Comorbid Psychiatric Disorders Impair Response to Psychosocial Treatment in Adolescents with Bipolar Disorder
At the 2019 meeting of the International Society for Bipolar Disorders, researcher Marc J. Weintraub and colleagues followed 145 adolescents with bipolar disorder over a period of two years. The adolescents with comorbid disorders (compared to those with bipolar disorder alone) fared more poorly in response to psychosocial treatment.
Weintraub and colleagues found that the adolescents who had anxiety disorders in addition to their bipolar disorder spent more weeks depressed, had more severe symptoms of (hypo)mania, and had more family conflict over the course of the study than those adolescents who had bipolar disorder alone.
Participants who had attention deficit hyperactivity disorder (ADHD) in addition to their bipolar disorder had more weeks with (hypo)manic symptoms, had more severe (hypo)manic symptoms, and greater family conflict than those with bipolar disorder alone.
Those participants with comorbid oppositional defiant disorder (ODD) or conflict disorder in addition to their bipolar disorder had more depressive symptoms and family conflict throughout the study.
Editor’s Note: How to better approach treatment in these diagnostically complex young people is an urgent unmet need, as most research excludes participants with more than one psychiatric disorder. Clinicians treating young people with bipolar disorder and comorbidities such as anxiety disorder, ADHD, and ODD must generally rely on inferences from children with these illnesses, using their own intuition about best treatment approaches rather than having evidence from systematic studies about how best to treat these children. It appears that both psychosocial and pharmacological treatments must be tailored to these more complicated presentations.
More Than 70% of People with Bipolar Disorder Have Additional Psychiatric Illness
At the 2019 meeting of the International Society for Bipolar Disorders, researcher Kathleen R. Merikangas reviewed large scale community studies of people with bipolar disorder in multiple countries. She reported that more than 70% of people with bipolar disorder have three or more lifetime disorders, not just bipolar disorder.
Preliminary findings suggested that adolescents with bipolar disorder did not tend to have other disorders in addition to their bipolar disorder, but as they approached young adulthood these became more common. Merikangas concluded, “These findings suggest that early intervention may prevent the secondary comorbidity that is related to greater impairment, worse course and poorer treatment response in bipolar disorder.”
Editor’s Note: It is a major deficit that not only is there limited data on early intervention in general, but virtually none about early intervention in the face of multiple comorbidities. This lack of treatment knowledge means that the majority of people with bipolar disorder are facing challenges that could be mitigated if only the needed clinical treatment research were done.
