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Cattarinussi G, Pouya P, Grimaldi DA, Dini MZ, Sambataro F, Brambilla P, Delvecchio G. Cortical alterations in relatives of patients with bipolar disorder: A review of magnetic resonance imaging studies. J Affect Disord 2024; 345:234-243. [PMID: 37865341 DOI: 10.1016/j.jad.2023.10.097] [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: 05/29/2023] [Revised: 09/11/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION Bipolar disorder (BD) is a severe mental disorder characterized by high heritability rates. Widespread brain cortical alterations have been reported in BD patients, mostly involving the frontal, temporal and parietal regions. Importantly, also unaffected relatives of BD patients (BD-RELs) present abnormalities in cortical measures, which are not influenced by disease-related factors, such as medication use and illness duration. Here, we collected all available evidence on cortical measures in BD-RELs to further our knowledge on the potential cortical alterations associated with the vulnerability and the resilience to BD. METHODS A search on PubMed, Web of Science and Scopus was performed to identify neuroimaging studies exploring cortical alterations in BD-RELs, including cortical thickness (CT), surface area (SA), gyrification (GI) and cortical complexity. Eleven studies were included. Of these, five assessed CT, five examined CT and SA and one explored CT, SA and GI. RESULTS Overall, a heterogeneous pattern of cortical alterations emerged. The areas more consistently linked with genetic liability for BD were the prefrontal and sensorimotor regions. Mixed evidence was reported in the temporal and cingulate areas. LIMITATIONS The small sample size and the heterogeneity in terms of methodologies and the characteristics of the participants limit the generalizability of our results. CONCLUSIONS Our findings suggest that the genetic liability for BD is related to reduced CT in the prefrontal cortex, which might be a marker of risk for BD, and increased CT within the sensorimotor cortex, which could represent a marker of resilience.
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Affiliation(s)
- Giulia Cattarinussi
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Parnia Pouya
- Research Center for Evidence-Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Iranian EBM Center: A Joanna Briggs Institute Affiliated Group, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mahta Zare Dini
- Research Center for Evidence-Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Iranian EBM Center: A Joanna Briggs Institute Affiliated Group, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fabio Sambataro
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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Helmink FGL, Vandeleur CL, Preisig M, Gunput STG, Hillegers MHJ, Mesman E. Functional outcomes across development in offspring of parents with bipolar disorder. J Affect Disord 2023; 340:490-505. [PMID: 37467795 DOI: 10.1016/j.jad.2023.07.072] [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: 09/06/2022] [Revised: 05/26/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Whereas the risk and course of psychopathology in offspring of parents with bipolar disorder (BD) have been the primary focus of high-risk offspring studies to date, functional outcomes have not been given much attention. We present a systematic review of functional outcomes and quality of life (QoL) across development in offspring of parents with BD and aim to explore the role of offspring psychopathology in these outcomes. METHOD We searched Embase, MEDLINE, PsycINFO, Web of Science, Cochrane Central, and Google Scholar from inception to June 24, 2022, for studies referring to functional outcomes (global, social, academic or occupational) or QoL in offspring of parents with BD. RESULTS From the 6470 records identified, 39 studies were retained (global = 17; social = 17; school = 16; occupational = 3; QoL = 5), including 13 studies that examined multiple domains. For all domains, high heterogeneity was found in study methods and quality. Only 56 % of studies adjusted for offspring psychopathology, impeding interpretation. Global and social functioning generally seemed to be impaired among older offspring (>16 years). Academic performance appeared to be unaffected. School behavior, occupational functioning, and QoL showed mixed results. Offspring psychopathology is associated with social functioning, but the relationship of offspring psychopathology with other domains is less clear. CONCLUSION Studies on functional outcome in offspring of parents with BD show predominantly mixed results. Inconsistent adjustment of psychopathology and age limits conclusive interpretation. Functional outcomes should be prioritized as research topics in high-risk studies and the potential associations between familial risk status, offspring psychopathology, and age may inform prevention strategies.
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Affiliation(s)
- Fleur G L Helmink
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Caroline L Vandeleur
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Esther Mesman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
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Hemager N, Gregersen M, Christiani CJ, Hjorthøj C, Knudsen CB, Veddum L, Andreassen AK, Brandt JM, Krantz MF, Burton BK, Bliksted V, Mors O, Greve AN, Thorup AAE, Nordentoft M, Jepsen JRM. Development of social functioning in preadolescent children at familial high-risk of schizophrenia or bipolar disorder - a 4-year follow-up study from age 7 to 11. Psychiatry Res 2023; 327:115397. [PMID: 37536146 DOI: 10.1016/j.psychres.2023.115397] [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: 04/21/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/05/2023]
Abstract
Social functioning is a major indicator of psychosis risk and evidence is lacking regarding social functioning development during preadolescence in children at familial high risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP). We aimed to investigate development of social functioning from age 7 to 11 in children at FHR-SZ or FHR-BP compared with population-based controls. At 4-year follow-up, 179 children at FHR-SZ (mean age 12.0 y, SD 0.3), 105 children at FHR-BP (mean age 11.9 y, SD 0.2), and 181 controls (mean age 11.9 y, SD 0.2) participated. We used the Vineland-II to measure social functioning. Development of social functioning was non-significantly different across groups on the Socialization Composite score as well as the subscales Interpersonal Relations, Play and Leisure, and Coping Skills. At 4-year follow-up, children at FHR-SZ demonstrated impaired social functioning, whereas children at FHR-BP displayed social functioning comparable to controls except from impaired coping skills. From age 7 to 11, the maturational pace of social functioning in children at FHR-SZ and FHR-BP is parallel to that of controls. Children at FHR-SZ show stable social functioning deficits, whereas children at FHR-BP show normal social functioning except from emergence of discretely impaired coping skills at age 11.
