A controlled family study of children with DSM-IV bipolar-I disorder and psychiatric co-morbidity

Abstract

Objective To estimate the spectrum of familial risk for psychopathology in first degree relatives of children with unabridged DSM-IV Bipolar-I Disorder (BP-I). Methods We conducted a blinded, controlled family study using structured diagnostic interviews of 157 children with BP-I probands (N=487 1st degree relatives), 162 ADHD (without BP-I) probands (N=511 1st degree relatives), and 136 healthy control (without ADHD or BP-I) probands (N=411 1st degree relatives). Results The morbid risk (MR) of BP-I disorder in relatives of BP-I probands (MR=0.18) was increased 4-fold (95%CI=2.3-6.9, p<0.001) over the risk to relatives of control probands (MR=0.05) and 3.5-fold (95%CI=2.1-5.8, p<0.001) over the risk to relatives of ADHD probands (MR=0.06). In addition, relatives of children with BP-I disorder had high rates of psychosis, major depression, multiple anxiety disorders, substance use disorders, ADHD, and antisocial disorders compared with relatives of Control probands. Only the effect for antisocial disorders lost significance after accounted for by the corresponding diagnosis in the proband. Familial rates of ADHD did not differ between ADHD and BP-I probands. Conclusions Our results document an increased familial risk for BP-I disorder in relatives of pediatric probands with DSM-IV BP-I disorder. Relatives of probands with BP-I disorder were also at increased risk for other psychiatric disorders frequently associated with pediatric BP-I disorder. These results support the validity of the diagnosis of BP-I in children as defined by DSM-IV. More work is needed to better understand the nature of the association between these disorders in probands and relatives.

Can unipolar and bipolar pediatric major depression be differentiated from each other? A systematic review of cross-sectional studies examining differences in unipolar and bipolar depression

“…These findings are consistent with those identified in adult patients with bipolar MDD (Akiskal et al, 1983;Coryell et al, 1995;Bechdolf et al, 2010) and with the literature on the risk factors for manic switching (Strober and Carlson, 1982;Geller et al, 1994;Biederman et al, 2009). Wozniak et al (2010) previously reported on the significantly increased morbid risk of bipolar disorder in relatives of children with bipolar disorder as compared to relatives of children with only ADHD. This study also found that relatives of children with bipolar disorder have higher rates of psychosis, major, multiple anxiety disorders, substance use disorders, ADHD, and antisocial disorders as compared to relatives of non-bipolar probands.…”

Further evidence that severe scores in the aggression/anxiety-depression/attention subscales of child behavior checklist (severe dysregulation profile) can screen for bipolar disorder symptomatology: a conditional probability analysis

“…Briefly, children with BP-I disorder 6 to 17 years of age of both sexes were assessed at the Clinical and Research Program in Pediatric Psychopharmacology at the Massachusetts General Hospital (Wozniak et al, 2005; Wozniak et al, 2010). Comparators were youth of similar age and sex with and without ADHD, without BP-I disorder (Biederman et al, 1992; Biederman et al, 1999; Biederman et al, 2006a; Biederman et al, 2006b).…”

Examining the Comorbidity Between Attention Deficit Hyperactivity Disorder and Bipolar I Disorder: A Meta-Analysis of Family Genetic Studies

“…Figure 1 depicts the number of articles identified and their disposition. We reanalyzed data from the Massachusetts General Hospital Pediatric Psychopharmacology Program to allow for stratifying relatives by parents, children, and siblings (29)(30)(31)(32)(33).…”