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Sheehan AE, Salvador PY, Bounoua N, Sadeh N. Impulsive Decision-Making, Affective Experiences, and Parental History of Self-Injurious Thoughts and Behaviors within Parent-Adolescent Dyads. Res Child Adolesc Psychopathol 2024; 52:1209-1220. [PMID: 38647794 PMCID: PMC11289229 DOI: 10.1007/s10802-024-01194-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
Impulsive decision-making, particularly during states of affective intensity, is associated with greater risk of engagement in self-injurious thoughts and behaviors (SITBs) during adolescence. The proximal (dyadic parent-adolescent affect and impulsivity) and distal (family history of SITBs) risk factors that occur within the family system could be relevant processes at stake in the intergenerational transmission of risk. The current study tests the interdependence of parent-adolescent factors associated with risk for SITBs and probes the extent to which parent-adolescent affective states influence their own (actor-effects) and each other's (partner-effects) impulsive decision-making, and further whether these relationships are moderated by a parent's history of SITBs. Participants included 212 (106 dyads) community parents and their adolescents who completed self-report and behavioral tasks related to positive and negative affective states, impulsive decision-making, and lifetime history of SITBs. Application of the Actor-Partner Interdependence Model (APIM) revealed a partner-effect where greater parent negative affect in the past week was associated with elevated adolescent impulsive decision-making among families with a history of SITBs (Estimate = 0.66, Standard Error = 0.13, p < 0.001). In addition, a significant actor-effect was observed where greater positive affect was associated with decreased impulsive decision-making among adolescents (Estimate = -0.21, Standard Error = 0.10, p = 0.03), however, moderating effects of parent history of SITBs were not detected. Findings from the present study shed light on the interdependence of affect and impulsivity within parent-adolescent dyads, and the extent to which these interactions may be particularly salient for families with known vulnerabilities for SITBs.
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Affiliation(s)
- Ana E Sheehan
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19176, USA.
| | - Paula Yoela Salvador
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19176, USA
| | - Nadia Bounoua
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19176, USA
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Naomi Sadeh
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19176, USA
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Gabrielle FF, Refaat G, Mahmoud DAM, Ezzat L, Hassan Kasem RE. The psychopathology among the offspring of schizophrenia and bipolar I disorder patients in an Egyptian sample: A comparative study. Int J Soc Psychiatry 2024; 70:482-488. [PMID: 38390657 DOI: 10.1177/00207640231216354] [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] [Indexed: 02/24/2024]
Abstract
BACKGROUND A variety of psychiatric illnesses can develop in children of parents who suffer from bipolar affective disorder. AIMS The purpose of the research was to investigate, among the offsprings of patients diagnosed with schizophrenia and bipolar disorder type I, the prevalence of a variety of psychiatric diseases as well as a range of behavioral abnormalities. METHOD This was a cross-sectional observational comparative study. The outpatient psychiatric clinics at Shebin Elkom Mental Health Hospital, Menofia Governorate, Egypt 500 offspring (there were 250 offspring of parents both diagnosed with schizophrenia and 250 offsprings born to parents with bipolar affective disorder). RESULTS Statistically significant association of male gender with somatic complaints, social problems, and attention problems in the bipolar offspring group. In addition, there was a statistically significant association between female gender and anxiety or depression in the bipolar offspring group. Moreover, there was a statistically significant association between male gender and thought problems and aggressive behavior in the schizophrenia group. Assessment of psychiatric symptoms using K-SADS in relation to gender revealed a statistically significant association of male gender with affective disorder, behavioral disorder, and substance use disorder in the bipolar offspring group. Moreover, there was a statistically significant association between female gender and psychotic disorder in the schizophrenia group. CONCLUSION We concluded that offspring with bipolar illness had a significant association with somatic symptoms, anxiety/depressive disorder, social issues, attention problems, and aggressive behavior. Schizophrenia offspring were strongly related to thought issues.
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Affiliation(s)
- Fiby Fayez Gabrielle
- Department of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ghada Refaat
- Department of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Lina Ezzat
- Department of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Abel MR, Henin A, Holmén J, Kagan E, Hamilton A, Noyola N, Hirshfeld-Becker DR. Anxiety and Disruptive Behavior Symptoms and Disorders in Preschool-Age Offspring of Parents With and Without Bipolar Disorder: Associations With Parental Comorbidity. J Atten Disord 2024; 28:625-638. [PMID: 38084063 DOI: 10.1177/10870547231215288] [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] [Indexed: 03/12/2024]
Abstract
OBJECTIVE We examined the relative contribution of parental bipolar disorder (BPD) and psychiatric comorbidities (disruptive behavior disorders [DBD] and anxiety disorders) in predicting psychiatric symptoms and disorders in 2-5-year-old offspring. METHODS Participants were 60 families with a parent with BPD and 78 offspring and 70 comparison families in which neither parent had a mood disorder and 91 offspring. Parent and offspring diagnoses and symptoms were assessed using standardized diagnostic interviews and measures, with offspring assessors masked to parental diagnoses. RESULTS Offspring of parents with BPD had significant elevations in behavioral, mood and anxiety disorders and symptoms. Both parental BPD and DBD contributed to elevations in child disruptive behavioral symptoms, whereas child anxiety symptoms were more strongly predicted by comorbid parental anxiety. Parental BPD was a stronger predictor than comorbid DBD of child DBDs. CONCLUSION Some of the elevated risk for disorders in preschoolers is accounted for by parental comorbidity.
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Affiliation(s)
- Madelaine R Abel
- Child Cognitive Behavioral Therapy Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Aude Henin
- Child Cognitive Behavioral Therapy Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jordan Holmén
- Child Cognitive Behavioral Therapy Program, Massachusetts General Hospital, Boston, MA, USA
- St. John's University, New York, NY, USA
| | - Elana Kagan
- Child Cognitive Behavioral Therapy Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Antonia Hamilton
- Child Cognitive Behavioral Therapy Program, Massachusetts General Hospital, Boston, MA, USA
- Syracuse University, New York, NY, USA
| | - Nestor Noyola
- Child Cognitive Behavioral Therapy Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dina R Hirshfeld-Becker
- Child Cognitive Behavioral Therapy Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Carlson GA. Does the apple fall far from the tree? Commentary on Hafeman et al., early indicators of bipolar risk in preschool offspring of parents with bipolar disorder. J Child Psychol Psychiatry 2023; 64:1501-1504. [PMID: 37424107 DOI: 10.1111/jcpp.13857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 07/11/2023]
Abstract
Comorbid externalizing and internalizing disorders are common in offspring of a parent with bipolar I or II disorder. In some cases, the symptoms are harbingers of future bipolar spectrum disorder. Even when they are not, they are likely to be impairing to the child. Clinicians need to be better informed about how the history leading up to mania/hypomania unfolds, and what comorbid disorders are impairing in and of themselves. More information is needed about the parents' psychopathology, course of illness and response to treatment. Until we have data on how to prevent bipolar disorder, the best course of action is to treat the child's current impairing symptoms and render the parent as asymptomatic as possible.
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Affiliation(s)
- Gabrielle A Carlson
- Division of Child and Adolescent Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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Hafeman DM, Merranko J, Joseph HM, Goldstein TR, Goldstein BI, Levenson J, Axelson D, Monk K, Sakolsky D, Iyengar S, Birmaher B. Early indicators of bipolar risk in preschool offspring of parents with bipolar disorder. J Child Psychol Psychiatry 2023; 64:1492-1500. [PMID: 36577710 PMCID: PMC10300228 DOI: 10.1111/jcpp.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Offspring of parents with bipolar disorder (BD-I/II) are at increased risk to develop the disorder. Previous work indicates that bipolar spectrum disorder (BPSD) is often preceded by mood/anxiety symptoms. In school-age offspring of parents with BD, we previously built a risk calculator to predict BPSD onset, which generates person-level risk scores. Here, we test whether preschool symptoms predict school-age BPSD risk. METHODS We assessed 113 offspring of parents with BD 1-3 times during preschool years (2-5 years old) and then approximately every 2 years for a mean of 10.6 years. We used penalized (lasso) regression with linear mixed models to assess relationships between preschool mood, anxiety, and behavioral symptoms (parent-reported) and school-age predictors of BPSD onset (i.e., risk score, subthreshold manic symptoms, and mood lability), adjusting for demographics and parental symptomatology. Finally, we conducted survival analyses to assess associations between preschool symptoms and school-age onset of BPSD and mood disorder. RESULTS Of 113 preschool offspring, 33 developed new-onset mood disorder, including 19 with new-onset BPSD. Preschool irritability, sleep problems, and parental factors were lasso-selected predictors of school-age risk scores. After accounting for demographic and parental factors, preschool symptoms were no longer significant. Lasso regressions to predict mood lability and subthreshold manic symptoms yielded similar predictors (irritability, sleep problems, and parental affective lability), but preschool symptoms remained predictive even after adjusting for parental factors (ps < .005). Exploratory analyses indicated that preschool irritability univariately predicted new-onset BPSD (p = .02) and mood disorder (p = .02). CONCLUSIONS These results provide initial prospective evidence that, as early as preschool, youth who will develop elevated risk scores, mood lability, and subthreshold manic symptoms are already showing symptomatology; these preschool symptoms also predict new-onset BPSD. While replication of findings in larger samples is warranted, results point to the need for earlier assessment of risk and development of early interventions.
