Lifetime Psychiatric Disorders in School-aged Offspring of Parents With Bipolar Disorder

Abstract

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.

Common Proteomic Changes in the Hippocampus in Schizophrenia and Bipolar Disorder and Particular Evidence for Involvement of Cornu Ammonis Regions 2 and 3

“…87 Our findings therefore provide further support for a reappraisal of these disorders as distinct diagnostic entities, 32 although other evidence for the distinct character must also be considered in any such reappraisal. 32,49,88,89 In keeping with previous proteomic studies of schizophrenia and bipolar disorder, 38 including one of the hippocampus in schizophrenia, 90 our findings implicate proteins involved in cytoskeletal 42,46,90 and metabolic 42,45,46,48,58 cellular mechanisms and, specifically in bipolar disorder, cell death pathways. 91,92 The results complement findings of transcriptomic investigations in these brain regions.…”

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

“…A recent meta‐analysis suggested that the most potent predictors were family history, an earlier age of onset and the presence of psychotic symptoms 574. There is an increased prevalence of BD among offspring of parents with BD 575, 576, 577. Although there is no uniform strategy for managing depression (or ADHD, anxiety, etc.)…”

Mood disorders in childhood and adolescence

“…In adults, the rates are around 5 to 10%, suggesting a larger genetic component in the early-onset form of BD. [42][43][44] In naturalistic studies of BD among children and adolescents, the recovery rates are high (70 to 100%), but the recurrence rate in 2 to 5 years is up to 80%. [45][46][47] Moreover, most of the time these patients experienced subsyndromal and syndromal mood symptomatology and frequent mood fluctuations, as reported in the Course and Outcome of Bipolar Youth (COBY, n=263) 2-year followup study.…”