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Affiliation(s)
- Nicoline Hemager
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark.
| | - Maja Gregersen
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Camilla Jerlang Christiani
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Carsten Hjorthøj
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Christina Bruun Knudsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Lotte Veddum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anna Krogh Andreassen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Julie Marie Brandt
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Mette Falkenberg Krantz
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Birgitte Klee Burton
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Child and Adolescent Psychiatry, Copenhagen University Hospital, Psychiatry Region Zealand, Roskilde, Denmark
| | - Vibeke Bliksted
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Aja Neergaard Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne Amalie Elgaard Thorup
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
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Development of social responsiveness and theory of mind in children of parents with schizophrenia or bipolar disorder. Schizophr Res Cogn 2022; 28:100242. [PMID: 35242611 PMCID: PMC8881607 DOI: 10.1016/j.scog.2022.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/20/2022] Open
Abstract
Social impairments are suggested as vulnerability markers for schizophrenia and bipolar disorder. Therefore, we investigated the development of social responsiveness and theory of mind (ToM) in children at familial high-risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP). This study is part of The Danish High Risk and Resilience Study, a longitudinal cohort study of children at FHR-SZ or FHR-BP and population-based controls (PBC). Social responsiveness was measured with the Social Responsiveness Scale (SRS-2), completed by teachers and primary caregivers. ToM was measured using The Animated Triangles Task (ATT). Both SRS-2 and ATT were applied at age 7 and 11. A total of 520 children participated (FHR-SZ, n = 201; FHR-BP, n = 119; PBC, n = 200). Results showed no significant time by group interactions. At follow-up, children at FHR-SZ exhibited impaired social responsiveness compared with PBC regardless of the informant. At both timepoints, a higher proportion of children at FHR-SZ were rated at a clinically significant level, implying inference in everyday social interactions. Compared with PBC, primary caregivers reported impairments in social responsiveness in children at FHR-BP at follow-up. The three groups did not differ in ToM at follow-up. Social responsiveness and ToM do not develop differently in children at FHR-SZ, FHR-BP and PBC from age 7 to 11, but impairments in social responsiveness remain stable and may constitute a vulnerability marker particularly in children at FHR-SZ, but also FHR-BP. ToM abilities seem to improve and remain intact, but ToM development and ToM task properties should be taken into consideration. No developmental differences in social abilities in children at familial high-risk Children at familial high-risk exhibit impaired social responsiveness. Social responsiveness impairments are detectable already at an early age. Impairments in social responsiveness may constitute a vulnerability marker. 11-Year-olds at familial high-risk have intact theory of mind.
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Krantz MF, Ellersgaard D, Andersen KK, Hemager N, Christiani C, Spang KS, Burton BK, Gregersen M, Søndergaard A, Greve A, Gantriis DL, Ohland J, Mortensen PB, Werge T, Nudel R, Wang Y, Hougaard DM, Plessen KJ, Bliksted V, Jepsen JRM, Thorup AAE, Mors O, Nordentoft M. Accumulation of Disadvantages Across Multiple Domains Amongst Subgroups of Children of Parents With Schizophrenia or Bipolar Disorder: Clustering Data from the Danish High Risk and Resilience Study VIA 7. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac010. [PMID: 39144761 PMCID: PMC11206045 DOI: 10.1093/schizbullopen/sgac010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Objective Children with familial high-risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) are frequently affected in a range of domains known to be precursors of severe mental illness. No previous studies have gathered known precursors to examine whether they distribute evenly across familial high risk (FHR) children or if they cluster among a smaller group. Since such examination holds the potential to identify high and low risk of severe mental illness groups, we aimed to cluster FHR and control children affected to various degrees. Method In The Danish High Risk and Resilience Study VIA 7, a clinical cohort study, 514 7-year-old children with FHR-SZ or FHR-BP and matched controls were assessed in domains of motor function, neurocognition, emotional control, behavior, social cognition, self-perception, language, psychotic experiences, and psychopathology, and grouped using cluster analysis. Associations between clusters and parents' level of education, functioning, caregiver status, child's level of stimulation and support in the home, and polygenic risk scores were examined. Results A total of four groups including one of broadly affected children were identified. The broadly affected group was represented 4-5-fold (18.1%) amongst FHR-SZ children and 2-3-fold (10.2%) amongst FHR-BP children, compared to controls (4.1%) (P < .001), and the broadly affected group had lower levels of caregiver functioning (P < .001) and stimulation and support at home (P < .001). Conclusion Precursors of severe mental illness distribute unevenly among FHR children; while approximately half are not affected in any domains, the other half are affected to various degrees. Targeted support towards the affected groups is indicated.
