Risk should be considered in children of parents with bipolar disorder

Mental health care providers should consider the future onset of bipolar disorder when assessing short episodes of manic symptoms, major depression and disruptive behavior disorders among high risk children, according to researchers.

“This may be particularly important if medication is going to be used for treating mood or behavioral symptoms in the child, because some medications might increase the risk of developing mania or psychotic symptoms in someone who is already at very high risk for developing bipolar disorder,” David Axelson, MD, medical director of Behavioral Health at Nationwide Children’s Hospital, said in a press release. “Prescribers might choose different medication options, or use lower doses and monitor for problems more closely.”

David Axelson

Axelson and colleagues conducted a longitudinal study comparing community offspring (n = 248) with those who had a greater risk for developing bipolar disorder due to a parents’ diagnosis (n = 391) and were aged 6 to 18 years.

“Short, distinct episodes of manic symptoms were the most specific predictor of developing bipolar disorder in high-risk offspring,” Axelson said. “But so far, many children with these short manic episodes have not progressed to full-fledged bipolar disorder.”

Data indicate that the high-risk group of children had significantly greater rates for subthreshold mania or hypomania (13.3% vs. 1.2%), manic, mixed, or hypomanic episodes (9.2% vs. 0.8%), and major depressive episodes (32% vs. 14.9%), compared with community controls.

This group also had higher rates of attention-deficit/hyperactivity disorder (30.7% vs. 18.1%), disruptive behavior disorders (27.4% vs.15.3%), anxiety disorders (39.9% vs. 21.8%), and substance use disorders (19.9% vs. 10.1%), but not unipolar major depressive disorder (18.9% vs. 13.7%), compared with controls.

Further analyses demonstrated that the subthreshold manic or hypomanic episodes (P = .03), major depressive episodes (P = .03), and disruptive behavior disorders (P = .05) were associated with manic, mixed or hypomanic episodes, the researchers wrote.

They also found that proband age at intake assessment was a confounder covariate (P = .02), according to data.

Axelson and colleagues will continue to work with the Pittsburgh Bipolar Offspring Study, according to the press release.

“We expect to find more exciting results that will impact the diagnosis and treatment of high-risk children as we follow the participants into young adulthood,” he said. – by Samantha Costa

Disclosure: Axelson reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.