Psychiatric phenomenology of child and adolescent bipolar offspring

Objective: To establish prodromal signs of and risk factors for childhood bipolar disorder (BD) by characterizing youths at high risk for ED. Method: Structured diagnostic interviews were performed on 60 biological offspring of at least one parent with ED. Demographics, family histories, and parental history of childhood disruptive behavioral disorders were also assessed. Results: Fifty-one percent of bipolar offspring had a psychiatric disorder, most commonly attention-deficit/hyperactivity disorder (ADHD), major depression or dysthymia, and ED. ED in offspring tended to be associated with earlier parental symptom onset when compared with offspring without a psychiatric diagnosis. Bipolar parents with a history of childhood ADHD were more likely to have children with ED, but not ADHD. Offspring with bilineal risk had increased severity of depressed and irritable mood, lack of mood reactivity, and rejection sensitivity, while severity of grandiosity, euphoric mood, and decreased need for sleep were not preferentially associated with such offspring. Conclusions: Bipolar offspring have high levels of psychopathology. Parental history of early-onset ED and/or childhood ADHD may increase the risk that their offspring will develop ED. Prodromal symptoms of childhood ED may include more subtle presentations of mood regulation difficulties and less presence of classic manic symptoms.