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Affiliation(s)
- Mette Falkenberg Krantz
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Capital Region of Denmark, Copenhagen University Hospital, Gentofte Hospitalsvej 15, opg. 15, 1. sal., 2900 Hellerup, Denmark
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N., Denmark
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
| | - Ditte Ellersgaard
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Capital Region of Denmark, Copenhagen University Hospital, Gentofte Hospitalsvej 15, opg. 15, 1. sal., 2900 Hellerup, Denmark
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
| | - Klaus Kaae Andersen
- Danish Cancer Society Research Center, Department of Statistics and Pharmacoepidemiology, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Nicoline Hemager
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Capital Region of Denmark, Copenhagen University Hospital, Gentofte Hospitalsvej 15, opg. 15, 1. sal., 2900 Hellerup, Denmark
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N., Denmark
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
| | - Camilla Christiani
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Capital Region of Denmark, Copenhagen University Hospital, Gentofte Hospitalsvej 15, opg. 15, 1. sal., 2900 Hellerup, Denmark
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N., Denmark
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
| | - Katrine Søborg Spang
- Copenhagen Research Unit, Child and Adolescent Mental Health Center, Gentofte Hospitalsvej 3A, opg. 3A, 1. sal, 2900 Hellerup, Denmark
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
| | - Birgitte Klee Burton
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N., Denmark
- Copenhagen Research Unit, Child and Adolescent Mental Health Center, Gentofte Hospitalsvej 3A, opg. 3A, 1. sal, 2900 Hellerup, Denmark
| | - Maja Gregersen
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Capital Region of Denmark, Copenhagen University Hospital, Gentofte Hospitalsvej 15, opg. 15, 1. sal., 2900 Hellerup, Denmark
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N., Denmark
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
| | - Anne Søndergaard
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Capital Region of Denmark, Copenhagen University Hospital, Gentofte Hospitalsvej 15, opg. 15, 1. sal., 2900 Hellerup, Denmark
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N., Denmark
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
| | - Aja Greve
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
- The Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Services, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Ditte Lou Gantriis
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
- The Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus N, Denmark
| | - Jessica Ohland
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Capital Region of Denmark, Copenhagen University Hospital, Gentofte Hospitalsvej 15, opg. 15, 1. sal., 2900 Hellerup, Denmark
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
| | - Preben Bo Mortensen
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
- Department of Economics and Business Economics, National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, Bygning R2640-R2641, 8210 Aarhus V, Denmark
| | - Thomas Werge
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N., Denmark
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Boserupvej 2, 4000 Roskilde, Denmark
- Center for GeoGenetics, GLOBE Institute, University of Copenhagen, Copenhagen, Denmark
| | - Ron Nudel
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Boserupvej 2, 4000 Roskilde, Denmark
| | - Yunpeng Wang
- Department of Psychology, Centre for Lifespan Changes in Brain and Cognition, University of Oslo, Forskningsveien 3A, 0317 Oslo, Norway
| | - David M Hougaard
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
- Department for Congenital Disorders, Center for Neonatal Screening, Statens Serum Institute, Artillerivej 5, 2300 Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Capital Region of Denmark, Copenhagen University Hospital, Gentofte Hospitalsvej 15, opg. 15, 1. sal., 2900 Hellerup, Denmark
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne,Switzerland
| | - Vibeke Bliksted
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
- The Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Services, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Jens Richardt Møllegaard Jepsen
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Capital Region of Denmark, Copenhagen University Hospital, Gentofte Hospitalsvej 15, opg. 15, 1. sal., 2900 Hellerup, Denmark
- Copenhagen Research Unit, Child and Adolescent Mental Health Center, Gentofte Hospitalsvej 3A, opg. 3A, 1. sal, 2900 Hellerup, Denmark
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
- Mental Health Services – Capital Region of Denmark, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Nordstjernevej 41, 2600 Glostrup,Denmark
| | - Anne A E Thorup
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Capital Region of Denmark, Copenhagen University Hospital, Gentofte Hospitalsvej 15, opg. 15, 1. sal., 2900 Hellerup, Denmark
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N., Denmark
- Copenhagen Research Unit, Child and Adolescent Mental Health Center, Gentofte Hospitalsvej 3A, opg. 3A, 1. sal, 2900 Hellerup, Denmark
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
| | - Ole Mors
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
- The Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Services, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Merete Nordentoft
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Capital Region of Denmark, Copenhagen University Hospital, Gentofte Hospitalsvej 15, opg. 15, 1. sal., 2900 Hellerup, Denmark
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N., Denmark
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Fuglesangs Allé 26, 8210 Aarhus V, Denmark
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Emotion socialization in mothers with mood disorders: Affective modeling and recollected responses to childhood emotion. Dev Psychopathol 2020; 33:1156-1169. [PMID: 32672147 DOI: 10.1017/s0954579420000395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Growing evidence suggests that emotion socialization may be disrupted by maternal depression. However, little is known about emotion-related parenting by mothers with bipolar disorder or whether affective modeling in early childhood is linked to young adults' recollections of emotion socialization practices. The current study investigates emotion socialization by mothers with histories of major depression, bipolar disorder, or no mood disorder. Affective modeling was coded from parent-child interactions in early childhood and maternal responses to negative emotions were recollected by young adult offspring (n = 131, 59.5% female, M age = 22.16, SD = 2.58). Multilevel models revealed that maternal bipolar disorder was associated with more neglecting, punishing, and magnifying responses to children's emotions, whereas maternal major depression was associated with more magnifying responses; links between maternal diagnosis and magnifying responses were robust to covariates. Young adult recollections of maternal responses to emotion were predicted by affective modeling in early childhood, providing preliminary validity evidence for the Emotions as a Child Scale. Findings provide novel evidence that major depression and bipolar disorder are associated with altered emotion socialization and that maternal affective modeling in early childhood prospectively predicts young adults' recollections of emotion socialization in families with and without mood disorder.
