Catrien G. Reichart

Prevalence of Psychopathology in Children of a Bipolar Parent

OBJECTIVE To determine psychopathology in adolescent children of a bipolar parent living in the Netherlands, using multiple sources of information (self-, parent, and teacher reports). METHOD Problem behavior in 140 offspring (aged 12-21 years) of 86 bipolar parents was assessed with the Child Behavior Checklist (CBCL), the Teachers Report Form (TRF), and the Youth Self-Report (YSR) between 1997 and 1999. All adolescents, bipolar parents, and their available spouses were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). RESULTS Higher problem scores were found for 8 of the 11 CBCL scales for girls and 4 of the 11 CBCL scales for boys, compared with a Dutch normative sample, and 1 Young Adult Self-Report (YASR) scale for girls compared with an American normative sample. Lower problem scores were found on 4 YSR and 4 YASR scales for boys, 1 TRF scale for girls, and 1 TRF scale for boys. The prevalence of current DSM-IV diagnoses in the offspring was 29% and of life-time DSM-IV diagnoses, 44%. CONCLUSIONS The prevalence of problem behavior and DSM-IV diagnoses found in our sample did not support the notion that the level of psychopathology in children aged 12 to 21 years of bipolar parents is highly elevated. This study, similar to prior studies, suffers from lack of information on the representativeness of the sample and a rather low response rate.

The Dutch Bipolar Offspring Study: 12-Year Follow-Up

OBJECTIVE Offspring of bipolar parents have a genetically increased risk of developing mood disorders. In a longitudinal study, the authors followed a bipolar offspring cohort from adolescence into adulthood to determine the onset, prevalence, and early course of mood disorders and other psychopathology. METHOD The Dutch bipolar offspring cohort is a fixed cohort initiated in 1997 (N=140; age range at baseline, 12-21 years). Bipolar offspring were psychiatrically evaluated at baseline and at 1-, 5-, and 12-year follow-ups. Of the original sample, 77% (N=108) were followed for the full 12 years. RESULTS Overall, 72% of the bipolar offspring developed a lifetime DSM-IV axis I disorder, 54% a mood disorder, and 13% bipolar spectrum disorders. Only 3% met DSM-IV criteria for bipolar I disorder. In 88% of the offspring with a bipolar spectrum disorder, the illness started with a depressive episode. In total, 24% of offspring with a unipolar mood disorder developed a bipolar spectrum disorder over time. Mood disorders were often recurrent (31%), were complex (comorbidity rate, 67%), and started before age 25. CONCLUSIONS Even after 12 years of follow-up, from adolescence into adulthood, bipolar I disorder was rare among bipolar offspring. Nevertheless, the risk of developing severe and recurrent mood disorders and other psychopathology was high. Future follow-up of this and other adult bipolar offspring cohorts is essential to determine whether recurrent mood disorders in bipolar offspring reflect the early stages of bipolar disorder.

Earlier onset of bipolar disorder in children by antidepressants or stimulants? An hypothesis.

Among adults and adolescents, bipolar disorder (BD) has a similar prevalence in the US and in the Netherlands. However, among pre-pubertal children, BD is frequently diagnosed in the US and seldomly in the Netherlands. This suggests that, among children, the prevalence of BD is lower in the Netherlands than in the US, indicating an earlier onset of BD in the US than in the Netherlands. It is hypothesized that this may be related to the greater use of antidepressants and stimulants for depression or attention deficit disorder with hyperactivity by US children. In those children who are genetically at risk to develop BD, these drugs may lead to a switch into mania.

Psychopathology in the adolescent offspring of bipolar parents.

BACKGROUND The aim of this study was to determine the prevalence and 14-months incidence of psychopathology in adolescent offspring of a bipolar parent. METHOD Parent, teacher and self-report rating scales and Kiddie-SADS were used to assess 132 13-23-year-old offspring of bipolar parents. RESULTS Compared to the general population, there were few differences between rating scale scores for bipolar offspring and problem scores for normative adolescents. Of the sample 49% had a lifetime psychiatric disorder, most commonly (33%) a mood disorder. LIMITATIONS There was no suitable control group and there are no comparison data for psychiatric diagnoses (DSM-IV), based on semi-structured interviews in the adolescent age group in the Netherlands. CONCLUSIONS The overall level of psychopathology of bipolar offspring was not particularly elevated, but when there were more problems, they tended to be mood disorders.

Signs of a higher prevalence of autoimmune thyroiditis in female offspring of bipolar parents

BACKGROUND Studies are inconsistent as to whether patients with bipolar disorder are more frequently affected by autoimmune thyroiditis. AIM To study the prevalence of autoimmune thyroiditis in offspring of bipolar patients. METHOD In 1998 140 children (age 12-21 years) of bipolar parents were evaluated psychiatrically using the K-SADS-PL and blood was drawn to determine thyroperoxidase antibodies (TPO-Abs) and serum TSH. Blood samples of high school students (aged 12-19 years, n=77) and young adults (aged 20-35 years, n=52) were used as comparisons. At follow-up the offspring were psychiatrically evaluated and tested for TPO-Abs and TSH twice (14 months and 55 months after enrollment). RESULTS TPO-Abs were predominantly found in female bipolar offspring, who had a significantly higher prevalence of positive TPO-Ab titers (9 out of 57 female offspring subjects) as compared to the female high school and young adult comparisons (4 out of 103 female control subjects). In TPO-Ab positive offspring (n=11) a raised prevalence of 55% of thyroid failure (i.e. a raised serum TSH or l-thyroxine treatment) was evident. TPO-Ab positive offspring did not show a raised prevalence of mood disorders (or any psychopathology) as compared to the TPO-Ab negative offspring. CONCLUSION Our study suggests that bipolar offspring are more vulnerable to develop thyroid autoimmunity independently from the vulnerability to develop psychiatric disorders.

