Manic Symptoms in Youth: Dimensions, Latent Classes, and Associations With Parental Psychopathology

Abstract

Objective The purpose of the study was to define the latent structure of parent-reported manic symptoms and their association with functional impairment and familial risk in a community sample of Brazilian children. Method We screened for manic symptoms in a community sample of 2,512 children 6 to 12 years of age. Parents of children with “episodes of going abnormally high” completed a detailed mania section (n = 479; 19.1%). Confirmatory factor analysis (CFA) tested a solution with “Under-Control (UC)” and “Exuberant (EX)” dimensions, investigating the severity (threshold) and factor loading of each symptom. We also used latent class analysis (LCA) to evaluate the latent categorical structure of manic symptoms. Associations of these latent constructs with psychiatric comorbidity, psychosocial impairment, and family history of psychopathology were tested. Results The 2-dimensional model fit the data well. Only the UC dimension was associated with psychiatric morbidity, psychosocial impairment, and a family history of mania, depression, or suicide attempts. Both UC and EX items discriminated subjects with “episodes of going abnormally high,” but EX items lay at the mild end of the severity spectrum, whereas UC items lay at the severe end. The LCA yielded a small group of children with high levels of manic symptoms and a distinct profile of psychiatric comorbidity and impairment (“high-symptom group”). Conclusion In a large, community-based sample, we found a 2-dimensional latent structure for parent-reported manic symptoms in youth, and demonstrated familial associations between the UC dimension and affective disorders. Both UC and EX items are clinically useful, but their contributions vary with symptom severity.

The predictive value of childhood subthreshold manic symptoms for adolescent and adult psychiatric outcomes

“…Our findings accord with previous studies that have identified this constellation of symptoms as a subthreshold bipolar phenotype in the general population (Pan et al, 2014;Stringaris et al, 2011). Moreover, our results are in line with findings of a recent study in offspring of BD parents which examined the predictive value of dimensional symptomatic measures for new-onset bipolar spectrum disorders (Hafeman et al, 2016).…”

“…The constellation of subthreshold symptoms that define this high-risk phenotype for BD is thought to reflect reduced control over cognition, emotion and behavior (Pan et al, 2014;Stringaris et al, 2011). As disruptive behavior disorders and ADHD are also characterized by dyscontrol symptoms (Martel et al, 2013), it is not surprising that these disorders were common in children in the mildly and highly symptomatic classes (Table 2).…”

“…Using this approach, two independent general population studies of British (5-16 years) and children, have reported the presence of subgroups with minimal, moderate and high levels of subthreshold manic symptoms (Pan et al, 2014;Stringaris et al, 2011). However, the predictive value of such stratification has yet to be tested.…”

The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research

“…Second-generation antipsychotics (SGAs) approved by the United States Food and Drug Administration (FDA) for the treatment of acute mania and/or mixed mania in children and adolescents (10–17 years) include risperidone, aripiprazole and quetiapine, olanzapine, and asenapine 13–17 (http://www.accessdata.fda.gov/scripts/cder/daf/). Lithium has FDA indication for the treatment and recurrence prevention of mania in youths aged 12 years and older, bolstered by a recently published positive 8-week RCT for youths 7–17 years old with BD-I manic/mixed episodes.…”

Suicidal ideation and behavior in institutions of higher learning: A latent class analysis

“…In the suicide risk literature, LCA has been used to identify precipitants for suicidal thoughts among adolescents of various ethnic and racial backgrounds (De Luca et al, 2014; Stoep et al, 2009); to predict suicidal behavior (Thompson et al, 2009); to recognize patterns in known risk factors for suicide among suicide decedents (Judd et al, 2012; Kim et al, 2003; Logan et al, 2011); to identify psychiatric disorder subtypes that might be more strongly associated with suicidal thoughts or behaviors (Li et al, 2014; Pan et al, 2014); and to explore interactions among suicide risk factors (Pena et al, 2012). …”