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Stephan NM, van Sprang ED, Wiebenga JXM, Dickhoff J, Schirmbeck F, de Haan L, van Amelsvoort T, Veling W, Alizadeh BZ, Simons CJP, Heering HD. Risk factors for suicidality across psychosis vulnerability spectrum. Schizophr Res 2023; 261:152-160. [PMID: 37769453 DOI: 10.1016/j.schres.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 06/14/2023] [Accepted: 09/09/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Suicide is a leading cause of death in individuals with psychotic disorders. Risk factors for suicidality across the psychosis vulnerability spectrum are insufficiently known. METHODS For patients (n = 830), siblings (n = 664) and controls (n = 444), suicidality was assessed by the use of a clinical interview. Multilevel modelling was used to investigate risk factors of suicidality. Lastly, risk factor × familial risk interaction effects were examined. RESULTS Multivariable models revealed a significant relation between suicidality and depressive symptoms across all three groups, and childhood trauma in patients and siblings. The association between suicidality and psychotic-like experiences is more pronounced in siblings compared to controls. CONCLUSION Across the psychosis vulnerability spectrum, depressive symptoms and childhood trauma have been associated with suicidality. Clinicians should pay attention to suicidality in individuals at high familial risk for psychosis with psychotic-like experiences.
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Affiliation(s)
| | - Eleonore Dorothée van Sprang
- Amsterdam UMC, Location VUMC, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jasper Xiao Ming Wiebenga
- Amsterdam UMC, Location VUMC, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Location AMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands
| | - Justine Dickhoff
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, Groningen, the Netherlands
| | - Frederike Schirmbeck
- Amsterdam UMC, Location AMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Department of Public Mental Health, Central Institute of Mental Health, Faculty Medicine Mannheim, Heidelberg University Mannheim, Germany
| | - Lieuwe de Haan
- Amsterdam UMC, Location AMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Wim Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, the Netherlands
| | - Claudia J P Simons
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Henriëtte Dorothée Heering
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Department of Research, 113 Suicide Prevention, the Netherlands.
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Sletved KSO, Maiggaard K, Thorup AAE, Kessing LV, Vinberg M. Familial load of psychiatric disorders and overall functioning in patients newly diagnosed with bipolar disorder and their unaffected first-degree relatives. Int J Bipolar Disord 2022; 10:28. [PMID: 36469186 PMCID: PMC9723061 DOI: 10.1186/s40345-022-00277-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Kimie Stefanie Ormstrup Sletved
- grid.466916.a0000 0004 0631 4836Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Maiggaard
- grid.466916.a0000 0004 0631 4836Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark ,grid.425848.70000 0004 0639 1831Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark ,grid.425848.70000 0004 0639 1831Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Vedel Kessing
- grid.466916.a0000 0004 0631 4836Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maj Vinberg
- grid.466916.a0000 0004 0631 4836Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark ,grid.4973.90000 0004 0646 7373Northern Zealand, Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark
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van Sprang ED, Maciejewski DF, Milaneschi Y, Elzinga BM, Beekman ATF, Hartman CA, van Hemert AM, Penninx BWJH. Familial risk for depressive and anxiety disorders: associations with genetic, clinical, and psychosocial vulnerabilities. Psychol Med 2022; 52:696-706. [PMID: 32624018 PMCID: PMC8961330 DOI: 10.1017/s0033291720002299] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/21/2020] [Accepted: 06/09/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND In research and clinical practice, familial risk for depression and anxiety is often constructed as a simple Yes/No dichotomous family history (FH) indicator. However, this measure may not fully capture the liability to these conditions. This study investigated whether a continuous familial loading score (FLS), incorporating family- and disorder-specific characteristics (e.g. family size, prevalence of depression/anxiety), (i) is associated with a polygenic risk score (PRS) for major depression and with clinical/psychosocial vulnerabilities and (ii) still captures variation in clinical/psychosocial vulnerabilities after information on FH has been taken into account. METHODS Data came from 1425 participants with lifetime depression and/or anxiety from the Netherlands Study of Depression and Anxiety. The Family Tree Inventory was used to determine FLS/FH indicators for depression and/or anxiety. RESULTS Persons with higher FLS had higher PRS for major depression, more severe depression and anxiety symptoms, higher disease burden, younger age of onset, and more neuroticism, rumination, and childhood trauma. Among these variables, FH was not associated with PRS, severity of symptoms, and neuroticism. After regression out the effect of FH from the FLS, the resulting residualized measure of FLS was still associated with severity of symptoms of depression and anxiety, rumination, and childhood trauma. CONCLUSIONS Familial risk for depression and anxiety deserves clinical attention due to its associated genetic vulnerability and more unfavorable disease profile, and seems to be better captured by a continuous score that incorporates family- and disorder-specific characteristics than by a dichotomous FH measure.
