Children and teens of parents with bipolar disorder have an increased risk of early-onset bipolar disorder, mood disorders and anxiety disorders, according to a study by University of Pittsburgh School of Medicine researchers published in the March issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

An estimated one in 100 children and teens worldwide has bipolar disorder. Identifying the condition early may improve long-term outcomes, potentially preventing high psychosocial and medical costs. Researchers from the Pittsburgh Bipolar Offspring Study suggest that having family members with bipolar disorder is the best predictor of whether their children will go on to develop the condition.

"A bipolar diagnosis at a young age deprives children of the opportunity to experience normal emotional, cognitive and social development, and this is why there is an urgent need to identify, diagnose and treat these patients early on," said Boris Birmaher, M.D., director of the Child and Adolescent Anxiety Program and co-director of the Child and Adolescent Bipolar Services at Western Psychiatric Institute and Clinic of UPMC, endowed chair in Early Onset Bipolar Disease and professor of psychiatry at the University of Pittsburgh School of Medicine.

Compared with the offspring of control parents, children with bipolar parents had a 14-fold increased risk of having a bipolar spectrum disorder, as well as a two-to three-fold increase of having a mood or anxiety disorder. Children in families where both parents had bipolar disorders also were more likely to develop the condition than those in families containing one parent with bipolar disorder. However, their risk for other psychiatric disorders was the same as children who had one bipolar parent.

Bipolar disorder, commonly called manic-depression, often emerges in adolescence, and is characterized by intense swings between depression, mania and periods with mixed symptoms. Bipolar spectrum disorders consist of three sub-types. Bipolar I (BP-I) is characterized by episodes of full-blown mania and major depression; bipolar II (BP-II) involves episodes of less severe mania, called hypomania, and major depression; and the third sub-type is called Bipolar Not Otherwise Specified (BP-NOS), which involves symptoms consistent with elated or irritable moods that are disruptive to daily living, plus two to three other symptoms of bipolar disorder.

In this blind study, researchers compared 388 children and teens, ages 6 to 18, of 233 parents with BP-I and BP-II to 251 offspring of 143 demographically matched control parents. Parents were assessed for psychiatric disorders, family mental health history, family environment, exposure to negative life events, and also were interviewed about their children. Children were assessed directly for bipolar disorder and other psychiatric disorders by researchers who did not know their parents' diagnoses.

"Consistent with prior research, most parents with bipolar disorder recalled that their illness started before age 20 and about 20 percent had illness that started before age 13," said Dr. Birmaher. "In contrast, most of their children developed their first bipolar disorder episode before age 12, suggesting the possibility that parents were more perceptive of their children's symptoms early in life or perhaps that bipolar disorder appears earlier in new generations."

The researchers note that these findings have important clinical implications. "Clinicians who treat adults with bipolar disorder should question them about their children's psychopathology to offer prompt identification and early interventions for any psychiatric problems that may be affecting the children's functioning, particularly early-onset bipolar disorder," said Dr. Birmaher. "Further studies are needed to help determine the clinical, biological and genetic risk factors that may be modified to prevent the development of psychiatric disorders in the children of those with bipolar disorder."

Co-authors of the Pittsburgh Bipolar Offspring Study include David Axelson, M.D., Kelly Monk, R.N., Catherine Kalas, R.N., Benjamin Goldstein, M.D., Mary Beth Hickey, B.A., Mihaela Obreja, M.S., Mary Ehmann, M.A., Satish Iyengar, Ph.D., Warl Shamseddeen, M.D., David Kupfer, M.D., and David Brent, M.D., all from WPIC and the University of Pittsburgh Department of Psychiatry.

The Pittsburgh Bipolar Offspring Study was supported in part by funding provided by the National Institute of Mental Health.

Western Psychiatric Institute and Clinic (WPIC) is considered to be one of the nation's foremost university-based psychiatric care facilities and one of the world's leading centers for research and treatment of mental health disorders. WPIC houses the Department of Psychiatry of the University of Pittsburgh School of Medicine and is the flagship of UPMC Behavioral Health, the psychiatric specialty division of the University of Pittsburgh Medical Center.

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