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Duffy A, Carlson G, Dubicka B, Hillegers MHJ. Pre-pubertal bipolar disorder: origins and current status of the controversy. Int J Bipolar Disord 2020; 8:18. [PMID: 32307651 PMCID: PMC7167382 DOI: 10.1186/s40345-020-00185-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/17/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Evidence from epidemiological, clinical and high-risk studies has established that the peak period of risk for onset of bipolar disorder spans late adolescence and early adulthood. However, the proposal of the existence of a pre-pubertal form of bipolar disorder manifesting in early childhood created substantial debate. In this narrative review, the literature and contributing factors pertaining to the controversy surrounding the proposed pre-pubertal bipolar disorder subtype are discussed. The resolution of the debate and lessons learned are highlighted. MAIN BODY In the mid 1990s US researchers proposed that chronic irritability and explosive temper in pre-pubertal children with pre-existing ADHD and/or other learning and developmental disorders might represent a variant of mania. A number of factors contributed to this proposal including severely ill children with no diagnostic home given changes in the ADHD DSM diagnostic criteria and over-reliance on symptoms and structured interviews rather than on a clinical assessment incorporating developmental history, social context and clinical course. Prospective studies of children at high familial risk did not support the proposed pre-pubertal bipolar phenotype; but rather provided convergent evidence that bipolar disorder onset in adolescence and early adulthood not uncommonly preceded by sleep and internalizing symptoms and most often debuting as depression in adolescence (after puberty). Epidemiological studies of population and hospital discharge data provided evidence that the pre-pubertal bipolar phenotype was largely a US driven phenomenon. CONCLUSIONS Psychiatric diagnosis is particularly challenging given the current lack of objective biomarkers. However, validity and utility of clinical diagnoses can be strengthened if all available predictive information is used to formulate a diagnosis. As in other areas of medicine, critical information required to make a valid diagnosis includes developmental history, clinical course, family history and treatment response-weighed against the known trajectories of classical disorders. Moreover, given that psychiatric disorders are in evolution over childhood and adolescence and symptoms, in of themselves, are often non-specific, a thorough clinical assessment incorporating collateral history and psychosocial context is paramount. Such an approach might have avoided or at least brought a more timely resolution to the debate on pre-pubertal mania.
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Affiliation(s)
- A. Duffy
- Queen’s University, Kingston, Canada
- Department of Psychiatry, University Oxford, Oxford, UK
| | - G. Carlson
- Renaissance School of Medicine, Stonybrook University, Stony Brook, NY USA
| | - B. Dubicka
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M. H. J. Hillegers
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
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8
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Christiani CJ, Jepsen JRM, Thorup A, Hemager N, Ellersgaard D, Spang KS, Burton BK, Gregersen M, Søndergaard A, Greve AN, Gantriis DL, Poulsen G, Uddin MJ, Seidman LJ, Mors O, Plessen KJ, Nordentoft M. Social Cognition, Language, and Social Behavior in 7-Year-Old Children at Familial High-Risk of Developing Schizophrenia or Bipolar Disorder: The Danish High Risk and Resilience Study VIA 7-A Population-Based Cohort Study. Schizophr Bull 2019; 45:1218-1230. [PMID: 30852621 PMCID: PMC6811824 DOI: 10.1093/schbul/sbz001] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To characterize social cognition, language, and social behavior as potentially shared vulnerability markers in children at familial high-risk of schizophrenia (FHR-SZ) and bipolar disorder (FHR-BP). METHODS The Danish High-Risk and Resilience Study VIA7 is a multisite population-based cohort of 522 7-year-old children extracted from the Danish registries. The population-based controls were matched to the FHR-SZ children on age, sex, and municipality. The FHR-BP group followed same inclusion criteria. Data were collected blinded to familial high-risk status. Outcomes were social cognition, language, and social behavior. RESULTS The analysis included 202 FHR-SZ children (girls: 46%), 120 FHR-BP children (girls: 46.7%), and 200 controls (girls: 46.5%). FHR-SZ children displayed significant deficits in language (receptive: d = -0.27, P = .006; pragmatic: d = -0.51, P < .001), social responsiveness (d = -0.54, P < .001), and adaptive social functioning (d = -0.47, P < .001) compared to controls after Bonferroni correction. Compared to FHR-BP children, FHR-SZ children performed significantly poorer on adaptive social functioning (d = -0.29, P = .007) after Bonferroni correction. FHR-BP and FHR-SZ children showed no significant social cognitive impairments compared to controls after Bonferroni correction. CONCLUSION Language, social responsiveness, and adaptive social functioning deficits seem associated with FHR-SZ but not FHR-BP in this developmental phase. The pattern of results suggests adaptive social functioning impairments may not be shared between FHR-BP and FHR-SZ in this developmental phase and thus not reflective of the shared risk factors for schizophrenia and bipolar disorder.
