These findings demonstrate that relatively few adolescents who had hypomania spectrum episodes continue to have hypomania in adulthood. No differences in adulthood mood symptoms were found between the different subgroups of hypomania. Adolescents who had a first- or second-degree family member with bipolar disorder were more likely to have bipolar disorder in adulthood. On the basis of these findings, these researchers question the long-term use of mood stabilizers in adolescents who have had a hypomanic episode.
Youths with bipolar disorder are at significant risk for suicide. Using a longitudinal 5-year study, Goldstein and colleagues7 examined risk factors for suicide attempts in 413 children and adolescents with a diagnosis of bipolar I disorder (n = 244), bipolar II disorder (n = 28), or bipolar disorder not otherwise specified (n = 141). Many (76; 18%) of the youths made a suicide attempt at least once during the follow-up period. Thirty-one (7%) attempted suicide multiple times. There were no significant differences in the rate of suicide attempts among youths with bipolar I disorder, bipolar II disorder, and bipolar disorder not otherwise specified.
The strongest predictors of suicide attempts were severity of the depressive episode at baseline and a family history of depression. Predictors of suicide attempt in the preceding 8-week period were mixed mood symptoms, substance disorder, and more weeks with depression. The authors recommended that these risk factors for suicide attempts be carefully assessed when treating youths with bipolar disorder.
Family functioning can affect and, in turn, is affected by, the symptoms of bipolar disorder in adolescents. Sullivan and colleagues8 examined the relationship between family functioning and symptoms of bipolar disorder in adolescents. Fifty-eight families of adolescents with bipolar disorder participated in a 2-year randomized trial of family-focused treatment for adolescents. The measures of family functioning included family cohesion, adaptability, and conflict. Family cohesion and adaptability did not change over the 2-year period. However, family conflict at baseline predicted the severity of adolescents’ manic symptoms over time. Adolescents’ symptoms of mania showed more rapid improvement in low-conflict than in high-conflict families. It was also found that a decrease in parent-reported conflict led to a decrease in adolescents’ symptoms of mania. The authors concluded that family conflict should be addressed in the treatment of adolescent bipolar disorder.