Skip to main content
×
Home
    • Aa
    • Aa

Evidence that bipolar disorder is the poor outcome fraction of a common developmental phenotype: an 8-year cohort study in young people

  • M. J. A. Tijssen (a1), J. van Os (a1) (a2), H.-U. Wittchen (a3) (a4), R. Lieb (a4) (a5), K. Beesdo (a3), R. Mengelers (a1), L. Krabbendam (a1) and M. Wichers (a1)...
Abstract
Background

Reported rates of bipolar syndromes are highly variable between studies because of age differences, differences in diagnostic criteria, or restriction of sampling to clinical contacts.

Method

In 1395 adolescents aged 14–17 years, DSM-IV (hypo)manic episodes (manic and hypomanic episodes combined), use of mental health care, and five ordinal subcategories representing the underlying continuous score of (hypo)manic symptoms (‘mania symptom scale’) were measured at baseline and approximately 1.5, 4 and 10 years later using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI).

Results

Incidence rates (IRs) of both (hypo)manic episodes and (hypo)manic symptoms (at least one DSM-IV core symptom) were far higher (714/105 person-years and 1720/105 person-years respectively) than traditional estimates. In addition, the risk of developing (hypo)manic episodes was very low after the age of 21 years [hazard ratio (HR) 0.031, 95% confidence interval (CI) 0.0050–0.19], independent of childhood disorders such as attention deficit hyperactivity disorder (ADHD). Most individuals with hypomanic and manic episodes were never in care (87% and 62% respectively) and not presenting co-morbid depressive episodes (69% and 60% respectively). The probability of mental health care increased linearly with the number of symptoms on the mania symptom scale. The incidence of the bipolar categories, in particular at the level of clinical morbidity, was strongly associated with previous childhood disorders and male sex.

Conclusions

This study showed, for the first time, that experiencing (hypo)manic symptoms is a common adolescent phenomenon that infrequently predicts mental health care use. The findings suggest that the onset of bipolar disorder can be elucidated by studying the pathway from non-pathological behavioural expression to dysfunction and need for care.

Copyright
Corresponding author
*Address for correspondence: Dr M. Wichers, Department of Psychiatry, Maastricht University, PO Box 616 (Vijverdal), 6200 MD Maastricht, The Netherlands. (Email: m.wichers@sp.unimaas.nl)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

HS Akiskal , ML Bourgeois , J Angst , R Post , H-J Möller , R Hirschfeld (2000). Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. Journal of Affective Disorders 59, S5–S30.

J Allardyce , T Suppes , J van Os (2007). Dimensions and the psychosis phenotype. International Journal of Methods in Psychiatric Research 16 (Suppl. 1), S34S40.

J Angst (1998). The emerging epidemiology of hypomania and bipolar II disorder. Journal of Affective Disorders 50, 143151.

J Angst , A Gamma , F Benazzi , V Ajdacic , D Eich , W Rössler (2003). Diagnostic issues in bipolar disorder. European Neuropsychopharmacology 13 (Suppl. 2), S43S50.

J Angst , A Marneros (2001). Bipolarity from ancient to modern times: conception, birth and rebirth. Journal of Affective Disorders 67, 3–19.

P Bebbington , R Ramana (1995). The epidemiology of bipolar affective disorder. Social Psychiatry and Psychiatric Epidemiology 30, 279292.

GA Carlson , EJ Bromet , S Sievers (2000). Phenomenology and outcome of subjects with early- and adult-onset psychotic mania. American Journal of Psychiatry 157, 213219.

GA Carlson , JH Kashani (1988). Manic symptoms in a non-referred adolescent population. Journal of Affective Disorders 15, 219226.

DJ Castle , RM Murray (1991). The neurodevelopmental basis of sex differences in schizophrenia. Psychological Medicine 21, 565575.

EJ Costello , S Mustillo , A Erkanli , G Keeler , A Angold (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry 60, 837844.

JA Egeland , AM Hostetter , DL Pauls , JN Sussex (2000). Prodromal symptoms before onset of manic-depressive disorder suggested by first hospital admission histories. Journal of the American Academy of Child and Adolescent Psychiatry 39, 12451252.

