Manic symptoms similar for children and adolescents

The nature of mania symptoms appears to be similar in young people with bipolar disorder, irrespective of whether they occur in childhood or adolescence, say researchers.

They found that the only exception was the emergence of psychotic symptoms, including hallucinations and delusions, in adolescents with adolescent-onset of symptoms, but not in children with child-onset symptoms.

"Adolescence marks a period of elevated risk for psychotic symptoms compared to the general population, particularly for adolescents at risk for schizophrenia or bipolar disorder," say Jeffrey Hunt (The Warren Alpert Medical School of Brown University, Providence, Pennsylvania, USA) and team.

Mania symptomatology that was similar across 163 children with child-onset of symptoms (before 12 years of age), 94 adolescents with child-onset of symptoms, and 90 adolescents with adolescent-onset of symptoms (after 12 years of age) was characterized by "activated/pleasure seeking" and "labile and disorganized" behaviors.

The researchers carried out a factor analysis of symptom ratings on the Schedule for Affective Disorders and Schizophrenia for School-Age Children Mania Rating Scale during each participant's most severe lifetime manic episode.

In the children with child-onset mania, two factors - "activated/pleasure seeking" and "labile and disorganized" symptoms - explained 28.4% of the total variance.

A total of 13 items were represented by "activated/pleasure seeking" and included elation, racing thoughts, increase in goal directed activity, accelerated speech, and increased productivity. "Labile and disorganized" symptoms included irritability, mood lability, poor judgment, and sentence incoherence.

For adolescents with child-onset mania, a single factor, representing both "activated/pleasure seeking" and "disorganized" behavior, explained 20.2% of the total variance.

Adolescents with adolescent-onset mania had two factors accounting for 32.1% of the total variance. The first factor represented 11 symptoms described as "activated/pleasure seeking," including energetic behavior, increase in goal directed activity, and increased productivity. The second factor described "disorganized" and psychotic behavior, and included derailment, hallucinations, sentence incoherence, delusions, mood lability, poor judgment, and irritability.

"The similarities in the factor structures indicated that manic symptoms have a similar underlying structure across current age and age of symptoms onset," the researchers write in the Journal of Affective Disorders.

"Future studies should examine how factors change over time from childhood to adolescence and future clinical prognosis for children and adolescents based on their factor scores.

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