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Affiliation(s)
- Camilla Jerlang Christiani
- Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark,To whom correspondence should be addressed; Mental Health Centre Copenhagen, Research Unit, The Danish High Risk and Resilience Study VIA 7; Kildegaardsvej 28, 15., 1., 2900 Hellerup, Denmark; tel: +4520220285; e-mail:
| | - Jens R M Jepsen
- Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark,Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Anne Thorup
- Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Nicoline Hemager
- Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark,Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Ditte Ellersgaard
- Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Katrine S Spang
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark,Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Birgitte K Burton
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark,Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Maja Gregersen
- Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Anne Søndergaard
- Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Aja N Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark,Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Ditte L Gantriis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark,Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Gry Poulsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark,Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Md Jamal Uddin
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark,Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark,Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Kerstin J Plessen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark,Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,Services of Child and Adolescent Psychiatry, Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Merete Nordentoft
- Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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9
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Hanford LC, Sassi RB, Hall GB. Accuracy of emotion labeling in children of parents diagnosed with bipolar disorder. J Affect Disord 2016; 194:226-33. [PMID: 26874055 DOI: 10.1016/j.jad.2016.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 12/20/2015] [Accepted: 01/12/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Emotion labeling deficits have been posited as an endophenotype for bipolar disorder (BD) as they have been observed in both patients and their first-degree relatives. It remains unclear whether these deficits exist secondary to the development of psychiatric symptoms or whether they can be attributed to risk for psychopathology. To explore this, we investigated emotion processing in symptomatic and asymptomatic high-risk bipolar offspring (HRO) and healthy children of healthy parents (HCO). METHODS Symptomatic (n:18, age: 13.8 ± 2.6 years, 44% female) and asymptomatic (n:12, age: 12.8 ± 3.0 years, 42% female) HRO and age- and sex-matched HCO (n:20, age: 13.3 ± 2.5 years, 45% female) performed an emotion-labeling task. Total number of errors, emotion category and intensity of emotion error scores were compared. Correlations between total error scores and symptom severity were also investigated. RESULTS Compared to HCO, both HRO groups made more errors on the adult face task (pcor=0.014). The HRO group were 2.3 times [90%CI:0.9-6.3] more likely and 4.3 times [90%CI:1.3-14.3] more likely to make errors on sad and angry faces, respectively. With the exception of sad face type errors, we observed no significant differences in error patterns between symptomatic and asymptomatic HRO, and no correlations between symptom severity and total number of errors. LIMITATIONS This study was cross-sectional in design, limiting our ability to infer trajectories or heritability of these deficits. CONCLUSIONS This study provides further support for emotion labeling deficits as a candidate endophenotype for BD. Our study also suggests these deficits are not attributable to the presence of psychiatric symptoms.
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Affiliation(s)
| | - Roberto B Sassi
- Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mood Disorders Outpatient Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Geoffrey B Hall
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
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10
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Bella T, Goldstein T, Axelson D, Obreja M, Monk K, Hickey MB, Goldstein B, Brent D, Diler RS, Kupfer D, Sakolsky D, Birmaher B. Psychosocial functioning in offspring of parents with bipolar disorder. J Affect Disord 2011; 133:204-11. [PMID: 21463899 PMCID: PMC3131462 DOI: 10.1016/j.jad.2011.03.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 02/24/2011] [Accepted: 03/09/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Offspring of parents with bipolar disorder are at increased risk for a range of psychopathology, including bipolar disorder. It is not clear if they also have impairments in their psychosocial functioning. METHODS We compared the psychosocial functioning of three groups of children enrolled in the Pittsburgh Bipolar Offspring Study (BIOS): offspring of probands with bipolar disorder (n=388), offspring of probands with other types of psychopathology (n=132), and offspring of healthy probands (n=118). Psychosocial functioning was assessed at study intake using the schedule of the Adolescent Longitudinal Interval Follow-Up Evaluation (A-LIFE), the Child Behavior Check List (CBCL) and the Children's Global Assessment Scale (CGAS). RESULTS Offspring of probands with bipolar disorder exhibited impairments in various aspects of psychosocial functioning. On all measures, they had worse functioning in comparison with offspring of healthy probands. Offspring of probands with bipolar disorder generally exhibited more impairment than offspring of probands with nonbipolar psychopathology. After adjusting for proband parent functioning and the child's Axis I psychopathology, functioning of offspring of probands with bipolar disorder was similar to that of offspring of healthy probands. LIMITATIONS Data are cross-sectional and therefore do not allow for causal conclusions about the association between parental psychopathology, child psychopathology and offspring psychosocial functioning. CONCLUSIONS Offspring of parents with bipolar disorder exhibit impairments in psychosocial functioning which appear largely attributable to proband parent functional impairment and the child's own psychopathology. As such, interventions to improve parental functioning, as well as early interventions to treat the child's psychopathology may help reduce the risk for long-term functional impairment in offspring.