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Affiliation(s)
- Eleonore D. van Sprang
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dominique F. Maciejewski
- Department of Developmental Psychopathology, Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Yuri Milaneschi
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Bernet M. Elzinga
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Aartjan T. F. Beekman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Catharina A. Hartman
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, Groningen, The Netherlands
| | - Albert M. van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Brenda W. J. H. Penninx
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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YILDIRIM F, TOROS F, KARPUZ D. Comparison of psychopathologies of children of Parents with Chronic Psychiatric Disease. ACTA MEDICA ALANYA 2021. [DOI: 10.30565/medalanya.733938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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5
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Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Rowe M, Grunze H, Suppes T, Keck PE, Leverich GS, Nolen WA. More childhood onset bipolar disorder in the United States than Canada or Europe: Implications for treatment and prevention. Neurosci Biobehav Rev 2017; 74:204-213. [PMID: 28119069 DOI: 10.1016/j.neubiorev.2017.01.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 01/18/2017] [Indexed: 02/05/2023]
Abstract
Evidence of a high or increasing incidence of childhood onset bipolar disorder in the United States (US) has been viewed skeptically. Here we review evidence that childhood onsets of bipolar disorder are more common in the US than in Europe, treatment delays are longer, and illness course is more adverse and difficult. Epidemiological data and studies of offspring at high risk also support these findings. In our cohort of outpatients with bipolar disorder, two of the major vulnerability factors for early onset - genetics and environmental adversity in childhood - were also greater in the US than in Europe. An increased familial loading for multiple psychiatric disorders was apparent in 4 generations of the family members of the patients from the US, and that familial burden was linked to early onset bipolar disorder. Since both early onset and treatment delay are risk factors for a poor outcome in adulthood, new clinical, research, and public health initiatives are needed to begin to address and ameliorate this ongoing and potentially devastating clinical situation.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C., USA.
| | - Lori L Altshuler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA, USA
| | - Ralph Kupka
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA; Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA
| | - Mark A Frye
- Department of Psychiatry, Mayo Clinic, Rochester, MI, USA
| | - Michael Rowe
- Bipolar Collaborative Network, Bethesda, MD, USA
| | - Heinz Grunze
- Paracelsius Medical University, Salzburg, Austria
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA; V.A. Palo Alto Health Care System, Palo Alto, CA, USA
| | - Paul E Keck
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Lindner Center of HOPE, Mason, OH, USA
| | | | - Willem A Nolen
- University Medical Center, University of Groningen, Groningen, The Netherlands
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6
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Post RM, Leverich GS, Kupka R, Keck PE, McElroy SL, Altshuler LL, Frye MA, Rowe M, Grunze H, Suppes T, Nolen WA. Increases in multiple psychiatric disorders in parents and grandparents of patients with bipolar disorder from the USA compared with The Netherlands and Germany. Psychiatr Genet 2015; 25:194-200. [PMID: 26146875 DOI: 10.1097/ypg.0000000000000093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We previously found that compared with Europe more parents of the USA patients were positive for a mood disorder, and that this was associated with early onset bipolar disorder. Here we examine family history of psychiatric illness in more detail across several generations. METHODS A total of 968 outpatients (average age 41) with bipolar disorder from four sites in the USA and three in the Netherlands and Germany (abbreviated as Europe) gave informed consent and provided detailed demographic and family history information on a patient questionnaire. Family history of psychiatric illness (bipolar disorder, unipolar depression, suicide attempt, alcohol abuse, substance abuse, and other illness) was collected for each parent, four grandparents, siblings, and children. RESULTS Parents of the probands with bipolar disorder from the USA compared with Europe had a significantly higher incidence of both unipolar and bipolar mood disorders, as well as each of the other psychiatric conditions listed above. With a few exceptions, this burden of psychiatric disorders was also significantly greater in the grandparents, siblings, and children of the USA versus European patients. CONCLUSION The increased complexity of psychiatric illness and its occurrence over several generations in the families of patients with bipolar disorder from the USA versus Europe could be contributing to the higher incidence of childhood onsets and greater virulence of illness in the USA compared with Europe. These data are convergent with others suggesting increased both genetic and environmental risk in the USA, but require replication in epidemiologically-derived populations with data based on interviews of the family members.
