An inexpensive family index of risk for mood issues improves identification of pediatric bipolar disorder.

Abstract

Family history of mental illness provides important information when evaluating pediatric bipolar disorder (PBD). However, such information is often challenging to gather within clinical settings. This study investigates the feasibility and utility of gathering family history information using an inexpensive method practical for outpatient settings. Families (N=273) completed family history, rating scales, MINI and KSADS interviews about youths 5–18 (median=11) years presenting to an outpatient clinic. Primary caregivers completed a half page Family Index of Risk for Mood issues (FIRM). All families completed the FIRM quickly and easily. Most (78%) reported 1+ relatives having history of mood or substance issues, M=3.7 (SD=3.3). A simple sum of familial mood issues discriminated cases with PBD from all other cases, AUROC=.63, p=.006. FIRM scores were specific to youth mood disorder and not ADHD or disruptive behavior disorder. FIRM scores significantly improved the detection of PBD even controlling for rating scales. No subset of family risk items performed better than the total. Family history information showed clinically meaningful discrimination of PBD. Two different approaches to clinical interpretation showed validity in these clinically realistic data. Inexpensive and clinically practical methods of gathering family history can help to improve the detection of PBD.

Increases in multiple psychiatric disorders in parents and grandparents of patients with bipolar disorder from the USA compared with The Netherlands and Germany

“…Direct interviews with family members would also be helpful, although Gershon and Guroff (1984) have suggested a high specificity of the family history method such that a reported positive is likely to be true. Algorta et al (2013) reported that parental report of psychiatric history provided valid information and helped discriminate pediatric bipolar disorder from other disorders. Some have suggested that cultural biases could account for the findings with Europeans minimizing illness in themselves and other family members.…”

The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research

“…Brief screening tools make adding family history clinically feasible. 122 High EE (ie, criticism, hostility, and emotional overinvolvement) and high family conflict are risk factors for treatment drop-out and more rapid relapse. 90 High-EE families may show larger responses to family-focused psychotherapeutic interventions.…”

Role of childhood adversity in the development of medical co-morbidities associated with bipolar disorder

“…Again, some investigators question the reliability of this type of family history, but others indicate that it has considerable reliability and validity (Algorta et al, 2011). However, our exclusive use of a parental history of illness, rather than that of any first-degree relative, may also increase accuracy of reporting.…”