WASHINGTON (H24N). It may be possible to spot warning signs for bipolar (or manic-depressive) disorder in very early childhood, according to researchers at the University of Miami School of Medicine in Florida.

Headed by Janice A. Egeland, MD, the investigators examined the medical records of 58 adults diagnosed with the problem, and found clusters of symptoms that often began in the first years of life. This is important because bipolar patients usually are diagnosed in their late teens and early 20s, when the characteristic cyclic mood swing patterns are well established. If physicians can identify children at risk for this problem they can intervene early and may be able to change the course of the disease.

Bipolar disorder affects at least 2 million Americans and tends to run in families. The mood swings are spaced by periods of normal behavior in a variety of patterns and a wide range of severities, and can be rapid (several cycles a year), slower, or only set off by specific events. Sufferers may experience bouts of uncontrollable mania that last for days and put them at risk for heart attacks from exhaustion, or appear only mildly euphoric as if they were newly in love. Depressions can range from days of silence and immobility to mild sad spells.

Some people experience highs and lows of equal intensity, and some have extremes at one end of the scale followed by small dips into the other side. The patterns repeat and can be identified, and this distinguishes them from other psychiatric problems, especially in children where, according to Egeland, the early cycles of irritability, hypersensitivity and low energy that can show up by the age of 10 are often mistaken for attention-deficit hyperactivity disorder. One clue is that the symptoms come in waves rather than being part of the child’s general nature.

Patients in Egeland’s study first exhibited symptoms nine to 12 years before the onset of the disorder. Some showed signs as early as preschool age. Egeland and her colleagues are currently following children and teens who are at high risk for the disorder due to family history, and hope to confirm whether the symptoms they observed in their retrospective study will accurately predict which of these children will develop the full-blown syndrome.

Although the drug lithium has been used successfully to control bipolar disorder, there is a problem with patient compliance. Some bipolar sufferers refuse to take the medication because they don’t want to give up their "highs." If the disease can be caught early, before mood swing patterns are established, Egeland hopes that physicians may be able to prevent the cycles altogether and allow people with bipolar disorder to lead normal lives.

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