Similar familial underpinnings for full and subsyndromal pediatric bipolar disorder: A familial risk analysis

Objective: Youth with subthreshold mania are at elevated risk of conversion to bipolar disorder (BP) I/II. Predictors for conversion have been published for the group as a whole. However, risk factors are heterogeneous, indicating the need for personalized risk assessment. Method: 140 BP Not-Otherwise-Specified (BP-NOS) youths (6–17 years old) followed through the Course and Outcome of Bipolar Youth (COBY) study with at least one follow-up assessment prior to conversion to BP-I/II were included. Youths were assessed on average every 7 months for a median of 11.5 years using standard instruments. Risk predictors reported in the literature were utilized to build a 5-year risk calculator. Discrimination was measured using the time-dependent area under the curve (AUC) after 1000 bootstrap resamples. Calibration was evaluated comparing observed vs. predicted probability of conversion. External validation was performed using an independent sample of 58 BP-NOS youths recruited from the Pittsburgh Bipolar Offspring Study. Results: Seventy-five (53.6%) COBY BP-NOS youths converted to BP-I/II, of which 57 (76.0%) converted within 5 years. Earlier-onset BP-NOS, familial hypomania/mania, and high mania, anxiety, and mood lability symptoms were important predictors of conversion. The calculator showed excellent consistency between the predicted/observed risks of conversion, good discrimination between converters/non-converters (AUC: 0.71, CI: 0.67–0.74), and a proportionally increasing rate of converters at each successive risk class. Discrimination in the external validation sample was good (AUC: 0.75). Conclusion: If replicated, the risk calculator provides a useful tool to predict personalized risk of conversion from subsyndromal mania to BP-I/II and inform individualized interventions and research.

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“…Other risk factors reported in the literature but not included in the meta-analysis were also analyzed (eg, comorbid disorders). 2–6,8,9,11,12,26…”

Section: Methodsmentioning

confidence: 99%

A Risk Calculator to Predict the Individual Risk of Conversion From Subthreshold Bipolar Symptoms to Bipolar Disorder I or II in Youth

Birmaher

Merranko

Goldstein

et al. 2018

Journal of the American Academy of Child & Adolescent Psych

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“…Many studies of pediatric and adult BP disorder document the familiality, morbidity, and disability associated with subthreshold forms of BP-I disorder. We recently documented similar familial underpinnings for subsyndromal and full pediatric BP disorder ( 15 ). Using data from a community sample, Lewinsohn et al ( 16 ) reported that youth with subthreshold BP-I disorder had impairment, comorbidity, and suicide attempts that were as severe as those with a full BP diagnosis.…”

Section: Discussionmentioning

confidence: 95%

“…There were no significant differences in sex, ethnicity, age, or SES between those with syndromatic persistence, symptomatic persistence, and syndromatic and symptomatic remission (Table 1). [range] 11.5±3.6 [4][5][6][7][8][9][10][11][12][13][14][15][16] 9.2±3.5 [4][5][6][7][8][9][10][11][12][13][14][15][16][17] 9.3±3.4 [4][5][6][7][8][9][10][11][12][13][14][15][16][17] F(2, 65)=2.14 0.13 Age at follow-up [range ] 16.9±4.2 [9][10][11][12][13][14]…”

Section: Demographic Characteristicsmentioning

confidence: 99%

Further evidence of high level of persistence of pediatric bipolar-I disorder from childhood onto young adulthood: a five-year follow up

Wozniak

Wolenski

Fitzgerald

et al. 2018

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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Background: Pediatric bipolar (BP)-I disorder affects a sizeable minority of children and is associated with high levels of morbidity. Relatively few studies have assessed the persistence of the disorder over time. Objective: The main aim of this study was to extend our findings from our 4-year follow-up study examining rates of persistence of pediatric BP-I disorder onto late adolescent years and young adulthood 5 years after our original study. Methods: We conducted a 1-year extension to our original prospective study of 78 youth, ages six to 17 years, with BP-I disorder at ascertainment, who were followed up into their adolescent and young adult years (14.9 ± 3.8). All subjects were comprehensively assessed with structured diagnostic interviews and psychosocial, educational, and treatment history assessments. Results: Of the 78 BP-I participating youth, 68 were re-accessioned one year following the 4-year follow-up study, thus effectively 5 years since the original study. Of these, 63% continued to meet full (50%) or subthreshold (13%) diagnostic criteria for BP-I and 18% continued to have full or subthreshold major depressive disorder. Only 19% of BP-I youth were euthymic at the 5-year follow up. Discussion: This 1-year extension study further documents the high level of persistence of pediatric BP-I from childhood onto late adolescence and young adulthood. The results provide compelling evidence of the morbidity and dysfunction associated with this disorder and its many forms. Clinical significance: This study adds to a small amount of literature on the persistence of pediatric BP disorder and the critical need for early identification and intervention.

