Subthreshold Manic Episodes Precursor of Bipolar Disorder in Children

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Children who experience subthreshold manic episodes have a much higher likelihood of developing bipolar disorder — if their parents have or had the disorders — compared to their peers.

David Axelson, MD, medical director of behavioral health at Nationwide Children’s Hospital in Columbus, Ohio, and colleagues say the study is the first to demonstrate that subthreshold manic episodes — those that come close to what is found in bipolar disorder but do not meet all the criteria — are key risk factors for the development of bipolar disorder and other mental illnesses in high-risk children.

Children of parents with bipolar disorder have substantially higher rates of subthreshold mania or hypomania (13.3 vs. 1.2%); manic, mixed or hypomanic episodes (9.2 vs. 0.8%); and major depressive episodes (32 vs. 14.9%) than their peers, the researchers reported in the American Journal of Psychiatry.

In addition, the cumulative rate of bipolar spectrum disorder at age 21 was 23% in the high-risk group compared to 3.2% in the control group. The mean age of bipolar onset was age 12, with the earliest manic episode found at 8 years old.

“Most children who have a parent with bipolar disorder will have a diagnosable psychiatric disorder, such as attention-deficit disorder, oppositional defiant disorder, an anxiety disorder or depression, at some point during their youth,” Axelson said in a statement. “However, most children who have a parent with bipolar disorder do not develop bipolar disorder.”

Subthreshold Manic Episodes Precursor of Bipolar Disorder in Children
Subthreshold Manic Episodes Precursor of Bipolar Disorder in Children

New research published today in the American Journal of Psychiatry indicates a strong link between subthreshold manic episodes and likelihood of developing bipolar disorder in children of parents with bipolar disorder. The study's findings could improve clinical assessment and care for these high-risk children by potentially enabling earlier identification, treatment or possible preventive measures.

The study is among the first to show that subthreshold manic episodes — experiences that approach but do not meet the cut-offs for full-blown bipolar disorder — are important diagnostic risk factors for the development of bipolar disorder and other mental health conditions in high-risk children. In addition, it found that children of parents with bipolar disorder have substantially higher rates of subthreshold mania or hypomania (13.3 vs 1.2%); manic, mixed or hypomanic episodes (9.2 vs 0.8%); and major depressive episodes (32% vs 14.9%) than community children.

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