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Affiliation(s)
- Danella M. Hafeman
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - John Merranko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Heather M. Joseph
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Tina R. Goldstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Benjamin I. Goldstein
- Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Jessica Levenson
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - David Axelson
- Nationwide Children’s Hospital and Ohio State College of Medicine, Columbus, OH
| | - Kelly Monk
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Khoury E, Acquaviva E, Purper-Ouakil D, Delorme R, Ellul P. Meta-analysis of personal and familial co-occurrence of Attention Deficit/Hyperactivity Disorder and Bipolar Disorder. Neurosci Biobehav Rev 2023; 146:105050. [PMID: 36657649 DOI: 10.1016/j.neubiorev.2023.105050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Attention Deficit Disorder / Hyperactivity (ADHD) and Bipolar Disorder (BD) are highly comorbid disorders. Studies have raised the hypothesis of shared genetic, neurobiological, and clinical factors. This would entail an excess risk of co-occurrence of both disorders. OBJECTIVE We present the first meta-analysis of individual and familial associations between ADHD and BD. METHODS From 2688 references, 59 were included, with a total of 550,379 ADHD patients, 57,799 BD patients and 12,608,137 controls. RESULTS Personal history of ADHD increased the risk of BD (OR = 6.06), and conversely individuals with BD had an increased risk of ADHD (OR = 8.94). First-degree relatives of ADHD patients had an increased risk of BD (OR = 1.94). Offspring of individuals with BD had a higher risk for ADHD (OR = 2.33). Finally, first-degree relatives of BD patients had an increased risk of ADHD (OR = 2.71). CONCLUSION We show a clear epidemiological overlap between ADHD and BD, as well as a strong familial association which advocates in favor of a more systematic screening.
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Affiliation(s)
- Elie Khoury
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, APHP, 48 boulevard Sérurier, 75019 Paris, France.
| | - Eric Acquaviva
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, APHP, 48 boulevard Sérurier, 75019 Paris, France.
| | - Diane Purper-Ouakil
- CHU Montpellier-Saint Eloi Hospital, University of Montpellier, Unit of Child and Adolescent Psychiatry (MPEA1), 80 Av. Augustin Fliche, 34090 Montpellier, France; INSERM CESP U 1018 Psychiatry, Development and Trajectories, France.
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, APHP, 48 boulevard Sérurier, 75019 Paris, France; Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France.
| | - Pierre Ellul
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, APHP, 48 boulevard Sérurier, 75019 Paris, France; INSERM Immunology-Immunopathology-Immunotherapy (i3), UMRS 959, Paris, France.
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7
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Davidsen KA, Munk-Laursen T, Foli-Andersen P, Ranning A, Harder S, Nordentoft M, Thorup AAE. Mental and pediatric disorders among children 0-6 years of parents with severe mental illness. Acta Psychiatr Scand 2022; 145:244-254. [PMID: 34351617 DOI: 10.1111/acps.13358] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Parental severe mental illness (SMI) increases the lifetime risk of mental and pediatric disorders in the offspring but little is known about specific disorders during early childhood. The primary aim was to investigate the incidence of mental and pediatric disorders among children 0-6 years old exposed to parental SMI, and secondarily to investigate the distribution of disorders on specific child age. METHODS A nationwide, register-based cohort study of 1,477,185 children born in Denmark between 1994.01.01 and 2016.12.31. Incidence rate ratios were calculated using Poisson regression analysis for any and specific mental and pediatric disorders. RESULTS IRR for any psychiatric disorder was elevated by a factor 2-5 among SMI offspring. Maternal schizophrenia resulted in the highest IRR = 5.23 (4.80-5.69) of any child psychiatric disorder. The risk of anxiety/OCD and attachment disorder among offspring exposed to parental, and in particular maternal, SMI was markedly raised with IRRs for anxiety/OCD between 7.59 and 17.02 and attachment disorders between 6.26 and 15.40. IRRs of mental disorders were highest at age 0-1 year and declined with age. IRR for any pediatric disorder was also elevated with IRRs between 1.01 and 1.28. Disorders of the digestive system and ill-defined symptoms were associated with the highest IRRs. Maternal (vs. paternal) SMI was associated with higher IRRs. IRRs declined slightly with child age. CONCLUSION Children exposed to parental SMI are at increased risk of mental and pediatric disorders during early childhood, particularly anxiety/OCD and attachment disorders. If associations are estimates of a modifiable causal relationship, our results indicate a need for early intervention to promote mental and pediatric health among SMI offspring.
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Affiliation(s)
- Kirstine Agnete Davidsen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Child and Adolescent Mental Health Services, Region of Southern Denmark, Odense, Denmark
| | - Thomas Munk-Laursen
- Department of Economics and Business Economics, National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
| | | | - Anne Ranning
- Mental Health Services Copenhagen, Capital Region of Denmark, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Harder
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Mental Health Services Copenhagen, Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark
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8
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Bastos RA, Campos LS, Faria-Schützer DB, Brito ME, da Silva DR, Dos Santos-Junior A, Turato ER. Offspring of mothers with bipolar disorder: a systematic review considering personality features. BRAZILIAN JOURNAL OF PSYCHIATRY 2022; 44:94-102. [PMID: 35170672 PMCID: PMC8827366 DOI: 10.1590/1516-4446-2020-1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/02/2021] [Indexed: 12/01/2022]
Abstract
Objective: To examine personality/temperament features and mental health vulnerability in offspring of mothers with bipolar disorders (BD), including dimensions which may impact psychological characteristics or therapeutic measures. Methods: A systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, was conducted to search for original articles that investigated personality/temperament features of offspring of women with BD and emotional factors involved in the mother-child relationship. The electronic search was performed in the PubMed, Web of Science, and PsycINFO databases from February 2010 to February 2017. Results: Ten quantitative studies were included in the analysis: seven from the United States, two from Brazil, and one from Canada. The narrative synthesis was categorized into three dimensions: 1) reliability of instruments for prediction of future psychopathology in offspring; 2) environmental risk factors for offspring; and 3) early interventions. The findings showed impairments in the offspring’s lives, high rates of behavior and temperament problems, and psychiatric disorders. Conclusion: BD is a frequent psychiatric disorder, and the offspring of mothers with this condition are exposed to complex family relationships and psychosocial difficulties. If they are to ensure a good provision of mental health and psychosocial care to this unique population, early interventions must not neglect their contextual specificities. Systematic review registration: PROSPERO CRD-42017039010
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Affiliation(s)
- Rodrigo A Bastos
- Departamento de Tocoginecologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Lia S Campos
- Departamento de Psicologia Médica e Psiquiatria, UNICAMP, Campinas, SP, Brazil
| | - Débora B Faria-Schützer
- Departamento de Tocoginecologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Maíra E Brito
- Departamento de Psicologia Médica e Psiquiatria, UNICAMP, Campinas, SP, Brazil
| | - Diego R da Silva
- Departamento de Psicologia Médica e Psiquiatria, UNICAMP, Campinas, SP, Brazil
| | | | - Egberto R Turato
- Departamento de Psicologia Médica e Psiquiatria, UNICAMP, Campinas, SP, Brazil
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Asmussen J, Skovgaard AM, Bilenberg N. Trajectories of dysregulation in preschool age. Eur Child Adolesc Psychiatry 2022; 31:313-324. [PMID: 33386524 DOI: 10.1007/s00787-020-01689-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023]
Abstract
Dysregulation of emotions, behaviour and attention is involved in several areas of childhood psychopathology, but knowledge about early developmental trajectories remains scarce. This study aims to explore continuity and associations of dysregulation in preschool age. Dysregulation was measured at age 2½ years and again at 5 years in a community-based birth cohort of 1099 children using the Child Behavior Checklist, preschool version (CBCL1½-5), answered by mothers. Based on the Dysregulation Profile (CBCL-DP) score, we defined four trajectory groups, using the 75th percentile from the Danish norm material as a cut-off. Associations between the four CBCL-DP trajectory groups and potential covariates, including child, parental and family factors, were analysed using univariate and multiple multinomial logistic regression. Nearly half (54%) of the children showed persistent low scores of CBCL-DP, 17% displayed continuing dysregulation problems, 13% had problems that increased from 2½ years to 5 years, whereas 16% of the children showed reduced problems across preschool age. Persistent dysregulation was associated with maternal postpartum depressive symptoms RRR = 2.20 (95% CI 1.29-3.75), low maternal educational level RRR = 1.69 (95% CI 1.08-2.66), and mothers' smoking during pregnancy RRR = 2.87 (95% CI 1.09-7.55). Persistent problems of emotional, behavioural and attention regulation in children aged 2½ years to 5 years is influenced by maternal educational level and post-partum depression symptoms. The study draws clinical attention to early symptoms of dysregulation and to the importance of addressing the specific needs of mentally vulnerable parents in intervention planning.
