
to treat youth with bipolar disorder more effectively and eventually give us
the knowledge base needed to prevent the onset of bipolar disorder in youth at
SOURCES:Archives of General Psychiatry, October 2008; vol 65: pp
1125-1133.News release, JAMA/Archives.
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