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Affiliation(s)
- Tolulope Bella
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Tina Goldstein
- Sunny brook Health Sciences Centre, University of Toronto, Faculty of Medicine, Toronto, ON Canada
| | - David Axelson
- Sunny brook Health Sciences Centre, University of Toronto, Faculty of Medicine, Toronto, ON Canada
| | - Mihaela Obreja
- Sunny brook Health Sciences Centre, University of Toronto, Faculty of Medicine, Toronto, ON Canada
| | - Kelly Monk
- Sunny brook Health Sciences Centre, University of Toronto, Faculty of Medicine, Toronto, ON Canada
| | - Mary Beth Hickey
- Sunny brook Health Sciences Centre, University of Toronto, Faculty of Medicine, Toronto, ON Canada
| | | | - David Brent
- Sunny brook Health Sciences Centre, University of Toronto, Faculty of Medicine, Toronto, ON Canada
| | - Rasim Somer Diler
- Sunny brook Health Sciences Centre, University of Toronto, Faculty of Medicine, Toronto, ON Canada
| | - David Kupfer
- Sunny brook Health Sciences Centre, University of Toronto, Faculty of Medicine, Toronto, ON Canada
| | - Dara Sakolsky
- Sunny brook Health Sciences Centre, University of Toronto, Faculty of Medicine, Toronto, ON Canada
| | - Boris Birmaher
- Sunny brook Health Sciences Centre, University of Toronto, Faculty of Medicine, Toronto, ON Canada
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11
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Frazier TW, Youngstrom EA, Horwitz SM, Demeter CA, Fristad MA, Arnold LE, Birmaher B, Kowatch RA, Axelson D, Ryan N, Gill MK, Findling RL. Relationship of persistent manic symptoms to the diagnosis of pediatric bipolar spectrum disorders. J Clin Psychiatry 2011; 72:846-53. [PMID: 21457674 PMCID: PMC3242357 DOI: 10.4088/jcp.10m06081yel] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 08/11/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The diagnosis of bipolar spectrum disorders (BPSDs [bipolar I and II disorders, cyclothymic disorder, and bipolar disorder not otherwise specified]) in youth remains controversial. The present study evaluated the possibility that the presence of persistent manic symptoms over a relatively short interval may increase the probability of a BPSD DSM diagnosis. METHOD Data were obtained from the screening and baseline assessments collected from 2005 through 2008 of an ongoing prospective, longitudinal study (Longitudinal Assessment of Manic Symptoms) examining the diagnosis and phenomenology of youth (N = 692) presenting to outpatient centers at ages 6-12 years. Youth were assessed for elevated symptoms of mania (ESM) with the Parent General Behavior Inventory-10-Item Mania Scale (PGBI-10M), the primary outcome measure. Screening and baseline scores separated individuals into those with ESM (ESM+; PGBI-10M score ≥ 12) and a control group of youth without ESM (ESM-; PGBI-10M score < 12). Youth were classified into 4 groups: persistent ESM+, remitted ESM+, persistent ESM-, and progressed to ESM+. RESULTS Individuals with persistent ESM+ were more likely to have a BPSD (relative risk = 3.04; 95% CI, 2.15-4.30). Using 2 administrations of the PGBI-10M spaced over a relatively brief interval (median = 4.0, mean = 6.1, SD = 5.9 weeks) improved the prediction of BPSD over using only the first administration (ΔR(2) = 0.10, Δχ(2)(1) = 50.06, P < .001). Likelihood ratios indicated that persistent ESM- substantially decreased the probability of BPSD. While high levels of persistent ESM+ increased the probability of a BPSD diagnosis, the final positive predictive value was only sufficient to signify the need for more thorough clinical evaluation. CONCLUSIONS In many cases, obtaining repeated parent report of mania symptoms substantially altered the probability of a BPSD diagnosis and may be a useful adjunct to a careful clinical evaluation. Future waves of data collection from this longitudinal study will be crucial for devising clinically useful methods for identifying or ruling out pediatric BPSD.
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Affiliation(s)
- Thomas W. Frazier
- Center for Pediatric Behavioral Health and Center for Autism, Cleveland Clinic, Cleveland, OH
| | - Eric A. Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sarah McCue Horwitz
- Department of Pediatrics and Stanford Health Policy, Stanford University School of Medicine, Stanford, CA
| | - Christine A. Demeter
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Mary A. Fristad
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH
| | - L. Eugene Arnold
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Robert A. Kowatch
- Division of Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - David Axelson
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Neal Ryan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Robert L. Findling
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, OH
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Rodgers MJ, Zylstra RG, McKay JB, Solomon AL, Choby BA. Adolescent bipolar disorder: a clinical vignette. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2010; 12. [PMID: 21085549 DOI: 10.4088/pcc.09r00895ora] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 11/24/2009] [Indexed: 10/19/2022]
Abstract
Adolescence is a vulnerable developmental phase marked by physical, psychological, and social changes that rapidly expose young people to a wide range of new stressors. When differentiating between bipolar disorder and teenage "acting out," a careful history is important. Adolescent bipolar disorder is a psychiatric illness characterized by fluctuating episodes of mood elevation and depression that is frequently neither recognized nor formally diagnosed. Adolescents with bipolar disorder often manifest a more nonepisodic, chronic course with continuous rapid-cycling patterns than do adults. Pharmacologic treatment of adolescent bipolar disorder is difficult and often requires combination therapy to address comorbidities like attention-deficit/hyperactivity disorder and anxiety disorder. Adjuncts to pharmacologic treatment of bipolar disorder can be beneficial. Psychosocial treatments include family education, enhanced parenting techniques, stress management, and the development of effective coping strategies.
