Prevalence of Psychopathology in Children of a Bipolar Parent

Wals, Marjolein; Hillegers, Manon H. J.; Reichart, Catrien G.; Ormel, Johan; Nolen, Willem A.; Verhulst, Frank C.

doi:10.1097/00004583-200109000-00019

Cited by 140 publications

(142 citation statements)

References 26 publications

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“…For example, in the study reported by Chang et al, 83 the mean age of the cohort was 11 years, 88% of the children diagnosed with BD also had a diagnosis of comorbid ADHD, and 8 of 9 were boys. By contrast, in the study reported by Reichart et al, [84][85][86] the subjects had a mean age of 16 years at baseline, 7 of 13 offspring diagnosed with BD were male, and only one of these had a diagnosis of comorbid ADHD. The differences between high-risk studies in age of onset and nature of the psychopathology can in part be attributed to differences in parental samples (for example, assortative mating and heterogeneity of BD), differential use and application of diagnostic assessments, and possibly, differential exposure to psychotropics.…”

Section: High-risk Offspring Studiesmentioning

confidence: 74%

Does Bipolar Disorder Exist in Children? A Selected Review

Duffy

2007

Can J Psychiatry

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Although there is increasing recognition that a substantial proportion of patients with bipolar disorder (BD) experience an onset of illness in adolescence, significant controversy remains over the validity of the diagnosis in very young children. In careful studies of adult patients dating from Kraepelin, first mood episodes not uncommonly occurred during adolescence. Some of these early-onset patients experienced subthreshold mood disturbances or predisposing temperaments earlier in childhood. Earlier onsets of BD have been reported in more recent clinical and community samples of children. Several factors possibly contributed to these earlier onsets, including exposure to psychotropics, bias in favour of a mood rather than a psychotic diagnosis, and recognition of softer-spectrum BDs. However, the validity of the diagnosis of BD in impulsive, irritable, labile, or behaviourally dysregulated children remains to be proven. Studies of high-risk children of well-characterized parents with BD have demonstrated that BD most often debuts as a depressive episode in mid to late adolescence and that activated episodes are rare prior to age 12 years. Some children manifest antecedent nonspecific psychopathology in early childhood. Therefore, as currently diagnosed, BD does not manifest as such typically until at least adolescence.

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Section: High-risk Offspring Studiesmentioning

confidence: 74%

Does Bipolar Disorder Exist in Children? A Selected Review

Duffy

2007

Can J Psychiatry

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“…Similar to HR subjects at risk for schizophrenia, psychiatric disorders are more common in offspring at risk for alcoholism, with both externalizing and internalizing disorders being more frequent than controls (Hill et al, 1999). Offspring at risk for bipolar disorder are also more likely to have externalizing disorders such as ADHD, but mood disorders are more common in this population (Chang et al, 2000;Henin et al, 2005;Wals et al, 2001). Offspring of depressive patients also have a similar pattern of psychopathology (Lieb et al, 2002).…”

Section: Discussionmentioning

confidence: 94%

Psychopathology among offspring of parents with schizophrenia: Relationship to premorbid impairments

Keshavan¹,

Montrose²,

Rajarethinam³

et al. 2008

Schizophrenia Research

104

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Introduction-A broad range of psychopathology, including externalizing disorders is seen in offspring at genetic risk for schizophrenia. However, it is unclear whether such psychopathology may underlie a higher predisposition to the premorbid antecedents of schizophrenia. We examined the prevalence and correlates of psychopathology in an ongoing study of offspring genetically at risk for schizophrenia.Methods-Seventy five consenting high risk offspring (HR: offspring, age 15.68±3.27 years; male/female 34/41) and 82 matched comparison subjects (40 males and 42 females; age 15.92±3.0 years) participated in this study. Diagnoses were ascertained using structured psychiatric interviews and consensus meetings, including all available clinical information.Results-Sixty (60%) of the HR offspring had one or more lifetime diagnosis of axis I psychiatric disorder. HR subjects with axis I psychopathology had significantly more soft neurological signs, poorer premorbid adjustment, and higher schizotypy scores as measured by Chapman psychosis proneness scales. Among those with psychopathology, HR subjects with externalizing disorders showed the most abnormal scores in schizotypy.Discussion-A substantial proportion of HR offspring of parents with schizophrenia manifest a broad range of childhood psychiatric disorders. Psychopathology, especially externalizing disorders such as attention deficit hyperactivity disorder (ADHD) may represent a subgroup with an increased risk for schizophrenia spectrum disorders. This possibility needs to be examined by prospective follow-up studies, and would be of considerable importance to early diagnosis and intervention efforts in schizophrenia.

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“…A Dutch longitudinal study 15 of the offspring (aged 12 to 21 years) of largely community-identified parents with BD was started in 1997. The parents were interviewed to confirm their diagnosis and met DSM-IV criteria for either BD I or II.…”

Section: Findings From Published High-risk Studiesmentioning

confidence: 99%

The Early Natural History of Bipolar Disorder: What We Have Learned from Longitudinal High-Risk Research

Duffy

2010

Can J Psychiatry

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Longitudinal high-risk research has provided convergent evidence that major mood and psychotic disorders often develop from nonspecific antecedents in predisposed people over time and development. For example, bipolar disorder (BD) appears to evolve from nonspecific childhood antecedents, including anxiety and sleep problems, followed by adjustment and minor mood disturbances through early adolescence, culminating in major mood episodes in later adolescence and early adulthood. Therefore, the current cross-sectional symptom-based diagnostic approach requires rethinking: it considers neither the familial risk nor the longitudinal clinical course, with the consequence that the early stages of illness are not recognized as belonging to the end-stage disorder. Emerging evidence of identifiable clinical stages in the development of BD has tremendous potential for early identification, development of stage-specific treatments, and advancing our understanding of the pathophysiology associated with illness onset and progression. The clinical staging model also has direct implications for the optimal organization of clinical services for high-risk youth. Specifically, specialty psychiatric programs are needed that break down traditional institutional barriers to provide surveillance and timely comprehensive psychiatric assessment during the entire risk period, from childhood through to early adulthood. In this regard, the development of specialty psychiatric programs aiming to identify youth in the early stages of evolving psychosis are substantially ahead of services for youth in the early stages of evolving major mood disorders.Can J Psychiatry. 2010;55(8):477-485. Highlights· Prospective longitudinal studies of the children of affected parents have provided an important opportunity to describe the early natural history of BD. · New evidence supports a clinical staging model that, if replicated, will improve early detection and provide a conceptual frame for early intervention and neurobiological research. · Implications of completed high-risk research point to the importance of a developmental approach to psychiatric diagnosis and highlight the need for specialty programs for youth at high risk of major mood disorders.

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Prevalence of Psychopathology in Children of a Bipolar Parent

Cited by 140 publications

References 26 publications

Does Bipolar Disorder Exist in Children? A Selected Review

Does Bipolar Disorder Exist in Children? A Selected Review

Psychopathology among offspring of parents with schizophrenia: Relationship to premorbid impairments

The Early Natural History of Bipolar Disorder: What We Have Learned from Longitudinal High-Risk Research

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