Am J Psychiatry 1997; 154:44-49
Copyright © 1997 by American Psychiatric Association
Phenomenology of adolescent and adult mania in hospitalized patients with bipolar disorder
SL McElroy, SM Strakowski, SA West, PE Keck Jr and BJ McConville
Biological Psychiatry Program, University of Cincinnati College of Medicine, OH 45267-0559, USA.
OBJECTIVE: Although available data suggest that bipolar disorder most
commonly begins in adolescence, it has often been underrecognized and
misdiagnosed in this age group. The authors hypothesized that this might in
part be because adolescent mania is phenomenologically different from adult
mania. To test this hypothesis, they compared a cohort of adolescents
hospitalized for acute mania with a group of hospitalized acutely manic
adults. METHOD: The authors compared symptomatic differences between 40
adolescent (ages 12-18 years) and 88 adult (ages 19-45 years) bipolar
patients hospitalized for acute mania. They also compared the two groups
with respect to demographic characteristics, psychiatric comorbidity,
family history, and short- term outcome. RESULTS: Compared with adults,
adolescent patients displayed a significantly higher rate of mixed bipolar
disorder and a significantly lower rate of psychotic features (by DSM-III-R
criteria), as well as higher ratings for many depressive symptoms
(including suicidality and depressed mood) and lower ratings for thought
disorder and delusions. Adolescents also displayed a significantly lower
rate of substance abuse and significantly higher rates of familial mood
disorder and drug abuse or dependence. CONCLUSIONS: Significant differences
were found in the phenomenology of adolescent and adult mania in this
study. The reasons for these differences are not known. Possible
explanations include artifact due to methodological limitations and
differences between adolescents and adults in familial loading for mood or
substance use disorders or in developmental or maturational stage.
