Prospective study of prodromal features for bipolarity in well Amish children.
OBJECTIVE
A prospective study of psychiatrically well Amish children to determine differences in the frequency and pattern of clinical features that may be prodromal for bipolar I disorder.


METHODS
Children with a bipolar I parent (n = 100) and children of well parents in a matched control sample (n = 110) were assessed annually for 7 years with semistructured interviews covering medical/developmental features and symptoms/behaviors that are possibly prodromal for bipolarity. Randomized histories of these 210 children were evaluated blindly by 4 clinicians for independent ratings of risk for bipolarity.


RESULTS
Thirty-eight percent of the children of bipolar parents were rated as at risk compared with 17% of children in the control sample. Most control sample children with risk ratings had well parents with a bipolar sibling (i.e., family history positive). Children with family histories negative for mental illness rarely received even a low risk rating. Clinical features significantly (p <or=.05) more frequent among children of a bipolar parent included mood lability, low energy, anxious/worried, hyper-alert, attention problems/distractible and school role impairment, easily excited, sensitivity, somatic complaints, and stubborn/determined.


CONCLUSIONS
Mini-clusters of early possible predictors suggest a natural history of episodic prodromal features rather than the chronic symptom pattern sometimes described for children at risk for bipolar disorder.
Egeland
Janice A
JA
Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, USA.
Shaw
Jon A
JA
Endicott
Jean
J
Pauls
David L
DL
Allen
Cleona R
CR
Hostetter
Abram M
AM
Sussex
James N
JN
D000293:Adolescent; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology; D002908:Chronic Disease; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires