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.

High expressed emotion (EE) attitudes among parents are associated with an increased likelihood of relapse among bipolar patients, but the origins of these attitudes are unclear. This study examined characteristics of bipolar disorder in adolescents that might be associated with high EE attitudes among parents. We hypothesized that an earlier onset of mood disorder and greater current illness severity would predict higher levels of criticism and emotional overinvolvement among parents. Demographic, diagnostic, and EE data were collected from interviews with parents of 44 bipolar adolescents (mean age 14.5 yrs.). Current illness severity and functioning were not associated with high-EE attitudes. Parents of girls, however, were more likely to be high in criticism than parents of boys. Parents of girls expressed more critical comments when the child had an adolescent compared to a childhood onset of bipolar disorder, whereas the reverse pattern was evident among parents of boys. We encourage prospective investigations of the developmental correlates of parental EE attitudes in larger, more heterogeneous samples of bipolar adolescents and children. KeywordsExpressed Emotion; Age at Onset; Bipolar Disorder; Gender; Developmental Psychopathology Early-onset bipolar disorder is characterized by severe and maladaptive shifts in mood, energy level, and behavior (Lewinsohn, Klein, and Seeley, 2000;Wilkinson, Taylor, & Holt, 2002). Symptoms of irritability, especially if phasic or episodic, are believed to be behavioral precursors of more classic bipolar symptoms in later childhood or adulthood (Fergus et al., 2003;Leibenluft, Cohen, Gorrindo, Brook, & Pine, 2006). Between 50% and 67% of bipolar patients experience illness onset before the age of 18, and 13% -28% before age 13 (Perlis et al., 2004).Factors that influence the onset of bipolar disorder may differ from factors that influence the course of the illness once diagnosed. Although heritability plays a central role in the etiology of the disease (Faraone, Glatt, & Tsuang, 2003), the family environment accompanying illness episodes may influence the frequency and timing of relapses. Bipolar adults who live with highly critical, hostile, or emotionally overinvolved (high expressed emotion, or high-EE) parents are significantly more likely to experience a relapse within one year after an acute episode than adult patients whose parents are low in EE (Miklowitz, Goldstein, Nuechterlein, Snyder, and Mintz, 1988;Yan, Hammen, Cohen, Daley, & Henry, 2004).Pediatric bipolar patients are usually under the direct care of their parents, and appear to be highly susceptible to variations in the emotional climate of the family (Jarbin, Grawe, & Hansson, 2000;Kim, Miklowitz, Biuckians, & Mullen, 2007;Fristad & Goldberg, 2003). However, few studies have examined the role of EE or other family environmental factors in the course of childhood bipolar disorder. Among patients with prepubertal or early adolescent bipolar disorder, Craney and Geller (2003) found that children wh...