Family History Of Bipolar Disorder Research Articles

Course of bipolar disorder in patients with Childhood maltreatment

IntroductionPatients with mood disorders have the greater frequency of childhood trauma compared with the general population, and adverse childhood experiences can exert a negative impact on their clinical course. Therefore, many studies confirmed the relationship between childhood traumas and the disadvantageous features of the illness course.ObjectivesThe aim of this study was to determine the impact of negative childhood experiences on the clinical course of bipolar disorder.MethodsIt was a cross-sectional descriptive and analytical study involving patients diagnosed with bipolar disorder and followed in the psychiatric department at the University Hospital of Sfax (Tunisia).Personal information form and Childhood trauma questionnaire (CTQ) were used for data acquisition. Euthymia was defined as a score on the Montgomery-Åsberg Depression Rating Scale (MADRS) not higher than 14 and by a score on the Young Mania Rating Scale (YMRS) not higher than seven.ResultsWe included 35 patients. Their mean age was 46.69 ± 12.01 years with a sex ratio (M/F)=0.45.The average onset of bipolar disorder was 28.37±10.26 years and the average disease duration was 18.26 ± 11.55 years.Almost the third of our population had a suicidal attempt (31.42%) and a violence history (28.57%). A family history of bipolar disorder was found in 57.14% of the patients.The patients have been hospitalized at least once in 42.85% of cases.Our patients have presented psychotic symptoms in 51.42% of cases and mixed characteristics in 57.14% of cases.Emotional, physical and sexual abuse were reported by 42.85%, 37.14% , 31,42% of patients, respectively, while 74,28% and 42.85% of patients reported physical neglect and emotional neglect.Early age at illness onset was significantly associated with total CTQ score (p=0.014) and the subtype sexual abuse (p=0.009). The presence of psychotic symptomswas significantly associated with total CTQ score (p=0.003) and emotional neglect (p=0.025). Physical neglect was associated with mixed characteristics (p=0.015). Emotional abuse was associated with a greater number of hospitalisations (p=0.023).ConclusionsOur results suggest that childhood trauma is associated with a more severe course of bipolar illness. Clinical assessment of patients with bipolar disorder should include investigation of exposure to childhood trauma in order to determine appropriate therapeutic strategies.Disclosure of InterestNone Declared

Resting-state Fronto-limbic Connectivity in Unipolar Depressive Patients as a Predictor for Sporadic Conversion to (Hypo)mania

IntroductionPatients with a bipolar disorder (BD) may experience one or several episodes of major depression before transitioning into a manic phase. Given that treatment with common antidepressants may exacerbate symptoms of mania in patients with BD, initial diagnosis of major depressive disorder (MDD) is a significant issue affecting BD patients. Currently, a family history of BD is used as an early identifier for BD, but as genetic factors associated with BD confer susceptibility to a wide range of psychiatric illnesses, this approach lacks specificity. Thus, there is a pressing need for a biomarker which specifically predicts development of bipolar symptoms in patients with MDD, rather than a trait vulnerability to psychiatric disorderObjectives The aim of this study is to assess alterations in fronto-limbic function that exist prior to the manifestation of the first manic episode in BD patients without familial predisposition for BD.MethodsTo identify a biomarker for conversion to BD we performed a study in a naturalistic sample of MDD patients without a familial risk for BD, which were followed for 9 years. We used a seed-based functional connectivity analysis to assess differences in resting-state fronto-limbic connectivity between MDD patients who converted to BD during the follow-up period (n = 11), and non-converting MDD patients (n = 56).ResultsClusters of significantly reduced functional connectivity were found in the fronto-limbic network of prospective converters relative to non-converters.ConclusionsFindings suggest that alterations of fronto-limbic functional connectivity during episodes of depression predate and associate with conversion to BD later in life, in the absence of familial risk. These fronto-limbic functional connectivity disturbances may be of interest for diagnosing early-stage BD, and may offer insight in the mechanisms that drive conversion in the absence of familial predisposition. Findings from this study need to be verified through large-scale longitudinal imaging studies in naturalistic cohorts of MDD patients.Disclosure of InterestNone Declared

Special Report: Bipolar Disorder II—Frequently Neglected, Misdiagnosed

Special Report: Bipolar Disorder II—Frequently Neglected, Misdiagnosed

Postpartum-onset obsessive-compulsive disorder: A harbinger of bipolar disorder.

