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Objective: The authors sought to assess the longitudinal course of youths with bipolar spectrum disorders over a 4-year period. Method: At total of 413 youths (ages 717 years) with bipolar I disorder (N=244), bipolar II disorder (N=28), and bipolar disorder not otherwise specified (N=141) were enrolled in the study. Symptoms were ascertained retrospectively on average every 9.4 months for 4 years using the Longitudinal Interval Follow-Up Evaluation. Rates and time to recovery and recurrence and week-by-week symptomatic status were analyzed. Results: Approximately 2.5 years after onset of their index episode, 81.5% of the participants had fully recovered, but 1.5 years later 62.5% had a syndromal recurrence, particularly depression. One-third of the participants had one syndromal recurrence, and 30% had two or more. The polarity of the index episode predicted that of subsequent episodes. Participants were symptomatic during 60% of the follow-up period, particularly with subsyndromal symptoms of depression and mixed polarity, with numerous changes in mood polarity. Manic symptomatology, especially syndromal, was less frequent, and bipolar II was mainly manifested by depressive symptoms. Overall, 40% of the participants had syndromal or subsyndromal symptoms during 75% of the follow-up period, and 16% of the participants experienced psychotic symptoms during 17% the follow-up period. Twenty-five percent of youths with bipolar II converted to bipolar I, and 38% of those with bipolar disorder not otherwise specified converted to bipolar I or II. Early onset, diagnosis of bipolar disorder not otherwise specified, long illness duration, low socioeconomic status, and family history of mood disorders were associated with poorer outcomes. Conclusions: Bipolar spectrum disorders in youths are characterized by episodic illness with subsyndromal and, less frequently, syndromal episodes with mainly depressive and mixed symptoms and rapid mood changes.

Objective: In a naturalistic follow-up of adult bipolar patients, the authors examined the contributions of demographic, phenomenological, and clinical variables, including antidepressant use, to prospectively observed mood episode frequency. Method: For 1,742 bipolar I and II patients in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), episodes of mood disorders were evaluated for up to 1 year of treatment. Results: At entry, 32% of the patients met the DSM-IV criteria for rapid cycling in the prestudy year. Of the 1,742 patients, 551 (32%) did not complete I year of treatnlent. Among the 1,191 patients remaining, those with prior rapid cycling (N=356) were more likely to have further recurrences, although not necessarily more than four episodes per year. At the end of 12 months, only 5% (N=58) of the patients could be classified as rapid cyclers; 34% (N=409) had no further mood episodes, 34% (N-402) experienced one episode, and 27% (N=322) had two or three episodes. Patients who entered the study with earlier illness onset and greater severity were more likely to have one or more episodes in the prospective study year. Antidepressant use during follow-up was associated with more frequent mood episodes. Conclusions: While DSM-IV rapid cycling was prospectively observed in only a small percentage of patients, the majority of these patients had continued recurrences at lower but clinically significant rates. This suggests that cycling is on a continuum and that prevention of recurrences may require early intervention and restricted use of antidepressants.

Objective: Despite clear gender differences in the symptoms and course of bipolar affective disorder, studies investigating age at onset by gender have yielded inconsistent results. The authors investigated gender differences in age at onset and incidence of first-episode mania and bipolar disorder in an epidemiological catchment area in southeast London over a 35-year period. Method: All adult cases of first-episode psychosis, mania, or hypomania presenting to services in Camberwell, southeast London (1965-1999), were identified. Computerized diagnoses for these cases were generated by using the Operational Checklist for Psychotic Disorders program. Incidence rates and rate ratios of DSM-IV bipolar 1 disorder, first manic episode, by gender and age (10-year age-at-onset categories) were calculated. Differences in age at onset of first-episode mania and bipolar disorder by gender were examined by using univariate and multivariate analyses. Results: Men had a significantly earlier onset of first-episode mania and bipolar disorder, with childhood antisocial behavior also being significantly associated, after multivariate analysis. Women had higher incidence rates of bipolar 1 disorder throughout adult life, except for early life (ages 16-25 years), although gender differences in individual age bands did not reach statistical significance. Conclusions: Men appear to have an earlier onset of mania and bipolar disorder than women. The association of male gender and childhood antisocial behavior with early-onset bipolar disorder raised the possibility of the existence of an early-onset subgroup.