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Affiliation(s)
- Robert M Post
- aBipolar Collaborative Network, Bethesda, Maryland bDepartment of Psychiatry and Behavioral Sciences, George Washington University, Washington, District of Columbia cDepartment of Psychiatry and Behavioral Neuroscience dDepartment of Psychiatry and Behavioral Neuroscience, Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati eLindner Center of HOPE, Mason, Ohio fDepartment of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California gDepartment of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles hDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine iV.A. Palo Alto HealthCare System, Palo Alto, California jDepartment of Psychiatry, Mayo Clinic, Rochester, Michigan, USA kDepartment of Psychiatry, VU University Medical Center, Amsterdam lDepartment of Psychiatry, University Medical Center, University of Groningen, Groningen, The Netherlands mDepartment of Psychiatry and Psychotherapy, Christian Doppler Klink, Paracelsus Medical University Salzburg, Austria
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7
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Post RM, Altshuler L, Kupka R, McElroy S, Frye MA, Rowe M, Leverich GS, Grunze H, Suppes T, Keck PE, Nolen WA. More pernicious course of bipolar disorder in the United States than in many European countries: implications for policy and treatment. J Affect Disord 2014; 160:27-33. [PMID: 24709019 DOI: 10.1016/j.jad.2014.02.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is some controversy but growing evidence that childhood onset bipolar disorder may be more prevalent and run a more difficult course in the United States than some European countries. METHODS We update and synthesize course of illness data from more than 960 outpatients with bipolar disorder (average age 40) from 4 sites in the U.S. and 3 sites in Netherlands and Germany. After giving informed consent, patients reported on parental history, childhood and lifetime stressors, comorbidities, and illness characteristics. RESULTS Almost all aspects of bipolar disorder were more adverse in patients from the US compared with Europe, including a significantly higher prevalence of: bipolar disorder in one parent and a mood disorder in both parents; childhood verbal, physical, or sexual abuse; stressors in the year prior to illness onset and the last episode; childhood onsets of bipolar illness; delay to first treatment; anxiety disorder, substance abuse, and medical comorbidity; mood episodes and rapid cycling; and nonresponse to prospective naturalistic treatment. LIMITATIONS Selection bias in the recruit of patients cannot be ruled out, but convergent data in the literature suggest that this does not account for the findings. Potential mechanisms for the early onset and more adverse course in the U.S. have not been adequately delineated and require further investigation. CONCLUSIONS The data suggest the need for earlier and more effective long-term treatment intervention in an attempt to ameliorate this adverse course and its associated heavy burden of psychiatric and medical morbidity.
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Affiliation(s)
- R M Post
- Bipolar Collaborative Network, 5415 W. Cedar Ln, Suite 201-B, Bethesda, MD 20814, United States; Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C., United States.