Postpartum-onset obsessive-compulsive disorder: A harbinger of bipolar disorder.

Long-term treatment of adult ADHD in a naturalistic setting: clinical predictors of attrition, medication choice, improvement, and response

Objectives: The aim of this study was to identify clinical predictors of treatment attrition, medication choice, improvement and response to pharmacotherapy in adult attention-deficit/hyperactivity disorder (ADHD). Methods: 150 ADHD patients were enrolled and naturalistically followed-up for at least 4 months. Conners’ Adult ADHD Rating Scales–Observer: Screening Version (CAARS-O:SV) were used to measure ADHD severity. Results: 58 subjects (38.7%) were lost at follow-up, while 75 (50%) completed follow-up assessment, on average after 26.05 ± 11.99 weeks; 35 were treated with atomoxetine (ATX) and 40 with methylphenidate (MPH). Treatments were moderately effective (d = 0.72) and 37 patients (49.3%) were responders (≥30% CAARS-O:SV decrease). Patients lost at follow-up had lower inattentive symptoms, less generalized anxiety and family history of bipolar disorder, more amphetamine use disorder than follow-up completers. Compared to ATX-treated subjects, MPH-treated patients had greater severity of hyperactivity/impulsivity and were more frequently diagnosed with alcohol use disorder. While MPH and ATX showed similar efficacy, more pronounced improvements were observed in patients with combined ADHD, anxiety and substance use disorders. ADHD severity and comorbid substance use positively predicted response. Conclusions: Consensus-based hierarchical treatment of ADHD comorbidity is not consistently supported. Comorbid anxiety, mood and substance use disorders should not discourage the treatment of adult ADHD.

Revisiting the concept of bipolar depression: comparison of diagnostic validators between melancholic and non-melancholic episodes.

The current definition of bipolar disorder derives with minimal changes from one that emerged through expert consensus in the late 1970s, and the topic of its validity tended to be neglected in the literature. The aim of this exploratory study was to compare patients with bipolar disorder with a history of melancholic and non-melancholic depressive episodes in a series of external diagnostic validators. One hundred eight subjects were categorized as melancholic or non-melancholic in relation to their history of depressive episodes through the clinician-rated Sydney Melancholia Prototype Index (SMPI). The external validators used were clinical-demographic variables, family history of bipolar disorder, neurocognitive performance and functional outcome. There were 43.5% of the patients with a history of melancholia and 56.5% of non-melancholic depression. Non-melancholic depressions were overrepresented in females, while melancholic depressions had a female:male ratio closer to unity. Patients with melancholia had more history of BD in first-degree relatives and better functional outcome than those with non-melancholic depression. There were no differences between groups regarding neurocognitive performance. Results tended to be unchanged when controlled for confounders. Our preliminary results highlight the inherent heterogeneity in the current concept of bipolar depression, and suggest the need for further clinical research to elucidate its validity.

The Mood Disorder Assessment Schedule: Initial validation of a new measure for early identification of bipolar spectrum disorders in inpatient adolescents

Due to the significant impairment associated with subthreshold bipolar symptomatology and the harmful effects of delayed diagnosis, there is a great need for diagnostic tools that can facilitate early identification of bipolar spectrum disorders. The Mood Disorder Assessment Schedule (MDAS) is a newly developed measure that focuses on autonomous changes in mood and energy, a key indicator of bipolar spectrum problems which is not included in current diagnostic tools for bipolar disorders. The current study tested the ability of the MDAS to identify individuals at risk for bipolar spectrum disorders. In a cross-sectional sample of 396 inpatient adolescents, the MDAS identified a group of individuals with several bipolar spectrum disorder (BSD) indicators, including greater manic and depressive symptoms, affective lability, suicidal behavior, adverse reactions to antidepressants, and a family history of bipolar disorder and suicidal behavior. When compared to a standard diagnostic interview for bipolar disorders (i.e., Kiddie Schedule for Affective Disorders and Schizophrenia [KSADS]), the MDAS yielded stronger clinical utility in its ability to identify individuals with BSD indicators. Therefore, the MDAS appears to be a promising diagnostic tool for identifying adolescents at risk for BSDs and may help facilitate earlier diagnosis and prevent harmful effects of improper treatment.

