Diagnosis of child mania has been contentious.
To investigate natural history and prospective validation of the existence
and long-episode duration of mania in children.
Four-year prospective longitudinal study of 86 subjects with intake
episode mania who were all assessed at 6, 12, 18, 24, 36, and 48 months. The
phenotype was defined as DSM-IV bipolar I disorder
(manic or mixed) with at least 1 cardinal symptom (elation and/or grandiosity)
to ensure differentiation from attention-deficit/hyperactivity disorder. Parent
and child informants were separately interviewed, by highly experienced research
nurses, using the Washington University in St Louis Kiddie Schedule for Affective
Disorders and Schizophrenia (WASH-U-KSADS). A Children's Global Assessment
Scale score of 60 or less was needed to establish definite impairment. Treatment
was by subjects' community practitioners.
Research unit in a university medical school.
Subjects were obtained from psychiatric and pediatric sites by consecutive
new case ascertainment, and their baseline age was 10.8 ± 2.7 years.
Onset of the baseline episode was 7.4 ± 3.5 years. (Data are given
as mean ± SD.)
Main Outcome Measures
Episode duration, weeks ill, recovery/relapse rates, and outcome predictors.
Prospective episode duration of manic diagnoses, using onset of mania
as baseline date, was 79.2 ± 66.7 consecutive weeks. Any bipolar disorder
diagnosis occurred during 67.1% ± 28.5% of total weeks, during the
209.4 ± 3.3 weeks of follow-up. Subjects spent 56.9% ± 28.8%
of total weeks with mania or hypomania (unipolar or mixed), and 38.7% ±
28.8% of these were with mania. Major or minor depression and dysthymia (unipolar
or mixed) occurred during 47.1% ± 30.4% of total weeks. Polarity switches
occurred 1.1 ± 0.7 times per year. Low maternal warmth predicted faster
relapse after recovery from mania (χ2 = 13.6, P = .0002), and psychosis predicted more weeks ill with mania or hypomania
(F1,80 = 12.2, P = .0008). Pubertal status
and sex were not predictive. (Data are given as mean ± SD.)
These findings validate the existence, long-episode duration, and chronicity
of child mania. Differences from the natural history of adult bipolar disorder