SV Faraone , J Biederman , S Milberger (1995). How reliable are maternal reports of their children's psychopathology? One-year recall of psychiatric diagnoses of ADHD children. Journal of the American Academy of Child and Adolescent Psychiatry 34, 10011008.

MB First (2006). Beyond clinical utility: broadening the DSM-V research appendix to include alternative diagnostic constructs. American Journal of Psychiatry 163, 16791681.

M Hanssen , M Bak , R Bijl , W Vollebergh , J van Os (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology 44, 181191.

A Henin , J Biederman , E Mick , DR Hirschfeld-Becker , GS Sachs , Y Wu , L Yan , J Ogutha , AA Nierenberg (2007). Childhood antecedent disorders to bipolar disorder in adults: a controlled study. Journal of Affective Disorders 99, 5157.

MHJ Hillegers , H Burger , M Wals , CG Reichart , FC Verhulst , WA Nolen , J Ormel (2004). Impact of stressful life events, familial loading and their interaction on the onset of mood disorders: study in a high risk cohort of adolescent offspring of parents with bipolar disorder. British Journal of Psychiatry 185, 97–101.

PR Joyce (1984). Age of onset in bipolar affective disorder and misdiagnosis as schizophrenia. Psychological Medicine 14, 145149.

LL Judd , HS Akiskal (2003). The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. Journal of Affective Disorders 73, 123131.

LL Judd , PJ Schettler , HS Akiskal (2002). The prevalence, clinical relevance, and public health significance of subthreshold depressions. Psychiatric Clinics of North America 25, 685698.

N Kaymaz , J van Os , R de Graaf , M ten Have , W Nolen , L Krabbendam (2007). The impact of subclinical psychosis on the transition from subclinical mania to bipolar disorder. Journal of Affective Disorders 98, 5564.

N Kennedy , J Boydell , S Kalidindi , P Fearon , PB Jones , J van Os , RM Murray (2005 a). Gender differences in incidence and age at onset of mania and bipolar disorder over a 35-year period in Camberwell, England. American Journal of Psychiatry 162, 257262.

RC Kessler , P Berglund , O Demler , R Jin , KR Merikangas , EE Walters (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593602.

RC Kessler , KA McGonagle , S Zhao , CB Nelson , M Hughes , S Eshleman , H-U Wittchen , KS Kendler (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry 51, 8–19.

L Krabbendam , J van Os (2005). Schizophrenia and urbanicity: a major environmental influence – conditional on genetic risk. Schizophrenia Bulletin 31, 795799.

JP Leff , M Fischer , A Bertelsen (1976). A cross-national epidemiological study of mania. British Journal of Psychiatry 129, 428442.

P Lewinsohn , DN Klein , JR Seeley (1995). Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. Journal of the American Academy of Child and Adolescent Psychiatry 34, 454463.

PM Lewinsohn , JR Seeley , DN Klein (2003). Bipolar disorders during adolescence. Acta Psychiatrica Scandinavica. Supplementum108, 4750.

R Lieb , B Isensee , K von Sydow , H-U Wittchen (2000). The Early Developmental Stages of Psychopathology study (EDSP): a methodological update. European Addiction Research 6, 170182.

JD Lish , S Dime-Meenan , PC Whybrow , RA Price , RMA Hirschfeld (1994). The National Depressive and Manic-depressive Association (DMDA) survey of bipolar members. Journal of Affective Disorders 31, 281294.

T Lloyd , N Kennedy , P Fearon , J Kirkbride , R Mallett , J Leff , J Holloway , G Harrison , P Dazzan , K Morgan , RM Murray , PB Jones (2005). Incidence of bipolar affective disorder in three UK cities: results from the AESOP study. British Journal of Psychiatry 186, 126131.

KR Merikangas , HS Akiskal , J Angst , PE Greenberg , RM Hirschfeld , M Petukhova , RC Kessler (2007). Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication. Archives of General Psychiatry 64, 543552.