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Affiliation(s)
- Melissa J Rodgers
- Department of Family Medicine, College of Medicine, University of Tennessee-Chattanooga, Chattanooga, Tennessee, USA
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13
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Continuity and cascade in offspring of bipolar parents: A longitudinal study of externalizing, internalizing, and thought problems. Dev Psychopathol 2010; 22:849-66. [DOI: 10.1017/s0954579410000507] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThere is growing evidence that many offspring of bipolar parents will develop moderate to severe forms of psychopathology during childhood and adolescence. The purpose of this study was to apply growth curve models to evaluate developmental progression with regard to continuity and cascades representative within the context of a family risk study of bipolar disorder (BD). Repeated assessments of externalizing, internalizing, and thought problems, spanning more than a decade, were examined in a total of 94 offspring of parents with BD (O-BD), major depressive disorder (O-UNI), or no significant psychiatric or medical problems (O-WELL). Continuity was defined by the growth curve of the O-WELL group who exhibited low levels of problems from early childhood through late adolescence. Discontinuity, as evidenced by greater complexity of growth curves relative to the O-WELL group, was exhibited in the at- risk offspring groups for internalizing problems. Different patterns of developmental cascades were supported for the at-risk group with O-UNI showing a robust cascade from self-regulatory deficits (externalizing problems) to internalizing problems. There was also support for a cascade from self-regulatory deficits to thought problems across the entire group (with some support that this pattern was accounted for primarily by O-BD). This study not only serves to advance our understanding of the risks associated with a family history of BD, but also provides a novel approach to examining developmental cascades.
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14
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Abstract
The interpersonal behavior of individuals who have affective disorders can increase the likelihood of interpersonal conflicts. A related issue is whether vulnerability for developing affective disorder expresses itself in social interactions that affect the mood of interaction partners as well. Adolescents (n = 119) have been divided into subgroups: "mania risk" (scoring high on "Hypomanic Personality"); "unipolar risk" (scoring high on "Rigidity"); and a control group (scoring low on both scales). Interviews were conducted by raters blind to risk status. Interviewers provided ratings of their own mood before and after the interview. Negative mood of the interviewers did not change. Interviewers' positive mood decreased when interacting with individuals at risk for unipolar disorder as well as when interacting with the control subjects, but not when interacting with people at risk for mania. It seems that individuals high in hypomanic traits keep the interaction partner longer engaged and interested.
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Abstract
OBJECTIVE Both first- (FGAs) and second-generation antipsychotics (SGAs) are routinely used in treating severe and persistent psychiatric disorders. However, until now no articles have analyzed systematically the safety of both classes of psychotropics during pregnancy. DATA SOURCES AND SEARCH STRATEGY: Medical literature information published in any language since 1950 was identified using MEDLINE/PubMed, TOXNET, EMBASE, and The Cochrane Library. Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from companies developing drugs. Search terms were pregnancy, psychotropic drugs, (a)typical-first-second-generation antipsychotics, and neuroleptics. A separate search was also conducted to complete the safety profile of each reviewed medication. Searches were last updated on July 2008. DATA SELECTION All articles reporting primary data on the outcome of pregnancies exposed to antipsychotics were acquired, without methodological limitations. CONCLUSIONS Reviewed information was too limited to draw definite conclusions on structural teratogenicity of FGAs and SGAs. Both classes of drugs seem to be associated with an increased risk of neonatal complications. However, most SGAs appear to increase risk of gestational metabolic complications and babies large for gestational age and with mean birth weight significantly heavier as compared with those exposed to FGAs. These risks have been reported rarely with FGAs. Hence, the choice of the less harmful option in pregnancy should be limited to FGAs in drug-naive patients. When pregnancy occurs during antipsychotic treatment, the choice to continue the previous therapy should be preferred.
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Affiliation(s)
- Salvatore Gentile
- Department of Mental Health ASL Salerno 1, Mental Health Center n. 4, Piazza Galdi, 841013 Cava de' Tirreni (Salerno), Italy.