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Affiliation(s)
- Jette Asmussen
- Research Unit of Child and Adolescent Mental Health, Department of Clinical Research, University of Southern Denmark, J.B Winsløws Vej 16, indgang 228, 5000, Odense C, Denmark.
| | - Anne Mette Skovgaard
- Faculty of Health Sciences, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Niels Bilenberg
- Research Unit of Child and Adolescent Psychiatry Odense, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Birmaher B, Merranko J, Hafeman D, Goldstein BI, Diler R, Levenson JC, Monk K, Iyengar S, Hickey MB, Sakolsky D, Axelson D, Goldstein T. A Longitudinal Study of Psychiatric Disorders in Offspring of Parents With Bipolar Disorder From Preschool to Adolescence. J Am Acad Child Adolesc Psychiatry 2021; 60:1419-1429. [PMID: 33785405 PMCID: PMC8473582 DOI: 10.1016/j.jaac.2021.02.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/25/2021] [Accepted: 02/19/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To compare the prevalence of psychopathology, particularly bipolar disorder (BD), between preschool offspring of parents with BD and community controls. METHOD A total of 116 offspring of BD-I/II parents and 98 controls (53 parents with non-BD psychopathology and 45 healthy parents) were recruited at ages 2 to 5 years and followed on average 9.6 years (on average: 2-5: 1.6 times; after age 5: 4 times) (average ages at intake/last follow-up: 3.8/13.4, retention: 98%). Participants were evaluated with standardized instruments blinded to parental diagnoses. RESULTS After adjusting for confounders, offspring of BD parents only showed more attention-deficit/hyperactivity disorder (ADHD) during ages 2 to 5 years than the other 2 groups. After age 5, offspring of BD parents did not differ from offspring of parents with non-BD psychopathology, but they had more anxiety, ADHD, and behavior problems than offspring of healthy parents. Only offspring of BD parents developed BD-I/II: 3.4% (n = 4) and BD-not-otherwise-specified (BD-NOS): 11.2% (n = 13), with mean onset ages 11.4 and 7.4, respectively. About 70% of offspring with BD had non-BD disorders before BD. Only ADHD, diagnosed before age 6 years, and early-onset parental BD were significantly associated with BD risk. CONCLUSION Most offspring of BD parents did not develop BD, but they were at specific high risk for developing BD, particularly those with preschool ADHD and early-onset parental BD. BD symptoms were scarce during the preschool years and increased throughout the school age, mainly in the form of BD-NOS, a disorder that conveys poor prognosis and high risk to develop BD-I/II. Developing early interventions to delay or, ideally, to prevent its onset are warranted.
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Affiliation(s)
- Boris Birmaher
- Drs. Birmaher, Hafeman, Diler, Levenson, Sakolsky, Goldstein, Mr. Merranko, and Mss. Monk and Hickey are with Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania.
| | - John Merranko
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | - Danella Hafeman
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | - Benjamin I. Goldstein
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | - Rasim Diler
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | - Jessica C. Levenson
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | - Kelly Monk
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | | | - Mary Beth Hickey
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | - Dara Sakolsky
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | - David Axelson
- Nationwide Children’s Hospital and The Ohio State College of Medicine, Columbus
| | - Tina Goldstein
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania.; Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario, Canada
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11
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Topal Z, Demir N, Tufan E, Tuman TC, Semerci B. Emotional and cognitive conflict resolution and disruptive mood dysregulation disorder in adolescent offspring of parents diagnosed with major depressive disorder, bipolar disorder, and matched healthy controls. Nord J Psychiatry 2021; 75:427-436. [PMID: 33591219 DOI: 10.1080/08039488.2021.1880635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS Children of parents with mood disorders have an elevated risk for various psychopathologies. In this study rate of psychopathologies among adolescent offspring of parents with major depressive (MDDoff) and bipolar disorder (BDoff), including disruptive mood dysregulation disorder (DMDD) along with the offspring ability to resolve cognitive and emotional conflicts were evaluated. METHOD 12-16 years old children of parents with MDD (n = 31, children= 36), BP (n = 20, children = 26) and controls (n = 25, children = 28) were enrolled. Children and parents were evaluated by using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID); respectively. The parents completed the Child Behavior Checklist (CBCL)-dysregulation profile. The Stroop test-TBAG form and emotional Stroop test were given out to evaluate conflict resolution ability. RESULTS The most common diagnoses among the whole sample were attention deficit and hyperactivity, separation anxiety and oppositional defiant disorders. Five cases (5.5%) of lifetime DMDD were found (three from MDDoff, the rest from BDoff). Completion times for the Stroop test-TBAG form were ranked as: BDoff > MDDoff > Hoff. In the emotional Stroop test, the BDoff responded significantly later and had significantly reduced correct responses. CONCLUSION Rates of lifetime DMDD were similar in the MDDoff and BDoff groups. BDoff may experience greater difficulties in resolving cognitive and emotional conflicts.
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Affiliation(s)
- Zehra Topal
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Osmangazi, Turkey
| | - Nuran Demir
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Yıldırım Bayezit University, Ankara, Turkey
| | - Evren Tufan
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Taha Can Tuman
- Department of Psychiatry, Health Practice and Researching Center, Istanbul Medipol University, İstanbul, Turkey
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Simonetti A, Kurian S, Saxena J, Verrico CD, Soares JC, Sani G, Saxena K. Cognitive correlates of impulsive aggression in youth with pediatric bipolar disorder and bipolar offspring. J Affect Disord 2021; 287:387-396. [PMID: 33838473 DOI: 10.1016/j.jad.2021.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Youth with bipolar disorder (BD) and offspring of individuals with BD (BD-OFF) are characterized by higher levels of impulsive and overt aggression. The cognitive basis underlying these aggressive behaviors are not clarified in this population. The aim of this study was to investigate the relationship between cognitive alterations and aggressive behavior in youth with BD and BD-OFF. METHODS Forty-two youth with BD, 17 BD-OFF and 57 healthy controls (HCs) were administered the Modified Overt Aggression Scale (MOAS), the Cambridge Neuropsychological Test Automated Battery (CANTAB), the Young Mania Rating Scale (YMRS) and the Children's Depression Rating Scale (CDRS). Multiple linear regression analyses were performed in the three groups separately. In each group, tests scores from the CANTAB were predictors. MOAS subscale scores and MOAS total scores were dependent variables. Results are corrected for age, IQ and mood state. RESULTS Both youth with BD and BD-OFF showed positive correlations between impairment in executive functions and levels of verbal aggression. In youth with BD, altered processing of either positive and negative stimuli positively correlated with MOAS total scores, whereas in BD-OFF, such relationship was negative. CONCLUSIONS Impulsive aggressive behaviors in youth with BD arise from a combination of altered affective processing and executive dysfunction. The negative relationship between affective processing and aggression in BD-OFF suggested the presence of possible mechanisms of resilience in this population.
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Affiliation(s)
- Alessio Simonetti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Neuroscience, Section of Psychiatry; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Italy; Centro Lucio Bini, Rome, Italy.
| | - Sherin Kurian
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Psychiatry, Texas Children's Hospital, Houston, TX, USA.
| | - Johanna Saxena
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Psychiatry, Texas Children's Hospital, Houston, TX, USA.
| | - Christopher D Verrico
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Italy; Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Kirti Saxena
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Psychiatry, Texas Children's Hospital, Houston, TX, USA.
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13
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Tsou YT, Li B, Wiefferink CH, Frijns JHM, Rieffe C. The Developmental Trajectory of Empathy and Its Association with Early Symptoms of Psychopathology in Children with and without Hearing Loss. Res Child Adolesc Psychopathol 2021; 49:1151-1164. [PMID: 33826005 PMCID: PMC8322017 DOI: 10.1007/s10802-021-00816-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 12/21/2022]
Abstract
Empathy enables people to share, understand, and show concern for others’ emotions. However, this capacity may be more difficult to acquire for children with hearing loss, due to limited social access, and the effect of hearing on empathic maturation has been unexplored. This four-wave longitudinal study investigated the development of empathy in children with and without hearing loss, and how this development is associated with early symptoms of psychopathology. Seventy-one children with hearing loss and cochlear implants (CI), and 272 typically-hearing (TH) children, participated (aged 1–5 years at Time 1). Parents rated their children’s empathic skills (affective empathy, attention to others’ emotions, prosocial actions, and emotion acknowledgment) and psychopathological symptoms (internalizing and externalizing behaviors). Children with CI and TH children were rated similarly on most of the empathic skills. Yet, fewer prosocial actions were reported in children with CI than in TH children. In both groups, affective empathy decreased with age, while prosocial actions and emotion acknowledgment increased with age and stabilized when children entered primary schools. Attention to emotions increased with age in children with CI, yet remained stable in TH children. Moreover, higher levels of affective empathy, lower levels of emotion acknowledgment, and a larger increase in attention to emotions over time were associated with more psychopathological symptoms in both groups. These findings highlight the importance of social access from which children with CI can learn to process others’ emotions more adaptively. Notably, interventions for psychopathology that tackle empathic responses may be beneficial for both groups, alike.
