Conclusions Lithium continues as the st and ard and most extensively evaluated treatment for bipolar disorder , especially for long-term prophylaxis
Background Lithium has been used clinical ly for 70 years , mainly to treat bipolar disorder .
Competing treatments and exaggerated impressions about complexity and risks of lithium treatment have led to its declining use in some countries , encouraging this up date about its safe clinical use .
Early-onset bipolar disorder and treatment delay are risk factors for poor outcome in adulthood.
OBJECTIVE We examined the influence of age at onset of illness and the delay in time to first treatment on morbidity in adulthood . METHOD 529 adult out patients with a mean age of 42 years , who entered our research network from 1996 through 2001 and who were diagnosed with bipolar disorder according to DSM-IV criteria , were rated prospect ively on a daily basis with the National Institute of Mental Health-Life Chart Method during naturalistic treatment for up to 4 years . RESULTS Fifty percent of patients had illness onset in childhood ( < 13 years of age ) or adolescence ( 13 - 18 years of age ) . In year 1 of follow-up , these patients , compared to those with adult onset , showed significantly ( P<.05 ) greater severity of depression and mania , greater number of episodes , more days depressed , more days of ultradian cycling , and fewer days euthymic . After 4 years , the mean severity and duration of depression remained greater and the number of days euthymic fewer in those with childhood compared to adult onset ( P<.05 ) . The delays to first treatment correlated inversely with age at onset of illness . Independently , delay to first treatment was associated with more time depressed , greater severity of depression , greater number of episodes , more days of ultradian cycling , and fewer days euthymic ( all P<.05 ) . CONCLUSIONS These data converge with other evidence that onset of bipolar disorder in childhood is common and often associated with extraordinarily long delays to first pharmacologic treatment . Both childhood onset and treatment delay were associated with a persistently more adverse course of illness rated prospect ively in adults . These data should help foster efforts to ensure earlier and more effective treatment of bipolar illness in children and adolescents . It is hoped that appropriate early intervention would result in a more benign illness and a better prognosis in adulthood
Conclusions Lithium continues as the st and ard and most extensively evaluated treatment for bipolar disorder , especially for long-term prophylaxis
Background Lithium has been used clinical ly for 70 years , mainly to treat bipolar disorder .
Competing treatments and exaggerated impressions about complexity and risks of lithium treatment have led to its declining use in some countries , encouraging this up date about its safe clinical use .