Six-month stability and outcome of a prepubertal and early adolescent bipolar disorder phenotype

Objective: Six-month follow-up data are provided on a prepubertal and early adolescent bipolar disorder phenotype (PEA-BP). Stabilities were defined a s continuous presence of PEA-BP and of individual mania criteria between ba seline and 6 months. Method: Baseline and 6-month assessments of consecutively ascertained PEA-B P outpatients (n = 91) included comprehensive instruments given to mothers and children, separately, by research nurses; consensus conferences; and of fsite blind best estimates of both diagnoses and mania items. To fit the st udy phenotype, subjects needed to have current DSM-IV mania or hypomania wi th elated mood and/or grandiosity as one mania criterion and to be definite cases by severity ratings. Results: Of the 93 baseline subjects, 91 completed the 6-month assessment, for a retention rate of 97.8%. Baseline age was 10.9 +/- 2.7 years, and age of onset of current episode was 7.3 +/- 3.5 years. At 6 months, 85.7% stil l had full criteria and severity for mania or hypomania, and only 14.3% had recovered. Six-month stabilities of elated mood and grandiosity were high. Cox modeling and logistic regression did not show any significant effect o f multiple covariates (e.g., gender, puberty, psychosis, mixed mania, rapid cycling, or naturalistic treatment). Conclusions: These longitudinal stability findings provide validation of a PEA-BP phenotype. Poor outcome was consistent,vith similarity of PEA-BP bas eline characteristics to those of treatment-resistant adult-onset mania.