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Affiliation(s)
- Yung-Ting Tsou
- Unit of Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.
| | - Boya Li
- Unit of Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Carin H Wiefferink
- Dutch Foundation for the Deaf and Hard of Hearing Child, Amsterdam, The Netherlands
| | - Johan H M Frijns
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Carolien Rieffe
- Unit of Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Human Media Interaction, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands.,Department of Psychology and Human Development, Institute of Education, University College London, London, UK
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14
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Ayano G, Betts K, Maravilla JC, Alati R. A Systematic Review and Meta-Analysis of the Risk of Disruptive Behavioral Disorders in the Offspring of Parents with Severe Psychiatric Disorders. Child Psychiatry Hum Dev 2021; 52:77-95. [PMID: 32291561 DOI: 10.1007/s10578-020-00989-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Inconsistent results of the association between severe psychiatric disorders (SPD) in parents and the risk of disruptive behavioral disorders (DBD) including conduct disorders (CD) and oppositional defiant disorders (ODD) in the offspring have been found by previous epidemiologic studies. PubMed, EMBASE, PsycINFO, and Scopus were searched for relevant studies. Fourteen studies met the predefined criteria for inclusion. A meta-analysis of the included studies revealed an elevated risk of DBD in the offspring of parents with SPD, bipolar, and depressive disorders. Our further analysis considering the specific DBD as an outcome showed that parents with SPD are at an increased risk of having a child with ODD as well as CD. Moreover, the current meta-analysis found that the children of parents with bipolar disorder were also at increased risk of ODD and CD. Parental schizophrenia and depressive disorders were not associated with higher risks of ODD and CD in the offspring.
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Affiliation(s)
- Getinet Ayano
- School of Public Health, Curtin University, Perth, WA, Australia.
| | - Kim Betts
- School of Public Health, Curtin University, Perth, WA, Australia
| | | | - Rosa Alati
- School of Public Health, Curtin University, Perth, WA, Australia.,School of Social Sciences, The University of Queensland, Brisbane, QLD, Australia
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15
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Zwicker A, Drobinin V, MacKenzie LE, Howes Vallis E, Patterson VC, Cumby J, Propper L, Abidi S, Bagnell A, Pavlova B, Alda M, Uher R. Affective lability in offspring of parents with major depressive disorder, bipolar disorder and schizophrenia. Eur Child Adolesc Psychiatry 2020; 29:445-451. [PMID: 31172297 DOI: 10.1007/s00787-019-01355-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 05/16/2019] [Indexed: 12/19/2022]
Abstract
Affective lability, defined as the propensity to experience excessive and unpredictable changes in mood, has been proposed as a potential transdiagnostic predictor of major mood and psychotic disorders. A parental diagnosis of bipolar disorder has been associated with increased affective lability in offspring. However, the association between affective lability and family history of other mood and psychotic disorders has not been examined. We measured affective lability using the self- and parent-reported Children's Affective Lability Scale in a cohort of 320 youth aged 6-17 years, including 137 offspring of a parent with major depressive disorder, 68 offspring of a parent with bipolar disorder, 24 offspring of a parent with schizophrenia, and 91 offspring of control parents. We tested differences in affective lability between groups using mixed-effects linear regression. Offspring of a parent with major depressive disorder (β = 0.46, 95% CI 0.17-0.76, p = 0.002) or bipolar disorder (β = 0.47, 95% CI 0.12-0.81, p = 0.008) had significantly higher affective lability scores than control offspring. Affective lability did not differ significantly between offspring of a parent with schizophrenia and offspring of control parents. Our results suggest that elevated affective lability during childhood is a marker of familial risk for mood disorders.
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Affiliation(s)
- Alyson Zwicker
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Vladislav Drobinin
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Lynn E MacKenzie
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Emily Howes Vallis
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Victoria C Patterson
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Jill Cumby
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lukas Propper
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - Sabina Abidi
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - Alexa Bagnell
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - Barbara Pavlova
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Martin Alda
- Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Rudolf Uher
- Nova Scotia Health Authority, Halifax, NS, Canada.
- Department of Pathology, Dalhousie University, Halifax, NS, Canada.
- Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada.
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
- IWK Health Centre, Halifax, NS, Canada.
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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16
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Vulnerability to bipolar disorder is linked to sleep and sleepiness. Transl Psychiatry 2019; 9:294. [PMID: 31712668 PMCID: PMC6848097 DOI: 10.1038/s41398-019-0632-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 10/01/2019] [Accepted: 10/20/2019] [Indexed: 12/16/2022] Open
Abstract
Sleep impairments are a hallmark of acute bipolar disorder (BD) episodes and are present even in the euthymic state. Studying healthy subjects who are vulnerable to BD can improve our understanding of whether sleep impairment is a predisposing factor. Therefore, we investigated whether vulnerability to BD, dimensionally assessed by the hypomanic personality scale (HPS), is associated with sleep disturbances in healthy subjects. We analyzed participants from a population-based cohort who had completed the HPS and had either a 7-day actigraphy recording or a Pittsburgh sleep quality index (PSQI) assessment. In addition, subjects had to be free of confounding diseases or medications. This resulted in 771 subjects for actigraphy and 1766 for PSQI analyses. We found strong evidence that higher HPS scores are associated with greater intraindividual sleep variability, more disturbed sleep and more daytime sleepiness. In addition, factor analyses revealed that core hypomanic features were especially associated with self-reported sleep impairments. Results support the assumption of disturbed sleep as a possibly predisposing factor for BD and suggest sleep improvement as a potential early prevention target.
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17
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Sebela A, Kolenic M, Farkova E, Novak T, Goetz M. Decreased need for sleep as an endophenotype of bipolar disorder: an actigraphy study. Chronobiol Int 2019; 36:1227-1239. [PMID: 31257931 DOI: 10.1080/07420528.2019.1630631] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Reports of subjective sleep impairments have been replicated in adults with bipolar disorder (BD), young BD patients, and even children of parents with BD. Furthermore, circadian rhythm alterations are a core feature of BD. Despite the impairment in circadian rhythms and altered sleep included in various heuristic developmental models of BD, thus far, biomarkers have not been sufficiently objectively validated. Thus, here, we assessed the rest-activity circadian rhythmicity and sleep macrostructure using actigraphy in a sample of unaffected child and adolescent offspring of bipolar parents (BO; n = 43; 21 females; 11.0 ± 3.2 years) and controls (n = 42; 17 females; 11.1 ± 3.4 years) comparable in sex (p = .4) and age (p = .7). All participants wore a MotionWatch 8 (Camntech, Cambridge, UK) actigraph on their nondominant wrist for ≥ 14 days and completed sleep diaries. Psychopathology was assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia and by subjective scales. The main areas of interest were rest-activity circadian rhythmicity, chronotype and sleep macrostructure. Subgroup analyses (child and adolescent subgroups) were conducted to identify physiological differences in sleep between these age groups. The BO and controls did not differ in the presence of current mood (p = .5) and anxiety (p = .6) disorders. The BO had shorter sleep time on free days (p = .007; effect size, Cohen´s d = 0.56), lower sleep efficiency on free days (p = .01; d = 0.47), lower prolongation of time in bed on free days (p = .046; d = 0.41), and lower social jet lag (p = .04; d = 0.5) than the controls. A longer sleep time on school days (p < .001; d = 0.21), lower prolongation of sleep time between school and free days (p = .008; d = 0.74), and larger difference in sleep onset latency between school days and free days (p = .009; d = 0.52) were observed in the adolescent BO than in the controls. The child BO had poorer sleep quality on free days than the controls (p = .02; d = 0.96). In all cases, the results remained significant after controlling for subthreshold mood and anxiety symptoms. The BO had less variable rest-activity rhythm than controls (p = .04; d = 0.32). No other significant differences between the BO and controls were observed in the rest-activity circadian rhythmicity and chronotype. The results showed decreased physiological catch-up sleep on free days in the BO, which may indicate a decreased need for sleep in this population. Thus, the decreased need for sleep observed in the unaffected BO may represent an endophenotype of BD.
