title: Prevention of bipolar disorder in at-risk children: theoretical assumptions and empirical foundations.
abstract: This article examines how bipolar symptoms emerge during development, and the potential role of psychosocial and pharmacological interventions in the prevention of the onset of the disorder. Early signs of bipolarity can be observed among children of bipolar parents and often take the form of subsyndromal presentations (e.g., mood lability, episodic elation or irritability, depression, inattention, and psychosocial impairment). However, many of these early presentations are diagnostically nonspecific. The few studies that have followed at-risk youth into adulthood find developmental discontinuities from childhood to adulthood. Biological markers (e.g., amygdalar volume) may ultimately increase our accuracy in identifying children who later develop bipolar I disorder, but few such markers have been identified. Stress, in the form of childhood adversity or highly conflictual families, is not a diagnostically specific causal agent but does place genetically and biologically vulnerable individuals at risk for a more pernicious course of illness. A preventative family-focused treatment for children with (a) at least one first-degree relative with bipolar disorder and (b) subsyndromal signs of bipolar disorder is described. This model attempts to address the multiple interactions of psychosocial and biological risk factors in the onset and course of bipolar disorder.
authors.affiliation: Department of Psychology, University of Colorado at Boulder, Boulder, CO 80309, USA. david.miklowitz@colorado.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
authors.forename: Kiki D
authors.initials: KD
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect / Q000502:physiology; D000679:Amygdala / Q000473:pathology; D000927:Anticonvulsants / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology / Q000517:prevention & control; D001714:Bipolar Disorder / Q000175:diagnosis / Q000235:genetics* / Q000503:physiopathology / Q000517:prevention & control*; D001921:Brain / Q000503:physiopathology; D002648:Child; D003131:Combined Modality Therapy; D003527:Cyclothymic Disorder / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology / Q000517:prevention & control; D042241:Early Diagnosis; D005196:Family Therapy; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D008016:Life Change Events; D012307:Risk Factors; D018433:Twin Studies as Topic; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid