Manic Symptoms May Pass from Bipolar Parent to Child

Children born to parents with bipolar disorder have a strong likelihood of experiencing episodes of manic symptoms themselves.

Researchers from Nationwide Children’s Hospital in Columbus, Ohio, compared 391 children aged 6 to 18 years who were born to bipolar parents with 248 demographically matched children whose parents did not have bipolar disorder. The study, which was published in the American Journal of Psychiatry, was conducted to identify diagnostic risk factors of manic, mixed, or hypomanic episodes in the so-called high-risk offspring of bipolar parents.

Children were evaluated longitudinally with diagnostic instruments used by staff blind to the parents’ diagnoses. Diagnostic standards for parents were based on the Structured Clinical Interview for DSM-IV, while those for children relied on the Schedule for Affective Disorders and Schizophrenia for School Age Children. Nearly all of the children completed follow-up assessments with a mean duration of about 7 years.

High-risk offspring had significantly higher rates of subthreshold mania or hypomania compared with their community peers (13.3% versus 1.2%), which also held true for manic, mixed, or hypomanic episodes (9.2% versus 0.8%) and major depressive episodes (32% versus 14.9%).

"Mental health practitioners should carefully assess for short episodes of manic symptoms, major depression, and disruptive behavior disorders in high-risk children, as these are risk factors for the future onset of bipolar disorder,” explained senior author David Axelson, MD, in a press release. “This may be particularly important if medication is going to be used for treating mood or behavioral symptoms in the child, because some medications might increase the risk of developing mania or psychotic symptoms in someone who is already at very high risk for developing bipolar disorder. Prescribers might choose different medication options, or use lower doses and monitor for problems more closely.”

In addition to bipolar disorder, the rates of other psychiatric conditions were higher in the high-risk offspring group compared with the normal-risk children, including attention deficit hyperactivity disorder (ADHD) (30.7% versus 18.1%), disruptive behavior disorders (27.4% versus 15.3%), anxiety disorders (39.9% versus 21.8%), and substance abuse disorders (19.9% versus 10.1%). However, major depression with no bipolarity was relatively similar in both the high-risk and normal-risk groups.

“Most children who have a parent with bipolar disorder will have a diagnosable psychiatric disorder, such as ADHD, oppositional defiant disorder, an anxiety disorder, or depression, at some point during their youth. However, most children who have a parent with bipolar disorder do not develop bipolar disorder,” Dr. Axelson continued. “Short, distinct episodes of manic symptoms were the most specific predictor of developing bipolar disorder in high-risk offspring. But, so far, many children with these short manic episodes have not progressed to full-fledged bipolar disorder.”