Psychopathology in children of bipolar parents
Division of Bipolar Disorders Research, University of Cincinnati, Cincinnati, Ohio, United States Journal of Affective Disorders
(Impact Factor: 3.38).
09/2007; 102(1-3):131-6. DOI: 10.1016/j.jad.2007.01.004
Few studies have examined the psychopathological profiles of child offspring of bipolar parents. Such investigations are useful as a first step to identifying potential prodromal manifestations of bipolar disorder.
The presence of psychopathology in 37 children with at least one parent with bipolar I disorder and 29 demographically matched children with parents free of any DSM-IV Axis I psychopathology was evaluated using the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U KSADS).
Twenty-nine (78%) of 37 high-risk children were diagnosed with at least one DSM-IV Axis I diagnosis as compared to seven (24%) of 29 children of healthy control parents (Fisher's exact test, p < 0.0001, odds ratio=11, 95% CI=3.33, 33). Sixteen percent (N=6) of high-risk offspring met DSM-IV criteria for bipolar I disorder as compared to none of the healthy control offspring (Fisher's exact test, p < 0.03). High-risk offspring also had statistically significant elevations in rates of other affective and disruptive behavior disorders as well as subsyndromal manifestations of psychopathology.
Children of bipolar parents had an elevated risk for developing bipolar and other psychiatric disorders. The study of children of bipolar parents who are at high risk for developing bipolar disorder themselves is essential to identify potential prodromal manifestations of the disorder and to eventually establish targeted early intervention strategies. Longitudinal studies to confirm the prodromal manifestations of bipolar disorder and risk factors associated with the development of specific diagnoses in children are needed.
Available from: Jeffrey R Strawn
- "A nxiety disorders are among the most common psychiatric conditions affecting children and adolescents (Kessler et al. 2012) and increase the risk of suicide attempts (Husky et al. 2012;Nock et al. 2013) as well as of secondary mood and other anxiety disorders (Pine et al. 1998;Beesdo et al. 2007;Beesdo-Baum and Knappe 2012). Additionally, anxiety disorders are common in youth at risk for developing bipolar disorder (Henin et al. 2005;Hirshfeld-Becker et al. 2006;Duffy et al. 2007) and anxious youth with a bipolar parent have three times the normal risk of developing mania, the onset of which occurs typically during adolescence (Singh et al. 2007). In youth with anxiety disorders, psychotherapeutic interventions are recommended in treatment guidelines, although when pharmacotherapy is considered, the first-line psychopharmacologic interventions for youth with anxiety disorders – antidepressants – are the mainstay of treatment (Connolly and Bernstein 2007;Strawn et al. 2012b). "
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We sought to evaluate the neurophysiology of mindfulness-based cognitive therapy for children (MBCT-C) in youth with generalized, social, and/or separation anxiety disorder who were at risk for developing bipolar disorder.
Nine youth (mean age: 13 ± 2 years) with a generalized, social, and/or separation anxiety disorder and a parent with bipolar disorder completed functional magnetic resonance imaging (fMRI) while performing a continuous processing task with emotional and neutral distractors (CPT-END) prior to and following 12 weeks of MBCT-C.
MBCT-C was associated with increases in activation of the bilateral insula, lentiform nucleus, and thalamus, as well as the left anterior cingulate while viewing emotional stimuli during the CPT-END, and decreases in anxiety were correlated with change in activation in the bilateral insula and anterior cingulate during the viewing of emotional stimuli (p < 0.05, uncorrected; p < 0.005 corrected; cluster size, 37 voxels).
MBCT-C treatment in anxious youth with a familial history of bipolar disorder is associated with increased activation of brain structures that subserve interoception and the processing of internal stimuli-functions that are ostensibly improved by this treatment.