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“…In addition to the morbidity of subthreshold BP disorder, it should be noted that children with subthreshold BP disorder have a high rate of conversion to full BP disorder, with some longitudinal studies citing rates of conversion at close to or greater than 50% . Children with subthreshold BP disorder have been shown to have similar rates of familial BP‐I disorder when compared to children with full BP‐I disorder and higher rates of familial BP‐I disorder than children with ADHD or controls, suggesting a diagnostic continuity between subthreshold BP disorder and full threshold BP disorder . Therefore, it is difficult to distinguish if these two diagnostic groups are discrete entities or represent one disorder with multiple contributing genetic and environmental factors leading to a pleomorphic presentation with variable symptomatic expression that may be above or below arbitrary thresholds set forth by our nosology.…”

Section: Discussionmentioning

confidence: 99%

The morbidity of subthreshold pediatric bipolar disorder: A systematic literature review and meta‐analysis

et al. 2018

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Objective: The objective of this study was to evaluate the morbidity of subthreshold pediatric bipolar (BP) disorder. Methods:We performed a systematic literature search in November 2017 and included studies examining the morbidity of pediatric subthreshold BP. Extracted outcomes included functional impairment, severity of mood symptoms, psychiatric comorbidities, suicidal ideation and behaviors, and mental health treatment. We used meta-analysis to compute the pooled standardized mean difference (SMD) for continuous measures and the pooled risk ratio (RR) for binary measures between two paired groups: subthreshold pediatric BP vs controls and subthreshold pediatric BP vs pediatric BP-I. Results: Eleven papers, consisting of seven datasets, were included. We compared subthreshold pediatric BP (N = 244) to non-BP controls (N = 1125) and subthreshold pediatric BP (N = 643) to pediatric BP-I (N = 942). Subthreshold pediatric BP was associated with greater functional impairment (SMD = 0.61, CI 0.25-0.97), greater severity of mood symptomatology (mania: SMD = 1.88, CI 1.38-2.38; depression: SMD = 0.66, CI 0.52-0.80), higher rates of disruptive behavior (RR = 1.75, CI 1.17-2.62), mood (RR = 1.78, CI 1.29-2.79) and substance use (RR = 2.27, CI 1.23-4.21)disorders, and higher rates of suicidal ideation and attempts (RR = 7.66, CI 1.71-34.33) compared to controls. Pediatric BP-I was associated with greater functional impairment, greater severity of manic symptoms, higher rates of suicidal ideation and attempts, and higher rates of mental health treatment compared to subthreshold pediatric BP. There were no differences between full and subthreshold cases in the severity of depressive symptoms or rates of comorbid disorders.Conclusions: Subthreshold pediatric BP disorder is an identifiable morbid condition associated with significant functional impairment including psychiatric comorbidities and high rates of suicidality. K E Y W O R D Sbipolar disorder, child, pediatric, subthreshold | INTRODUC TI ONAs pediatric bipolar (BP) disorder tends to evolve over time, some youth may present to clinical attention with insufficient symptoms to fulfill full diagnostic criteria for a diagnosis of BP disorder.However, while much is known about full threshold pediatric BP disorder, little is known about subthreshold forms of pediatric BP disorder.

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Similar familial underpinnings for full and subsyndromal pediatric bipolar disorder: A familial risk analysis

Cited by 12 publications

References 35 publications

A Risk Calculator to Predict the Individual Risk of Conversion From Subthreshold Bipolar Symptoms to Bipolar Disorder I or II in Youth

A Risk Calculator to Predict the Individual Risk of Conversion From Subthreshold Bipolar Symptoms to Bipolar Disorder I or II in Youth

Further evidence of high level of persistence of pediatric bipolar-I disorder from childhood onto young adulthood: a five-year follow up

The morbidity of subthreshold pediatric bipolar disorder: A systematic literature review and meta‐analysis

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