A nationwide population‐based longitudinal study mapping psychiatric disorders during lifetime in siblings to patients with bipolar disorder

Kessing, Lars Vedel; Ziersen, Simon Christoffer; Andersen, Per Kragh; Vinberg, Maj

doi:10.1111/acps.13263

Cited by 14 publications

(12 citation statements)

References 24 publications

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“…The heritability of bipolar disorder is among the highest of psychiatric disorders (Lohoff & Berettini, 2010). Up to 50% of first-degree relatives to patients with bipolar disorder will develop a mood disorder or another psychiatric illness (Mesman, Nolen, Reichart, Wals, & Hillegers, 2013; Rasic, Hajek, Alda, & Uher, 2014; Vedel Kessing, Ziersen, Andersen, & Vinberg, 2021) and first-degree relatives to patients with bipolar disorder have a 5- to 10-fold increased risk of developing bipolar disorder themselves (Mortensen, Pedersen, Melbye, Mors, & Ewald, 2003). Meta-analyses show that unaffected first-degree relatives present with cognitive impairment compared with healthy control individuals without a familial predisposition to bipolar disorder (Arts, Jabben, Krabbendam, & van Os, 2008; Bora, 2017).…”

Section: Introductionmentioning

confidence: 99%

Socio-economic functioning in patients with bipolar disorder and their unaffected siblings – results from a nation-wide population-based longitudinal study

Sletved¹,

Ziersen²,

Andersen³

et al. 2021

Psychol. Med.

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Background Few studies have reported real-life data on socio-economic functioning in patients with bipolar disorder and their unaffected first-degree relatives. Methods We used Danish nation-wide population-based longitudinal register linkage to investigate socio-economic functioning in 19 955 patients with bipolar disorder, their 13 923 siblings and 20 sex, age and calendar-matched control individuals from the general population. Follow-up was from 1995 to 2017. Results Patients with a diagnosis of bipolar disorder had lower odds of having achieved the highest educational level [OR 0.75 (95% confidence interval (CI) 0.73–0.77)], being employed [OR 0.16 (95% CI 0.159–0.168)], having achieved the 80% highest quartile of income [OR 0.33 (95% CI 0.32–0.35)], cohabitating [OR 0.44 (95% CI 0.43–0.46)] and being married [OR 0.54 (95% CI 0.52–0.55)] at first contact to hospital psychiatry as inpatient or outpatient compared with control individuals from the general population. Similarly, siblings to patients with bipolar disorder had a lower functioning within all five socio-economic areas than control individuals. Furthermore, patients and partly siblings showed substantially decreased ability to enhance their socio-economic functioning during the 23 years follow-up compared to controls. Conclusions Socio-economic functioning is substantially decreased in patients with bipolar disorder and their siblings and does not improve during long-term follow-up after the initial hospital contact, highlighting a severe and overlooked treatment gap.

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Section: Introductionmentioning

confidence: 99%

Socio-economic functioning in patients with bipolar disorder and their unaffected siblings – results from a nation-wide population-based longitudinal study

Sletved¹,

Ziersen²,

Andersen³

et al. 2021

Psychol. Med.

Self Cite

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“…In this study, the patients’ overall functioning was less impaired, most likely because they were newly diagnosed with BD, earlier in their illness course and included at an early stage of the BD illness. Since the patients included in this study were younger, they may also have a lower FL of psychiatric disorders as their first-degree relatives have had fewer cumulative years at risk of developing psychiatric disorders [ 34 ]. Moreover, the other study was conducted on American outpatients, limiting the direct comparability of SES since there may be vast differences between American and Danish (European) patients with BD [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Familial load of psychiatric disorders and overall functioning in patients newly diagnosed with bipolar disorder and their unaffected first-degree relatives

Sletved

Maiggaard

Thorup

et al. 2022

Int J Bipolar Disord

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Background Overall functioning is already impaired in patients newly diagnosed with bipolar disorder (BD) and, to a lesser degree, also in their unaffected first-degree relatives (UR). Further, aggregation of psychiatric disorders among the patients’ first-degree relatives seems to be associated with higher illness burden and poorer prognosis. However, whether this aggregation of psychiatric disorders among first-degree relatives, the familial load (FL), impacts overall functioning in patients newly diagnosed with BD and their UR remains unresolved. Methods In total, 388 patients newly diagnosed with BD, 144 of their UR and 201 healthy control individuals were included. Overall functioning was assessed using three different assessment methods: The interviewer based “Functioning Assessment Short Test” (FAST), the questionnaire “Work and Social Adjustment Scale” (WSAS) and six outcome measures covering the participants’ socio-economic status (SES); educational achievement, employment, work ability, relationship, cohabitation and marital status. Familial load of psychiatric disorder was assessed using the “Family History Research Diagnostic Criteria” interview. Associations between FL and overall functioning in patients and UR were investigated categorically using logistic and continuously in linear regression models. Results Contrasting with the hypotheses, the FL of psychiatric disorders was not associated with impaired overall functioning, neither in patients newly diagnosed with BD nor in their UR. Conclusion The findings indicate that impaired functioning in the early phase of BD is not associated with aggregation of psychiatric disorders among first-degree relatives. The observed functional impairment in patients newly diagnosed with BD seems driven by the personal impact of the disorder rather than the impact of having first-degree relatives with psychiatric disorders. Keywords: bipolar disorder, first-degree relatives, familial load of psychiatric disorders, functioning, socio-economic status.

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“…The risk to first-degree relatives of bipolar probands is approximately 8-10 times higher compared to the general population 296 . In addition to an elevated risk of bipolar disorder, family members are at increased risk of other mental disorders (e.g., major depressive disorder, psychotic disorders) 297 . A number of susceptibility loci for bipolar disorder have been identified via genome-wide association studies, but family history remains the best proxy of the genetic liability to the disorder.…”

Section: Family Historymentioning

confidence: 99%

The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management

et al. 2022

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Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multiomic" measures, electronic health records), analyzed using ad vanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at pointofcare is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features -especially during depressive episodes -and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentallyoriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, provid ing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at pointofcare.

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A nationwide population‐based longitudinal study mapping psychiatric disorders during lifetime in siblings to patients with bipolar disorder

Cited by 14 publications

References 24 publications

Socio-economic functioning in patients with bipolar disorder and their unaffected siblings – results from a nation-wide population-based longitudinal study

Socio-economic functioning in patients with bipolar disorder and their unaffected siblings – results from a nation-wide population-based longitudinal study

Familial load of psychiatric disorders and overall functioning in patients newly diagnosed with bipolar disorder and their unaffected first-degree relatives

The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management

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