A systematic review of the frequency and severity of manic symptoms reported in studies that compare phenomenology across children, adolescents and adults with bipolar disorders

International Journal of Bipolar Disorders, Feb 2017

Background In the last two decades, there has been a significant increase in the diagnosis of Bipolar Disorder (BD) in children. The notion of prepubertal onsets of BD is not without controversy, with researchers debating whether paediatric cases have a distinct symptom profile or follow a different illness trajectory from other forms of BD. The latter issue is difficult to address without long-term prospective follow-up studies. However, in the interim, it is useful to consider the phenomenology observed in groups of cases with different ages of onset and particularly to compare manic symptoms in children diagnosed with BD compared to cases presenting with BD in adolescence and adulthood. This review systematically explores the phenomenology of manic or hypomanic episodes in groups defined by age at onset of BD (children, adolescents and adults; or combined age groups e.g. children and adolescents versus adults). Methods Literature reviews of PubMed and Scopus were conducted to identify publications which directly compared the frequency or severity of manic symptoms in individuals with BD presenting with a first episode of mania in childhood, adolescence or adulthood. Results Of 304 studies identified, 55 texts warranted detailed review, but only nine studies met eligibility criteria for inclusion. Comparison of manic symptoms across age groups suggested that irritability is a key feature of BD with an onset in childhood, activity is the most prominent in adolescent-onset BD and pressure of speech is more characteristic of adult-onset BD. However, none of the eligible studies made a direct comparison of phenomenology in children versus adults. Assessment procedures varied in quality and undermined the reliability of cross-study comparisons. Other limitations were: the scarcity of comparative studies, the geographic bias (most studies originated in the USA), the failure to fully consider the impact of psychiatric comorbidities on recorded symptoms and methodological heterogeneity. Conclusions Despite frequent discussion of similarities and differences in phenomenology of mania presenting in different age groups, systematic research is lacking and studies are still required to reliably establish whether the frequency and severity of manic symptoms varies. Such information has implications for clinical practice and the classification of mental disorders.

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A systematic review of the frequency and severity of manic symptoms reported in studies that compare phenomenology across children, adolescents and adults with bipolar disorders

Ryles et al. Int J Bipolar Disord A systematic review of the frequency and severity of manic symptoms reported in studies that compare phenomenology across children, adolescents and adults with bipolar disorders Faye Ryles 1 4 Thomas D. Meyer 1 3 Jaime Adan‑Manes 1 2 Iain MacMillan 1 4 Jan Scott 0 1 0 Academic Psychiatry, Wolfson Unit, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University , Newcastle upon Tyne , UK 1 Keywords: Systematic review , Mania, Phenomenology, Children, Adolescents, Adults, Manic symptoms, Irritability, Activity, Cognition 2 Department of Psychiatry, La Princesa Hospital , Madrid , Spain 3 Department of Psychiatry and Behavioral Sciences, University of Texas , Houston, TX , USA 4 Early Intervention in Psychiatry Hub, NTW NHS Trust , Newcastle upon Tyne , UK Background: In the last two decades, there has been a significant increase in the diagnosis of Bipolar Disorder (BD) in children. The notion of prepubertal onsets of BD is not without controversy, with researchers debating whether paediatric cases have a distinct symptom profile or follow a different illness trajectory from other forms of BD. The latter issue is difficult to address without long‑ term prospective follow‑ up studies. However, in the interim, it is useful to consider the phenomenology observed in groups of cases with different ages of onset and particularly to compare manic symptoms in children diagnosed with BD compared to cases presenting with BD in adolescence and adulthood. This review systematically explores the phenomenology of manic or hypomanic episodes in groups defined by age at onset of BD (children, adolescents and adults; or combined age groups e.g. children and adolescents versus adults). Methods: Literature reviews of PubMed and Scopus were conducted to identify publications which directly compared the frequency or severity of manic symptoms in individuals with BD presenting with a first episode of mania in childhood, adolescence or adulthood. Results: Of 304 studies identified, 55 texts warranted detailed review, but only nine studies met eligibility criteria for inclusion. Comparison of manic symptoms across age groups suggested that irritability is a key feature of BD with an onset in childhood, activity is the most prominent in adolescent‑ onset BD and pressure of speech is more characteristic of adult‑ onset BD. However, none of the eligible studies made a direct comparison of phenomenology in children versus adults. Assessment procedures varied in quality and undermined the reliability of cross‑ study comparisons. Other limitations were: the scarcity of comparative studies, the geographic bias (most studies originated in the USA), the failure to fully consider the impact of psychiatric comorbidities on recorded symptoms and methodological heterogeneity. Conclusions: Despite frequent discussion of similarities and differences in phenomenology of mania presenting in different age groups, systematic research is lacking and studies are still required to reliably establish whether the frequency and severity of manic symptoms varies. Such information has implications for clinical practice and the classification of mental disorders. - Background Bipolar Disorder (BD) is a severe mental disorder that involves changes in mood, cognition and behaviour. It can be divided into three broad subgroups: BD-I (characterized by episodes of mania and depression); BD-II (hypomania and depression) and a heterogeneous group that is sometimes referred to as ‘spectrum disorders’, which includes BD-NOS (Not Otherwise Specified), cyclothymia, and other less well-defined BD-like syndromes (Akiskal et al. 2000; American Psychiatric Association (APA) 2000, 2013). The worldwide prevalence of all manifestations of BD is about 4% (Angst 1988). The peak age of onset is 15–25  years, but the incidence remains quite high throughout early and mid-adult life (Merikangas et  al. 2011). It is suggested that cases with adolescent or adult onset typically present with similar symptom profiles for each phase of the disorder e.g. manic, hypomanic, depressive and mixed episodes (where depressive and manic symptoms occur simultaneously), and that the frequency of different types of episodes are also comparable (e.g. depressive episodes are common; mixed states are relatively rare) (Angst 1988). There have been some variations reported in these characteristics by age of onset, but overall cases presenting in adolescence or adulthood are usually regarded as having ‘adult-pattern’ BD with distinct episodes (Carlson 2011; Merikangas et al. 2011; Douglas and Scott 2014). In the last two decades, there has been a significant increase in the diagnosis of BD in childhood, the socalled paediatric or juvenile-onset form of BD (Moreno et  al. 2007). The notion of prepubertal onsets of BD is not universally accepted, with researchers debating everything from whether the condition exists in this age group (or if it is (...truncated)


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Faye Ryles, Thomas D. Meyer, Jaime Adan-Manes, Iain MacMillan, Jan Scott. A systematic review of the frequency and severity of manic symptoms reported in studies that compare phenomenology across children, adolescents and adults with bipolar disorders, International Journal of Bipolar Disorders, 2017, pp. 4, Volume 5, Issue 1, DOI: 10.1186/s40345-017-0071-y