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13-10-2011 | Mental health | Article

Anxiety and externalizing disorders precede adolescent bipolar disorder

Abstract

Free abstract

MedWire News: Childhood anxiety and externalizing disorders, such as attention-deficit hyperactivity disorder (ADHD), are associated with an increased risk for major affective illness in adolescence, research shows.

The results, from a longitudinal study of individuals at risk for bipolar disorder (BD), are reported in the Archives of General Psychiatry by John Nurnberger (Indiana University School of Medicine, Indianapolis, USA) and colleagues.

At present, the childhood precursors of adult BD remain debated, although family history is the strongest predictive factor in the development of the disorder.

In this study, the researchers examined lifetime prevalence and early clinical predictors for psychiatric disorders in 141 high-risk children and adolescents from families of probands with BD.

By age 17 years, the lifetime prevalence of major affective disorder was 23.4% in the high-risk cases and 4.4% in children of mentally healthy controls.

Overall, the prevalence of BD was 8.5% in the high-risk cohort, while no BD was reported in the control group. The adjusted relative risk (RR) for developing BD was more than five times greater in the children of families with BD (RR=5.33), than in those from the families in the control group.

Within the high-risk case cohort, 33 patients manifested major affective disorder, 21 individuals showed signs of minor affective disorder, and 87 individuals did not have affective disorder.

Inhigh-risk children, but not controls, a childhood diagnosis of an anxiety disorder or an externalizing disorder significantly predicted the onset of major affective disorders later in life, at RRs of 2.6 and 3.6, respectively.

Childhood diagnoses of anxiety and externalizing disorders appear to be significant in families with bipolar disorder probands "in that they presaged adolescent development of major affective disorders," state the researchers.

The team concludes that their findings have clinical significance. "They reinforce the importance of family history in evaluating the meaning of diagnoses in children and adolescents, and they support a different monitoring and management strategy for children and adolescents with a positive family history of BP."

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