Abstract
Bipolar disorder in children and adolescents is a major public health problem associated with significant functional impairment. Similar to adults with bipolar disorder, children and adolescents are at increased risk for substance-related disorders, weight problems, and impaired social support systems. Substance-related problems complicate treatment course. They often follow the onset of bipolar disorder; thus, the opportunity for prevention and/or early intervention exists. Evidence supports an association between mood disorders and weight gain. Psychotropic agents to treat bipolar disorder, particularly some second-generation antipsychotics, may be associated with weight gain. Obesity is associated with worse outcomes in bipolar disorder, so prevention of weight gain is clinically important. Environmental factors may contribute to relapse, so interventions to optimize social support systems are being evaluated. Pediatric bipolar disorder requires comprehensive management to achieve optimal outcome. Further research to study modifiable factors that contribute to its morbidity and chronicity is needed.
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Geller B, Tillman R, Craney JL, et al.: Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Arch Gen Psychiatry 2004, 61: 459–467.
Lish JD, Dime-Meenan S, Whybrow PC, et al.: The National Depressive and Manic-Depressive Association (DMDA) survey of bipolar members. J Affect Disord 1994, 31: 281–294.
Perlis RH, Miyahara S, Marangell LB, et al.: Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Biol Psychiatry 2004, 55: 875–881.
Pavuluri MN, Birmaher B, Naylor MW: Pediatric bipolar disorder: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 2005, 44: 846–871.
Lewinsohn PM, Klein DN, Seeley JR: Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. J Am Acad Child Adolesc Psychiatry 1995, 34: 454–463.
Katzow JJ, Hsu DJ, Ghaemi SN: The bipolar spectrum: a clinical perspective. Bipolar Disord 2003, 5: 436–442.
Gershon ES, Hamovit JH, Guroff JJ, et al.: Birth-cohort changes in manic and depressive disorders in relatives of bipolar and schizoaffective patients. Arch Gen Psychiatry 1987, 44: 314–319.
Horwarth E, Cohen RS, Weissman MM: Epidemiology of depressive and anxiety disorders. In Textbook in Psychiatric Epidemiology, edn 2. Edited by Tsuang MT, Tohen M. New York: Wiley-Liss; 2002: 389–426.
Lange KJ, McInnis MG: Studies of anticipation in bipolar affective disorder. CNS Spectr 2002, 7: 196–202.
Harpaz IH, Leslie DL, Martin A, et al.: Changes in child and adolescent inpatient psychiatric admission diagnoses between 1995 and 2000. Soc Psychiatry Psychiatr Epidemiol 2005, 40: 642–647.
Sajatovic M: Bipolar disorder: disease burden. Am J Manag Care 2005, 11(3 Suppl): S80–S84.
Wozniak J, Biederman J, Kiely K, et al.: Mania-like symptoms suggestive of childhood-onset bipolar disorder in clinically referred children. J Am Acad Child Adolesc Psychiatry 1995, 34: 867–876.
Kovacs M, Pollock M: Bipolar disorder and comorbid conduct disorder in childhood and adolescence. J Am Acad Child Adolesc Psychiatry 1995, 34: 715–723.
Cooke RG, Robb JC, Young LT, et al.: Well-being and functioning in patients with bipolar disorder assessed using the MOS 20-Item short form (SF-20). J Affect Disord 1996, 39: 93–97.
Strober M, Schmidt-Lackner S, Freeman R, et al.: Recovery and relapse in adolescents with bipolar affective illness: a five-year naturalistic, prospective follow-up. J Am Acad Child Adolesc Psychiatry 1995, 34: 724–731.
Kowatch RA, Youngstrom EA, Danielyan A, et al.: Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescents. Bipolar Disord 2005, 7: 483–496.
West SA, Strakowski SM, Sax KW, et al.: Phenomenology and comorbidity of adolescents hospitalized for the treatment of acute mania. Biol Psychiatry 1996, 39: 458–460.
Geller F, Cooper TB, Sun K, et al.: Double-blind and placebo-controlled study of lithium for adolescent bipolar disorders with secondary substance dependency. J Am Acad Child Adolesc Psychiatry 1998, 37: 171–178.