PERIOD3 (PER3) VNTR Variant Associated with Seasonal Pattern and Family History in Bipolar Disorder.

Dysregulation of circadian rhythms has been thought to be associated with psychiatric disorders such as bipolar disorder (BD) and depression. We aimed to evaluate the relationship between clinical specifiers of BD, mainly seasonal pattern (SP), and the variable number tandem repeat (VNTR) variant of the PERIOD3 (PER3) gene (rs57875989) in BD patients by comparing genotype distributions with healthy controls considering clinical parameters. A sample of 98 BD patients and 97 healthy volunteers were included in the study. The Clinical Interview for DSM-IV Axis-I Disorders (SCID-I) was administered to all participants. The patients were evaluated with some scales (Sociodemographic and Clinical Data Form, The Young Mania Rating Scale (YMRS), the Hamilton Depression Rating Scale (HAM-D), and The Clinical Global Impression Scale (CGI)) in terms of clinical features and symptom severity. Blood samples were obtained from participants to isolate their DNA. PCR-RFLP was used to determine the PER3 gene variant. The PER3 genotype (4/4, 4/5, 5/5) distribution of BD was found to be significantly different from the control group. There was a statistically significant difference in the PER3 genotype distribution between BD patients with SP and BD patients without SP. Again, the PER3 allele (4, 5) distributions of BD patients with the SP were statistically different from the control group. The BD patients' PER3 genotype distributions with a family history of BD were significantly different from the BD patients without family history or control group. It was found that the VNTR variant of the PER3 gene (rs57875989) may be associated with the SP and family history of BD as well as the BD itself. Further studies with the VNTR variant of the PER3 gene (rs57875989) in different ethnic populations are also required to determine these polymorphisms' exact role in BD.

A study to identify unrecognized bipolar disorder in patients of major depressive disorder taking antidepressants

Background: Unrecognized bipolar spectrum disorder under cover diagnosis of major depression disorder leads to wrong medications (antidepressants in absence of mood stabilizer), which may switch to mania. Aim and Objectives: A study was to identify unrecognized bipolar disorder in patients of major depressive disorder taking antidepressants. Materials and Methods: This is an observational and cross-sectional study of 150 patients previously diagnosed as major depressive disorder taking antidepressants from tertiary care hospital. Patients were assessed by proforma containing demographic details, Questionnaire of mood disorder questionnaire (MDQ), and Hamilton depression rating scale (HAMD) followed by clinical interview according to DSM-5 to confirm diagnosis. Statistical analysis was done. Results: We found 6.67% depression patients screened positive on MDQ for bipolar disorder and diagnosis is confirmed by interview according to DSM-5. MDQ positive patients have early age of onset of depression(P=0.0109), long duration of depression(P=0.0478), presence of previous suicide attempt(P=0.0130), and family history of bipolar disorder(P=0.0361). No statistically significant difference was observed between mean HAMD score and severity of depression between MDQ positive and negative group. Conclusion: Among patients prescribed antidepressants for depression, there is a substantial proportion with unrecognized bipolar disorder and most of them had never received diagnosis of bipolar disorder. When seeing patients with depression disorder, clinicians should review the life history for screening of unrecognized bipolar disorder by looking for early age onset of depressive episode and long lifetime duration of depression, previous suicide attempt, and family history of bipolar disorder.

Mood Instability in Youth at High Risk for Bipolar Disorder.

