Author(s): Axelson D, Goldstein B, Goldstein T, Monk K, Yu H,
Abstract Share this page
Abstract OBJECTIVE: The authors sought to identify diagnostic risk factors of manic, mixed, or hypomanic episodes in the offspring of parents with bipolar disorder ("high-risk offspring"). METHOD: High-risk offspring 6-18 years old (N=391) and demographically matched offspring (N=248) of community parents without bipolar disorder were assessed longitudinally with standardized diagnostic instruments by staff blind to parental diagnoses. Follow-up assessments were completed in 91\% of the offspring (mean follow-up interval, 2.5 years; mean follow-up duration, 6.8 years). RESULTS: Compared with community offspring, high-risk offspring had significantly higher rates of subthreshold mania or hypomania (13.3\% compared with 1.2\%), manic, mixed, or hypomanic episodes (9.2\% compared with 0.8\%), and major depressive episodes (32.0\% compared with 14.9\%). They also had higher rates of attention deficit hyperactivity disorder (30.7\% compared with 18.1\%), disruptive behavior disorders (27.4\% compared with 15.3\%), anxiety disorders (39.9\% compared with 21.8\%), and substance use disorders (19.9\% compared with 10.1\%), but not unipolar major depressive disorder (major depression with no bipolarity; 18.9\% compared with 13.7\%). Multivariate Cox regressions showed that in the high-risk offspring, subthreshold manic or hypomanic episodes (hazard ratio=2.29), major depressive episodes (hazard ratio=1.99), and disruptive behavior disorders (hazard ratio=2.12) were associated with subsequent manic, mixed, or hypomanic episodes. Only subthreshold manic or hypomanic episodes (hazard ratio=7.57) were associated when analyses were restricted to prospective data. CONCLUSIONS: Subthreshold manic or hypomanic episodes were a diagnostic risk factor for the development of manic, mixed, or hypomanic episodes in the offspring of parents with bipolar disorder and should be a target for clinical assessment and treatment research. Major depressive episodes and disruptive behavior disorders are also indications for close clinical monitoring of emergent bipolarity in high-risk offspring.
This article was published in Am J Psychiatry
and referenced in Journal of Pediatric Neurology and Medicine