A 10-Year Prospective Study of Prodromal Patterns for Bipolar Disorder Among Amish Youth

Shaw, Jon A.; Egeland, Janice A.; Endicott, Jean; Allen, Cleona R.; Hostetter, Abram M.

doi:10.1097/01.chi.0000177052.26476.e5

Cited by 137 publications

(120 citation statements)

References 20 publications

Supporting

Mentioning

103

Contrasting

Unclassified

Order By: Relevance

“…A similar cluster of prodromal behaviors was identified by Egeland et al (2000Egeland et al ( , 2003Shaw, Egeland, Endicott, Allen, & Hostetter, 2005) in a 7-10 year follow-up of Amish children. Few of the children of bipolar I or II parents actually developed bipolar disorder within the time frame.…”

Section: Studies Of Bipolar Disorder Not Otherwise Specified (Bd-nos)mentioning

confidence: 73%

Prevention of bipolar disorder in at-risk children: Theoretical assumptions and empirical foundations

Miklowitz

Chang

2008

Dev Psychopathol

View full text Add to dashboard Cite

This article examines how bipolar symptoms emerge during development, and the potential role of psychosocial and pharmacological interventions in the prevention of the onset of the disorder. Early signs of bipolarity can be observed among children of bipolar parents and often take the form of subsyndromal presentations (e.g., mood lability, episodic elation or irritability, depression, inattention, and psychosocial impairment). However, many of these early presentations are diagnostically nonspecific. The few studies that have followed at-risk youth into adulthood find developmental discontinuities from childhood to adulthood. Biological markers (e.g., amygdalar volume) may ultimately increase our accuracy in identifying children who later develop bipolar I disorder, but few such markers have been identified. Stress, in the form of childhood adversity or highly conflictual families, is not a diagnostically-specific causal agent but does place genetically and biologically vulnerable individuals at risk for a more pernicious course of illness. A preventative family-focused treatment for children with (a) at least one first-degree relative with bipolar disorder, and (b) subsyndromal signs of bipolar disorder, is described. This model attempts to address the multiple interactions of psychosocial and biological risk factors in the onset and course of bipolar disorder.

show abstract

Section: Studies Of Bipolar Disorder Not Otherwise Specified (Bd-nos)mentioning

confidence: 73%

Prevention of bipolar disorder in at-risk children: Theoretical assumptions and empirical foundations

Miklowitz

Chang

2008

Dev Psychopathol

View full text Add to dashboard Cite

show abstract

“…There are 3 comparable studies with standardized methodology, well-characterized parent samples, and repeated assessments of offspring over a 5-to 10-year period. 84,87,88 In all these studies, the families included were mostly intact, had limited or no assortative mating, existed in the context of relatively organized and stable communities, and had offspring with little or no exposure to stimulants or antidepressants.…”

Section: Longitudinal Prospective Studiesmentioning

confidence: 99%

“…In the Canadian study, nonspecific disorders or disorders other than mood disorders (that is, sleep, anxiety, and in some subjects, neurodevelopmental disorders) were antecedents to the onset of subsequent BD in high-risk children. 89 In the 10-year prospective follow-up study of the offspring of Amish parents with BD I, 87,90 prodromal symptoms indicating risk for BD included anxiety or somatic complaints, distractibility or role impairment in school, excitability, hyperalertness, and mood lability. As the children grew older, more classic bipolar symptoms became significant; these included talking loudly, excessive talking, high energy, problems with thinking and concentration, and problems with sleep (that is, decreased sleep, early awakening, and initial insomnia).…”

Section: Longitudinal Prospective Studiesmentioning

confidence: 99%

Does Bipolar Disorder Exist in Children? A Selected Review

Duffy

2007

Can J Psychiatry

View full text Add to dashboard Cite

Although there is increasing recognition that a substantial proportion of patients with bipolar disorder (BD) experience an onset of illness in adolescence, significant controversy remains over the validity of the diagnosis in very young children. In careful studies of adult patients dating from Kraepelin, first mood episodes not uncommonly occurred during adolescence. Some of these early-onset patients experienced subthreshold mood disturbances or predisposing temperaments earlier in childhood. Earlier onsets of BD have been reported in more recent clinical and community samples of children. Several factors possibly contributed to these earlier onsets, including exposure to psychotropics, bias in favour of a mood rather than a psychotic diagnosis, and recognition of softer-spectrum BDs. However, the validity of the diagnosis of BD in impulsive, irritable, labile, or behaviourally dysregulated children remains to be proven. Studies of high-risk children of well-characterized parents with BD have demonstrated that BD most often debuts as a depressive episode in mid to late adolescence and that activated episodes are rare prior to age 12 years. Some children manifest antecedent nonspecific psychopathology in early childhood. Therefore, as currently diagnosed, BD does not manifest as such typically until at least adolescence.

show abstract

“…Finally, an interesting longitudinal prospective study 17,18 of the offspring of Amish parents with BD I has focused on mapping the earliest signs and prodromal symptoms of BD. The parent probands were conservatively diagnosed for participation in a separate genetic study.…”

Section: Findings From Published High-risk Studiesmentioning

confidence: 99%

The Early Natural History of Bipolar Disorder: What We Have Learned from Longitudinal High-Risk Research

Duffy

2010

Can J Psychiatry

View full text Add to dashboard Cite

Longitudinal high-risk research has provided convergent evidence that major mood and psychotic disorders often develop from nonspecific antecedents in predisposed people over time and development. For example, bipolar disorder (BD) appears to evolve from nonspecific childhood antecedents, including anxiety and sleep problems, followed by adjustment and minor mood disturbances through early adolescence, culminating in major mood episodes in later adolescence and early adulthood. Therefore, the current cross-sectional symptom-based diagnostic approach requires rethinking: it considers neither the familial risk nor the longitudinal clinical course, with the consequence that the early stages of illness are not recognized as belonging to the end-stage disorder. Emerging evidence of identifiable clinical stages in the development of BD has tremendous potential for early identification, development of stage-specific treatments, and advancing our understanding of the pathophysiology associated with illness onset and progression. The clinical staging model also has direct implications for the optimal organization of clinical services for high-risk youth. Specifically, specialty psychiatric programs are needed that break down traditional institutional barriers to provide surveillance and timely comprehensive psychiatric assessment during the entire risk period, from childhood through to early adulthood. In this regard, the development of specialty psychiatric programs aiming to identify youth in the early stages of evolving psychosis are substantially ahead of services for youth in the early stages of evolving major mood disorders.Can J Psychiatry. 2010;55(8):477-485. Highlights· Prospective longitudinal studies of the children of affected parents have provided an important opportunity to describe the early natural history of BD. · New evidence supports a clinical staging model that, if replicated, will improve early detection and provide a conceptual frame for early intervention and neurobiological research. · Implications of completed high-risk research point to the importance of a developmental approach to psychiatric diagnosis and highlight the need for specialty programs for youth at high risk of major mood disorders.

show abstract

A 10-Year Prospective Study of Prodromal Patterns for Bipolar Disorder Among Amish Youth

Cited by 137 publications

References 20 publications

Prevention of bipolar disorder in at-risk children: Theoretical assumptions and empirical foundations

Prevention of bipolar disorder in at-risk children: Theoretical assumptions and empirical foundations

Does Bipolar Disorder Exist in Children? A Selected Review

The Early Natural History of Bipolar Disorder: What We Have Learned from Longitudinal High-Risk Research

Contact Info

Product

Resources

About