Diagnostic characteristics of 93 cases of a prepubertal and early adolescent bipolar disorder phenotype by gender, puberty and comorbid attention deficit hyperactivity disorder

Objective: Etiopathogenetic and treatment studies require homogeneous pheno types. Therefore, effects of gender, puberty, and comorbid attention defici t hyperactivity disorder (ADHD) on DSM-nl mania criteria and other characte ristics of a prepubertal and early adolescent bipolar disorder (PEA-BP) phe notype were investigated. Method: Consecutively ascertained PEA-BP (with or without comorbid ADHD) ou tpatients (n = 93) were blindly assessed by research nurses with comprehens ive instruments given to mothers and children separately, consensus confere nces, and offsite blind best estimates of both diagnoses and mania items. T o fit the study phenotype, subjects needed to have current DSM-IV mania or hypomania with elated mood and/or grandiosity as one criterion and to be de finite cases by severity ratings. Results: Subjects were aged 10.9 +/- 2.6 years, had current episode length of 3.6 +/- 2.5 years, and had early age of onset at 7.3 +/- 3.5 years. No s ignificant differences were found by gender, puberty, or comorbid ADHD on r ates of mania criteria (e.g., elation, grandiosity, racing thoughts), mixed mania, psychosis, rapid cycling, suicidality, or comorbid oppositional def iant disorder (ODD), with few exceptions. Subjects with comorbid ADHD were more likely to be younger and male. Pubertal subjects had higher rates of h ypersexuality. Conclusions: These findings support that the PEA-BP phenotype is homogeneou s except for differences (hyperactivity, hypersexuality) that mirror normal development.