Toward the definition of a bipolar prodrome: Dimensional predictors of bipolar spectrum disorders in at-risk youths

  • Hafeman D
  • Merranko J
  • Axelson D
 et al. 
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Objective: The authors sought to assess dimensional symptomatic\r
predictors of new-onset bipolar spectrum disorders in\r
youths at familial risk of bipolar disorder (“at-risk” youths).\r
Method: Offspring 6–18 years old of parents with bipolar\r
I or II disorder (N=359) and community comparison offspring\r
(N=220) were recruited. At baseline, 8.4% of the offspring of\r
bipolar parents had a bipolar spectrum disorder. Over 8 years,\r
14.7% of offspring for whom follow-up data were available\r
(44/299) developed a new-onset bipolar spectrum disorder\r
(15 with bipolar I or II disorder). Measures collected at baseline\r
and follow-up were reduced using factor analyses, and\r
factors (both at baseline and at the visit prior to conversion or\r
last contact) were assessed as predictors of new-onset bipolar\r
spectrum disorders.\r
Results: Relative to comparison offspring, at-risk and bipolar\r
offspring had higher baseline levels of anxiety/depression,\r
inattention/disinhibition, externalizing, subsyndromal manic,\r
and affective lability symptoms. The strongest predictors\r
of new-onset bipolar spectrum disorders were baseline\r
anxiety/depression, baseline and proximal affective lability,\r
and proximal subsyndromal manic symptoms (p,0.05).\r
While affective lability and anxiety/depression were elevated\r
throughout follow-up in those who later developed a bipolar\r
spectrum disorder,manic symptoms increased up to the point\r
of conversion. A path analysis supported the hypothesis that\r
affective lability at baseline predicts a new-onset bipolar\r
spectrum disorder in part through increased manic symptoms\r
at the visit prior to conversion; earlier parental age\r
at mood disorder onset was also significantly associated\r
with an increased risk of conversion. While youths without\r
anxiety/depression, affective lability, and mania (and with a\r
parent with older age at mood disorder onset) had a 2%\r
predicted chance of conversion to a bipolar spectrum disorder,\r
those with all risk factors had a 49% predicted chance\r
of conversion.\r
Conclusions: Dimensional measures of anxiety/depression,\r
affective lability, and mania are important predictors of newonset\r
bipolar spectrum disorders in at-risk youths. These\r
symptoms emerged from among numerous other candidates,\r
underscoring the potential clinical and research utility\r
of these findings.

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  • Danella M. Hafeman

  • John Merranko

  • David Axelson

  • Benjamin I. Goldstein

  • Tina Goldstein

  • Kelly Monk

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