Retrospective age at onset of bipolar disorder and outcome during two-year follow-up: results from the STEP-BD study
Roy H Perlis
Bipolar Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
Search for more papers by this authorEllen B Dennehy
Department of Psychological Sciences, Purdue University, West Lafayette, IN
Search for more papers by this authorDavid J Miklowitz
Departments of Psychology and Psychiatry, University of Colorado, Boulder, CO
Search for more papers by this authorMelissa P DelBello
Bipolar Disorders Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati
Search for more papers by this authorMichael Ostacher
Bipolar Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
Search for more papers by this authorJoseph R Calabrese
University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
Search for more papers by this authorRebecca M Ametrano
Bipolar Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
Search for more papers by this authorStephen R Wisniewski
Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA
Search for more papers by this authorCharles L Bowden
Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX
Search for more papers by this authorMichael E Thase
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
Search for more papers by this authorAndrew A Nierenberg
Bipolar Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
Search for more papers by this authorGary Sachs
Bipolar Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
Search for more papers by this authorRoy H Perlis
Bipolar Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
Search for more papers by this authorEllen B Dennehy
Department of Psychological Sciences, Purdue University, West Lafayette, IN
Search for more papers by this authorDavid J Miklowitz
Departments of Psychology and Psychiatry, University of Colorado, Boulder, CO
Search for more papers by this authorMelissa P DelBello
Bipolar Disorders Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati
Search for more papers by this authorMichael Ostacher
Bipolar Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
Search for more papers by this authorJoseph R Calabrese
University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
Search for more papers by this authorRebecca M Ametrano
Bipolar Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
Search for more papers by this authorStephen R Wisniewski
Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA
Search for more papers by this authorCharles L Bowden
Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX
Search for more papers by this authorMichael E Thase
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
Search for more papers by this authorAndrew A Nierenberg
Bipolar Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
Search for more papers by this authorGary Sachs
Bipolar Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
Search for more papers by this authorThis project has been funded in whole or in part with federal funds from the National Institute of Mental Health (NIMH), NIH. Any opinions, findings, and conclusions or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the NIMH. This article was approved by the publication committee of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Individual disclosures are listed before the references.
Abstract
Objective: Symptoms of bipolar disorder are increasingly recognized among children and adolescents, but little is known about the course of bipolar disorder among adults who experience childhood onset of symptoms.
Methods: We examined prospective outcomes during up to two years of naturalistic treatment among 3,658 adult bipolar I and II outpatients participating in a multicenter clinical effectiveness study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Age at illness onset was identified retrospectively by clinician assessment at study entry.
Results: Compared to patients with onset of mood symptoms after age 18 years (n = 1,187), those with onset before age 13 years (n = 1,068) experienced earlier recurrence of mood episodes after initial remission, fewer days of euthymia, and greater impairment in functioning and quality of life over the two-year follow-up. Outcomes for those with onset between age 13 and 18 years (n = 1,403) were generally intermediate between these two groups.
Conclusion: Consistent with previous reports in smaller cohorts, adults with retrospectively obtained early-onset bipolar disorder appear to be at greater risk for recurrence, chronicity of mood symptoms, and functional impairment during prospective observation.
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