Juvenile Bipolar Disorder: Evaluation of Symptom Profiles, Treatment Outcomes, and Predictors of Treatment Effectiveness for Clients from a Community Mental Health Clinic

This thesis describes the phenomenology and prospective course of illness for an Australian sample of youth with bipolar disorder (BD), treated with a combination of pharmacotherapy and standardised psychological intervention within a community mental health clinic. Index episode demographic, clinical and structured diagnostic interview data were collected for 88 participants (63 female) aged 8–18 years (M = 14.8, SD = 2.5) meeting DSM-IV-TR criteria for BD-I (n = 24), BD-II (n = 13) or BD-NOS (n = 51). Assessments were re-administered for 51 participants, on average 26 months following initial assessment. There was strong evidence of ongoing symptomatology, distress and impairment, and progression from subsyndromal to syndromal disorder. BD-I in youth appears to be an ongoing syndromal illness likely to be continuous with BD in adulthood. BD-II in youth follows a more benign course. BD-NOS appears to be an evolving early prodromal phase of syndromal BD. Those with adolescent-onset BD appear to have an early-onset version of classical adult BD. In contrast, childhood-onset BD phenotypes characterised by subthreshold mood symptoms and externalising symptoms do not appear continuous with adult forms of the disorder. Our findings suggest psychological interventions may reduce psychosocial impairment and duration of hospitalisation. Psychiatric admission may reduce severe mood symptoms, but not functional impairment or clinical distress. Mood stabilisers may reduce functional impairment and likelihood of suicide attempts. Recommendations are provided regarding putative risk factors, phenotypic subsyndromal profiles and proximal prodromal symptoms that should be included for further study as potential clinical high-risk syndromes for BD in future indicated prevention and secondary prevention research