Famularo R, Stone K, Popper C: Preadolescent alcohol abuse and dependence. Am J Psychiatry 1985, 142: 1187–1189.
Todd RD, Geller B, Neuman R, et al.: Increased prevalence of alcoholism in relatives of depressed and bipolar children. J Am Acad Child Adolesc Psychiatry 1996, 35: 716–724.
Strakowski SM, DelBello MP, Fleck DE, et al.: Effects of co-occurring alcohol abuse on the course of bipolar disorder following a first hospitalization for mania. Arch Gen Psychiatry 2005, 62: 851–858.
Wilens TE, Biederman J, Kwon A, et al.: Risk of substance abuse disorders in adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2004, 43: 1380–1386.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.
Kowatch RA, Fristad M, Birmaher B, et al.: Treatment guidelines for children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2005, 44: 213–235.
Centers for Disease Control and Prevention (CDC): Annual smoking-attributable mortality, years of potential life lost, and productivity losses-United States, 1997–2001. MMWR Morb Mortal Wkly Rep 2005, 54: 625–628.
Grant BF, Hasin DS, Chou SP, et al.: Nicotine dependence and psychiatric disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry 2004, 61: 1107–1115.
Waxmonsky JA, Thomas MR, Miklowitz DJ, et al.: Prevalence and correlates of tobacco use in bipolar disorder: data from the first 2000 participants in the Systematic Treatment Enhancement Program. Gen Hosp Psychiatry 2005, 27: 321–328.
Wilens TE, Biederman J, Milberger S, et al.: Is bipolar disorder a risk for cigarette smoking in ADHD? Am J Addict 2000, 9: 187–195.
Ogden CL, Carroll MD, Curtin LR, et al.: Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006, 295: 1549–1555.
Simon GE, Von Korff M, Saunders K, et al.: Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry 2006, 63: 824–830.
Elmslie JL, Silverstone JT, Mann JI, et al.: Prevalence of overweight and obesity in bipolar patients. J Clin Psychiatry 2000, 61: 179–184.
McElroy SL, Frye MA, Suppes T, et al.: Correlates of overweight and obesity in 644 patients with bipolar disorder. J Clin Psychiatry 2002, 63: 207–213.
Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL: Overweight and obesity in the United States: prevalence and trends, 1960–1994. Int J Obes Relat Metab Disord 1998, 22: 39–47.
Geller B, Zimerman B, Williams M, et al.: Bipolar disorder at prospective follow-up of adults who had prepubertal bipolar disorder. Am J Psychiatry 2001, 158: 125–127.
Pine DS, Goldstein RB, Wolk S, et al.: The association between childhood depression and adulthood body mass index. Pediatrics 2001, 107: 1049–1056.
Hasler F, Pine DS, Kleinbaum DG, et al.: Depressive symptoms during childhood and adult obesity: the Zurich Cohort Study. Mol Psychiatry 2005, 10: 842–850.
Anderson SE, Cohen P, Naumova EN, et al.: Association of depression and anxiety disorders with weight change in a prospective community-based study of children followed up into adulthood. Arch Pediatr Adolesc Med 2006, 160: 285–291.
Fagiolini A, Kupfer DJ, Houck PR, et al.: Obesity as a correlate of outcome in patients with bipolar I disorder. Am J Psychiatry 2003, 160: 112–117.
Keck PE, McElroy SL: Bipolar disorder, obesity, and pharmacotherapy-associated weight gain. J Clin Psychiatry 2003, 64: 1426–1435.
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity: Consensus development conference on antipsychotic drugs and obesity and diabetes. J Clin Psychiatry 2004, 65: 267–272.
Biederman J, Mick E, Wozniak J, et al.: An open-label trial of risperidone in children and adolescents with bipolar disorder. J Child Adolesc Psychopharmacol 2005, 15: 311–317.
DelBello MP, Schwiers ML, Rosenberg HL, et al.: A double-blind, randomized, placebo-controlled study of quetiapine as adjunctive treatment for adolescent mania. J Am Acad Child Adolesc Psychiatry 2002, 41: 1216–1223.
