Fertility and childhood bipolar disorder

University of Louisville, Department of Psychiatry, 501 E Broadway, Suite 340, Louisville, KY 40202, United States.
Medical Hypotheses (Impact Factor: 1.07). 02/2007; 69(3):587-9. DOI: 10.1016/j.mehy.2006.12.055
Source: PubMed


The observation that the diagnosis of bipolar illness is increasingly being made in the young is fascinating and potentially quite instructive. Several potential reasons have been put forward, which may all play a role. These include increased awareness, a cohort effect, changes in the diagnostic criteria, increased use of stimulants and antidepressants unmasking the illness, and others. It is interesting to note that this increase in recognition of bipolar illness in the young comes about one generation after the introduction of lithium as a therapeutic agent in bipolar disorder. We propose that the introduction of lithium may have increased fertility (broadly defined) of bipolar patients allowing for the expression of genetic anticipation by having a second and third generation of offspring that are affected at earlier ages. A similar phenomenon was seen in schizophrenia after the introduction of phenothiazines for the treatment of psychosis. These pharmacologic and social changes may have all conspired to increase reproductive success of bipolar subjects, giving rise to a new generation of bipolar patients with earlier onset and more severe manifestation of their disorder.

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    • "For example, fragmentation of nuclear and extended families, economic or life style stressors, or even changes in dietary habits may be conspiring to increase the prevalence of depression and its resistance to somatic treatment . Additionally, the biological course of major depression itself may be changing due to a multitude of biologic and genetic factors, as may be occurring in bipolar illness [21]. Alternatively, the loss of efficacy of the antidepressant may be related to clinical issues such as inadequate dosing of antidepressants [22] or antidepressant tolerance [23]. "
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    Medical Hypotheses 04/2011; 76(6):769-73. DOI:10.1016/j.mehy.2011.01.020 · 1.07 Impact Factor
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    Acta Psychiatrica Scandinavica 08/2009; 120(6):492-5. DOI:10.1111/j.1600-0447.2009.01426.x · 5.61 Impact Factor
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    ABSTRACT: Schizophrenia (SC) and bipolar disorder (BP) are two of the most severe and incapacitating mental disorders. It has been questioned whether these two conditions designate distinct illnesses with different etiologies or whether they represent different ends of a clinical spectrum with a common etiology. This study compares social and clinical characteristics of 84 SC and 84 BP subjects from the Costa Rican Central Valley (CRCV) using information from the DIGS, FIGS and psychiatric records. Each of these subjects had a best estimate lifetime consensus diagnosis of either bipolar type I or SC. Subjects with SC differed from subjects with BP in social adjustment measures like marital and employment status, and number of children. Both groups were very similar in years of education, age of onset of their illness, history of other psychiatric co-morbidities, and treatment received. The high percentage of psychosis in the BP group (97.6%) may largely explain the similarities found between groups in their clinical characteristics. The differences in social and functional decline support the original dichotomy described by Kraepelin based on chronicity and periodicity between these two psychotic disorders.
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