A child whose mom or dad has bipolar disorder is more likely to have episodes that could point to a bipolar diagnosis in the future, and pediatricians and parents should be alert to those signs, according to the lead author of a new study. The research compared 391 Pittsburgh-area children with a bipolar parent to 248 children who did not have a parent with diagnosed bipolar disorder. The kids were 6 to 18 years old, and researchers followed them for an average of almost seven years. The study appears in this week’s American Journal of Psychiatry. Less-severe shorter episodes of manic behavior proved to, in some cases, predict serious problems later in life in the offspring of bipolar parents. That discovery should prompt more-careful monitoring of those kids to be sure they are getting the best mental-health care during critical developmental years, according to the study’s authors. Such episodes, which might not normally trigger a referral to a psychiatrist or consideration of bipolar disorder, should be closely examined in children with a family history, said Dr. David Axelson, who led the study and is medical director of behavioral health and chief of psychiatry at Nationwide Children’s Hospital. “It’s a distinct period of a mood change where they might be excessively happy and or angry or explosively irritable beyond what you would expect,” said Axelson, who moved here from Pittsburgh. “ It’s laughing inappropriately at things they normally wouldn’t find funny, an increase in energy, an inability to sit still, an increase in speed of thinking or talking. Family members will find that it will be hard to understand what the kid’s saying.” And the child might do risky things, such as climbing tall trees, walking on a roof or trying dangerous stunts on a bicycle. The study found that 13.3 percent of the children of parents with bipolar disorder had subthreshold mania or hypomania compared with 1.2 percent of the children whose parents didn’t have a bipolar diagnosis. The kids with bipolar in the family also were much more likely to have full manic, manic-depressive or hypomanic episodes (9.2 percent as compared with less than 1 percent) and major depressive episodes (32 percent versus about 15 percent). About half of the study participants who developed bipolar disorder had a predictive episode before developing the illness. It’s important that doctors and parents not jump to conclusions without strong evidence, Axelson said, because not every child who has tantrums or hyperactive days is at risk. And not every child who has a parent with bipolar disorder will develop the disease. In this study, less than one-fourth of the high-risk children developed bipolar illness by age 21, he said.
Misdiagnosing early signs of bipolar disorder as depression or attention deficit hyperactivity disorder and prescribing drugs based on those diagnoses could create worse problems in a child who is in the early stages of bipolar disorder, Axelson said. Treating a child with medication typically prescribed for bipolar disorder must be done with great care because of significant side effects, he said. Other interventions, including therapy, can be helpful. And children who might have bipolar disorder could often benefit from seeing a psychiatrist trained to sort out the intricacies of the disease, he said. Dr. Melissa DelBello, the chairwoman of psychiatry and behavioral neuroscience at the University of Cincinnati, said the research is important and is the largest prospective look at children at high risk of bipolar compared to those at normal risk. “The future of psychiatry involves early intervention and ultimately prevention strategies,” said DelBello, who was not involved in the research. “I think high-risk populations should be screened.” Laura Moskow Sigal, the executive director of Mental Health America of Franklin County, said pediatricians and family doctors should evaluate the mental health of patients the same way they evaluate physical health and that family history should prompt closer monitoring. “I know pediatricians are moving in that direction, but not all of them are there yet,” she said, adding that parents and teachers play crucial roles because they see the child’s behavior consistently. Early diagnosis can mean the difference between a healthy life with a well-managed disease and a crisis that could upend the lives of the person with bipolar and his or her loved ones, Moskow Sigal said. Said DelBello: “The earlier we intervene and the earlier we identify the bipolar, the less functional impairment there will be.” Beyond helping doctors and parents identify early signs of bipolar, research into this group of families could also help pave the way for better diagnostic tools, including brain imaging and genetic tests, Axelson said. He said he’d like to see this work replicated in a larger group of children.
This article first appeared The Columbus Dispatch, 3 March 2015.