Classifying Mood Symptom Trajectories in Adolescents With Bipolar Disorder - 20/02/20
, Christopher D. Schneck, MD b, David A. Axelson, MD c, Boris Birmaher, MD d, Robert A. Kowatch, MD, PhD c, David J. Miklowitz, PhD aAbstract |
Objective |
The Course and Outcome of Bipolar Youth study found that children and adolescents with bipolar spectrum disorders followed 1 of 4 distinct mood trajectories over 8 years of follow-up, with as many as 25% of participants showing a predominantly euthymic course. We evaluated whether similar patterns of illness course are observed in adolescents with bipolar I and II disorder who participated in a 2-year clinical trial.
Method |
A total of 144 adolescents with bipolar I or II disorder, identified shortly after a mood episode, were assessed over a 2-year period. Participants were randomly assigned to one of 2 psychosocial family treatments during the first 9 months of the study, and pharmacotherapy was provided throughout the 2 years. Using latent class growth analyses, we classified participants into distinct courses of illness based on mood ratings collected over the 2 years. We examined demographic and illness variables as predictors of these course classifications.
Results |
Latent class growth analyses indicated four mood trajectories: “predominantly euthymic” (29.9% of sample), “ill with significantly improving course” (11.1%), “moderately euthymic” (26.4%), and “ill with moderately improving course” (32.6%). Adolescents in these classes were euthymic 77.7%, 53.6%, 44.1%, and 18.6% of the weeks of follow-up, respectively. Psychosocial treatment condition and baseline medication exposure were not associated with trajectories. However, youth with more severe baseline depressive symptoms, suicidality, lower quality of life scores, and minority race/ethnicity had more symptomatic courses of illness over time.
Conclusion |
A substantial proportion (25%−30%) of youth with bipolar I or II disorder maintain euthymic states over extended periods of follow-up. Identifying youth who are more and less likely to remain stable over time may help guide psychosocial and pharmacological treatments after an illness episode.
Clinical trial registration information |
Effectiveness of Family-Focused Treatment Plus Pharmacotherapy for Bipolar Disorder in Adolescents; clinicaltrials.gov/; NCT00332098.
Le texte complet de cet article est disponible en PDF.Key words : latent class growth analysis, quality of life, early-onset, euthymic, recovery
Plan
| This article was reviewed under and accepted by Associate Editor Robert R. Althoff, MD, PhD. |
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| Financial support for this study was provided by the National Institute of Mental Health (NIMH) grants R01MH093676, R01MH073871, R01MH073817, R01MH074033, R34MH077856, and R34117200. |
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| The authors thank the following individuals for their assistance in data collection, data management, and treatment: Adrine Biuckians, PhD, Jedediah Bopp, PhD, Victoria Cosgrove, PhD, L. Miriam Dickinson, PhD, Dana Elkun, MA, MFA, Elizabeth George, PhD, Chris Hawkey, PhD, Jessica Lunsford-Avery, PhD, Zachary Millman, MS, Aimee Sullivan, PhD, Dawn Taylor, PhD, and Marianne Wamboldt, MD, at the University of Colorado, Boulder and University of Colorado Denver Health Sciences Center; and Mary Beth Hickey, BA, at the University of Pittsburgh Medical Center. |
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| Disclosure: Dr. Schneck has received research support from the NIMH and the Ryan White HIV/AIDS Treatment Extension Act. Dr. Axelson has received royalties from UpToDate and has served as a consultant for Janssen Research. Dr. Birmaher has received research support from NIMH and has received royalties from Random House, Lippincott Williams and Wilkins, and UpToDate. Dr. Kowatch has served on the Data Safety Monitoring Committees of Pfizer and Forest Pharmaceuticals. Dr. Miklowitz has received research funding from the NIMH, the Brain and Behavior Research Foundation, the Attias Family Foundation, the Danny Alberts Foundation, the Carl and Roberta Deutsch Foundation, the Kayne Family Foundation, the Max Gray Foundation, the American Foundation for Suicide Prevention, and AIM for Mental Health. He has received book royalties from Guilford Press and John Wiley and Sons. Dr. Weintraub has reported no biomedical financial interests or potential conflicts of interest. |
Vol 59 - N° 3
P. 381-390 - mars 2020 Retour au numéro
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