Early Risk Factors for BP in Adolescents With Mood Disorders
Early Risk Factors for BP in Adolescents With Mood Disorders
Numerous studies have shown that adolescents with mood disorders are at an increased risk of continued mood disorders in early adulthood. However, the presence of (hypo)manic symptoms during childhood and adolescence does not necessarily indicate a continuing course of bipolar disorder (BPD) in adulthood. The early signs that predict the continued course of adolescent mood disorders are not well established. Thus, we do not know which adolescents with a mood disorders will develop BPD, major depressive disorder (MDD), or neither as adults.
BPD is a severe condition associated with substantial impairments in emotional, cognitive, and social functioning. An increased knowledge regarding the early signs of BPD might provide insight regarding the development of the mood disorder and help identify individuals at risk of developing BPD and enable early intervention.
Adolescent BPD is associated with early signs such as mood lability or swings, anxiety, hyperarousal, somatic complaints, behavioral dysregulation, attention difficulties and school problems. Several studies have investigated whether the early signs of psychopathology predict BPD later in life. Numerous studies have demonstrated high rates of developing mania among children or adolescents with depression. Therefore, early-onset depressive symptoms or MDD might predict later BPD. Disruptive behavioral disorders, in combination with mood changes, have been identified as more specific markers of the early onset of BPD. In addition, previous authors have found that the presence of anxiety disorders, especially panic disorder, might be a marker of the early onset of BPD.
Still, the best-established early marker of BPD risk remains family history. This factor has been widely accepted in clinical practice, despite the fact that the majority of the high-risk offspring of individuals with mood disorders do not develop BPD. However, a large proportion of offspring develop other mental disorders.
The clinical usefulness of the early markers/premorbid problems as predictors of subsequent BPD has not been proven. The generally high frequency of pre-morbidities and comorbidities between adolescent mood disorders, externalizing disorders and internalizing disorders raises questions regarding the relevance of these disorders for the continued disease course.
To summarize, conclusive findings within this area of research are sparse and additional research is needed. The present study is based on a unique community sample of adolescents with mood disorders, followed up after 15 years. Although previous publications form this cohort have not focused on the potential risk factors of BPD, certain results have indicated that specific factors might be important. We have shown that long-term adolescent depression strongly predicts both continued MDD and BPD in adulthood. In another publication, we reported that multiple somatic symptoms in adolescence independently predict both continued MDD and BPD in adulthood. Depressed adolescents with more than four somatic symptoms had particularly poor outcomes, with high rates of severe, recurrent, and chronic depression or BPD. Somewhat surprisingly, we also found, that adolescents with hypomania spectrum episodes did not have a higher risk of BPD in adulthood compared with those with only MDD. On the other hand, a family history of BPD appears to predict BPD in adulthood. Adolescents with either hypomania spectrum disorder or MDD, who also had a 1 - and/or 2 - degree family member with BPD, were more likely to have BPD as adults compared with those without this history. Adolescents with MDD and a 1 - and/or 2 - degree relative with BPD were more likely to develop BPD versus those with MDD and no such history. Similarly, adolescents with hypomania spectrum disorder tended to have (hypo)mania episode(s) in adulthood if they had a 1 - and/or 2 - degree family member with BPD.
The present study includes a range of potential child and adolescent risk factors for developing BPD. Our overarching aim was to identify the early risk factors of adult BPD (compared with MDD or no mood episodes in adulthood) among individuals with adolescent mood episodes. We investigated the potential risk factors for the following:
Background
Numerous studies have shown that adolescents with mood disorders are at an increased risk of continued mood disorders in early adulthood. However, the presence of (hypo)manic symptoms during childhood and adolescence does not necessarily indicate a continuing course of bipolar disorder (BPD) in adulthood. The early signs that predict the continued course of adolescent mood disorders are not well established. Thus, we do not know which adolescents with a mood disorders will develop BPD, major depressive disorder (MDD), or neither as adults.
BPD is a severe condition associated with substantial impairments in emotional, cognitive, and social functioning. An increased knowledge regarding the early signs of BPD might provide insight regarding the development of the mood disorder and help identify individuals at risk of developing BPD and enable early intervention.
Adolescent BPD is associated with early signs such as mood lability or swings, anxiety, hyperarousal, somatic complaints, behavioral dysregulation, attention difficulties and school problems. Several studies have investigated whether the early signs of psychopathology predict BPD later in life. Numerous studies have demonstrated high rates of developing mania among children or adolescents with depression. Therefore, early-onset depressive symptoms or MDD might predict later BPD. Disruptive behavioral disorders, in combination with mood changes, have been identified as more specific markers of the early onset of BPD. In addition, previous authors have found that the presence of anxiety disorders, especially panic disorder, might be a marker of the early onset of BPD.
Still, the best-established early marker of BPD risk remains family history. This factor has been widely accepted in clinical practice, despite the fact that the majority of the high-risk offspring of individuals with mood disorders do not develop BPD. However, a large proportion of offspring develop other mental disorders.
The clinical usefulness of the early markers/premorbid problems as predictors of subsequent BPD has not been proven. The generally high frequency of pre-morbidities and comorbidities between adolescent mood disorders, externalizing disorders and internalizing disorders raises questions regarding the relevance of these disorders for the continued disease course.
To summarize, conclusive findings within this area of research are sparse and additional research is needed. The present study is based on a unique community sample of adolescents with mood disorders, followed up after 15 years. Although previous publications form this cohort have not focused on the potential risk factors of BPD, certain results have indicated that specific factors might be important. We have shown that long-term adolescent depression strongly predicts both continued MDD and BPD in adulthood. In another publication, we reported that multiple somatic symptoms in adolescence independently predict both continued MDD and BPD in adulthood. Depressed adolescents with more than four somatic symptoms had particularly poor outcomes, with high rates of severe, recurrent, and chronic depression or BPD. Somewhat surprisingly, we also found, that adolescents with hypomania spectrum episodes did not have a higher risk of BPD in adulthood compared with those with only MDD. On the other hand, a family history of BPD appears to predict BPD in adulthood. Adolescents with either hypomania spectrum disorder or MDD, who also had a 1 - and/or 2 - degree family member with BPD, were more likely to have BPD as adults compared with those without this history. Adolescents with MDD and a 1 - and/or 2 - degree relative with BPD were more likely to develop BPD versus those with MDD and no such history. Similarly, adolescents with hypomania spectrum disorder tended to have (hypo)mania episode(s) in adulthood if they had a 1 - and/or 2 - degree family member with BPD.
The present study includes a range of potential child and adolescent risk factors for developing BPD. Our overarching aim was to identify the early risk factors of adult BPD (compared with MDD or no mood episodes in adulthood) among individuals with adolescent mood episodes. We investigated the potential risk factors for the following:
adult BPD among individuals with previous mood episodes (either MDD or hypomania spectrum episodes) during adolescence;
the development of adult BPD among those with adolescent hypomania spectrum episodes; and
the development of adult BPD among those with adolescent MDD.
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