| | - L Altshuler
- UCLA Mood Disorders Research Program, VA Medical Center, Los Angeles, CA, United States
| | - R Kupka
- Department of Psychiatry, VU University Medical Center, Amsterdam, Netherlands
| | - S McElroy
- Lindner Center of HOPE Mason, OH, United States; Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, United States
| | - M A Frye
- Psychiatry, Mayo Clinic, Rochester, MI, United States
| | - M Rowe
- Biostatistician, Bipolar Collaborative Network, Bethesda, MD, United States
| | - G S Leverich
- Bipolar Collaborative Network, 5415 W. Cedar Ln, Suite 201-B, Bethesda, MD 20814, United States
| | - H Grunze
- Institute of Neuroscience, University of Newcastle upon Tyne, Newcastle, United Kingdom
| | - T Suppes
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - P E Keck
- Psychiatry & Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Lindner Center of HOPE Mason, OH, United States
| | - W A Nolen
- University Medical Center, University of Groningen, Groningen, Netherlands
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8
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Wilde A, Chan HN, Rahman B, Meiser B, Mitchell PB, Schofield PR, Green MJ. A meta-analysis of the risk of major affective disorder in relatives of individuals affected by major depressive disorder or bipolar disorder. J Affect Disord 2014; 158:37-47. [PMID: 24655763 DOI: 10.1016/j.jad.2014.01.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/19/2014] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND To conduct a meta-analysis to estimate the incidence of major depressive disorder (MDD) and bipolar disorder (BD) in first-degree relatives (FDRs) of probands affected by MDD or BD. The risk for MDD in FDR of BD probands and vice versa is also investigated. METHODS A systematic review of case-control and cohort studies, which were published between 1977 and 2012; reported relative risks (RR) or odd ratios (OR) or equivalent raw data; made an explicit distinction between MDD and BD; used operational diagnostic criteria; and reported systematic proband recruitment and ascertainment of relatives. Studies were obtained by electronic MEDLINE and EMBASE searches and hand-searching. Estimates were derived from pooled data using random effects methods. RESULTS Of an initial sample of 241 articles, 22 were eligible for inclusion. For FDRs of one proband with MDD compared to healthy control probands, estimates for MDD were OR=2.14 (95% CI 1.72-2.67), increasing to OR=3.23 (95% CI 2.11-4.94) for two MDD probands. For FDRs of one BD proband compared to healthy control probands, estimates for BD were OR=7.92 (95% CI 2.45-25.61), and OR=6.58 (95% CI 2.64-16.43) for FDRs of two BD probands. CONCLUSIONS These findings support previously published data indicating strong familiality for both MDD and BD. Data will be useful in providing individuals with a family history of MDD or BPD with tailored risk estimates.
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Affiliation(s)
- A Wilde
- School of Psychiatry, University of New South Wales, NSW 2052, Australia; Black Dog Institute, Sydney, NSW 2031, Australia.
| | - H-N Chan
- School of Psychiatry, University of New South Wales, NSW 2052, Australia; Black Dog Institute, Sydney, NSW 2031, Australia; Department of Psychiatry, Singapore General Hospital, 169608, Singapore
| | - B Rahman
- School of Public Health and Community Medicine, University of New South Wales, NSW 2052, Australia
| | - B Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
| | - P B Mitchell
- School of Psychiatry, University of New South Wales, NSW 2052, Australia; Black Dog Institute, Sydney, NSW 2031, Australia
| | - P R Schofield
- Neuroscience Research Australia, Sydney, NSW 2031, Australia; School of Medical Sciences, University of New South Wales, NSW 2052, Australia
| | - M J Green
- School of Psychiatry, University of New South Wales, NSW 2052, Australia; Black Dog Institute, Sydney, NSW 2031, Australia; Neuroscience Research Australia, Sydney, NSW 2031, Australia
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A three generations nation-wide population study of family load estimates in bipolar disorder with different age at onset. J Affect Disord 2013; 150:146-51. [PMID: 23332644 DOI: 10.1016/j.jad.2012.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 12/17/2012] [Accepted: 12/17/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This nation-wide register-based study investigates how often bipolar disorder (BD) occurs in affected families compared to control families by estimating the family load as a random effect; this effect measures the degree of dependence among family members in relation to BD. Furthermore, the study addresses the impact of certain risk factors, namely, sex, age at onset of BD, degree of urbanization, year of birth, month of birth, and maternal and paternal age at birth. METHOD A total of N=1204 children and adolescent psychiatric cases born between 1950 and 1997 and registered in the Danish Central Psychiatric Register (DPCR) developed BD before the age of 58 years. N=3553 controls without any psychiatric diagnosis were matched for age, gender, and region of residence. Psychiatric diagnoses were also obtained on the relatives, e.g. parents, siblings, and offspring as a part of the Danish Three Generation Study (3GS). A family component was obtained by using different regression models. RESULTS Familial factors accounted for 20% of the variation in disease outcome when controlling for year and month of birth, sex, and degree of urbanization. Only female sex was associated with an increased hazard ratio of BD. Also having a mother, father or a sibling with the disorder was proven to be a significant risk factor. Furthermore, case relatives did not develop BD earlier than control relatives. CONCLUSION These findings based on a very large and representative dataset provide further and very solid evidence for the high family aggregation of BD.
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Vandeleur C, Rothen S, Gholam-Rezaee M, Castelao E, Vidal S, Favre S, Ferrero F, Halfon O, Fumeaux P, Merikangas KR, Aubry JM, Burstein M, Preisig M. Mental disorders in offspring of parents with bipolar and major depressive disorders. Bipolar Disord 2012; 14:641-53. [PMID: 22938168 PMCID: PMC7041416 DOI: 10.1111/j.1399-5618.2012.01048.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES There is limited information on the specificity of associations between parental bipolar disorder (BPD) and major depressive disorder (MDD) and the risk of psychopathology in offspring. The chief aim of the present study was to investigate the association between mood disorder subtypes in the two parents and mental disorders in the offspring. METHODS A total of 376 offspring (aged 6.0-17.9 years; mean=11.5years) of 72 patients with BPD (139 offspring), 56 patients with MDD (110 offspring), and 66 controls (127 offspring) participated in a family study conducted in two university hospital centers in Switzerland. Probands, offspring, and biological co-parents were interviewed by psychologists blind to proband diagnoses, using a semi-structured diagnostic interview. RESULTS Rates of mood and anxiety disorders were elevated among offspring of BPD probands (34.5% any mood; 42.5% any anxiety) and MDD probands (25.5% any mood; 44.6% any anxiety) as compared to those of controls (12.6% any mood; 22.8% any anxiety). Moreover, recurrent MDD was more frequent among offspring of BPD probands (7.9%) than those of controls (1.6%). Parental concordance for bipolar spectrum disorders was associated with a further elevation in the rates of mood disorders in offspring (64.3% both parents versus 27.2% one parent). CONCLUSIONS These findings provide unique information on the broad manifestations of parental mood disorders in their offspring. The earlier onset and increased risk of recurrent MDD in the offspring of parents with BPD compared to those of controls suggests that the episodicity characterizing BPD may emerge in childhood and adolescence.
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Affiliation(s)
- Caroline Vandeleur
- Department of Mental Health and Psychiatry, University Hospital of Geneva.
| | - Stéphane Rothen
- Department of Mental Health and Psychiatry, University
Hospital of Geneva, Lausanne, Switzerland,Department of Psychiatry, University Hospital of Lausanne,
Lausanne, Switzerland
| | - Mehdi Gholam-Rezaee
- Department of Psychiatry, University Hospital of Lausanne,
Lausanne, Switzerland
| | - Enrique Castelao
- Department of Psychiatry, University Hospital of Lausanne,
Lausanne, Switzerland
| | - Sonia Vidal
- Department of Mental Health and Psychiatry, University
Hospital of Geneva, Lausanne, Switzerland,Department of Psychiatry, University Hospital of Lausanne,
Lausanne, Switzerland
| | - Sophie Favre
- Department of Mental Health and Psychiatry, University
Hospital of Geneva, Lausanne, Switzerland
| | - François Ferrero
- Department of Mental Health and Psychiatry, University
Hospital of Geneva, Lausanne, Switzerland
| | - Olivier Halfon
- Department of Psychiatry, University Hospital of Lausanne,
Lausanne, Switzerland
| | - Pierre Fumeaux
- Department of Psychiatry, University Hospital of Lausanne,
Lausanne, Switzerland
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research
Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Jean-Michel Aubry
- Department of Mental Health and Psychiatry, University
Hospital of Geneva, Lausanne, Switzerland
| | - Marcy Burstein
- Genetic Epidemiology Research Branch, Intramural Research
Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Martin Preisig
- Department of Psychiatry, University Hospital of Lausanne,
Lausanne, Switzerland
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Concomitants of family histories of mood disorders and alcoholism in a clinical cohort of patients with bipolar I and II disorder. J Nerv Ment Dis 2012; 200:388-94. [PMID: 22551791 DOI: 10.1097/nmd.0b013e3182531f2e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We diagnosed 191 secondary-care outpatients and inpatients with DSM-IV BD I or II. Sociodemographic and clinical characteristics, including axis I and II comorbidity, neuroticism, and prospective life-chart were evaluated at intake and at 6 and 18 months. The family history (FH) of mood disorders, alcoholism, or any major psychiatric disorders among first-degree relatives was investigated in a semistructured interview. Most (74%) patients had some positive FH; 55% of mood disorder, 36% of alcoholism. Positive FH was associated with psychiatric comorbidity and depressive course in the proband. Based on a multinomial logistic regression model, patients with an FH of mood disorder and alcoholism had an odds ratio of 4.8 (p = 0.001) for having an anxiety disorder. Overall, the first-degree relatives of patients with BD have multiple types of mental disorders, which correlate with bipolar patients' course of illness and psychiatric comorbidity. The strongest associations are between FH of mood disorders and presence of comorbid anxiety disorders.