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Affiliation(s)
- Antonin Sebela
- a Diagnostics and Treatment of Mental Disorders, National Institute of Mental Health , Klecany , Czech Republic.,b First Faculty of Medicine, Charles University in Prague , Prague 2 , Czech Republic
| | - Marian Kolenic
- a Diagnostics and Treatment of Mental Disorders, National Institute of Mental Health , Klecany , Czech Republic.,c Third Faculty of Medicine, Charles University Prague , Prague 10 , Czech Republic
| | - Eva Farkova
- a Diagnostics and Treatment of Mental Disorders, National Institute of Mental Health , Klecany , Czech Republic.,c Third Faculty of Medicine, Charles University Prague , Prague 10 , Czech Republic
| | - Tomas Novak
- a Diagnostics and Treatment of Mental Disorders, National Institute of Mental Health , Klecany , Czech Republic.,c Third Faculty of Medicine, Charles University Prague , Prague 10 , Czech Republic
| | - Michal Goetz
- d Second Faculty of Medicine, Charles University Prague , Praha 5 , Czech Republic.,e Department of Child Psychiatry, Motol University Hospital , Praha 5 , Czech Republic
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18
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Goodday SM, Preisig M, Gholamrezaee M, Grof P, Duffy A. Temperament and self-esteem in high-risk offspring of bipolar parents: Vulnerability and scar effects. J Affect Disord 2019; 243:209-215. [PMID: 30245253 DOI: 10.1016/j.jad.2018.09.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/16/2018] [Accepted: 09/15/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND The nature of the temporal relationship between psychological factors and mood episodes is unclear. The objectives of this study were to determine if temperament and self-esteem predict the onset of mood episodes, and if prior mood episodes influence the stability of these factors over time in high-risk offspring of bipolar parents. METHODS Offspring of a parent with bipolar disorder participating in the Flourish Prospective Offspring Study were clinically assessed repeatedly using semi-structured KSADS-PL/SADS-L format interviews, and completed repeated measures of self-esteem, and temperament. Shared frailty survival models and mixed effects regression models were used to determine if psychological factors predicted incident mood episodes, and whether these factors change over time after the incident mood episode, respectively. RESULTS Emotionality, shyness and self-esteem were not associated with the hazard of incident major depression; however, increased activity reduced the hazard of this outcome (hazard ratio [HR]: 0.51; 95% CI: 0.27, 0.98). Emotionality and shyness scores increased, while sociability, activity and self-esteem scores decreased after the incident major depressive episode (emotionality: mean change [MC]: 0.35, p = 0.0289; shyness: MC: 0.40, p = 0.0196; sociability: MC: -0.49, p = 0.0001, activity: MC: -0.32, p = 0.0001; self-esteem: MC: -0.79, p = 0.001). LIMITATIONS Psychological measures were based on self-report and some models had low numbers limiting the numbers of covariates included as potential confounders. DISCUSSION Among the assessed temperamental dimensions, activity showed a protective effect for major depressive episode onset suggesting this temperamental characteristic could serve as a protective target in high risk youth. Conversely, all assessed psychological factors shifted towards increased vulnerability after the first depressive episode.
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Affiliation(s)
| | - Martin Preisig
- Psychiatric University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Paul Grof
- University of Toronto, Department of Psychiatry, Ontario, Canada; Mood Disorders Centre of Ottawa, Ontario, Canada
| | - Anne Duffy
- Mood Disorders Centre of Ottawa, Ontario, Canada; Queen's University, Department of Psychiatry, Ontario, Canada
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19
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Meier SM, Pavlova B, Dalsgaard S, Nordentoft M, Mors O, Mortensen PB, Uher R. Attention-deficit hyperactivity disorder and anxiety disorders as precursors of bipolar disorder onset in adulthood. Br J Psychiatry 2018; 213:555-560. [PMID: 29925436 DOI: 10.1192/bjp.2018.111] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) and anxiety disorders have been proposed as precursors of bipolar disorder, but their joint and relative roles in the development of bipolar disorder are unknown.AimsTo test the prospective relationship of ADHD and anxiety with onset of bipolar disorder. METHOD We examined the relationship between ADHD, anxiety disorders and bipolar disorder in a birth cohort of 2 409 236 individuals born in Denmark between 1955 and 1991. Individuals were followed from their sixteenth birthday or from January 1995 to their first clinical contact for bipolar disorder or until December 2012. We calculated incidence rates per 10 000 person-years and tested the effects of prior diagnoses on the risk of bipolar disorder in survival models. RESULTS Over 37 394 865 person-years follow-up, 9250 onsets of bipolar disorder occurred. The incidence rate of bipolar disorder was 2.17 (95% CI 2.12-2.19) in individuals with no prior diagnosis of ADHD or anxiety, 23.86 (95% CI 19.98-27.75) in individuals with a prior diagnosis of ADHD only, 26.05 (95% CI 24.47-27.62) in individuals with a prior diagnosis of anxiety only and 66.16 (95% CI 44.83-87.47) in those with prior diagnoses of both ADHD and anxiety. The combination of ADHD and anxiety increased the risk of bipolar disorder 30-fold (95% CI 21.66-41.40) compared with those with no prior ADHD or anxiety. CONCLUSIONS Early manifestations of both internalising and externalising psychopathology indicate liability to bipolar disorder. The combination of ADHD and anxiety is associated with a very high risk of bipolar disorder.Declaration of interestNone.
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Affiliation(s)
- Sandra M Meier
- Postdoctoral Fellow, Child and Adolescent Mental Health Centre-Mental Health Services Capital Region,Copenhagen Region,Psychosis Research Unit,Aarhus University HospitalandThe Lundbeck Foundation Initiative for Integrative Psychiatric Research,iPSYCH,Denmark
| | - Barbara Pavlova
- Assistant Professor,Department of Psychiatry,Dalhousie University and Nova Scotia Health Authority,Canada
| | - Søren Dalsgaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research,iPSYCH,National Centre for Register-Based Research, NCRR,Aarhus University,DenmarkandDepartment for Child and Adolescent Psychiatry,Hospital of Telemark,Norway
| | - Merete Nordentoft
- Professor, The Lundbeck Foundation Initiative for Integrative Psychiatric Research,iPSYCH, and Copenhagen University Hospital, Mental Health Center Copenhagen,Denmark
| | - Ole Mors
- Professor, Psychosis Research Unit,Aarhus University Hospital andThe Lundbeck Foundation Initiative for Integrative Psychiatric Research,iPSYCH,Denmark
| | - Preben B Mortensen
- Professor, The Lundbeck Foundation Initiative for Integrative Psychiatric Research,iPSYCH,National Centre for Register-Based Research, NCRR,Aarhus UniversityandCIRRAU - Centre for Integrated Register-based Research,Aarhus University
| | - Rudolf Uher
- Professor, Department of Psychiatry,Dalhousie University and Senior Researcher, Nova Scotia Health Authority,Canada
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20
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Prevalence of psychopathology in bipolar high-risk offspring and siblings: a meta-analysis. Eur Child Adolesc Psychiatry 2018; 27:823-837. [PMID: 28936622 DOI: 10.1007/s00787-017-1050-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 09/13/2017] [Indexed: 02/08/2023]
Abstract
This meta-analysis aimed to update existing data on the comparison of prevalence rates of psychopathology primarily among offspring with at least one parent with bipolar disorder (BD) and offspring of parents without psychiatric illness. Seventeen studies were derived from a systematic search of PsychInfo, Medline, Scopus and Embase. Inclusion criteria were use of a control offspring group, standardized diagnostic procedures and reporting of clear frequency data. Risk of psychopathology was estimated by aggregating frequency data from selected studies. Compared to control offspring, high-risk BD offspring are nine times more likely to have a bipolar-type disorder, almost two and a half times more likely to develop a non-BD affective disorder and over two times more likely to develop at least one anxiety disorder. High-risk offspring also showed a significant increased risk of other non-mood psychopathology such as attention deficit hyperactivity disorder (ADHD), any type of behavioral disorder and substance use disorder (SUDs). Risk of developing a broad range of affective and non-affective psychopathology is significantly higher in high-risk BD offspring. Identifying clinical presentations of this genetically high-risk cohort is important in establishing appropriate preventative treatment.