Available from: Alex Wilde
- "(iv) Two studies did not compare incidence of MDD or BD in FDRs and/or SDRs of probands affected by MDD or BD to population incidence rates or controls (Hillegers et al., 2005; Schreier et al., 2006). (v) Forty-one publications did not report data point estimates of the effect measure, or were reported without p values, CIs or raw data, from which the effect measure could be calculated (Andreasen et al., 1987; Brent et al., 2004; Chang et al., 2000; Dienes et al., 2002; Dierker et al., 1999; Eley et al., 2004; Ferro et al., 2000; Gershon, 1982; Giovanni et al., 2010; Grigoroiu- Serbanescu et al., 1989; Grove et al., 1987; Hillegers et al., 2005; Kaufman et al., 1998; Kendler et al., 1997; Kessler et al., 1998; Lavori et al., 1987; Levinson et al., 2003; Li et al., 2008; Lieb et al., 2002; Marazita et al., 1997; Martinez-Devesa et al., 2007; McGuffin et al., 1988; McMahon et al., 1995; Merikangas et al., 1988; Mitchell et al., 1989; Moberg, 1991; Mojtabai, 2005; Murray et al., 2011; Olino et al., 2008; Orvaschel, 1990; Peterson et al., 1982; Ryan et al., 1992; Singh et al., 2007; Stevenson et al., 2010; Thorndike et al., 1996; Todd et al., 1994; Tozzi et al., 2008; Wals et al., 2003; Wals et al., 2004; Weissman et al., 1984a; Wickramaratne and Weissman, 1998). (vi) Wickramaratne and Weissman (1998) duplicated cases reported in two later studies, respectively (Beardslee et al., 1996; Wickramaratne et al., 2000), which were subsequently excluded because they did not report the outcomes of interest. "
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To conduct a meta-analysis to estimate the incidence of major depressive disorder (MDD) and bipolar disorder (BD) in first-degree relatives (FDRs) of probands affected by MDD or BD. The risk for MDD in FDR of BD probands and vice versa is also investigated.
A systematic review of case-control and cohort studies, which were published between 1977 and 2012; reported relative risks (RR) or odd ratios (OR) or equivalent raw data; made an explicit distinction between MDD and BD; used operational diagnostic criteria; and reported systematic proband recruitment and ascertainment of relatives. Studies were obtained by electronic MEDLINE and EMBASE searches and hand-searching. Estimates were derived from pooled data using random effects methods.
Of an initial sample of 241 articles, 22 were eligible for inclusion. For FDRs of one proband with MDD compared to healthy control probands, estimates for MDD were OR=2.14 (95% CI 1.72–2.67), increasing to OR=3.23 (95% CI 2.11–4.94) for two MDD probands. For FDRs of one BD proband compared to healthy control probands, estimates for BD were OR=7.92 (95% CI 2.45–25.61), and OR=6.58 (95% CI 2.64–16.43) for FDRs of two BD probands.
These findings support previously published data indicating strong familiality for both MDD and BD. Data will be useful in providing individuals with a family history of MDD or BPD with tailored risk estimates.
Available from: Sue Maree Cotton
- "Affective psychoses have been neglected in the development of early intervention strategies (Conus and McGorry, 2002). Most knowledge on the onset of bipolar affective disorders (BPAD) is derived from studies conducted in populations of bipolar off-spring (Lapalme et al., 1997; DelBello and Geller, 2001; Chang et al., 2000, 2003; Egeland et al., 2000; Shaw et al., 2005; Hillegers et al., 2005; Jones et al., 2006; Duffy et al., 2007; Singh et al., 2007). While genetic factors may play a role in the development of BPAD, a significant proportion of patients do not have any family history of bipolar illness. "
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ABSTRACT: Little is known about the early phases of bipolar disorders (BPAD) and most of current knowledge derives from putative "high-risk" studies conducted in populations of bipolar off-spring; such information may therefore be relevant only to a sub-group of at-risk subjects.
Retrospective assessment of the phase preceding the emergence of mania and of premorbid characteristics of patients treated for a first episode of psychotic mania. The collected data was used mainly to generate hypotheses.
Before onset of a first episode of psychotic mania, patients go through a phase of change from previous mental state where they present mood symptoms, sleep disruption and general functional decline. These clinical manifestations are however likely to have low specificity. However, their occurrence in patients presenting certain risk factors or markers of vulnerability that were identified at a relatively high prevalence in our sample, may be an indicator of impending first episode mania.
This is a retrospective study, in a small sample of patients presenting with psychotic mania. Criteria identified need therefore to be validated in larger prospective studies.
Early identification of patients at risk to develop a first episode of psychotic mania is unlikely to be possible on the basis of symptoms alone. However, the occurrence of certain clinical characteristics in patients who have risk factors or markers of vulnerability to BPAD could be a sign of impending first episode mania.
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