MedWire News: The children of bipolar disorder parents face the highest risk for mood episodes during adolescence, with depression almost always the index episode, the results of a Canadian and Czech study indicate.

There is currently little information on the early clinical stages of bipolar disorder, with descriptions of onset and early course reliant largely on patient recall, explain Anne Duffy, from Dalhousie University in Halifax, Canada, and colleagues.

To investigate further, the team studied 207 children aged 8–25 years from 105 families with parents who had known bipolar disorder. The children completed the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version at enrolment, annually, and at any time symptoms developed until their 30th birthday, with each child followed-up for 1–15 years.

In all, 67 participants met the criteria for one or more major mood episodes. The average age at analysis was 24 years and the average age of onset was 17 years, with no child experiencing onset before 12 years of age.

In 90% of cases, the first episode was major depression, and 61 patients had a remitting or partially remitting episode course. Among remitting patients, 89% of first episodes were depressive, compared with 68% of second episodes, 78% of third episodes, and 58% of fourth episodes.

The average duration of first depressive episodes among remitting or partially remitting patients was 6.1 months, compared with 1.7 months for the first hypomanic/manic or mixed episode. The average cycle length was 26.3 months.

Analysis revealed an increase risk for new onsets of major mood episodes from age 12 years that continued to 30 years of age. A similar pattern was seen for recurrence risk, at a risk for recurrence of 61% by 5 years.

The researchers write in the British Journal of Psychiatry: “These findings emphasize the need to identify children at familial risk for bipolar disorder and to provide continuity of expert psychiatric surveillance and assessment over this period.

“This involves programs spanning child and adult institutions, and close collaboration between child and adult psychiatry services.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

Free abstract