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Más allá de la psicosis: el reto de la intervención precoz en los trastornos bipolares. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2012; 5:1-4. [DOI: 10.1016/j.rpsm.2011.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 05/18/2011] [Indexed: 11/19/2022]
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Zappitelli MC, Bordin IA, Hatch JP, Caetano SC, Zunta-Soares G, Olvera RL, Soares JC. Lifetime psychopathology among the offspring of Bipolar I parents. Clinics (Sao Paulo) 2011; 66:725-30. [PMID: 21789371 PMCID: PMC3109366 DOI: 10.1590/s1807-59322011000500003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 01/20/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recent studies have demonstrated high rates of psychopathology in the offspring of parents with bipolar disorder. The aim of this study was to identify psychiatric diagnoses in a sample of children of bipolar parents. METHOD This case series comprised 35 children and adolescents aged 6 to 17 years, with a mean age of 12.5 ± 2.9 years (20 males and 15 females), who had at least one parent with bipolar disorder type I. The subjects were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version (K-SADS-PL). Family psychiatric history and demographics were also evaluated. RESULTS Of the offspring studied, 71.4% had a lifetime diagnosis of at least one psychiatric disorder (28.6% with a mood disorder, 40% with a disruptive behavior disorder and 20% with an anxiety disorder). Pure mood disorders (11.4%) occurred less frequently than mood disorders comorbid with attention deficit hyperactivity disorder (17.1%). Psychopathology was commonly reported in second-degree relatives of the offspring of parents with bipolar disorder (71.4%). CONCLUSIONS Our results support previous findings of an increased risk for developing psychopathology, predominantly mood and disruptive disorders, in the offspring of bipolar individuals. Prospective studies with larger samples are needed to confirm and expand these results.
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Maziade M, Gingras N, Rouleau N, Poulin S, Jomphe V, Paradis ME, Mérette C, Roy MA. Clinical diagnoses in young offspring from eastern Québec multigenerational families densely affected by schizophrenia or bipolar disorder. Acta Psychiatr Scand 2008; 117:118-26. [PMID: 18028250 PMCID: PMC2253694 DOI: 10.1111/j.1600-0447.2007.01125.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The follow-up since 1989 of a large sample of multigenerational families of eastern Québec that are densely affected by schizophrenia (SZ) or bipolar disorder (BP) has permitted to look at the rates of DSM diagnoses in the young offspring of a SZ parent (HRSZ) and of a BP parent (HRBP) who had an extremely loaded family history. METHOD The sample (average age of 17.5, SD 4.5) consisted of 54 high-risk offspring (HR) having one parent affected by a DSM-IV SZ or BP. The parents descended from 21 multigenerational families that constitute a quasi-total sample of such kindred in eastern Québec. The HRs were administered a lifetime best estimate DSM-IV diagnosis. RESULTS We observed that the rates, the diversity of diagnoses, the high comorbidity, the severity and the age of onset of the clinical diagnoses tended to be similar with those already reported in the offspring of affected parents with a low familial loading. Although the sample size was small, HRSZ and HRBP also tended to show similarities in their clinical status. CONCLUSION Overall, taking into account methodological limitations, the observation early in life of some shared characteristics among HRSZ and HRBP in terms of non-psychotic diagnosis may be congruent with the accumulating evidence that several phenotypic features are shared in adulthood by the two major psychoses.