AA Nierenberg , S Miyahara , T Spencer , SR Wisniewski , MW Otto , N Simon , MH Pollack , MJ Ostacher , L Yan , R Siegel , GS Sachs (2005). Clinical and diagnostic implications of lifetime attention-deficit/hyperactivity disorder comorbidity in adults with bipolar disorder: data from the first 1000 STEP-BD participants. Biological Psychiatry 57, 14671473.

H Pfister , H-U Wittchen (1995). M-CIDI Computer Program. Max-Planck-Institut für Psychiatrie, Klinisches Institut: Munich.

P Rasanen , J Tiihonen , H Hakko (1998). The incidence and onset-age of hospitalized bipolar affective disorder in Finland. Journal of Affective Disorders 48, 6368.

V Reed , F Gander , H Pfister , A Steiger , H Sonntag , C Trenkwalder , W Hundt , H-U Wittchen (1998). To what degree does the Composite International Diagnostic Interview (CIDI) correctly identify DSM-IV disorders? Testing validity issues in a clinical sample. International Journal of Methods in Psychiatric Research 7, 142155.

E Regeer , L Krabbendam , R de Graaf , M ten Have , W Nolen , J van Os (in press). Berkson's bias and the mood dimensions of bipolar disorder. International Journal of Methods in Psychiatric Research.

EJ Regeer , L Krabbendam , R de Graaf , M ten Have , WA Nolen , J van Os (2006). A prospective study of the transition rates of subthreshold (hypo)mania and depression in the general population. Psychological Medicine 36, 619627.

DA Regier , JH Boyd , JDJ Burke , DS Rae , JK Myers , M Kramer , LN Robins , LK George , M Karno , BZ Locke (1988). One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites. Archives of General Psychiatry 45, 977986.

J Spauwen , L Krabbendam , R Lieb , H-U Wittchen , J van Os (2006). Evidence that the outcome of developmental expression of psychosis is worse for adolescents growing up in an urban environment. Psychological Medicine 36, 407415.

CC Spicer , EH Hare , E Slater (1973). Neurotic and psychotic forms of depressive illness: evidence from age-incidence in a national sample. British Journal of Psychiatry 123, 535541.

E Szádóczky , Z Papp , J Vitrai , Z Ríhmer , J Füredi (1998). The prevalence of major depressive and bipolar disorders in Hungary: results from a national epidemiologic survey. Journal of Affective Disorders 50, 153162.

MM Weissman , RC Bland , GJ Canino , C Faravelli , S Greenwald , H-G Hwu , PR Joyce , EG Karam , C-K Lee , J Lellouch , J-P Lepine , SC Newman , M Rubio-Stipec , JE Wells , PJ Wickramaratne , H-U Wittchen , E-K Yeh (1996). Cross-national epidemiology of major depression and bipolar disorder. Journal of the American Medical Association 276, 293299.

H-U Wittchen (1994). Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. Journal of Psychiatric Research 28, 5784.

H-U Wittchen , G Lachner , U Wunderlich , H Pfister (1998 a). Test–retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI). Social Psychiatry and Psychiatric Epidemiology 33, 568578.

H-U Wittchen , S Mühlig , L Pezawas (2003). Natural course and burden of bipolar disorders. International Journal of Neuropsychopharmacology 6, 145154.

H-U Wittchen , A Perkonigg , G Lachner , CB Nelson (1998 b). Early Developmental Stages of Psychopathology study (EDSP): objectives and design. European Addiction Research 4, 1827.

H-U Wittchen , H Pfister (1997). DIA-X-Interviews: Manual for the screening procedure and interview; Longitudinal Interview (DIA-X-Lifetime); Additional Book (DIA-X-Lifetime); Cross-sectional Interview (DIA-X-12 monthly version); Additional Book (DIA-X-12 monthly version); Computer program to execute the interviews (longitudinal and cross-sectional studies). Analysis program. Swets & Zeitlinger: Frankfurt, Germany.

H-U Wittchen , LN Robins , LB Cottler , N Sartorius , JD Burker , D Regier (1991). Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials. British Journal of Psychiatry 159, 645653, 658.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: