Few Bipolar Adolescents Recover Fully From First Manic Episode

CINCINNATI—Adolescents with bipolar disorder have a poor recovery following their first hospitalization for a manic episode, say researchers at the University of Cincinnati (UC).

A study led by Melissa DelBello, MD, and published in the April 2007 issue of the American Journal of Psychiatry, shows that while 85 percent of the adolescents studied experienced a “syndromic” recovery (no longer meeting full diagnostic criteria for bipolar disorder), only 39 percent showed significant symptom reduction and full functional recovery. The study also found that a majority of the hospitalized adolescents failed to take medications as prescribed.

“Very few studies have looked at the outcomes of adolescents with bipolar disorder,” says DelBello, associate professor in the department of psychiatry. “And none—to our knowledge—looked at syndromic, symptomatic and functional recovery along with medication adherence.”

The research team studied 71 adolescents hospitalized for a manic or mixed (manic/depressive) bipolar episode. The patients were evaluated during hospitalization and at one, four, eight and 12 months after.

Only 35 percent (25 adolescents) reported full medication adherence. The authors also found that boys experience greater symptomatic recovery than girls.

Recurrence following syndromic recovery was more likely among patients who took antidepressants and those who abused alcohol. It was less common among those who received psychotherapy.

Bipolar disorder is a mood disorder characterized by periods of extreme highs (manic states) and lows. Manic episodes can be accompanied by increased energy, unusual behavior, racing thoughts, limited sleep, poor judgment and unrealistic beliefs in one’s abilities.

A National Institute of Mental Health (NIMH)–supported study estimates that 1 percent of adolescents between 14 and 18 meet the criteria for bipolar disorder, or a similar, milder illness known as cyclothymia—suggesting it may be as common among youths as it is among adults.

“Further studies of longer duration are needed to determine whether adolescents with bipolar disorder ultimately progress into adults with bipolar disorder,” the authors write.

The study was supported by the NIMH, part of the National Institutes of Health.

Coauthors—all from UC—include Caleb Adler, MD, David Fleck, MD, Dennis Hanseman, PhD, and Stephen Strakowski, MD.