Carlyn Lampert

A family study of bipolar I disorder in adolescence: Early onset of symptoms linked to increased familial loading and lithium resistance

Lifetime rates of psychiatric illness were compared in relatives of adolescent probands with bipolar I disorder and in relatives of age-matched schizophrenic controls. Familial aggregation of major affective disorders was observed in bipolar probands, the rate of bipolar I disorder greatly exceeding that reported in relatives of adult bipolar probands. Adolescent probands with childhood onset of psychiatric disturbance were distinguished from probands who had no premorbid childhood psychiatric abnormality in two ways: (1) significantly increased aggregation of bipolar I disorder in first-degree relatives; and (2) poorer antimanic response to lithium carbonate. These data underscore important heterogeneity in adolescent-onset bipolar disorder.

Recovery and Relapse in Adolescents with Bipolar Affective Illness: A Five-Year Naturalistic, Prospective Follow-up

OBJECTIVE This study was a 5-year naturalistic prospective follow-up of 54 consecutive admissions of adolescents to a university inpatient service with a diagnosis of bipolar I affective illness. METHOD Subjects received structured clinical evaluations every 6 months after entry to establish time to recovery and subsequent relapse. Regression models were used to identify predictors of differential course. RESULTS Rate of recovery varied by polarity of episode at time of entry, with quick recovery observed in subjects with pure mania or mixed states, and a protracted index episode in subjects with pure depression. Multiple relapses were most often seen in subjects with mixed or cycling episodes at intake. CONCLUSIONS Polarity of illness may have utility in identifying bipolar adolescents with a more recurrent illness. Comparison with adult data suggests that recurrence risks may vary as a function of age at onset or stage of the disease process.

The course of major depressive disorder in adolescents: I. Recovery and risk of manic switching in a follow-up of psychotic and nonpsychotic subtypes.

Fifty-eight adolescents meeting Research Diagnostic Criteria (RDC) for major depressive disorder were observed for 24-months after inpatient admission in a prospective, naturalistic design study to assess time to recovery, risk of manic switching, and level and persistence of psychosocial impairment. Subjects were further categorized as psychotic or nonpsychotic by RDC. The cumulative probability of recovery by 24 months was high (90%); however, the episode was protracted with only 6.9% recovering within 12 weeks and only 29.3% recovering by week 20. Time to recovery did not vary by RDC subtype, but manic switching was observed only among psychotics, at a rate of 28%. Psychotics were more likely than were nonpsychotics to exhibit psychosocial impairment through 6 months of follow-up, but this difference narrows by 24 months. Implications of these findings for understanding developmental effects on the course and treatment of depression in adolescents are discussed.

Early childhood attention deficit hyperactivity disorder predicts poorer response to acute lithium therapy in adolescent mania.

We compared the response to acute lithium therapy in 30 adolescents, 13-17 years of age, with mania and a prior history of early childhood attention deficit hyperactivity disorder (ADHD) to a sex- and age-matched control group of adolescent manics without premorbid psychiatric illness. Response to treatment was assessed daily over the course of 28 days using measures of global clinical improvement and severity ratings on the Bech-Rafaelsen Mania Scale (BRMS). BRMS scores decreased by a mean of 24.3 in the subgroup without prior ADHD compared to 16.7 in patients with ADHD (P = 0.0005). The average percent drop in BRMS scores over the study period in these two subgroups was 80.6% and 57.7%, respectively (P = 0.0005). Time to onset of sustained global clinical improvement was also assessed using Kaplan-Meier survival methods and possible covariates of time to improvement were tested in a Cox proportional hazards model. Median time to onset of sustained improvement was lengthened significantly in patients with early ADHD (23 days) compared to those without it (17 days; log rank chi2 = 7.2, P = 0.007). The results suggest that early childhood ADHD defines an important source of heterogeneity in bipolar illness with developmental, clinical, and neuropharmacogenetic implications.

Intensity and predictors of treatment received by adolescents with unipolar major depression prior to hospital admission

We sought to characterize the type and intensity of treatment received in the community by 80 adolescents with unipolar major depressive disorder prior to hospital admission for this index episode of illness.