Mental disorders often surface during adolescence. While the reasons are not entirely clear, experts suspect that rapid brain development may be the cause. Prevention and early intervention are keys to successful treatment. Therefore, identifying childhood risk factors can allow physicians to screen for mental health problems before they become difficult to treat.
Treating a mental disorder is further complicated by the frequent occurrence of comorbid mental disorders. For instance, an individual with an eating disorder may also struggle with depression or anxiety. Understanding the ways that comorbid disorders influence the patient can help clinicians implement successful treatment strategies.
Though previous research has showed attention deficit hyperactivity disorder (ADHD) as a risk marker for children with major depressive disorder (MDD) to convert to bipolar I disorder, a recent study by Joseph Biederman of Massachusetts General Hospital and colleagues sought to predict what exactly causes the conversion. The findings appear in the Journal of Affective Disorders.
The research team evaluated a group of children exhibiting subthreshold bipolar I disorder symptoms and impaired emotional regulation over an average of 11.4 years, finding that they exhibited the highest level of risk for bipolar I conversion.
Of the children that were included in the study, 24 converted to bipolar I within the follow-up period, with 79 not converting. Seven of the children exhibited subthreshold bipolar disorder symptoms at the beginning of the study, but 57 percent of those children went on to experience a full diagnosis compared with 21 percent of the children that had no symptoms.
After taking several variables into account, such as gender, age and emotional dysregulation, the findings showed that having such symptoms increased the likelihood of a conversion to bipolar I by 9.57 times.
Biederman says the findings support the careful monitoring of children that meet criteria for MDD and also exhibit subthreshold bipolar disorder symptoms. An awareness of this connection could impact therapeutic practices, particularly when considering the manic variations that could occur when antidepressants are introduced into the treatment strategy.
The researchers also identified emotional dysregulation as a bipolar I conversion factor. Deficient emotional self-regulation and severe emotional dysregulation were determined to increase the risk of conversion to bipolar I disorder. This finding remained robust even after accounting for gender, age and subthreshold bipolar symptoms.
Careful monitoring of children with ADHD and MDD could help clinicians identify children most at risk for the development of bipolar I. This could allow for treatment to be available at the earliest onset of the disorder. Early intervention could allow clinicians to successfully address the symptoms and help the patient maintain a stable everyday life.
Understanding how various mental health symptoms can overlap in children and teenagers is critical in providing adequate and effective treatment. Comorbid disorders can make treatment complicated, but in order to successfully and safely address the symptoms it is important to have the full picture of the patient’s mental health. Psychological screenings conducted during a regular physical exam can help determine whether additional care is needed.