Get access

Early symptoms of mania and the role of parental risk

Authors


  • RLF receives or has received research support, acted as a consultant or served on a speakers bureau for Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Celltech-Medeva, Forest, GlaxoSmithKline, Johnson & Johnson, Eli Lilly & Co, New River, Novartis, Otsuka, Pfizer, Sanofi-Synthelabo, Shire, Solvay, and Wyeth. EAY has received research support from Abbott Laboratories. JRC has received research support, acted as a consultant or served on a speakers bureau for Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co, GlaxoSmithKline, Janssen, Merck, Otsuka, Pfizer, and Teva. NKMcN, RJS, CAD, DB, and SYK have no financial ties to disclose.

Robert L Findling, MD, Division of Child & Adolescent Psychiatry, University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH 44106-5080, USA. Fax: (216) 844 7090; e-mail: robert.findling@uhhs.com

Abstract

Objectives:  The objectives of this study were to: (i) describe the phenomenology of youths diagnosed with subsyndromal bipolar disorders; (ii) describe the phenomenology of youngsters who are the children of bipolar parents, who are also experiencing subsyndromal symptoms of bipolar disorder (patients with ‘cyclotaxia’); and (iii) explore which symptoms may be most useful in identifying youths with cyclotaxia.

Methods:  Four hundred outpatients between the ages of 5 and 17 years received a diagnostic assessment and psychometric questionnaires pertaining to mood symptomatology and psychosocial functioning. Parental diagnostic information was also obtained. Children and adolescents were assigned to one of three diagnostic groups: a ‘syndromal bipolar disorder (BP)’ group (n = 118), a ‘sub-syndromal bipolar (SUB-BP)’ group (n = 75), or a ‘non-bipolar (NON-BP)’ group (n = 207). In addition, based on parental diagnoses, youths were assigned to either a high genetic risk group (n = 167) or a low genetic risk group (n = 233).

Results:  Youths with subsyndromal bipolar disorders were found to have intermediate degrees of manic symptoms than youths with bipolar disorder and youths without a bipolar diagnosis. Offspring of parents having a bipolar disorder were more likely to show symptoms of hypomania and mania than youths without a bipolar parent. Youths at genetic risk for developing a bipolar disorder were not found to be at higher risk for having a diagnosis of attention-deficit hyperactivity disorder or a disruptive behavior disorder. Finally, results suggest that elevated mood with irritability and rapid mood fluctuations are the key distinguishing characteristics of ‘cyclotaxia’.

Conclusions:  There exists a group of youngsters who are the offspring of a parent/parents with a bipolar disorder who do not suffer from BP 1 or BP 2, yet have elevated mood symptoms and psychosocial dysfunction. As a result of these observations, treatment studies are needed for youths with ‘cyclotaxia’.

Ancillary