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21
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Ellersgaard D, Jessica Plessen K, Richardt Jepsen J, Soeborg Spang K, Hemager N, Klee Burton B, Jerlang Christiani C, Gregersen M, Søndergaard A, Uddin MJ, Poulsen G, Greve A, Gantriis D, Mors O, Nordentoft M, Elgaard Thorup AA. Psychopathology in 7-year-old children with familial high risk of developing schizophrenia spectrum psychosis or bipolar disorder - The Danish High Risk and Resilience Study - VIA 7, a population-based cohort study. World Psychiatry 2018; 17:210-219. [PMID: 29856544 PMCID: PMC5980633 DOI: 10.1002/wps.20527] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This study aimed to compare the psychopathological profiles of children at familial high risk of schizophrenia spectrum psychosis (FHR-SZ) or bipolar disorder (FHR-BP) with population-based controls. We used Danish nationwide registers to retrieve a cohort of 522 seven-year-old children of parents with schizophrenia spectrum psychosis (N=202), bipolar disorder (N=120) or none of these disorders (N=200). Psychopathology was assessed by reports from multiple informants, including children, parents and teachers. Lifetime DSM-IV diagnoses were ascertained by blinded raters through the Schedule for Affective Disorders and Schizophrenia for School-Age Children. The dimensional assessment of psychopathology was performed by the Child Behavior Checklist, the Teacher's Report Form, a modified version of the ADHD-Rating Scale, the Test Observation Form, and the State-Trait Anxiety Inventory for Children. Current level of functioning was evaluated using the Children's Global Assessment Scale (CGAS). The prevalence of lifetime psychiatric diagnoses was significantly higher in both FHR-SZ children (38.7%, odds ratio, OR=3.5, 95% confidence interval, CI: 2.2-5.7, p < 0.001) and FHR-BP children (35.6%, OR=3.1, 95% CI: 1.8-5.3, p < 0.001) compared with controls (15.2%). FHR-SZ children displayed significantly more dimensional psychopathology on all scales and subscales compared with controls except for the Anxious subscale of the Test Observation Form. FHR-BP children showed higher levels of dimensional psychopathology on several scales and subscales compared with controls, but lower levels compared with FHR-SZ children. Level of functioning was lower in both FHR-SZ children (CGAS mean score = 68.2; 95% CI: 66.3-70.2, p < 0.0001) and FHR-BP children (73.7; 95% CI: 71.2-76.3, p < 0.05) compared with controls (77.9; 95% CI: 75.9-79.9). In conclusion, already at the age of seven, FHR-SZ and FHR-BP children show a higher prevalence of a broad spectrum of categorical and dimensional psychopathology compared with controls. These results emphasize the need for developing early intervention strategies towards this vulnerable group of children.
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Affiliation(s)
- Ditte Ellersgaard
- Mental Health Services ‐ Capital Region of DenmarkMental Health Centre CopenhagenCopenhagenDenmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark,Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Kerstin Jessica Plessen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark,Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Mental Health Services ‐ Capital Region of DenmarkChild and Adolescent Mental Health CentreCopenhagenDenmark
| | - Jens Richardt Jepsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark,Mental Health Services ‐ Capital Region of DenmarkChild and Adolescent Mental Health CentreCopenhagenDenmark,Mental Health Services ‐ Capital Region of DenmarkCenter for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia ResearchCopenhagenDenmark
| | - Katrine Soeborg Spang
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark,Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Mental Health Services ‐ Capital Region of DenmarkChild and Adolescent Mental Health CentreCopenhagenDenmark
| | - Nicoline Hemager
- Mental Health Services ‐ Capital Region of DenmarkMental Health Centre CopenhagenCopenhagenDenmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark,Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Mental Health Services ‐ Capital Region of DenmarkChild and Adolescent Mental Health CentreCopenhagenDenmark
| | - Birgitte Klee Burton
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark,Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Mental Health Services ‐ Capital Region of DenmarkChild and Adolescent Mental Health CentreCopenhagenDenmark
| | - Camilla Jerlang Christiani
- Mental Health Services ‐ Capital Region of DenmarkMental Health Centre CopenhagenCopenhagenDenmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark,Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Maja Gregersen
- Mental Health Services ‐ Capital Region of DenmarkMental Health Centre CopenhagenCopenhagenDenmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark
| | - Anne Søndergaard
- Mental Health Services ‐ Capital Region of DenmarkMental Health Centre CopenhagenCopenhagenDenmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark
| | - Md Jamal Uddin
- Mental Health Services ‐ Capital Region of DenmarkMental Health Centre CopenhagenCopenhagenDenmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark,Department of Public Health ‐ Section of BiostatisticsUniversity of CopenhagenCopenhagenDenmark
| | - Gry Poulsen
- Mental Health Services ‐ Capital Region of DenmarkMental Health Centre CopenhagenCopenhagenDenmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark,Department of Public Health ‐ Section of BiostatisticsUniversity of CopenhagenCopenhagenDenmark
| | - Aja Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark,Psychosis Research Unit, Aarhus University HospitalAarhusDenmark
| | - Ditte Gantriis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark,Psychosis Research Unit, Aarhus University HospitalAarhusDenmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark,Psychosis Research Unit, Aarhus University HospitalAarhusDenmark
| | - Merete Nordentoft
- Mental Health Services ‐ Capital Region of DenmarkMental Health Centre CopenhagenCopenhagenDenmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark,Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)AarhusDenmark,Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Mental Health Services ‐ Capital Region of DenmarkChild and Adolescent Mental Health CentreCopenhagenDenmark
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Goodday S, Levy A, Flowerdew G, Horrocks J, Grof P, Ellenbogen M, Duffy A. Early exposure to parental bipolar disorder and risk of mood disorder: the Flourish Canadian prospective offspring cohort study. Early Interv Psychiatry 2018; 12:160-168. [PMID: 26486425 DOI: 10.1111/eip.12291] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/21/2015] [Indexed: 11/28/2022]
Abstract
AIM Exposure to postnatal parental depression is associated with offspring mood disorder later in life; however, little is known about exposure to parental bipolar disorder (BD) and subsequent risk of psychopathology. The aim of this study was to determine the association between the duration, severity and timing of exposure to parental BD in early childhood and subsequent risk of mood disorder. METHODS 189 offspring of a parent with BD completed annual assessments following Kiddie Schedule for Affective Disorders (KSADS) format semistructured interviews as part of an ongoing 16-year prospective cohort study. Clinical data from the affected parents were collected over the first decade of their offspring's life using SADS-L format semistructured interviews and coded using the Affective Morbidity Index (AMI). RESULTS A longer duration of exposure to parental BD was associated with a 1.5-fold risk of any psychopathology (95% confidence interval (CI): 1.0-2.3) and a 2.5-fold increased risk of substance use disorders (95% CI: 1.2-5.3). Exposure during the first 2 years of life was significantly associated with the risk of mood disorder (hazard ratio (HR): 1.1, 95% CI: 1.0-1.2), whereas exposure later in childhood was not. CONCLUSIONS The duration of exposure to active parental BD in childhood is an important risk factor for the subsequent development of mood and non-mood psychopathology risk in offspring. These findings emphasize the importance of effective treatment of parents with BD to help both themselves and their children, especially early in development.
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Affiliation(s)
- Sarah Goodday
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Adrian Levy
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Gordon Flowerdew
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Julie Horrocks
- Department of Mathematics & Statistics, University of Guelph, Guelph, Canada
| | - Paul Grof
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Mood Disorders Centre of Ottawa, University of Ottawa Health Services, Ottawa, Ontario, Canada
| | - Mark Ellenbogen
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Anne Duffy
- Mood Disorders Centre of Ottawa, University of Ottawa Health Services, Ottawa, Ontario, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
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23
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Kunze B, Wang B, Isensee C, Schlack R, Ravens-Sieberer U, Klasen F, Rothenberger A, Becker A. Gender associated developmental trajectories of SDQ-dysregulation profile and its predictors in children. Psychol Med 2018; 48:404-415. [PMID: 28637519 DOI: 10.1017/s0033291717001714] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Severe mood dysregulation is common in childhood and can be highly impairing. The Dysregulation Profile (DP) can be considered as a broader phenotype of emotional dysregulation, including affect, cognition and behaviour. Since mood dysregulation may persist, but differently in boys and girls, the gender associated course needs to be considered longitudinally to gain a better insight in order to support the children more adequately. This study is focusing on gender associated subgroup trajectories of the Strengths and Difficulties Questionnaire-Dysregulation Profile (SDQ-DP) in middle childhood (9-13 years of age) and includes the potential impact of clinical and psychosocial characteristics. METHOD The data set was available from the BELLA study on mental health and well-being in children and adolescents, which is the mental health module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). A representative epidemiological sample of 564 children living in Germany was examined at three assessment points over 2 years (data collection 2003-2006). The SDQ-DP of children aged 9-13 years was evaluated using Latent Class Growth Analysis (LCGA). RESULTS For both genders three trajectories with low (girls 67.0% and boys 59.5%), moderate (girls 28.0% and boys 31.7%) and high SDQ-DP (girls 5.0% and boys 8.8%) scores were detected. The courses of low and moderate subgroups were stable, while in the high SDQ-DP subgroup boys showed a decreasing and girls an increasing trend in symptom severity on a descriptive level. The results of the multinomial logistic regression analyses revealed a significant influence of mainly externalising but also internalising problems both increasing the risk of moderate and high SDQ-DP in both genders. Good quality of life was a protective factor for the SDQ-DP course in all subgroups. CONCLUSION In addition to the known clinical and scientific value of the SDQ-DP, three distinguishable trajectories of SDQ-DP in boys and girls could be found. High externalising problems at the beginning of the trajectory were associated with an undesirable course of SDQ-DP. These findings might be helpful for better psychoeducation, counselling and monitoring in clinical cases and public health.
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Affiliation(s)
- B Kunze
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
| | - B Wang
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
| | - C Isensee
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
| | - R Schlack
- Robert Koch Institute,Department of Epidemiology and Health Monitoring,Berlin,Germany
| | - U Ravens-Sieberer
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Hamburg- Eppendorf,Germany
| | - F Klasen
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Hamburg- Eppendorf,Germany
| | - A Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
| | - A Becker
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
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24
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Abstract
SummaryWe offer a contemporary review of studies of the offspring of parents with bipolar disorder and explore the clinical characteristics of these populations. We discuss how different methodological approaches may influence study findings and may explain some of the heterogeneity in the results reported. We also highlight some of the environmental risk factors that may increase the likelihood of transition from an ‘at-risk’ or high-risk state to bipolar disorder. Last, we briefly discuss the implications of study findings for early intervention strategies and comment on such issues as genetic counselling and primary and early secondary prevention programmes.
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25
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A developmental approach to dimensional expression of psychopathology in child and adolescent offspring of parents with bipolar disorder. Eur Child Adolesc Psychiatry 2017; 26:1165-1175. [PMID: 28283835 DOI: 10.1007/s00787-017-0965-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 02/21/2017] [Indexed: 12/16/2022]
Abstract
The aim of this is to describe psychopathology, functioning and symptom dimensions accounting for subthreshold manifestations and developmental status in child and adolescent offspring of parents with bipolar disorder ("high-risk offspring"). The study population comprised 90 high-risk offspring (HR-offspring) and 107 offspring of community control parents (CC-offspring). Direct clinical observations and parental and offspring reports based on selected standardized clinical scales were used to assess offspring threshold and subthreshold diagnoses, symptoms and functioning. All outcomes were compared between the whole HR-offspring and CC-offspring samples and then by developmental status. After controlling for potential confounders, HR-offspring showed significantly poorer adjustment for childhood (r = 0.18, p = 0.014) and adolescence (r = 0.21, p = 0.048) than CC-offspring, as well as more emotional problems (r = 0.24, p = 0.001) and higher depression scores (r = 0.16, p = 0.021). As for differences in lifetime categorical diagnoses (threshold and subthreshold) between HR-offspring and CC-offspring, the prevalence of disruptive disorders was higher in pre-pubertal HR-offspring (OR 12.78 [1.45-112.42]), while prevalence of mood disorders was higher in post-pubertal HR-offspring (OR 3.39 [1.14-10.06]). Post-pubertal HR-offspring presented more prodromal (r = 0.40, p = 0.001), negative (r = 0.38, p = 0.002), manic (r = 0.22, p = 0.035) and depressive (r = 0.23, p = 0.015) symptoms than pre-pubertal HR-offspring, as well as more peer relationship problems (r = 0.31, p = 0.004), poorer childhood adjustment (r = 0.22, p = 0.044) and worse current psychosocial functioning (r = 0.27, p = 0.04). Externalizing psychopathology is more prevalent in pre-pubertal HR-offspring, while depressive and prodromal symptoms leading to functional impairment are more prominent in post-pubertal HR-offspring. Developmental approaches and dimensional measures may be useful for identifying children at high risk of developing bipolar disorder and help guide specific preventive strategies.
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26
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Palacio-Ortiz JD, Peña-Quintero CE, Gómez-Valero MA, Bustamante-Gómez PA, Arroyave-Sierra PH, Vargas-Upeguí CD, López-Jaramillo C. Trastornos psiquiátricos a través de la vida: un estudio de comparación de hijos de padres con trastorno afectivo bipolar tipo I frente a hijos de padres controles de la comunidad. ACTA ACUST UNITED AC 2017; 46:129-139. [DOI: 10.1016/j.rcp.2016.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/02/2016] [Accepted: 06/22/2016] [Indexed: 11/24/2022]
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27
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Diler RS, Goldstein TR, Hafeman D, Merranko J, Liao F, Goldstein BI, Hower H, Gill MK, Hunt J, Yen S, Keller MB, Axelson D, Strober M, Iyengar S, Ryan ND, Birmaher B. Distinguishing Bipolar Depression from Unipolar Depression in Youth: Preliminary Findings. J Child Adolesc Psychopharmacol 2017; 27:310-319. [PMID: 28398819 PMCID: PMC5439419 DOI: 10.1089/cap.2016.0154] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To identify mood symptoms that distinguishes bipolar disorder (BP) depression versus unipolar depression in youth during an acute depressive episode. METHODS Youth with BP (N = 30) were compared with youth with unipolar depression (N = 59) during an acute depressive episode using the depression and mania items derived from the Schedule for Affective Disorders and Schizophrenia for Children (K-SADS)-Present Version. The results were adjusted for multiple comparisons, and any significant between-group differences in demographic, nonmood comorbid disorders, and psychiatric family history. RESULTS In comparison with unipolar depressed youth, BP depressed youth had significantly higher scores in several depressive symptoms and all subsyndromal manic symptoms, with the exception of increased goal-directed activity. Among the depressive symptoms, higher ratings of nonsuicidal physical self-injurious acts and mood reactivity, and lower ratings of aches/pains, were the symptoms that best discriminated BP from unipolar depressed youth. Subsyndromal manic symptoms, particularly motor hyperactivity, distractibility, and pressured speech, were higher in BP depressed youth and discriminated BP depressed from unipolar depressed youth. CONCLUSIONS The results of this study suggest that it is possible to differentiate BP depression from unipolar depression based on depressive symptoms, and in particular subsyndromal manic symptoms. If replicated, these results have important clinical and research implications.
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Affiliation(s)
- Rasim Somer Diler
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Tina R. Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John Merranko
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Fangzi Liao
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Benjamin I. Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, Toronto, Canada
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jeffrey Hunt
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Martin B. Keller
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - David Axelson
- Department of Psychiatry, Nationwide Children's Hospital, The Ohio State College of Medicine, Columbus, Ohio
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Neal D. Ryan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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28
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Melo MCA, Garcia RF, Linhares Neto VB, Sá MB, de Mesquita LMF, de Araújo CFC, de Bruin VMS. Sleep and circadian alterations in people at risk for bipolar disorder: A systematic review. J Psychiatr Res 2016; 83:211-219. [PMID: 27661417 DOI: 10.1016/j.jpsychires.2016.09.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sleep and circadian abnormalities have been mostly demonstrated in bipolar patients. However, it is not clear whether these alterations are present in population at high risk for bipolar disorder (BD), indicating a possible risk factor for this condition. OBJECTIVE This systematic review aims to define current evidence about sleep and rhythm alterations in people at risk for BD and to evaluate sleep and circadian disorders as risk factor for BD. METHODS The systematic review included all articles about the topic until February 2016. Two researchers performed an electronic search of PubMed and Cochrane Library. Keywords used were 'sleep' or 'rhythm' or 'circadian' AND 'bipolar disorder' or 'mania' or 'bipolar depression' AND 'high-risk' or 'risk'. RESULTS Thirty articles were analyzed (7451 participants at risk for BD). Sleep disturbances are frequent in studies using both subjective measures and actigraphy. High-risk individuals reported irregularity of sleep/wake times, poor sleep and circadian rhythm disruption. Poor sleep quality, nighttime awakenings, and inadequate sleep are possible predictive factors for BD. A unique study suggested that irregular rhythms increase risk of conversion. People at risk for BD showed high cortisol levels in different times of day. Studies about anatomopathology, melatonin levels, inflammatory cytokines and oxidative stress were not identified. The most important limitations were differences in sleep and rhythm measures, heterogeneity of study designs, and lack of consistency in the definition of population at risk. CONCLUSION Sleep and circadian disturbances are common in people at risk for BD. However, the pathophysiology of these alterations and the impact on BD onset are still unclear.
