Article

Childhood-onset bipolar disorder: Evidence for increased familial loading of psychiatric illness

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 6.35). 03/2007; 46(2):197-204. DOI: 10.1097/01.chi.0000246069.85577.9e
Source: PubMed

ABSTRACT To determine whether childhood-onset bipolar disorder (BP) is associated with an increased psychiatric family history compared with adolescent-onset BP.
Semistructured psychiatric interviews were conducted for 438 youth with BP spectrum disorders. To evaluate the effects of age at onset and psychiatric family history, the sample was divided into childhood-onset BP (age and BP onset <12 years; n = 192), adolescents with early-onset BP (age > or =12 years and BP onset <12 years; n = 136), and adolescents with late-onset BP (age and BP onset > or =12 years; n = 110). Lifetime family history of psychiatric illness was ascertained for first- and second-degree relatives through both direct interview of caretakers and the Family History Screen.
After significant demographic and clinical factors were controlled for, children and adolescents with childhood-onset BP showed higher percentages of positive first-degree family history for depression, anxiety, attention-deficit/hyperactivity, conduct, and substance dependence disorders and suicidal behaviors compared with adolescents with late onset. Subjects with childhood-onset BP also showed elevated familial loading for depression and attention-deficit/hyperactive disorder in second-degree relatives.
These data support a model that postulates a higher density of familial risk for a broad range of psychopathology in childhood-onset BP.

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Available from: Neal D Ryan, Aug 30, 2015
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    • "Of particular concern, the pooled approach did not detect a significant relationship between early-onset and having a first-degree relative with mood disorder. Thus, this finding would be in contradiction with several prior studies demonstrating relationships between genetic loading and childhood-onset bipolar disorder (Heleniuset al., 2013; Leboyer and Henry, 2005; Lin et al., 2006; Rende et al., 2007; Schurhoff et al., 2003), emphasizing that very early-onset patients may be driving these findings. As expected, illness duration was markedly longer for patients with childhood-(25.4 years) compared to adolescent-(16.7 years) and adultonset (13.8 years) bipolar disorder – indeed, illness duration may mediate relationships between early-onset and unfavorable illness characteristics. "
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    • "Rende et al (Rende et al., 2007) reported that 33% of children with BP-I disorder had a family history of ADHD and, although the morbid risk of ADHD was not specifically estimated, Geller et al (Geller et al., 2006) found that relatives with ADHD, of child bipolar probands, were at increased risk for bipolar disorder. The familial relationship between ADHD and BP-I observed in these studies of BP-I probands (Geller et al., 2006, Rende et al., 2007) is consistent with our previous family studies of ADHD and BP-I (Faraone et al., 1997, Faraone et al., 2001, Wozniak et al., 1995b). That these disorders may also share familial risk factors could explain the association of the dopamine transporter gene with both bipolar disorder (Greenwood et al., 2006, Mick et al., 2007) and ADHD (Asherson et al., 2007, Brookes et al., 2006a, Brookes et al., 2006b). "
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    • "The interviewer indicates whether participants endorsed the presence of these symptoms using a 3-point scale (0=not present, 1=present, and 9=don't know) and which relative was affected. We considered family members to be positive for a disorder if the interviewer coded a " 1 " for " definite " endorsement of an item consistent with other research (Rende et al., 2007). The calculation for family loading for five family history variables (PTSD, anxiety, depression, alcohol use disorders, and drug use disorders) was adapted from previous research (Johnson & Pickens, 2001; Milne et al., 2008), and determined by summing the total number of first degree full biological relatives who, based on the reports of the recruits, screened positive ( " definite " ) for symptoms, separately for each family history variable, divided by the total number of first degree relatives, providing an estimate of family loading for that variable. "
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