Multiple Episodes in Children and Adolescents with Bipolar Disorder: Comorbidity, Hospitalization, and Treatment (Data from a Cohort of 8,129 Patients of a National Managed Care Database)

Abstract

Objective: The purpose of this study was to delineate the prevalence, demographic characteristics, comorbidity, hospitalization, and medication use of a large cohort of patients with and without multiple episodes per year. We hypothesized that children and adolescents with multiple episodes per year would have a higher comorbidity and require more hospitalizations and pharmacological treatment than their counterparts without multiple episodes. Methods: Analysis was conducted on a cohort of 8,129 children and adolescents patients (≤ 18 y.o.) with bipolar disorders (BD), from the Integrated Healthcare Information Services (IHCIS) identified from June 30, 2000 to July 1, 2003. Demographics variables, type of hospitalization, and psychotropic medication used in the year of follow-up were compared between children and adolescents with multiple and those without multiple episodes per year. Results: Included were 58 patients with multiple episodes (defined as: ≥ 4 or more reports of inpatient treatment for any affective disorders per year) and 8,071 without multiple episodes. Children and adolescents with multiple episodes versus those without multiple episodes were differentiated as follows: more comorbid attention deficit disorder (ADD) (80.9% versus 29.4%) (χ2=70.61, df=1, p < 0.0001); higher rate of hospital admission for depression (12.1% vs. 1.8%, χ2=27.86, df=1, p < 0.0001); for other psychiatric conditions (48.3% vs. 11.2, χ2=74.47, df=1, p < 0.0001) and for medical conditions (22.4% vs. 3.9%, χ2=46.26, df=1, p < 0.0001). Patients with multiple episodes per year were more likely than those without multiple episodes to be given mood stabilizers (91.4% vs. 60.3%, χ2=22.02, df=1, p < 0.0001), antidepressants (79.3% vs. 59.2%, χ2=8.82, df=1, p=.0003), and antipsychotics (89.7% vs. 45.8%, χ2=42.91, df=1, p < 0.0001). The use of stimulants did not differ between the two groups (24.1% vs. 23.0%), χ2=0.02, df=1, p=0.96). Conclusions: Our findings support previous studies demonstrating that children and adolescents with multiple episodes per year present a higher comorbidity and require more hospitalizations and pharmacological treatment than those without multiple episodes. The diagnosis and treatment of children and adolescents with BD will have to take into account the high comorbidity of ADD mainly in children and adolescents with multiple episodes. Future prospective studies will help to better characterize the impact of multiple episodes in the course of pediatric BD and facilitate appropriate treatment strategies.