Dimensional and Categorical Correlates of Substance Use Disorders among Canadian Adolescents with Bipolar Disorder.

OBJECTIVES: Despite increasing evidence of excessive substance use disorder (SUD) prevalence among adolescents with bipolar disorder (BP), little is known about this topic among Canadian adolescents with BP. We therefore sought to examine the clinical characteristics and dimensional measures of psychopathology associated with comorbid SUD among Canadian BP adolescents. METHOD: Participants were 100 adolescents, ages 13-19 years, with BP I, II, or not otherwise specified (NOS). Diagnoses (current and lifetime) were determined via the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Present and Lifetime version (KSADS-PL). Participants were considered to have lifetime SUD if they met DSM-IV criteria for abuse of or dependence on alcohol or any drug other than nicotine. Chi-square analyses and independent samples t-tests were followed by logistic regression analyses. RESULTS: The lifetime prevalence of SUD was 33% (primarily alcohol and cannabis use disorders). In univariate analyses, SUD was associated with greater lifetime prevalence of conduct disorder, oppositional defiant disorder, panic disorder, assault of others, and a greater number of stressful life events. SUD was significantly associated with greater self-reported impulsivity and parent-report of anger/depression in the adolescent. In multivariable analyses, SUD was associated with panic disorder and oppositional defiant disorder. CONCLUSION: SUD is highly prevalent among Canadian adolescents with BP and is associated with anxiety disorders, behavioural disorders, and trait impulsivity. Targeting these clinical characteristics may help guide preventative and treatment strategies for this population.

OBJECTIFS: Malgré des preuves croissantes de la prévalence excessive du trouble d'utilisation de substances (TUS) chez des adolescents souffrant de trouble bipolaire (TB), ce sujet est très peu connu des adolescents canadiens souffrant de TB. Nous avons donc cherché à examiner les caractéristiques cliniques et les mesures dimensionnelles de la psychopathologie associée au TUS comorbide chez les adolescents canadiens souffrant de TB. MÉTHODE: Les participants étaient 100 adolescents de 13 à 19 ans souffrant de TB I, II, ou non spécifié ailleurs (NSA). Les diagnostics (actuels et de durée de vie) ont été déterminés par le tableau des troubles affectifs et de la schizophrénie pour les enfants d'âge scolaire, version actuelle et de durée de vie (KSADS-PL). Les participants étaient évalués avoir un TUS de durée de vie s'ils satisfaisaient aux critères du DSM-IV en matière d'abus ou de dépendance à l'alcool ou à toute autre drogue que la nicotine. Les analyses chi-carré et les tests t d'échantillons indépendants ont été suivis d'analyses de régression logistique. RÉSULTATS: La prévalence de durée de vie du TUS était de 33 % (principalement des troubles d'utilisation d'alcool et de cannabis). Dans les analyses univariées, le TUS était associé à une prévalence de durée de vie plus marquée du trouble des conduites, du trouble oppositionnel avec provocation, du trouble panique, d'agression physique et d'un plus grand nombre d'événements de la vie stressants. Le TUS était significativement associé à une plus grande impulsivité auto-déclarée et à des rapports des parents sur la colère/dépression de l'adolescent. Dans les analyses multivariées, le TUS était associé au trouble panique et au du trouble oppositionnel avec provocation. CONCLUSION: Le TUS est hautement prévalent chez les adolescents canadiens souffrant de TB et est associé aux troubles anxieux, aux troubles du comportement, et à l'impulsivité. Cibler ces caractéristiques cliniques peut aider à guider l'élaboration de stratégies préventives et de traitement pour cette population.

Controlled Study of Obesity Among Adolescents with Bipolar Disorder.

