Citation

Geoffroy PA, Etain B, Leboyer M, Bellivier F. Ann. Med. Psychol. (Paris) 2012; 170(7): 502-509.

Copyright

(Copyright © 2012, Societe Medico-Psychologique, Publisher Elsevier Publishing)

DOI

10.1016/j.amp.2012.07.005

PMID

unavailable

Abstract

OBJECTIVES: Bipolar affective disorder (BPAD) is a multifactorial disorder with heterogeneous clinical presentation, in particular according to age at onset (AAO). AAO has been discussed as a potential specifier in future nosographical classification and may be included in future algorithms of treatment decisions.

METHODS: The present article provides a comprehensive review of existing clinical data on age at onset and on pharmacological strategies in early onset BPAD.

RESULTS: Seven admixtures studies have demonstrated the existence of three subgroups of BPAD individuals according to AAO (early, intermediate and late AAO) with two cut-off points of 21 (21.28. years ± 1.6) and 33. years (33.57. years ± 5.8). Differential clinical features and outcomes have characterized the early onset subgroup: higher rate of suicide attempts, rapid cycles, alcohol and drugs abuse, psychotic symptoms and co-morbid anxiety disorders. This might partially explain the delayed diagnosis and mood stabilizer initiation. Implementation of AAO in the algorithms of treatment might be discussed although the level of proof for focused medications strategies remains to be consolidated. Targeted prevention of specific comorbidities also should be strongly recommended.

CONCLUSION: Given the high frequency of early onset BPAD, awareness of clinicians should be stimulated in order to provide an early and accurate detection, preventive strategies and possibly specific cares. © 2012 Elsevier Masson SAS.

Language: fr

Keywords

adult; human; bipolar disorder; Bipolar disorder; suicide attempt; comorbidity; drug abuse; alcohol abuse; article; disease classification; treatment planning; disease association; clinical feature; anxiety disorder; diagnostic accuracy; onset age; rapid cycling bipolar disorder; Therapeutic; delayed diagnosis; Admixture; Early onset; Marker; Subgroup