Findling RL, McNamara NK, Gracious BL, et al.: Combination lithium and valproex sodium in pediatric bipolarity. J Am Acad Child Adolesc Psychiatry 2003, 42: 895–901.
Frazier JA, Biederman J, Tohen M, et al.: A prospective open-label trial of olanzapine monotherapy in children and adolescents with bipolar disorder. J Child Adolesc Psychopharmacol 2001, 11: 239–250.
Masi G, Mucci M, Millepiedi S: Clozapine in adolescent inpatients with acute mania. J Child Adolesc Psychopharmacol 2002, 12: 93–99.
Pavuluri MN, Henry DB, Devineni B, et al.: A pharmacotherapy algorithm for stabilization and maintenance of pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 2004, 43: 859–867.
Pavuluri MN, Henry DB, Carbray JA, et al.: Open-label prospective trial of risperidone in combination with lithium or divalproex sodium in pediatric mania. J Affect Disord 2004, 82(Suppl 1): 103–111.
Pavuluri MN, Henry DB, Carbray JA, et al.: Divalproex sodium for pediatric mixed mania: a 6-month prospective trial. Bipolar Disord 2005, 7: 266–273.
Frazier JA, Meyer MC, Biederman J, et al.: Risperidone treatment for juvenile bipolar disorder: a retrospective chart review. J Am Acad Child Adolesc Psychiatry 1999, 38: 960–965.
DelBello MP, Kowatch RA, Warner J, et al.: Adjunctive topiramate treatment for pediatric bipolar disorder: a retrospective chart review. J Child Adolesc Psychopharmacol 2002, 12: 323–330.
Kafantaris V, Coletti DJ, Dicker R, et al.: Lithium treatment of acute mania in adolescents: a large open trial. J Am Acad Child Adolesc Psychiatry 2003, 42: 1038–1045.
Morriss R, Mohammed F: Metabolism, lifestyle, and bipolar affective disorder. J Psychopharmacol 2005, 19(6 Suppl): 94–101.
Geller B, Bolhfner K, Craney JF, et al.: Psychosocial functioning in a prepubertal and early adolescent bipolar disorder phenotype. J Am Acad Child Adolesc Psychiatry 2000, 39: 1543–1548.
Geller B, Craney JL, Bolhofner K, et al.: Two-year prospective follow-up of children with a prepubertal and early adolescent bipolar disorder phenotype. Am J Psychiatry 2002, 159: 927–933.
Alloy LB, Abramson LY, Urosevic S, et al.: The psychosocial context of bipolar disorder: environmental, cognitive and developmental risk factors. Clin Psychol Rev 2005, 25: 1043–1075.
Brown GW, Monck EM, Carstairs FM, et al.: Influence of family life on the course of schizophrenic illness. Br J Prev Soc Med 1962, 1: 55–68.
Miklowitz DJ, Goldstein MJ, Nuechterlain KH, et al.: Family factors and the course of bipolar affective disorder. Arch Gen Psychiatry 1988, 45: 225–231.
Fristad MA, Gavazzi SM, Mackinaw-Koons B: Family psychoeducation: an adjunctive intervention for children with bipolar disorder. Biol Psychiatry 2003, 53: 1000–1008.
Pavuluri MN, Graczyk PA, Henry DB, et al.: Child- and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: development and preliminary results. J Am Acad Child Adolesc Psychiatry 2004, 43: 528–537.
Frank E, Hlastala S, Ritenour A, et al.: Inducing lifestyle regularity in recovering bipolar disorder patients: results from the maintenance therapies in bipolar disorder protocol. Biol Psychiatry 1997, 41: 1165–1173.
Malkoff-Schwartz S, Frank E, Anderson B, et al.: Stressful life events and social rhythm disruption in the onset of manic and depressive bipolar episodes. Arch Gen Psychiatry 1998, 55: 702–707.
Schroeder SA: What to do with a patient who smokes. JAMA 2005, 29: 482–487.
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Jolin, E.M., Weller, E.B. & Weller, R.A. The public health aspects of bipolar disorder in children and adolescents. Curr Psychiatry Rep 9, 106–113 (2007). https://doi.org/10.1007/s11920-007-0079-6
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DOI: https://doi.org/10.1007/s11920-007-0079-6