Targeting Specific Factors Might Improve Bipolar Disorder Outcomes

Aprospective study on bipolar disorder in youth, led by Boris Birmaher, M.D., has identified a number of factors associated with the development of stable mood over the long term.

Birmaher, a professor of psychiatry at the University of Pittsburgh, reported the study results at the 25th Annual New York Mental Health Research Symposium of the Brain & Behavior Research Foundation in New York City in October. While there, he was also honored for outstanding achievements in childhood-onset bipolar disorder research.

Birmaher and his coworkers followed 367 children with bipolar disorder for an average of eight years to determine their prognosis. At the end of the period, about 45 percent were doing “relatively well”—that is, had had a stable mood for most of the follow-up period.

The findings by Birmaher and his team also showed that youth whose illness started later in adolescence; who at intake had less severe depressive and manic symptoms, less suicidality, and less substance abuse; and who lived in families with a higher socioeconomic status were more likely to do well. These findings suggest that treatments that could delay the onset of the illness or target the other factors might be able to increase the chances of achieving a lasting stable mood, Birmaher and his coworkers contended.

Birmaher and his group would also like to determine whether youth with bipolar disorder are going to have the disorder for the rest of their lives. Some of the subjects in their study have been off bipolar medications for several years now and are doing well, he said. But whether that will continue to be the case is not known, he admitted. It could be that “the illness will again kick in, especially under stress.”

An audience member asked Birmaher how bipolar disorder can be differentiated from ADHD in children. It can be difficult, he replied, since symptoms such as impulsivity, hyperactivity, and excessive talking can indicate either bipolar disorder or ADHD. But if the symptoms tend to be episodic rather than chronic, and the typical manic symptoms cluster together, it may be a sign that a child has bipolar illness instead of ADHD, he said. ■

To watch a video interview with Birmaher, go to http://bbrfoundation.org/brain-matters-discoveries/watch-dr-boris-birmaher%E2%80%99s-video-2013-colvin-prize-for-outstanding.