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16
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McClure-Tone EB. Socioemotional functioning in bipolar disorder versus typical development: Behavioral and neural differences. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1468-2850.2009.01150.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Linnen AM, aan het Rot M, Ellenbogen MA, Young SN. Interpersonal functioning in adolescent offspring of parents with bipolar disorder. J Affect Disord 2009; 114:122-30. [PMID: 18692905 DOI: 10.1016/j.jad.2008.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 06/20/2008] [Accepted: 06/24/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND Poor interpersonal functioning may represent a putative prodromal feature of major affective disorder. However, no studies have examined the naturalistic patterns of social behaviours among the offspring of parents with a major affective disorder. The present study assessed daily social interactions among 25 offspring of parents with bipolar disorder and 23 control participants in late adolescence and young adulthood. METHODS Using event-contingent recording procedures, interpersonal behaviours and perceptions were assessed along four scales (quarrelsomeness, agreeableness, dominance, and submissiveness) and were measured during specific social interactions over 14 days. RESULTS Multilevel modeling analyses revealed no group differences on any of the four scales, but gender by group interactions were was observed. High-risk males reported higher mean levels of quarrelsome behaviour and lower mean levels of agreeable behaviour than high-risk females, whereas low-risk males and females reported comparable levels of affiliative behaviours. High-risk participants reported more externalizing, but not internalizing, problems on the Achenbach Youth Self-Report Form than low-risk participants. LIMITATIONS Although event-contingent recording reduces the self-report bias associated with self-report questionnaires, participants may have been biased in the selection of interactions they chose to record. CONCLUSIONS Overall, the offspring of parents with BD, relative to controls, report no deficits in social functioning in the natural environment. However, high-risk youth displayed elevated externalizing problems and gender-specific patterns of social functioning that may precede the development of major affective disorder.
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Affiliation(s)
- Anne-Marie Linnen
- Centre for Research in Human Development, Concordia University, Montréal (Québec), Canada
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18
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Ostiguy CS, Ellenbogen MA, Linnen AM, Walker EF, Hammen C, Hodgins S. Chronic stress and stressful life events in the offspring of parents with bipolar disorder. J Affect Disord 2009; 114:74-84. [PMID: 18814916 DOI: 10.1016/j.jad.2008.08.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Revised: 08/04/2008] [Accepted: 08/07/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND The stress generation theory suggests that depressed individuals and children of depressed mothers are prone to create stressors that are interpersonal and dependent on their own behaviour. Exposure to "self-generated" stress is believed to increase the risk for onset and recurrence of depression. Much less is known about stress in the offspring of parents with bipolar disorder (OBD). METHODS As part of a longitudinal study, 37 OBD and 33 offspring of parents with no affective disorder (13 to 26 years old) were interviewed using the UCLA Life Stress Interview, assessing their current life circumstances (chronic stress) and recent negative life events (episodic stress). RESULTS The OBD reported more difficulties in interpersonal and non-interpersonal domains of chronic stress than controls. The group differences remained significant after controlling for the presence of affective disorders, indicating that the effect of risk status on chronic stress is independent of the problems associated with having a disorder. With respect to episodic stress, the OBD were 3.9 times more likely to have experienced a moderate to severe interpersonal stressor compared to the control group. There was no group difference for dependent events, but the OBD experienced more severe independent events than controls. LIMITATIONS Methodological limitations include a small sample size, large age range, and the absence of parent-reported stress and symptomatology. CONCLUSIONS Although the findings do not support the stress generation theory, they suggest that elevated levels of episodic and chronic stress may be important markers of risk for affective disorders in high-risk participants.
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Affiliation(s)
- Caroline S Ostiguy
- Centre for Research in Human Development, Concordia University, Montreal, Qc, Canada
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19
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Abstract
Since its “rebirth” in 1966, bipolar disorder (BPD) has rapidly come to occupy a central position in the research and treatment of mood disorders. Compared with major depressive disorder (MDD), BPD is a more serious condition, characterized by much more frequent recurrence, more complex comorbidity, and higher mortality. One major problem is the lack of valid definitions in adult and in child psychiatry; the current definitions are unsatisfactory, and heavily favor an overdiagnosis of MDD. Biological research is partially based on those definitions, which have a short half-life. An additional, dimensional, approach, quantifying hypomania, depression, and anxiety by self-assessment and symptom checklists is recommended, A further, related problem is the early recognition of the onset of BPD, especially in adolescence, and the identification of correlates in childhood. Early and timely diagnosis of BPD is necessary to enable prompt intervention and secondary prevention of the disorder. The paper describes the current status and future directions of developing clinical concepts of bipolarity
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Affiliation(s)
- Jules Angst
- Zurich University, Psychiatric Hospital, Research Department, Zurich, Switzerland.
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Abstract
PURPOSE OF REVIEW Bipolar disorder (BPD) is increasingly diagnosed in youth in both outpatient and inpatient settings. Research on BPD in youth has also increased dramatically; this paper summarizes issues of clinical relevance in primary care, advancements in the last year, and areas in which more research is needed. RECENT FINDINGS Key issues and new developments are summarized in the following areas such as epidemiology and relevance, assessment and differential diagnosis, patient and family decision support, shared decision making and triage, treatment, and monitoring and collaboration with mental health professionals. Recent practice guidelines have important implications for diagnosis and treatment. SUMMARY Early-onset BPD appears to have a more severe course and more comorbidity than later life onset, as well as longer delays in treatment seeking. Affected children show differences in cognitive functioning and neuroanatomy compared with the general population. Assessment of BPD in children needs to be comprehensive and longitudinal, as diagnosis remains a debated topic. Medications are a primary part of treatment, but more double-blind, placebo-controlled trials are needed. Psychosocial adjunctive treatment is important. Children with a family history of BPD are at risk for impaired functioning and psychopathology; high-risk studies will increase our understanding of the onset and course of BPD.
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