OBJECTIVE: Despite numerous studies regarding obesity (OB) in adult bipolar disorder (BP), there are few studies on this topic among adolescents. The current study attempts to extend the literature on prevalence and correlates of OB in adolescent BP by including control participants, and determining OB by direct measurement. METHODS: Participants were 75 treatment-seeking adolescents, ages 13-19 years, with BP-I, -II, or -not otherwise specified, and 47 adolescents without major psychiatric illness. Diagnoses and clinical characteristics were assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children, Present and Lifetime version (KSADS-PL). Family psychiatric history was assessed using the Family History Screen. OB was defined as adjusted body-mass index ≥95th percentile. Variables associated with OB in univariate analyses informed variable selection for within-group logistic regression analysis among BP adolescents. RESULTS: BP participants had a significantly higher rate of OB (18%) compared to controls (4%; χ2 = 5.3; p = 0.02). BP remained a significant predictor for OB when controlling for race (odds ratio [OR] = 5.1, 95% confidence interval [CI] = 1.1-24.0, p = 0.04). In univariate analyses among BP adolescents, OB was significantly associated with suicide attempt, self-injurious behavior, and oppositional defiant disorder. In multivariable analyses, suicide attempt and antidepressants that were not selective serotonin reuptake inhibitors were significantly associated with OB. CONCLUSIONS: OB is excessively prevalent among adolescents with BP and is associated with proxies for illness severity, including suicide attempts. Additional research is warranted to identify strategies to prevent and treat OB among BP adolescents, and to elucidate processes underlying the elevated risk of suicide attempts.

Correlates of Adolescent-reported and Parent-reported Family Conflict Among Canadian Adolescents With Bipolar Disorder.

BACKGROUND: Family conflict exacerbates the course of bipolar disorder (BP) among adults. However, few studies have examined family conflict among adolescents with BP, and fewer have looked at adolescent-reported and parent-reported family conflict separately. METHODS: Subjects were 89 adolescents, aged 13 to 19 years, with a diagnosis of BP on the basis of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (KSADS-PL). Subjects were divided into high-conflict and low-conflict groups using a median split on the Conflict Behavior Questionnaire (child report and parent report). The χ(2) analyses and independent samples t tests were performed for univariate analyses. Multivariable logistic regression analyses were performed on variables with P<0.2. RESULTS: Parent-reported and adolescent-reported Conflict Behavior Questionnaire scores were significantly correlated (r=0.50, P<0.001). High parent-reported family conflict was positively associated with recent manic symptoms, externalizing comorbidities, and dimensional scores reflecting emotional dysregulation. High adolescent-reported family conflict was positively associated with recent manic symptoms and emotional dysregulation, and negatively associated with socioeconomic status and lifetime psychiatric hospitalization. Bipolar subtype was significantly associated with high versus low family conflict. LIMITATIONS: The limitations of this study included being a cross-sectional study, use of a medium-sized sample, and lack of a control group. CONCLUSIONS: Despite substantial agreement between adolescents and parents regarding the amount of family conflict, there were meaningful differences in the factors associated with adolescent-reported and parent-reported conflict. These findings demonstrate the importance of ascertaining family conflict from adolescents as well as from parents. Moreover, these findings can potentially inform family therapy, which is known to be effective for adolescents with BP.

Significance of borderline personality-spectrum symptoms among adolescents with bipolar disorder.

BACKGROUND: Little is known regarding correlates of borderline personality-spectrum symptoms (BPSS) among adolescents with bipolar disorder (BP). METHODS: Participants were 90 adolescents, 13-19 years of age, who fulfilled DSM-IV-TR criteria for BP using semi-structured diagnostic interviews. BPSS status was ascertained using the Life Problems Inventory which assessed identity confusion, interpersonal problems, impulsivity, and emotional lability. Analyses compared adolescents with "high" versus "low" BPSS based on a median split. RESULTS: Participants with high, relative to low, BPSS were younger, and had greater current and past depressive episode severity, greater current hypo/manic episode severity, younger age of depression onset, and reduced global functioning. High BPSS participants were more likely to have BP-II, and had higher rates of social phobia, generalized anxiety disorder, conduct disorder, oppositional defiant disorder, homicidal ideation, assault of others, non-suicidal self-injury, suicidal ideation, and physical abuse. Despite greater illness burden, high BPSS participants reported lower rates of lithium use. The most robust independent predictors of high BPSS, identified in multivariate analyses, included lifetime social phobia, non-suicidal self-injury, reduced global functioning, and conduct and/or oppositional defiant disorder. LIMITATIONS: The study design is cross-sectional and cannot determine causality. CONCLUSIONS: High BPSS were associated with greater mood symptom burden and functional impairment. Presence of high BPSS among BP adolescents may suggest the need to modify clinical monitoring and treatment practices. Future prospective studies are needed to examine the direction of observed associations, the effect of treatment on BPSS, and the effect of BPSS as a moderator or predictor of treatment response.

