Clinical Characteristics of Early Onset Bipolar Disorder: A Retrospective Chart Review Study

Woo, Young Sup; Park, Min Hyeon; Seo, Ho Jun; Chae, Jeong Ho; Jun, Tae Youn; Bahk, Won Myong

Abstract

OBJECTIVE
Bipolar disorder is a disease with diverse clinical profiles and outcomes. In recent years, it is suggested that if bipolar disorder occurs early in one's life, functional and symptomatic prognoses are poor. The prognoses include severe symptoms, frequent psychotic symptoms, comorbidity of mental illnesses, slow improvement of the symptoms, and high suicide rate. We investigated the clinical characteristics of early onset bipolar inpatients. METHOD: The subjects of this study were selected from the patients who were discharged after hospitalization between January 1, 2001 and May 31, 2005 and diagnosed with bipolar disorder according to DSM-IV criteria. These patients were examined for the following data; the type of bipolar disorder, comorbid psychiatric disorders, the age at onset of the illness, the acuteness of the disorder, and the duration of the disorder. The presence of four major clinical psychopathology, rapid cycling, psychotic symptoms, comorbid psychiatric disorders, and suicide attempt, was also examined. The patients whose onset of the illness was before the age of 19 were classified as the early onset group and after the age of 19 were classified as the late onset group. Data on demographics, family histories, four major clinical psychopathologies and other clinical variables were compared between the early onset group and the late onset group.
RESULTS
Of the 53 patients, 19 patients belonged to the early onset group. There was higher incidence of psychotic symptoms in the early onset group than in the late onset group, and the difference was statistically significant according to the Chi2-test (84.2% vs 44.1%, p=0.005). The incidence of comorbid psychiatric disorders was higher in the early onset group than in the late onset group, and the difference was also statistically significant according to the Chi2-test (52.6% vs 23.5%, p=0.032). However, there was no statistically significant difference between the groups regarding the incidence of rapid cycling and suicide attempt. The result of logistics regression showed correlation of psychotic symptoms (OR=6.756; 1.655< or =95% CI< or =27.580) and comorbid psychiatric disorders (OR=3.611; 1.088< or =95% CI< or =11.984) with the early onset group.
CONCLUSION
Early onset of bipolar disorder is related to the manifestation of psychotic symptoms and frequently accompanies comorbid psychiatric disorders. The results of this study will help understand the mechanism of the onset of complex bipolar disorder and estimate the prognosis.