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Clinical differences between patients with pediatric bipolar disorder with and without a parental history of bipolar
Bruno Raffa Ramos1, Diego Librenza-Garcia2, Franco Zortea3
1Pediatric Bipolar Disorder Research Program, ProCAB and Laboratory of Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento - Faculdade de Medicina, UFRGS, Porto Alegre, RS, Brazil.
Insights
Pediatric Bipolar Disorder (PBD) with a parental history shows higher ADHD comorbidity and earlier onset. These findings suggest PBD patients with a family history may represent a distinct clinical subtype.
Area of Science:
- Child and Adolescent Psychiatry
- Genetics of Mental Disorders
- Pediatric Mental Health
Background:
- Pediatric Bipolar Disorder (PBD) is highly heritable, accounting for 18% of pediatric mental health hospitalizations.
- Limited research explores clinical differences in PBD based on parental history of Bipolar Disorder (BD).
- The contribution of heritability to attentional deficits in PBD remains unclear.
Purpose of the Study:
- To investigate clinical differences in Pediatric Bipolar Disorder (PBD) between youth with and without a parental history of Bipolar Disorder (BD).
- To examine the association between parental history of BD and attentional deficits (ADHD) in pediatric patients.
- To explore if PBD patients with a parental history represent a distinct endophenotype.
Main Methods:
- Assessed 61 youth (6-17 years) with PBD: 27 with a parental history of BD and 31 without.
- Utilized standardized assessments including the K-SADS-PL-W, administered by child and adolescent psychiatrists.
- Employed a logistic multivariate model analyzing ADHD, rapid cycling, and lifetime psychosis.
Main Results:
- ADHD comorbidity rates were significantly higher in PBD patients with a parental history of BD.
- A trend towards earlier symptom onset was observed in PBD patients with a parental history of BD.
- No significant differences were found in suicide attempts, rapid cycling, or psychosis rates among PBD offspring.
Conclusions:
- PBD patients with a parental history of BD may exhibit a distinct clinical presentation or endophenotype.
- Parental history of BD is associated with increased ADHD comorbidity and earlier symptom onset in pediatric patients.
- Further longitudinal and larger-scale studies are warranted to validate these findings.
Abstract:
Pediatric Bipolar Disorder (PBD) is a highly heritable condition responsible for 18% of all pediatric mental health hospitalizations. Despite the heritability of this disorder, few studies have assessed potential differences in the clinical manifestation of PBD among patients with a clear parental history of BD. Additionally, while recent studies suggest that attentional deficits are a potential endophenotypic marker of PBD, it is unclear whether heritability is a relevant contributor to these symptoms. In order to address this gap, the present study assessed 61 youth with PBD (6-17 years old), corresponding to 27 offspring of BD patients, and 31 PBD patients without a parental history of the disorder. All standardized assessments, including the K-SADS-PL-W were performed by trained child and adolescent psychiatrists. We performed a logistic multivariate model using the variables of ADHD, rapid cycling, and lifetime psychosis. Rates of ADHD comorbidity were significantly higher among PBD patients who had a parent with BD. Furthermore, PBD patients who had a parent with BD showed a trend toward significance of earlier symptom onset. PBD offspring did not show increased rates of suicide attempts, rapid cycling, or psychosis. Given these findings, it appears that PBD patients who have a parent with BD may represent a distinct endophenotype of the disorder. Future longitudinal and larger studies are required to confirm our findings.
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