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Affiliation(s)
- M Maziade
- Centre de recherche Université Laval Robert-Giffard, QC, Canada.
| | - N Gingras
- Centre de recherche Université Laval Robert-GiffardQC, Canada
| | - N Rouleau
- Centre de recherche Université Laval Robert-GiffardQC, Canada,École de psychologie, Université Laval, QuébecQC, Canada
| | - S Poulin
- Centre de recherche Université Laval Robert-GiffardQC, Canada
| | - V Jomphe
- Centre de recherche Université Laval Robert-GiffardQC, Canada
| | - M-E Paradis
- Centre de recherche Université Laval Robert-GiffardQC, Canada
| | - C Mérette
- Centre de recherche Université Laval Robert-GiffardQC, Canada
| | - M-A Roy
- Centre de recherche Université Laval Robert-GiffardQC, Canada
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Wals M, Reichart CG, Hillegers MHJ, Nolen WA, Van Os J, Ormel J, Verhulst FC. Prediction of change in level of problem behavior among children of bipolar parents. Acta Psychiatr Scand 2006; 113:23-30. [PMID: 16390365 DOI: 10.1111/j.1600-0447.2005.00655.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the effects of familial loading, birth weight, and family problems on change in parent-reported problems across a 14-month period among children of bipolar parents. METHOD Emotional and behavioral problems in a sample of 140 offspring of bipolar parents and familial loading in first- and second-degree relatives were assessed at two measurements. Parents reported the birth weight of their offspring and completed a questionnaire on family problems. Multiple linear regression analyses were performed to assess associations of the three predictors with change in problem scores at follow-up. RESULTS Familial loading of unipolar disorder was a unique predictor for an increase in problem scores from the first to the second measurement with beta-coefficients ranging from 0.17 to 0.25. Birth weight and family problems were not associated with change in problem scores across the two measurements. CONCLUSION Familial loading of unipolar disorder predicted an increase in behavioral and emotional problems across the 14-month follow-up.
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Affiliation(s)
- M Wals
- Department of Child/Adolescent Psychiatry, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
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Abstract
OBJECTIVE To review the literature of the past decade covering the epidemiology, clinical characteristics, assessment, longitudinal course, biological and psychosocial correlates, and treatment and prevention of pediatric bipolar disorder (BD). METHOD A computerized search for articles published during the past 10 years was made and selected studies are presented. RESULTS Pediatric BD is increasingly recognized, and there are several prevailing views on core features of this disorder. The incidence and prevalence of the disorder and the associated comorbidities vary according to study setting and criteria used. This disorder is highly recurrent and accompanied by substantial psychiatric and psychosocial morbidity. Familial studies, including "top down" (offspring of parents with BD) and "bottom up" (relatives of youths with BD) studies indicate that pediatric BD is aggregated in families with adult or later-onset BD and suggest the existence of genetic predisposition. Greater understanding of the risk factors for early onset BD and recognition of the phenomenology of prodromal symptoms offers hope for early identification and prevention. Neuroimaging studies indicate frontotemporal and frontostriatal pathology, but none of these findings seems to be disorder specific. Combination pharmacotherapies appear promising, and the field awaits further short- and long-term randomized, placebo-controlled trials. Preliminary studies of various psychotherapies, including psychoeducation strategies tailored specifically for BD in youths, look encouraging. CONCLUSIONS Considerable advances have been made in our knowledge of pediatric BD; however, differing viewpoints on the clinical presentation of BD in children are the rule. Phenomenological and longitudinal studies and biological validation using genetic, neurochemical, neurophysiological, and neuroimaging methods may strengthen our understanding of the phenocopy. Randomized, controlled treatment studies for the acute and maintenance treatment of BD disorder are warranted.