Correlates of psychiatric hospitalization in a clinical sample of Canadian adolescents with bipolar disorder.

OBJECTIVE: To identify factors associated with psychiatric hospitalization among adolescents with bipolar disorder (BD). METHODS: Participants were 100 adolescents, ages 13-19, who fulfilled DSM-IV criteria for bipolar I disorder [(BD-I), n=26], bipolar II disorder [(BD-II), n=40], or operationalized criteria for BD not otherwise specified [(BD-NOS), n=34], via the Schedule for Affective Disorders and Schizophrenia, Present and Lifetime version (KSADS-PL). Demographic, clinical, and family history variables were measured via clinical interview with the participant and a parent or guardian. RESULTS: The lifetime prevalence of psychiatric hospitalization was 50%. Significant predictors of psychiatric hospitalization in univariate analyses included older age, BD-I, history of suicide attempt, psychosis, lifetime use of second generation antipsychotics (SGAs), lithium, SSRI antidepressants and any medication. BD-II was negatively associated with psychiatric hospitalization. In multivariable analyses, older age, history of suicide attempt, psychosis and use of SGAs were positively associated with hospitalization, whereas BD-II was negatively associated with hospitalization. CONCLUSIONS: Psychiatric hospitalization in adolescents with BD is highly prevalent and associated with older age and proxies for greater illness severity. Further studies are needed to identify strategies for reducing the need for psychiatric hospitalizations among adolescents with BD.

Clinical characteristics associated with lithium use among adolescents with bipolar disorder.

OBJECTIVE: Little is known regarding demographic and/or clinical characteristics associated with the use of lithium among adolescents with bipolar disorder (BP) in naturalistic clinical settings. We therefore examined factors associated with lithium among adolescents with BP presenting to a tertiary outpatient clinic. METHODS: Participants were 100 adolescents 13-19 years of age, with BP-I, BP-II, or BP not otherwise specified (BP-NOS). Diagnoses and lifetime medication exposure were determined using the Schedule for Affective Disorders and Schizophrenia for School Age Children, Present and Lifetime Version (KSADS-PL). Analyses examined for demographic and clinical correlates of lifetime lithium exposure. RESULTS: Twenty percent of participants reported lifetime lithium use. Participants with, versus those without, lifetime lithium use were significantly older and significantly more likely to have BP-I, lifetime history of psychiatric hospitalization, and psychosis. Lithium-treated participants were significantly more likely to report use of second-generation antipsychotics (SGAs) and antimanic anticonvulsants. In contrast, participants with lithium exposure were significantly less likely to have BP-II, self-injurious behavior, and a family history of depression. Adolescents with lithium exposure had significantly less parent-reported family conflict and mood lability, and significantly less self-reported impulsivity, emotional dysregulation, identity confusion, and interpersonal problems. In multivariable analyses, lithium use was associated with greater lifetime SGA use, lower parent-reported family conflict, and lower adolescent-reported interpersonal problems. CONCLUSIONS: Lithium was infrequently used among adolescents with BP in this sample. Although constrained by retrospective methodology and a single site, our findings suggest that clinicians may be deferring lithium use until late in treatment. The fact that there are lower rates of lithium use among adolescents with suicidal ideation, impulsivity, mood lability, and family history of depression suggests potential missed opportunities for use of lithium among high-risk adolescents with BP.