Mood instability is associated with the onset of bipolar disorder (BD) in youth with a family history of the illness. In a clinical trial with youth at high risk for BD, we examined the association between mood instability and symptomatic, psychosocial, and familial functioning over an average of 2 years. Youth (aged 9-17 years) with major depressive disorder or other specified BD, current mood symptoms, and a family history of BD were rated by parents on a mood instability scale. Participants were randomly assigned to 4 months of family-focused therapy or enhanced care psychoeducation, both with medication management as needed. Independent evaluators rated youth every 4-6 months for up to 4 years on symptom severity and psychosocial functioning, whereas parents rated mood instability of the youth and levels of family conflict. High-risk youth (N= 114; mean age 13.3 ± 2.6 years; 72 female) were followed for an average of 104.3 ± 65.8 weeks (range, 0-255 weeks) after randomization. Youth with other specified BD (vs major depressive disorder), younger age, earlier symptom onset, more severe mood symptoms, lower psychosocial functioning, and more familial conflict over time had higher mood instability ratings throughout the study period. Mood instability mediated the association between baseline diagnosis and mother/offspring conflict at follow-up (Z= 2.88, p= .004, αβ= 0.19, 95% CI= 0.06-0.32). Psychosocial interventions did not moderate these associations. A questionnaire measure of mood instability tracked closely with symptomatic, psychosocial, and family functioning in youth at high risk for BD. Interventions that are successful in reducing mood instability may enhance long-term outcomes among high-risk youth. Early Intervention for Youth at Risk for Bipolar Disorder; https://clinicaltrials.gov/; NCT01483391.

31.2 Neural and Clinical Alternations in ADHD in Youth With and Without a Familial Risk for Bipolar Disorder

We used proton magnetic resonance spectroscopy (1H MRS) and structural MRI to compare baseline clinical and neural characteristics among youth who have ADHD with and without a family history of bipolar disorder (BP) and healthy comparison (HC) youth, and differences in clinical changes between youth who have ADHD with and without a family history of BP, following treatment with mixed amphetamine salts-extended release (MAS-XR).

Lithium and Valproate in Bipolar Disorder: From International Evidence-based Guidelines to Clinical Predictors.

Since decades, lithium and valproate remain the pharmacological cornerstone to treat bipolar disorder. Different response patterns occur according to the phases of illness. At same time, individual pretreatment variables may concur to determine a specific drug-response. Our narrative review focuses on these two key clinical aspects to summarize the state of art. Information from i) clinical trials and ii) the most relevant international guidelines is collected to assess the clinical and preclinical factors that may guide the use of lithium rather than valproate. Lithium may be effective in treating acute mania, and lithium efficacy is maximized when used to prevent both manic and depressive episodes. Lithium may be a better treatment choice in patients with: positive family history for bipolar disorder, mania-depression-interval pattern, few previous affective episodes/hospitalizations, high risk for suicide, no comorbidities. Valproate may be more effective as antimanic rather than prophylactic agent. Valproate might be a better choice in patients with many previous affective episodes/hospitalizations and psychiatric comorbidities. Finally, neither lithium nor valproate are suggested for the treatment of acute mixed states or bipolar depression. To consider clinical and preclinical factors may thus be useful to select the best treatment strategy.

Acute mania following COVID-19 in a woman with no past psychiatric history case report

BackgroundThe COVID-19 pandemic that began in late 2019 is caused by infection with the severe acute respiratory syndrome coronavirus-2. Since that time, many neuropsychiatric sequelae including psychosis, neurocognitive disorders, and mood disorders have been observed. The mechanism underlying these effects are currently unknown, however several mechanisms have been proposed.Case presentationA 47-year-old woman with past medical history including hypertension and premenstrual syndrome but no psychiatric history presented to the psychiatric hospital with new onset mania. She had developed symptoms of COVID-19 and was later diagnosed with COVID pneumonia. During quarantine, she reported high levels of stress, grief, and anxiety. Seventeen days into her illness, she developed altered mental status, sleeplessness, elevated mood, talkativeness, and preoccupations. Her spouse was concerned for her safety and contacted emergency medical services who brought her to the psychiatric hospital. She had not slept for five days prior to her arrival and exhibited flight of ideas, talkativeness, and grandiose ideas. She reported a family history of bipolar disorder but no past manic or depressive episodes. She was diagnosed with acute mania and stabilized using antipsychotics, a mood stabilizer, and a short course of a benzodiazepine. Many of her symptoms improved, including her elevated mood, increased activity level, and flight of ideas though she continued to have decreased need for sleep as her benzodiazepine was tapered. She and her partner were agreeable to transitioning to outpatient care after her mood stabilized.ConclusionsThis report emphasizes the link between COVID-19 and neuropsychiatric symptoms. Acute mania has no recognized association with COVID-19, but similar presentations have been reported. The patient’s age and time to onset of psychiatric symptoms is consistent with previous reports. Given the growing body of evidence, this association warrants further investigation. Severe acute respiratory syndrome coronavirus-2 causes systemic inflammation and has been shown to be neurotropic. In addition, patients undergoing quarantine experience anxiety related to the disease in addition to social isolation. Psychiatric practitioners should be aware of these effects and advocate for psychiatric evaluation following COVID-19 infection. Understanding the sequelae of infectious disease is crucial for responding to future pandemics.

Mood Swing during Menstruation: Confounding Factors and Drug Use.

Premenstrual syndrome (PMS) is a physiologic process in women where mood swing is one of the symptoms influencing the psycho-emotional, physical, and behavioral reactions exhibited by women during menstruation. This study elucidates the effect of mood swing, confounding factors and healthcare-seeking behaviors of women in an educational environment. Exactly 328 women who were within reproductive ages 16 and 35 years participated in this study. A survey method was adopted; validated and standardized questionnaires were administered to confidentially assess the effect of mood swing via PMS. All data were analyzed with SPSS 25.0; descriptive method was adopted and results were expressed in percentages. Mood swing was discovered as a symptom overlapping with psycho-emotional, physical, and behavioral symptoms during menstruation. The overall PMS prevalence was 67.4% while PMDD prevalence was 25.6%. Psycho-emotional symptoms: anger, irritability, depression. Physical symptoms: coldness, paleness, food craving, breast tenderness, digestive changes. Behavioral symptoms: social withdrawal, nocturnal social activity, absenteeism, poor work or academic performance, increased libido. Confounding factors include stress, gynecological conditions such as endometriosis, uterine fibroid, ovarian cyst, pelvic adhesion, and polycystic ovarian syndrome. Also, 22.9% had a family history of bipolar disorder (BD) while 30.2% had previous diagnosis. Severe pain was a major factor for seeking treatment; Paracetamol, and Piroxicam were frequently used drugs. Severe PMS triggers mood swing and can badly affect academic or work activities; victims either endure the pain due to socio-cultural and financial factors or take unsuitable medications where abuse is inevitable.

A Double-Blind Randomized Trial to Investigate Mechanisms of Antidepressant-Related Dysfunctional Arousal in Depressed or Anxious Youth at Familial Risk for Bipolar Disorder.

Antidepressants are standardly used to treat moderate to severe symptoms of depression and/or anxiety in youth but may also be associated with rare but serious psychiatric adverse events such as irritability, agitation, aggression, or suicidal ideation. Adverse events are especially common in youth with a family history of bipolar disorder (BD) who are at heightened risk for dysfunction in neurobiological systems that regulate emotion and arousal. To further understand this phenomenon, this study will examine (a) baseline risk factors associated with dysfunctional arousal in a sample of youth at high-risk for BD treated with or without an antidepressant, (b) whether antidepressant-related changes in arousal are mediated by changes in prefrontal-limbic circuitry, and (c) whether pharmacogenetic factors influence antidepressant-related changes in arousal. High-risk youth (aged 12–17 years with moderate to severe depressive and/or anxiety symptoms and at least one first-degree relative with bipolar I disorder) will be randomized to receive psychotherapy plus escitalopram or psychotherapy plus placebo. Neuroimaging and behavioral measures of arousal will be collected prior to randomization and at 4 weeks. Samples for pharmacogenetic analysis (serum escitalopram concentration, CYP2C19 metabolizer phenotype, and HTR2A and SLC6A4 genotypes) will be collected at 8 weeks. Youth will be followed for up to 16 weeks to assess change in arousal measures.

