Paradigm Shift: Preliminary Clinical Categorization of Ultrahigh Risk for Childhood Bipolar Disorder to Facilitate Studies on Prevention

Leverich²,

et al. 2015

Psychiatric Genetics

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The increased complexity of psychiatric illness and its occurrence over several generations in the families of patients with bipolar disorder from the USA versus Europe could be contributing to the higher incidence of childhood onsets and greater virulence of illness in the USA compared with Europe. These data are convergent with others suggesting increased both genetic and environmental risk in the USA, but require replication in epidemiologically-derived populations with data based on interviews of the family members.

Section: Resultsmentioning

confidence: 99%

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

Leverich²,

et al. 2015

Psychiatric Genetics

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“…Furthermore, attention to the parental loading of unilineal bipolar disorder and bilineal mood disorder may facilitate evaluation and potential psychotherapeutic and pharmacological intervention in those at highest risk (25).…”

Section: Discussionmentioning

confidence: 99%

Increased parental history of bipolar disorder in the United States: association with early age of onset

Leverich

et al. 2013

Acta Psychiatr Scand

ObjectiveEarly‐onset bipolar (BP) disorder and other poor prognosis characteristics are more prevalent in patients from the United States than from the Netherlands and Germany (abbreviated as Europe). We explored the impact of parental loading for affective illness on onset and other characteristics of BP disorder.MethodParental history for unipolar (UP) and bipolar (BP) depression and course of illness characteristics were obtained from self‐report in adults (average age 42) with BP disorder. Illness characteristics were examined by χ2 and multinomial logistic regression in relationship to the degree of parental loading: i) both parents negative; ii) one UP disorder; iii) one with BP disorder; and iv) both affected.ResultsAfter controlling for many poor prognosis factors, compared with those from Europe, patients from the United States had more iii) one parent with BP disorder and iv) both parents affected. An early age of onset of BP disorder was independently associated with this increased parental loading for affective disorder.ConclusionParental history of BP disorder and both parents with a mood disorder were more common in the United States than Europe and were associated with an early onset of bipolar disorder and other poor prognosis characteristics. These findings deserve replication and exploration of the potential mechanisms involved and their therapeutic implications.

“…8,40 Psychotherapeutic interventions have proved effective for those at high risk with prodromal syndromes, 41,42 and study of safe potentially effective early interventions such as omega-3-fatty acids and N-acetylcysteine would be It is illegal to post this copyrighted PDF on any website.…”

Section: J Clin Psychiatry 77:8 August 2016mentioning

confidence: 99%

“…44 Even if no cohort and anticipation effects existed, the current crisis of inadequate approaches to research on and treatment of bipolar disorder in the United States is already of staggering proportions. 18,40,[45][46][47] Given the likelihood of increasing difficulties in future generations based on a host of factors driving the likely cohort effects seen here and in the literature, the costs of early-onset bipolar disorder and its pernicious course will greatly worsen unless appropriate therapeutic interventions are generated and delivered. …”

Section: J Clin Psychiatry 77:8 August 2016mentioning

confidence: 99%

Further Evidence of a Cohort Effect in Bipolar Disorder

Keck

et al. 2016

J. Clin. Psychiatry

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Objective: Given that a cohort effect is rarely mentioned as one of the possible contributors to the increased incidence of childhood-onset bipolar disorder in the United States, we reexamined evidence for the phenomenon within our outpatient Bipolar Collaborative Network. Methods: 968 outpatients (mean age, 41 years) with DSM bipolar disorder from 1995 to 2002 from 4 sites in the United States and 3 in the Netherlands and Germany (abbreviated as Europe) gave informed consent and provided detailed demographic, illness, and family history information on a patient questionnaire. Family history of bipolar disorder, depression, suicide attempt, alcohol abuse, substance abuse, and "other" illness was collected for each parent and the 4 grandparents. Age at onset and family history of illness burden were then assessed as a function of the age of the patient at network entry. Results: Data for patients aged 35 years or older (n = 613) were included in the first analysis. Compared to older patients, those who were younger when they entered the network had an earlier age at onset of their bipolar disorder (r = 0.33, P < .001). Similarly, the youngest patients at entry (representing the most recent cohorts) had parents and grandparents with more psychiatric illness than patients born in earlier cohorts (n = 968). Conclusions: These preliminary data, taken with the substantial literature, suggest a cohort effect for earlier age at onset of bipolar disorder and greater burden of psychiatric disorders in 2 generations of direct progenitors of our patients. The resulting likely increase in severity of bipolar illness in future generations based on this earlier age at onset and increased familial loading, particularly in the United States, deserves focused clinical and public health attention and attempts at amelioration.