Objective: The purpose of this article is to review the literature concerning gender differences in the course of bipolar illness and discuss issues relevant to the treatment of women with the illness. Method: The literature concerning the following topics is reviewed: gender differences in the course of bipolar illness; effects of the female reproductive cycle on the course of bipolar illness; special considerations in the treatment of bipolar women (focusing on the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-thyroid axes); and hypotheses to explain the greater prevalence of rapid cycling among bipolar women than among bipolar men. Results: Data clearly indicate that rapid cycling is more common among bipolar women. Data also suggest that bipolar women may have more depressive episodes (and fewer manic episodes) and may be more likely to suffer from mixed (as opposed to pure) mania than bipolar men. While it is clear that bipolar women are at high risk for postpartum episodes, the effects of other reproductive system events (i.e., puberty, menstrual cycle, pregnancy, menopause, use of oral contraceptives or hormone replacement therapy) on the course or treatment of bipolar illness have received little systematic study. It is unclear whether women are at higher risk than men for developing lithium-induced hypothyroidism. Higher rates of hypothyroidism, greater use of antidepressants, and gonadal steroid effects are possible explanations for the greater prevalence of rapid cycling among bipolar women. Conclusions: Gender differences in bipolar illness and the effects of the female reproductive system on the course and treatment of the illness deserve more study. The importance of a longitudinal approach to these questions is emphasized.

Some evidence suggests that the incidence of bipolar affective disorder (manic-depressive illness) decreases with age. Previous studies have reported an average age of onset in the second decade of life and that the disease rare occurs after age 60. There have been studies, however, that have reported contradictory results. In an effort to replicate findings that many elderly patients have a significant incidence of the disease, 75 elderly inpatients with bipolar affective disorder were identified and records were reviewed for age of onset of the first symptoms of their illness. There were 52 women and 23 men in this sample, all over 60 years of age. The average age of onset of first symptoms was age 46.5 years; for men the average age was 52.7 years and for women 43.7 years. Very few subjects showed evidence of symptoms prior to age 40. In 13 subjects, head injury preceded the first manic episode; for this group, a family history of mental illness was less common than for those who did not have a history of head injury. In general, bipolar illness is thought to correlate with a family history of mental illness. These results support research that suggests the incidence of onset of bipolar illness in old age may be under-recognized. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychiatric hospitals and clinics in the UK are required to submit information about in-patients to the Department of Health, including diagnosis, age, and sex. Diagnoses are based on criteria from the latest edition of the World Health Organization's International Classification of Diseases (ICD-9). The number of first admissions by age and sex for the ICD-9 category of manic-depressive psychosis, manic type between 1982 and 1986 was computed to determine if there were any sex-related differences in the age of onset. The ICD-9 places manic-depressive psychosis, manic type under the category of affective (mood) psychoses. The disorder is characterized by states of elation or excitement out of keeping with the patient's circumstances, and varies from hypomania (enhanced liveliness) to violent and uncontrollable excitement, with a susceptibility to aggression and anger, distractibility, grandiose ideas, and impaired judgment. Previous studies of sex differences in manic-depressive disorder found that more women than men were affected. Analysis of the data in this study demonstrated that between the ages of 10 to 29 years, the rate of onset was nearly equal between the sexes. From age 30 through age 54, females had a notably higher inception rate than males. However, when the overall population age distribution of men and women was taken into account, there was no difference found in the rate of bipolar affective disorder between the sexes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective: Preliminary data suggested that there are three subgroups of bipolar affective disorder based on age at onset. The authors sought to replicate those findings and determine the cut-off age of each subgroup. Method: Admixture analysis was used to determine the best-fitting model for the observed ages at onset of 368 consecutively admitted patients. The results obtained were compared with those of the previously described model. The authors also investigated whether affected siblings are more likely to belong to the same theoretical age-at-onset subgroup as identified by admixture analysis. Results: The existence of three subgroups defined by age at onset was confirmed. The mean ages estimated in this model were 17.4 years (SD=2.3), 25.1 years (SD-6.2), and 40.4 years (SD=11.3). Affected siblings were more likely to belong to the same theoretical subgroup. Conclusions: There are three age-at-onset subgroups of bipolar patients, and specific familial vulnerability factors might underlie each subgroup.

AMELIA ISLAND, FLA. -- Underrecognition of psychiatric disorders in many ethnic minorities has led to an increased risk of substance abuse and violence, according to Dr. William B. Lawson. A [...]

"What is Bipolar Disorder? A Guide to Hope and Recovery for African Americans," a brochure now available from the National Mental Health Association, addresses bipolar disorder in the African American [...]