Preliminary communicationPsychotic symptoms in pediatric bipolar disorder and family history of psychiatric illness
Introduction
Pediatric Bipolar Disorder (BP) is associated with higher rates of psychosis as compared to later onset BP (Pavuluri et al., 2004). Presentation of psychosis in pediatric BP is clinically significant and indicative of poorer functioning and course (Pavuluri et al., 2004, Pavuluri et al., 2005). Given the prevalence and prognostic significance of psychotic presentation in pediatric BP, it is of importance to determine if there are unique etiological factors associated with its emergence.
Prior work on adolescent and adult samples has examined if there are patterns of familial aggregation that discriminate presence versus absence of psychotic symptoms in individuals with BP. One line of evidence suggests some specificity of familial aggregation for psychosis in BP families, with reports of increased rates of schizophrenia (Valles et al., 2000) and psychotic symptoms (Potash et al., 2003) in pedigrees of BP probands with psychosis. In contrast, a community study of adult BP probands reported that schizophrenia and psychotic symptoms in BP pedigrees were not associated with presence versus absence of psychotic symptoms in the BP probands (Rende et al., 2005). Less attention has been given to familial loading for other psychiatric disorders.
To date, family studies of psychosis in BP have been limited to adolescent and adult cohorts. This paper utilizes a bottom-up design in the ongoing multi-site (University of Pittsburgh, Brown University, University of California at Los Angeles) collaborative NIMH funded study Course and Outcome of Bipolar Illness in Youth (COBY; Birmaher et al., 2006). The family history method was used to collect information on a wide range of psychiatric disorders in first degree relatives of pediatric BP probands with onset in childhood and adolescence. We utilized this sample to examine if lifetime presence/absence of psychosis in BP probands was associated with family history of psychiatric disorders.
Section snippets
Participants
Children and adolescents ages 7 to 17 years 11 months (M = 12.8; SD = 3.2) whose primary diagnoses were Diagnostic and Statistical Manual-IV (DSM-IV) BP-I, BP-II, or an operationalized definition of BP-NOS, and their parents were enrolled in the COBY (Axelson et al., in press, Birmaher et al., 2006). Subjects were recruited from consecutive admissions to outpatient (64.6%) and inpatient (16.3%) services, advertisement (11.4%), and referrals from other physicians (7.6%), and were enrolled
Results
We first examined if presence/absence of psychosis was associated with demographic variables as well as comorbid psychiatric disorders in probands to determine possible confounds in the association between psychosis and family loading for psychiatric disorders. As shown in Table 1, there were no significant differences between the proband groups on demographic variables (sex, race, ethnicity, SES). Probands with psychosis had higher rates of BP-I, comorbid anxiety disorders, panic disorder, and
Discussion
This study suggests that familial loading for a spectrum of internalizing disorders is associated with presentation of psychotic symptoms in pediatric BP. Such a viewpoint was supported by controlling for the elevated rates of comorbid disorders in probands with psychosis, including anxiety disorders, panic disorder, and suicide attempt. The significance of the adjusted odds ratios argues against a specific familial co-aggregation of comorbid presentation and rather supports the idea of a
Acknowledgement
This work was supported by grants MH59929 (Dr. Birmaher), MH59977 (Dr. Strober) and MH59691 (Dr. Keller) from the National Institute of Mental Health. The authors would like to thank Carol Kostek for her assistance with manuscript preparation, COBY faculty: Kristin Bruning MD; Jennifer Dyl PhD. Raters: Mathew Arruda BA; Mark Celio BA; Jennifer Fretwell BA; Michael Henry BS; Risha Henry PhD; Norman Kim PhD; Marguerite Lee BA; Marilyn Matzko EdD; Heather Schwickrath MA; Anna Van Meter BA; Matthew
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