Context: Whether offspring of parents with bipolar disorder (BP) are at specifically high risk to develop BP and other psychiatric disorders has not been adequately studied. Objective: To evaluate lifetime prevalence and specificity of psychiatric disorders in offspring of parents with BP-I and BP-II. Design: Offspring aged 6 to 18 years who have parents with BP and community control subjects were interviewed with standardized instruments. All research staff except the statistician were blind to parental diagnoses. Setting: Parents with BP were recruited primarily through advertisement and outpatient clinics. Control parents were ascertained by random-digit dialing and were group matched for age, sex, and neighborhood to parents with BP. Participants: Three hundred eighty-eight offspring of 233 parents with BP and 251 offspring of 143 demographically matched control parents. Main Outcome Measures: Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) Axis I disorders. Results: Adjusting for demographic factors, living with 1 vs both biological parents, both biological parents' non-BP psychopathology, and within-family correlations, offspring of parents with BP showed high risk for BP spectrum disorders (odds ratio [OR]=13.4; 95% confidence interval [CI], 2.9-61.6) and any mood (OR=5.2; 95% CI, 2.3-11.4), anxiety (OR=2.3; 95% CI, 1.3-4.0), and Axis I (OR=2.2; 95% CI, 1.5-3.3) disorders. Off-spring of parents with BP with high socioeconomic status showed more disruptive behavior disorders and any Axis I disorders than offspring of control parents with high socioeconomic status. Families in which both parents had BP had more offspring with BP than families with only 1 parent with BP (OR=3.6; 95% CI, 1.1-12.2). More than 75.0% of offspring who developed BP had their first mood episode before age 12 years, with most of these episodes meeting criteria for BP not otherwise specified and, to a lesser degree, major depression. Conclusions: Offspring of parents with BP are at high risk for psychiatric disorders and specifically for early-onset BP spectrum disorders. These findings further support the familiality and validity of BP in youth and indicate a need for early identification and treatment.

Youths who present with RAP in primary care deserve careful assessment for anxiety and depressive disorders. Future studies should examine treatments that are proved to be efficacious for pediatric anxiety and/or depressive disorders as potential interventions for RAP. Longitudinal, family, and psychobiological studies are needed to illuminate the nature of observed associations among RAP, anxiety, and depression.

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Objective-To assess the psychometrics of the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime Version (KSADS-PL) in diagnosing DSM-IV psychiatric disorders and subsyndromal symptomatology in preschool children.Method-Parents were interviewed about their children using the KSADS-PL, and they completed the Early Childhood Inventory-4 (ECI-4) and Child Behavior Checklist for Ages 1½-5 Years (CBCL). Discriminant, divergent, and convergent validity of the KSADS-PL were evaluated in 204 offspring ages 2-5 years old of parents from an ongoing study. Inter-rater reliability as well as predictive validity of intake diagnoses at second assessment approximately two years after intake were evaluated. Fourteen children were also assessed by the Preschool Age Psychiatric Assessment (PAPA).Results-Children who were diagnosed with Oppositional Defiant Disorder, Attention Deficit Hyperactivity Disorder, anxiety, mood, or elimination disorders had significantly higher scores on the ECI-4 than children without these disorders. Significant correlations were found for all convergent CBCL scales. Divergent validity was acceptable for emotional disorders. Inter-rater kappa coefficients for all diagnoses were good. Above noted results were similar for children with at least one positive KSADS-PL key screen symptom. A significantly higher percentage of children with an intake diagnosis had a diagnosis approximately two years after intake compared to those without an intake disorder. Overall, there was consistency between the PAPA and the KSADS-PL.

Morningness/eveningness (M/E) is a stable, quantifiable measure reflecting preferred circadian phase. Two prior studies suggest that bipolar I disorder (BP1) cases are more likely to have lower M/E scores, i.e., be evening types compared with control groups. These studies did not recruit controls systematically and did not evaluate key clinical variables. We sought to replicate the reported associations in a large, well defined sample, while evaluating potential confounding factors. Adults with bipolar disorder (BP) were compared with community controls drawn randomly from the same residential areas (190 cases and 128 controls). M/E was evaluated using the composite scale of morningness (CSM). After accounting for variables correlated with M/E, BP cases had significantly lower CSM scores than controls (i.e., more evening-type or fewer morning-type). There were no significant differences in M/E scores between BP1 or BP2 disorder cases (n = 134 and 56, respectively). CSM scores were stable over approximately 2 years in a subgroup of participants (n = 52). Individuals prescribed anxiolytic drugs, antidepressants, antipsychotic drugs, mood stabilizers or stimulant drugs had significantly lower age-corrected CSM scores compared with persons not taking these drugs. BP cases are more likely to be evening types, suggesting circadian phase delay in BP cases. Individuals with elevated depressive mood scores are more likely to be evening types. Our results suggest a replicable relationship between circadian phase and morbid mood states.

Objective-To compare mother-child interactions and parenting styles in families of children with major depressive disorder, youths at high risk for depression, and healthy controls.Method-Currently depressed (n = 43), high-risk (n = 28), and healthy control (n = 41) youths and their mothers engaged in a standardized videotaped problem-solving interaction. Measures of affect and behavior for both mothers and children were obtained, in addition to global measures of parenting.Results-Depressed children demonstrated more negativity and less positivity in dyadic interactions than did children at high risk and control children. Mothers of depressed children were more disengaged than control mothers. Exploratory repeated-measures analyses in a subgroup of depressed children (n = 16) suggested mother-child interactions do not significantly change when children recover from depression. Children at high risk demonstrated less positivity in dyadic interactions than did controls. Mothers with a history of major depressive disorder and mothers with higher current depressive symptoms demonstrated patterns of disengagement and low control in interactions with children.Conclusions-Mother-child interactions in depressed youths are marked by maternal disengagement and low child positivity that may not improve when children recover. The bidirectional effects of maternal disengagement and low levels of child positivity may precede onset of major depressive disorder in children and serve as risk factors for recurrent depression in youths.Keywords major depressive disorder; high risk; mother-child interaction; parenting Family interactions provide a rich context for studying the bidirectional relationship between interpersonal environments and the onset and course of psychopathology in depressed children and adolescents. Depressed children and adolescents have discordant family relationships, marked by high rates of conflict, hostility, rejection, low support and cohesion, Copyright © 2008 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript and poor communication, [1][2][3][4][5] that may persist after children and adolescents recover from acute depressive episodes. 6,7 As such, maladaptive family interactions have been postulated to be one of the mechanisms by which depression develops and is maintained in at-risk children and adolescents. 4,8 Research on children of depressed mothers further indicates that poor family functioning, negative mother-child interactions and maladaptive parenting strategies may predate the development of depression in children with familial loading for depression. 9,10 Because of the bidirectional nature of child and parent factors that contribute overall discordant interactions in families of depressed children, it remains unclear whether negative family interactions precede depression in children and adolescents or whether negative family interactions are a consequence of children's depressive symptoms 1,11-13 or both. Two recently published studies sought to untangle ...

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