Characteristics prior to and at time of diagnosis in pediatric bipolar disorder
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Characteristics prior to and at time of diagnosis in pediatric bipolar disorder. / Frahm Laursen, Mathilde; Correll, Christoph U.; Licht, Rasmus W.; Rodrigo-Domingo, María; Pagsberg, Anne Katrine; Nielsen, René Ernst.
I: Nordic Journal of Psychiatry, Bind 77, Nr. 3, 2023, s. 282-292.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Characteristics prior to and at time of diagnosis in pediatric bipolar disorder
AU - Frahm Laursen, Mathilde
AU - Correll, Christoph U.
AU - Licht, Rasmus W.
AU - Rodrigo-Domingo, María
AU - Pagsberg, Anne Katrine
AU - Nielsen, René Ernst
N1 - Publisher Copyright: © 2022 The Nordic Psychiatric Association.
PY - 2023
Y1 - 2023
N2 - Objectives: Describe symptoms before and at time of register-diagnosis in children and adolescents. Methods: A random sample was selected for chart-review from a Danish nationwide cohort of patients <18 years registered with an incident ICD-10 register-diagnosis of single hypomanic/manic episode or bipolar disorder between 1995 and 2014. Patients with symptoms which adequately documented a BD diagnosis in the chart were included for analysis. Results: 521 were diagnosed in the study period. A random sample of 25% were selected, and 106 charts were possible to retrieve, with 48 chart reviews resulting in confirmation of diagnosis. Time from first reported affective symptoms to diagnosis was 2.6 ± 2.7 years for depressive symptoms, 2.5 ± 2.9 years for mixed symptoms, 1.4 ± 1.6 years for hypomanic symptoms, and 0.4 ± 0.5 years for manic symptoms. A hierarchical clustering analysis revealed three patient-profiles: primarily hypomanic/manic, primarily depressive, and more rare, primarily mixed profile. Frequently reported symptoms prior to diagnosis include anhedonia (79%), irritability (71%), hyperactivity (62.5%), decreased energy (62.5%), and psychotic symptoms (52%). Symptoms of ADHD (19%), comorbid ADHD (15%), symptoms of anxiety (52%), comorbid anxiety (4%), suicidal thoughts (50%), suicide attempts (8%), cutting (23%), substance misuse (21%), and criminal activity (10%) were reported before incident BD diagnosis. Conclusion: The observed patient-profiles leading to diagnosis were primarily manic or depressive, resembling presentations in adults. The presence of ADHD, anxiety, suicide attempts, cutting, and criminal activity prior to diagnosis emphasizes the need for treatment of children and adolescents with affective symptoms. The gap from appearance of the symptoms to diagnosis suggests a window for earlier treatment.
AB - Objectives: Describe symptoms before and at time of register-diagnosis in children and adolescents. Methods: A random sample was selected for chart-review from a Danish nationwide cohort of patients <18 years registered with an incident ICD-10 register-diagnosis of single hypomanic/manic episode or bipolar disorder between 1995 and 2014. Patients with symptoms which adequately documented a BD diagnosis in the chart were included for analysis. Results: 521 were diagnosed in the study period. A random sample of 25% were selected, and 106 charts were possible to retrieve, with 48 chart reviews resulting in confirmation of diagnosis. Time from first reported affective symptoms to diagnosis was 2.6 ± 2.7 years for depressive symptoms, 2.5 ± 2.9 years for mixed symptoms, 1.4 ± 1.6 years for hypomanic symptoms, and 0.4 ± 0.5 years for manic symptoms. A hierarchical clustering analysis revealed three patient-profiles: primarily hypomanic/manic, primarily depressive, and more rare, primarily mixed profile. Frequently reported symptoms prior to diagnosis include anhedonia (79%), irritability (71%), hyperactivity (62.5%), decreased energy (62.5%), and psychotic symptoms (52%). Symptoms of ADHD (19%), comorbid ADHD (15%), symptoms of anxiety (52%), comorbid anxiety (4%), suicidal thoughts (50%), suicide attempts (8%), cutting (23%), substance misuse (21%), and criminal activity (10%) were reported before incident BD diagnosis. Conclusion: The observed patient-profiles leading to diagnosis were primarily manic or depressive, resembling presentations in adults. The presence of ADHD, anxiety, suicide attempts, cutting, and criminal activity prior to diagnosis emphasizes the need for treatment of children and adolescents with affective symptoms. The gap from appearance of the symptoms to diagnosis suggests a window for earlier treatment.
KW - Bipolar disorder
KW - characteristics
KW - pediatric onset
KW - symptoms
U2 - 10.1080/08039488.2022.2096112
DO - 10.1080/08039488.2022.2096112
M3 - Journal article
C2 - 35816446
AN - SCOPUS:85133659894
VL - 77
SP - 282
EP - 292
JO - Nordisk Psykiatrisk Tidsskrift
JF - Nordisk Psykiatrisk Tidsskrift
SN - 0803-9496
IS - 3
ER -
ID: 325889680