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Affiliation(s)
- Mani N Pavuluri
- Pediatric Mood Disorders Clinic and Bipolar Research Program, Department of Psychiatry, University of Illinois at Chicago, 60612-7327, USA.
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Wals M, Hillegers MHJ, Reichart CG, Verhulst FC, Nolen WA, Ormel J. Stressful life events and onset of mood disorders in children of bipolar parents during 14-month follow-up. J Affect Disord 2005; 87:253-63. [PMID: 15979149 DOI: 10.1016/j.jad.2005.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Revised: 04/25/2005] [Accepted: 04/25/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although multiple studies have examined the association between stressful life events (SLEs) and the development of mood disorders, the exact nature of the association and the degree to which it is independent from familial loading (FL) and gender-specific are still not fully elucidated. AIMS To study the association between person-independent and -dependent SLEs and first onset or recurrence of a DSM-IV mood disorder episode (MDE) in offspring of bipolar parents. To examine interaction effects of SLEs with familial loading and gender. METHOD Offspring of bipolar parents (N=132) were assessed with the K-LEDS, the FHRDC and the K-SADS. Logistic regression analysis was used to examine main and interaction effects of various operationalizations of SLEs, familial loading and gender. RESULTS Dependent SLEs were more likely to occur before onset among the 13 offspring who had a MDE onset during the 14-month follow-up (39%) than in a comparable period among the 67 controls without any lifetime diagnosis (10%). Associations were slightly stronger for first onsets than for recurrences. The association between SLEs and MDE onset/recurrence was independent of socio-demographic characteristics and familial loading, but disappeared when adjusted for baseline anxious/depressive symptoms. Gender and familial loading did not modify the influence of any SLE measure on the development of mood disorders. CONCLUSIONS In this sample of bipolar offspring dependent stressful SLEs triggered the onset of MDEs, but this association disappeared after adjustment of prior anxious/depressive symptoms, indicating that the association between SLEs and MDE is probably a spurious association. No interaction was found between SLE and FL and gender. Prior anxious/depressive symptoms seem to increase the risk for both occurrence of dependent SLEs and MDE onset or recurrence. LIMITATIONS Limited statistical power due to small number of MDE onsets.
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Affiliation(s)
- Marjolein Wals
- Erasmus Medical Center Rotterdam/Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Rotterdam, The Netherlands.
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Bibliography. Current world literature. Child and Adolescent psychiatry. Curr Opin Psychiatry 2005; 18:455-66. [PMID: 16639142 DOI: 10.1097/01.yco.0000172068.09144.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hillegers MHJ, Burger H, Wals M, Reichart CG, Verhulst FC, Nolen WA, Ormel J. Impact of stressful life events, familial loading and their interaction on the onset of mood disorders: study in a high-risk cohort of adolescent offspring of parents with bipolar disorder. Br J Psychiatry 2004; 185:97-101. [PMID: 15286059 DOI: 10.1192/bjp.185.2.97] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Stressful life events are established as risk factors for the onset of mood disorders, but few studies have investigated their impact on the development of mood disorders in adolescents. AIMS To study the effect of life events on the development of mood disorders in the offspring of parents with bipolar disorder, with respect to the possibility of a decay effect and modification by familial loading. METHOD In a high-risk cohort of 140 Dutch adolescent offspring of parents with bipolar disorder, we assessed life events, current and past DSM-IV diagnoses and familial loading. To explore their interaction and impact on mood disorder onset, we constructed four different models and used a multivariate survival analysis with time-dependent covariates. RESULTS The relationship between life events and mood disorder was described optimally with a model in which the effects of life events gradually decayed by 25% per year. The effect of life event load was not significantly stronger in the case of high familial loading. CONCLUSIONS Independent of familial loading, life events increase the liability to mood disorders in children of patients with bipolar disorder but the effects slowly diminish with time.
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Affiliation(s)
- Manon H J Hillegers
- Altrecht Institute for Mental Health Care, Lange Nieuwstraat 119, 3512 PG Utrecht, The Netherlands.
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