title: Prospective study of prodromal features for bipolarity in well Amish children.
abstract: 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.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, USA.
authors.forename: Janice A
authors.initials: JA
authors.lastname: Egeland
authors.forename: Jon A
authors.initials: JA
authors.lastname: Shaw
authors.forename: Jean
authors.initials: J
authors.lastname: Endicott
authors.forename: David L
authors.initials: DL
authors.lastname: Pauls
authors.forename: Cleona R
authors.initials: CR
authors.lastname: Allen
authors.forename: Abram M
authors.initials: AM
authors.lastname: Hostetter
authors.forename: James N
authors.initials: JN
authors.lastname: Sussex
mesh_terms: 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