Characteristics of youth at high risk for bipolar disorder compared to youth with bipolar I or II disorder.

Significant efforts have been undertaken to characterize the phenomenology of the high-risk period for bipolar disorder (BD) through the examination of youth at familial risk (i.e., having a first- or second-degree relative with BD) or clinical high risk for the disorder (i.e., youth with BD Not Otherwise Specified [NOS] or major depressive disorder [MDD]). However, little is known about the phenomenology of youth at both familial and clinical high risk for BD. In this study, we examined the clinical and psychosocial characteristics of youth at familial and clinical high risk (HR) for BD, and compared these characteristics to those of youth with BD I and II. Both groups were recruited based on current, active mood symptoms from separate randomized trials of family therapy. A total of 127 HR youth were evaluated: 52 (40.9%) were diagnosed with BD-NOS and 75 (59.1%) were diagnosed with MDD. Compared to adolescents with BD I and II (n = 145), HR youth had higher rates of anxiety disorders, and comparable rates of attention-deficit/hyperactivity disorder and oppositional defiant disorder/conduct disorder. Manic symptom severity and psychosocial functioning were progressively more impaired consistent with diagnostic severity: BD I > BD II > BD-NOS > MDD. Nonetheless, HR youth exhibited depressive symptom severity that was comparable to adolescents with BD I. These results provide further support for the high rates of anxiety disorders and premorbid dysfunction in addition to active mood symptoms for youth at risk for BD, and suggest anxiety is an important phenomenological characteristic and treatment target in the high-risk period.

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Declaration of competing interest The authors declare no conflicts of interest. Dr. Weintraub receives research support from Aim for Mental Health and the Shear Family Foundation. Dr. Schneck receives research support from the NIMH and the Ryan White HIV/AIDS Treatment Extension Act. Dr. Walshaw has no disclosures. Dr. Chang is a consultant for Sunovion, Allergan, and Impel Neuropharma; he is also on the speakers' bureau for Sunvion. Dr. Singh receives research support from Stanford's Maternal Child Health Research Institute, National Institute of Mental Health, National Institute of Aging, Johnson and Johnson, Allergan, and the Brain and Behavior Research Foundation. She is on the advisory board for Sunovion, is a consultant for Google X and Limbix, and receives royalties from the American Psychiatric Association Publishing. Dr. Axelson receives royalties from UpToDate and has served as a consultant for Janssen Research. Dr. Birmaher has received research support from NIMH and receives royalties from Random House, Lippincott Williams & Wilkins, and UpToDate. Dr. Miklowitz has received research funding from the NIMH, Brain and Behavior Research Foundation, Attias Family Foundation, Danny Alberts Foundation, Carl and Roberta Deutsch Foundation, Kayne Family Foundation, Max Gray Foundation, American Foundation for Suicide Prevention, and AIM for Mental Health. He receives book royalties from Guilford Press and John Wiley & Sons.