title: Early symptoms of mania and the role of parental risk.
abstract: OBJECTIVE
  The objectives of this study were to: (i) describe the phenomenology of youths diagnosed with subsyndromal bipolar disorders; (ii) describe the phenomenology of youngsters who are the children of bipolar parents, who are also experiencing subsyndromal symptoms of bipolar disorder (patients with 'cyclotaxia'); and (iii) explore which symptoms may be most useful in identifying youths with cyclotaxia.
  
  
  METHODS
  Four hundred outpatients between the ages of 5 and 17 years received a diagnostic assessment and psychometric questionnaires pertaining to mood symptomatology and psychosocial functioning. Parental diagnostic information was also obtained. Children and adolescents were assigned to one of three diagnostic groups: a 'syndromal bipolar disorder (BP)' group (n = 118), a 'sub-syndromal bipolar (SUB-BP)' group (n = 75), or a 'non-bipolar (NON-BP)' group (n = 207). In addition, based on parental diagnoses, youths were assigned to either a high genetic risk group (n = 167) or a low genetic risk group (n = 233).
  
  
  RESULTS
  Youths with subsyndromal bipolar disorders were found to have intermediate degrees of manic symptoms than youths with bipolar disorder and youths without a bipolar diagnosis. Offspring of parents having a bipolar disorder were more likely to show symptoms of hypomania and mania than youths without a bipolar parent. Youths at genetic risk for developing a bipolar disorder were not found to be at higher risk for having a diagnosis of attention-deficit hyperactivity disorder or a disruptive behavior disorder. Finally, results suggest that elevated mood with irritability and rapid mood fluctuations are the key distinguishing characteristics of 'cyclotaxia'.
  
  
  CONCLUSIONS
  There exists a group of youngsters who are the offspring of a parent/parents with a bipolar disorder who do not suffer from BP 1 or BP 2, yet have elevated mood symptoms and psychosocial dysfunction. As a result of these observations, treatment studies are needed for youths with 'cyclotaxia'.
authors.affiliation: Department of Psychiatry, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106, USA. robert.findling@uhhs.com
authors.forename: Robert L
authors.initials: RL
authors.lastname: Findling
authors.forename: Eric A
authors.initials: EA
authors.lastname: Youngstrom
authors.forename: Nora K
authors.initials: NK
authors.lastname: McNamara
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stansbrey
authors.forename: Christine A
authors.initials: CA
authors.lastname: Demeter
authors.forename: Denise
authors.initials: D
authors.lastname: Bedoya
authors.forename: Shoshana Y
authors.initials: SY
authors.lastname: Kahana
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D001714:Bipolar Disorder / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology* / Q000523:psychology; D002648:Child; D016241:Child of Impaired Parents; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015588:Observer Variation; D010287:Parent-Child Relations; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires