Research report
Psychopathology in children of bipolar parents

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Abstract

Background

Few studies have examined the psychopathological profiles of child offspring of bipolar parents. Such investigations are useful as a first step to identifying potential prodromal manifestations of bipolar disorder.

Methods

The presence of psychopathology in 37 children with at least one parent with bipolar I disorder and 29 demographically matched children with parents free of any DSM-IV Axis I psychopathology was evaluated using the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U KSADS).

Results

Twenty-nine (78%) of 37 high-risk children were diagnosed with at least one DSM-IV Axis I diagnosis as compared to seven (24%) of 29 children of healthy control parents (Fisher's exact test, p < 0.0001, odds ratio = 11, 95% CI = 3.33, 33). Sixteen percent (N = 6) of high-risk offspring met DSM-IV criteria for bipolar I disorder as compared to none of the healthy control offspring (Fisher's exact test, p < 0.03). High-risk offspring also had statistically significant elevations in rates of other affective and disruptive behavior disorders as well as subsyndromal manifestations of psychopathology.

Conclusions

Children of bipolar parents had an elevated risk for developing bipolar and other psychiatric disorders. The study of children of bipolar parents who are at high risk for developing bipolar disorder themselves is essential to identify potential prodromal manifestations of the disorder and to eventually establish targeted early intervention strategies. Longitudinal studies to confirm the prodromal manifestations of bipolar disorder and risk factors associated with the development of specific diagnoses in children are needed.

Introduction

Several studies have reported that children of bipolar adults are vulnerable to developing affective and other psychiatric disorders (Akiskal et al., 1985, Carlson and Weintraub, 1993, Duffy et al., 2001). Such investigations are useful as an initial step to identify potential prodromal manifestations of bipolar disorder. Indeed, offspring studies that involve children and adolescents as opposed to adults are particularly useful for developing early intervention strategies as these individuals are still within the age of risk for developing mood disorders. Specifically, studies of offspring of bipolar parents suggest that they have an elevated risk of developing bipolar disorder as well as other psychopathology, including anxiety disorders, major depressive disorder (MDD), and attention-deficit hyperactivity disorder (ADHD) (Merikangas et al., 1988, Chang et al., 2000, DelBello and Geller, 2001, Lapalme et al., 1997). In a meta-analysis, Lapalme et al. (1997) analyzed 17 studies of offspring of bipolar parents conducted between 1979 and 2003, and reported that 52% of these offspring had a DSM-IV Axis I diagnosis, including 27% with affective disorders as compared to 29% and 8.3%, respectively, in offspring with healthy parents (p < 0.00001).

Other more recent studies also report increased rates of psychopathology in child and adolescent offspring of bipolar adults. Chang et al. (2000) evaluated 60 children with at least one bipolar parent and found that 15% had major depressive disorder or dysthymia, 15% had bipolar disorder or cyclothymia, and 28% had ADHD. Another study of 132 adolescent and young adult offspring of bipolar parents showed that a lifetime psychiatric disorder was present in 49% of the sample (Reichart et al., 2004). However, neither of these two studies included a healthy comparison group. Henin et al. also showed an increased risk for psychopathology in offspring of parents with bipolar disorder (Henin et al., 2005), suggesting that disruptive behavior disorders, anxiety disorders, and early onset depression may be useful markers of risk for subsequent bipolar disorder in high-risk samples. This latter study included a comparison group with structured diagnostic interviews by interviewers who were blinded to group status of the subject. However, the comparison group included families with parents with other psychiatric disorders.

Prior investigations of bipolar offspring have been limited by several factors. Many studies did not use a control group, included offspring of both bipolar and unipolar depressed parents within the same group, diagnosed subjects without structured or semi-structured interviews, did not assess level of severity of symptoms, and did not perform diagnostic interviews by interviewers blinded to group status. To address these limitations, we investigated rates of DSM-IV Axis I psychopathology in children with at least one parent with bipolar I disorder as compared to children of parents without any psychiatric disorder as determined by structured clinical interviews performed by interviewers blind to diagnostic group. Based on previous literature, in this pilot study we hypothesized that children of parents with bipolar disorder would have increased rates of affective disorders, ADHD, and subsyndromal manifestations of psychopathology as compared to demographically matched children of parents free of psychopathology.

Section snippets

Subjects

Adults with bipolar I disorder who had children between the ages of 8 and 17 years were recruited from inpatient and outpatient treatment programs at the University of Cincinnati College of Medicine and were classified as the offspring of bipolar parents group (OBP group, N = 37). A comparison group of children of parents free of DSM-IV Axis I psychopathology were also recruited for this study as the “offspring of healthy controls” group (OHC group, N = 29) from community advertisements and local

Demographics

There were no statistically significant group differences in sex, age, ethnicity, parental level of education or income between OBP and OHC (Table 2). Parental income was greater in the OHC group than the OBP group (p = 0.02), but the results were unchanged after the analyses were adjusted for income level.

Rates of psychopathology

The OBP group had significantly higher rates of any syndromal DSM-IV Axis I diagnosis than the OHC group. Twenty-nine (78%) of OBP were diagnosed with at least one Axis I disorder as compared

Discussion

Our results indicate that child and adolescent offspring of parents with bipolar I disorder have an elevated risk for developing affective disorders, especially bipolar disorders, ADHD, and disruptive behavior disorders. Our results are consistent with those of Henin et al. (2005) and Chang et al. (2000) in that an overall increased risk for psychopathology in offspring of bipolar parents was demonstrated. Significant increases in rates of ADHD and ODD or CD were also observed in OBP,

Acknowledgements

This study was supported by the Stanley Medical Research Institute. A preliminary abstract of this paper was presented at the American Psychiatric Association Annual Meeting, Washington DC, USA, May 17, 1999, New Research Poster NR23.

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