A comparison of the phenomenology and treatment of youths and adults with bipolar I disorder in a state mental health system

Background: Presenting symptoms of and treatments used for child/adolescent and adult patients diagnosed with bipolar I disorder in a state mental health system are described and compared. Methods: Medical records were reviewed for 267 cases of bipolar I disorder reported in the statewide patient information system. Results: The child/adolescent patients were significantly more likely to have irritability documented, be treated with stimulant medications, and meet the criteria for major depression while adults were significantly more likely to have a broader array of documented symptoms: euphoria, fatigue, trouble concentrating, and hyper-religiosity. Suicidality (thoughts and gestures) was higher in both age groups than previously reported in the clinical literature. No difference was evident in the mood-related pharmacotherapy. Child/adolescent cases were seen more often for re-evaluations, medication visits, and individual and family therapy sessions, whereas adult cases were more likely to receive case management services and less-frequent medication monitoring visits. Conclusions: Youths with bipolar I disorder were more likely to present with irritability and depressive symptoms, and be treated with stimulants and a range of therapeutic interventions, whereas adults with more broadly documented symptoms were receiving minimal treatment services.