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29
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Fernandez E, Johnson SL. Anger in psychological disorders: Prevalence, presentation, etiology and prognostic implications. Clin Psychol Rev 2016; 46:124-35. [DOI: 10.1016/j.cpr.2016.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 12/14/2015] [Accepted: 04/25/2016] [Indexed: 01/21/2023]
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30
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Sexual Risk Behaviors in the Adolescent Offspring of Parents with Bipolar Disorder: Prospective Associations with Parents' Personality and Externalizing Behavior in Childhood. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 44:1347-59. [PMID: 26767833 DOI: 10.1007/s10802-015-0112-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We recently reported that adolescent and young adult offspring of parents with bipolar disorder (OBD), relative to control offspring, were more likely to engage in sexual risk behaviors (SRBs). The present prospective study aimed to determine the contribution of parents' personality and offspring behaviour problems in middle childhood to offspring SRBs 10 years later. We hypothesized that offspring externalizing problems in childhood would mediate the relationship between parents' personality traits of neuroticism and agreeableness and adolescent SRBs. Furthermore, we expected these associations to be more robust among the OBD than controls. At baseline, 102 offspring (52 OBD and 50 controls) aged between 4 and 14 years were assessed along with their parents, who completed a self-report personality measure and child behavior rating. Behaviour ratings were also obtained from the children's teachers. Ten years later the offspring completed an interview assessing SRBs. Mediation analyses using bootstrapping revealed that, after controlling for age and presence of an affective disorder, externalizing behaviors served as a pathway through which high parental neuroticism, low parental agreeableness, and low parental extraversion were related to SRBs in offspring. Moderated mediation analyses revealed that the relationship between parental neuroticism and childhood externalizing problems was stronger for OBD than controls. These findings add to our previous results showing parents' personality contributes to intergenerational risk transfer through behavioral problems in middle childhood. These results carry implications for optimal timing of preventative interventions in the OBD.
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31
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Emotion-relevant impulsivity predicts sustained anger and aggression after remission in bipolar I disorder. J Affect Disord 2016; 189:169-75. [PMID: 26437231 DOI: 10.1016/j.jad.2015.07.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/02/2015] [Accepted: 07/14/2015] [Indexed: 01/04/2023]
Abstract
Recent evidence suggests that anger and aggression are of concern even during remission for persons with bipolar I disorder, although there is substantial variability in the degree of anger and aggression across individuals. Little research is available to examine psychological models of anger and aggression for those with remitted bipolar disorder, and that was the goal of this study. Participants were 58 persons diagnosed with bipolar I disorder using the Structured Clinical Interview for DSM-IV, who were followed with monthly symptom severity interviews until they achieved remission, and then assessed using the Aggression-Short Form. We examined traditional predictors of clinical parameters and trauma exposure, and then considered three trait domains that have been shown to be elevated in bipolar disorder and have also been linked to aggression outside of bipolar disorder: emotion-relevant impulsivity, approach motivation, and dominance-related constructs. Emotion-relevant impulsivity was related to anger, hostility, verbal aggression, and physical aggression, even after controlling for clinical variables. Findings extend the importance of emotion-relevant impulsivity to another important clinical outcome and suggest the promise of using psychological models to understand the factors driving aggression and anger problems that persist into remission among persons with bipolar disorder.
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32
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Bowden CL, Singh V. The use of antidepressants in bipolar disorder patients with depression. Expert Opin Pharmacother 2015; 17:17-25. [PMID: 26479314 DOI: 10.1517/14656566.2016.1104299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The proportion of time that bipolar patients experience depressive symptoms and clinical states, with associated psychosocial impairment and elevated risk of suicide, is significantly greater than the time spent in manic/hypomanic forms of bipolar disorders. Yet, manic states and symptoms have been the focus and interest of most clinical research over the past quarter century. Not a single antidepressant approved for treatment of major depressive disorder, as monotherapy, has received regulatory approval for treatment of bipolar depression as monotherapy, despite their common use in bipolar depression. AREAS COVERED We reviewed randomized studies, particularly ones initially intended for registration purposes, and systematic treatment guidelines, in development of this guide to treatment decision and implementation of interventions for depression in bipolar disorders. EXPERT OPINION The Expert Opinion section emphasizes strategies, not individual agents. The efficacious performance of mood stabilizers and second-generation antipsychotics as a component of the strategy is strongly supported by published studies. However, this section relies largely on secondary publications and our combined clinical experience, as few randomized, blinded studies have had, as their focus, the comparison of combined regimens for depression. This article summarizes the design features and results of studies dealing with depressive features and intervention strategies for bipolar disorders. The emphasis of the recommendations is on pragmatic treatment decisions that clinicians can make to enhance the probability of both short and long term benefits for patients.
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Affiliation(s)
- Charles L Bowden
- a Clinical Professor of Psychiatry and Pharmacology , University of Texas Health Science Center at San Antonio , San Antonio , TX , USA
| | - Vivek Singh
- b Professor and Chairman for Department of Psychiatry, Paul L. Foster School of Medicine , Texas Tech University Health Sciences Center , El Paso , TX , USA
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33
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Tseng WL, Guyer AE, Briggs-Gowan MJ, Axelson D, Birmaher B, Egger HL, Helm J, Stowe Z, Towbin KA, Wakschlag LS, Leibenluft E, Brotman MA. Behavior and emotion modulation deficits in preschoolers at risk for bipolar disorder. Depress Anxiety 2015; 32:325-34. [PMID: 25691090 PMCID: PMC4409452 DOI: 10.1002/da.22342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 10/07/2014] [Accepted: 11/23/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is highly familial, but studies have yet to examine preschoolers at risk for BD using standardized, developmentally appropriate clinical assessment tools. We used such methods to test whether preschoolers at familial risk for BD have more observed difficulty modulating emotions and behaviors than do low-risk preschoolers. Identification of emotional and behavioral difficulties in at-risk preschoolers is crucial for developing new approaches for early intervention and prevention of BD. METHODS Using the standardized disruptive behavior diagnostic observation schedule (DB-DOS) protocol for preschoolers, we compared 23 preschoolers (M(age): 4.53 ± 0.73 years; 18 males) with a first-degree relative with BD to 21 preschoolers (M(age): 4.65 ± 0.84 years; 11 males) without a family history of BD. We characterized psychopathology in this sample using the Preschool Aged Psychiatric Assessment and behavioral and emotional problems using the Child Behavior Checklist. RESULTS High-risk preschoolers demonstrated significantly more intense, pervasive, and clinically concerning problems in anger modulation and behavior dysregulation on the DB-DOS than the low-risk group. High-risk relative to low-risk preschoolers, were also more likely to have maternal-reported anxiety and oppositional defiant disorders and internalizing and externalizing problems. CONCLUSIONS Clinically concerning problems in anger modulation and behavior regulation, measured during standardized laboratory observation, differentiate preschoolers at high familial risk for BD from those at low risk. Investigation in a large longitudinal sample is critical for replication and for determining whether these observed behavioral differences can be reliably used as prodromal indicators of mood disorders.
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Affiliation(s)
- Wan-Ling Tseng
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services
| | - Amanda E. Guyer
- Department of Human Ecology, Center for Mind and Brain, University of California, Davis
| | | | - David Axelson
- Nationwide Children’s Hospital and The Ohio State University School of Medicine
| | | | | | - Jonathan Helm
- Center for Mind and Brain, University of California, Davis
| | | | - Kenneth A. Towbin
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services
| | - Lauren S. Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services
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Erkan M, Gencoglan S, Akguc L, Ozatalay E, Fettahoglu EC. Attachment styles and psychopathology among adolescent children of parents with bipolar disorder. Med Sci Monit 2015; 21:1083-8. [PMID: 25877235 PMCID: PMC4410723 DOI: 10.12659/msm.893372] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to compare attachment styles and psychopathology in adolescent children of parents with bipolar disorder (BD) with a healthy control group. MATERIAL AND METHODS We studied 25 adolescents who had at least 1 parent with BD (BD group) and 28 adolescents who had no parents with BD (control group). The adolescent participants were between the ages of 12 and 17 years. We used the Adolescent Relationship Scales Questionnaire (A-RSQ) for the adolescents in the BD vs. control groups, and we used the Schedule for Affective Disorders and Schizophrenia for School-age Children - present and lifetime version (K-SADS-PL). We used the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinician Version for each parent of adolescents in the BD and control groups to rule out psychopathologies. RESULTS Attachment styles of participants were assessed according to A-RSQ, dismissing attachment style scores of adolescents in BD group were found significantly higher compared to the healthy control group (p<0.05). As a result of the assessments, 12 adolescents (48%) out of 25 in the BD group and 5 adolescents (18%) out of 28 in the control group were given DSM-IV Axis I diagnosis, which is a statistically significant result (p<0.05). However, when psychiatric diagnoses were assessed separately, the difference was not statistically significant. CONCLUSIONS We found that the adolescent children of parents with BD have increased risk of developing mental illnesses, and that these adolescents adopt dismissing attachment styles.
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Affiliation(s)
- Mustafa Erkan
- Department of Child and Adolescent Psychiatry, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Salih Gencoglan
- Department of Child and Adolescent Psychiatry, Yuzuncu Yil University School of Medicine, Van, Turkey
| | - Leyla Akguc
- Department of Psychiatry, Mardin State Hospital, Mardin, Turkey
| | - Esin Ozatalay
- Department of Child and Adolescent Psychiatry, Akdeniz University School of Medicine, Antalya, Turkey
| | - Emine Cigil Fettahoglu
- Department of Child and Adolescent Psychiatry , Akdeniz University School of Medicine, Antalya, Turkey
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