March 01, 2016
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Symptoms may be stronger predictors of bipolar disorder than diagnoses in at-risk youth

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Anxiety, depression, affective lability and mania were significant predictors of new-onset bipolar spectrum disorder in youth with familial risk for mood disorders.

“Multiple lines of evidence indicate the presence of significant psychopathology preceding onset of bipolar illness. Based on retrospective studies of both adults and children, sleep disturbances, anxiety, depressive symptoms, affective lability, subthreshold hypomanic symptoms, behavioral dyscontrol and irritability have been reported to precede onset of bipolar disorder. Many of these characteristics have also been identified in youths at genetic risk for bipolar,” Danella M. Hafeman, MD, PhD, of University of Pittsburgh, and colleagues wrote. “While these findings indicate the presence of prodromal symptoms, their nonspecificity limits their clinical and research utility.”

To assess dimensional symptomatic predictors of new-onset bipolar spectrum disorders in youth with familial risk, researchers compared 359 children, aged 6 to 18 years, of parents with bipolar I or II disorder with 220 community comparison youth. Factor analyses reduced measures collected at baseline and follow-up, and factors were assessed as predictors of new-onset bipolar spectrum disorder.

Over 8 years, 14.7% of offspring with available follow-up data (n = 44) developed new-onset bipolar spectrum disorder.

Baseline levels of anxiety, depression, inattention/disinhibition, externalizing, subsyndromal manic and affective lability symptoms were higher among participants at-risk or diagnosed with bipolar spectrum disorder, compared with controls.

Baseline anxiety and depression, baseline and proximal affective lability and proximal subsyndromal manic symptoms were the strongest predictors of new-onset bipolar spectrum disorder (P < .05).

Affective lability, anxiety and depression were increased throughout follow-up among participants who later developed bipolar spectrum disorder. Manic symptoms increased up to the point of conversion.

A path analysis indicated evidence that affective lability at baseline predicted new-onset bipolar spectrum disorder, partly due to manic symptoms at the visit prior to conversion.

Earlier parental age at mood disorder onset was also significantly associated with increased risk for conversion.

Youth without anxiety, depression, affective lability and mania had a 2% predicted chance of conversion to bipolar spectrum disorders, compared with a 49% predicted chance among youth with all risk factors.

“This study is the first large effort to document the relevant prodromal factors for bipolar disorder in the context of an unfolding process across time,” Shelli Avenevoli, PhD, acting deputy director of the NIMH, said in a press release. “It demonstrates the potential of combining dimensional symptoms and family risk to enhance risk prediction and for investigating the nature of the prodrome.” – by Amanda Oldt

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