Impact of Birth Weight and Genetic Liability on Psychopathology in Children of Bipolar Parents

OBJECTIVE To test different models for ways in which birth weight and familial loading influence the risk for psychopathology in bipolar offspring. METHOD DSM-IV diagnoses of 140 bipolar offspring (12-21 years of age) were assessed with the K-SADS-PL. Parents were interviewed using the Family History-Research Diagnostic Criteria to determine familial loading of mood and substance use disorders. Parents reported the birth weight of their offspring. Age- and sex-adjusted hazard ratios were calculated. RESULTS Low birth weight was associated with mood and non-mood disorders in bipolar offspring (hazard ratio = 0.6, confidence interval = 0.4-0.8), even after controlling for familial loading of unipolar disorder, bipolar disorder, or substance use disorder. There were no significant interactions between birth weight and familial loading of unipolar disorder, familial loading of bipolar disorder, and familial loading of substance use disorder. CONCLUSIONS Birth weight is associated with mood as well as non-mood disorders. This association is independent from the association of familial loading of mood and substance use disorder with mood- and non-mood disorders in bipolar offspring.

Multiple dimensions of familial psychopathology affect risk of mood disorder in children of bipolar parents

The aim of our study was to determine whether familial loading of unipolar disorder, bipolar disorder, and substance use disorder are associated with DSM‐IV mood disorders in adolescents at risk for bipolar disorder. One hundred and forty adolescents aged 12–21 years of 86 bipolar parents participated in the study. Lifetime DSM‐IV diagnoses of the bipolar offspring were assessed with the Schedule for Affective Disorders and Schizophrenia for School Age Children Kiddie‐SADS‐Present and Lifetime Version (SADS‐PL). Parents were interviewed using the Family History Research Diagnostic Criteria (FH‐RDC) which were used to calculate a continuous familial loading score (FL) for unipolar disorder, bipolar disorder, and for substance use disorder in first‐ and second‐degree relatives of the adolescents. FL for unipolar disorder and substance use disorder were strong and independent predictors for lifetime mood disorders in the adolescents. The gender adjusted hazard ratios for mood disorders in the children were 1.5 (95% confidence interval (CI) = 1.2–2.0) for FL of unipolar disorder and 1.8 (95% CI = 1.3–2.4) for FL of substance use disorder. Expression of mood disorders in children of bipolar parents varies with the degree of additional FL of unipolar disorder and substance use disorder in the extended family.

The use of the GBI in a population of adolescent offspring of parents with a bipolar disorder

OBJECTIVE To assess the psychometric properties and the usefulness of the General Behavior Inventory (GBI) in the adolescent age range. METHOD The GBI, the Schedule for Affective Disorders and Schizophrenia for School Age Children, Kiddie-SADS-Present and Lifetime Version (K-SADS-PL) and the Youth Self-Report (YSR) were used to assess 117 adolescents of a bipolar parent twice with an interval of 14 months. Based on the K-SADS results, the bipolar offspring were assigned to one of three groups: with mood disorders, with non-mood disorders, and with no disorders. RESULTS Principal component analyses resulted in the same two-factor solution as reported for adults. The Depression scale of the GBI discriminated between adolescents with a DSM-IV mood disorder, a non-mood disorder and no disorder on Axis I. Significant correlations between GBI scales and the corresponding Internalizing and Externalizing scales of the YSR showed convergent validity. CONCLUSIONS The GBI can be used in the adolescent age range as a self-report to discriminate mood disorders from non-mood disorders or no disorders.

Perceived parental rearing of bipolar offspring

Objective:  To explore the impact of growing up with a parent with a bipolar disorder. First, we compared parental rearing behavior perceived by young adult offspring of bipolar parents with parental rearing behavior perceived by same aged young adults from the general population. Secondly, we examined the associations between perceived parental rearing behavior and parental psychopathology and psychopathology in offspring.

Categorical and dimensional psychopathology in Dutch and US offspring of parents with bipolar disorder: A preliminary cross-national comparison

OBJECTIVE Accumulating evidence suggests cross-national differences in adults with bipolar disorder (BD), but also in the susceptibility of their offspring (bipolar offspring). This study aims to explore and clarify cross-national variation in the prevalence of categorical and dimensional psychopathology between bipolar offspring in the US and The Netherlands. METHODS We compared levels of psychopathology in offspring of the Pittsburgh Bipolar Offspring Study (n=224) and the Dutch Bipolar Offspring Study (n=136) (age 10-18). Categorical psychopathology was ascertained through interviews using the Schedule for Affective Disorders and Schizophrenia for School Age Children (K-SADS-PL), dimensional psychopathology by parental reports using the Child Behavior Checklist (CBCL). RESULTS Higher rates of categorical psychopathology were observed in the US versus the Dutch samples (66% versus 44%). We found no differences in the overall prevalence of mood disorders, including BD-I or -II, but more comorbidity in mood disorders in US versus Dutch offspring (80% versus 34%). The strongest predictors of categorical psychopathology were maternal BD (OR: 1.72, p<.05), older age of the offspring (OR: 1.19, p<.05), and country of origin (US; OR: 2.17, p<.001). Regarding comorbidity, only country of origin (OR: 7.84, p<.001) was a significant predictor. In general, we found no differences in dimensional psychopathology based on CBCL reports. LIMITATIONS Preliminary measure of inter-site reliability. CONCLUSIONS We found cross-national differences in prevalence of categorical diagnoses of non-mood disorders in bipolar offspring, but not in mood disorder diagnoses nor in parent-reported dimensional psychopathology. Cross-national variation was only partially explained by between-sample differences. Cultural and methodological explanations for these findings warrant further study.