Mixed features in depression: frequency and associated factors

Introduction Mixed states in mood disorders present significant clinical and prognostic challenges. Although the DSM-5 has broadened diagnostic criteria for mixed states with the development of the ‘mixed features’ specifier and its application to unipolar depressive disorders, some mixed episodes might still be overlooked.Objectivesto evaluate the frequency and the factors associated with mixed depression according to the broader Koukopoulos criteria in a sample of patients with a major depressive episodeMethodsWe included 99 consecutive patients presenting for a major depressive episode of bipolar (n=10) or unipolar major depressive (n=89) disorder at our outpatient clinic. Major depression was ascertained using SCID- IV criteria, and mixed features were determined using Koukopoulos’ diagnostic criteriaResults Mean age of the sample was 35.5 years [14-58]. Women accounted for 63.6% of patients. Mixed features were found in 19.5% (n=19) of the sample, 80% (n=8) among patients with bipolar disorders (BD) and 12.3% (n=11) among those with major depressive disorder (MDD). Individuals with mixed features had more substance abuse (p=0.005) and more suicide attempts (p=0.01). Individuals receiving antipsychotics had a lower risk of mixed features (p=0.000) while antidepressant treatment did not have any affect. A family history of BD, psychosis, suicide and substance abuse were found in these patients. Mixed features in depression were more frequent in patients with BD than in MDD.ConclusionsOur study showed a high frequency of mixed features in depression, especially bipolar depression when Koukopoulos criteria are applied. Special attention should be given to these patients given the association with substance use and suicidalityDisclosureNo significant relationships.

Impact of sunlight exposure on the age of onset of bipolar disorder

IntroductionBipolar disorder is a multifactorial disorder influenced by multiple genetic and environmental factors.There is limited understanding of how non-genetic factors may impact the age of onset of bipolar disorderObjectivesTo study the age of onset of bipolar disease in Tunisia (where the average duration of sunshine is 8 hours/day) and compare it to the age of onset in countries with a lower duration of sunshine (Germany 0.17h/day; Norway 1.40h/day).MethodsWe conducted a retrospective study of 100 patients with bipolar disorder type I followed at the psychiatric department Aziza Othmana at Razi hospital.The data collection was done using a pre-established paper form exploring sociodemographic and clinical data.The duration of sunshine was estimated according to the average number of hours of sunshine per day in each country collected through meteorological sites.Results Our population was predominantly male (60%) with a mean age of 48.7 years.The first episode was manic in 76% of cases. The mean age of onset in our sample was 25.86 years, with extremes ranging from 13 to 49 years.An early onset (threshold age=21 years) was found in 36% of the Tunisian population. The age of onset was earlier in patients with a family history of bipolar disorder: 22.76 years vs 28.23 years. A late onset (threshold age=37 years) was found in 13% of the Tunisian population.ConclusionsThe study confirmed that there is an inverse relationship between the degree of sunlight and the age of onset of the disease, especially in the presence of a family history of mood disordersDisclosureNo significant relationships.

Impulsive traits and dual pathology in patients with depression and alcohol dependence, a case report

IntroductionAlcohol dependence is one of the most frequent comorbidities in depression. Multiple environmental and neurobiological factors are directly involved in these diseases. In particular, impulsivity is present in many patients with dual pathology and may play a relevant role in its causes, clinical manifestations and prognosis.ObjectivesTo review the relationship between impulsive traits and dual pathology in patients with depression and alcohol dependence.MethodsPresentation of a clinical case supported by a non- systematic review of literature containing the key-words “impulsivity”, “depression” and “alcohol dependence”.ResultsThis is a case report of a 43-year-old male with a known history of alcohol dependence and recurrent depression. Interestingly, the patient has a family history of bipolar disorder and alcohol abuse disorder on the paternal side, and frontotemporal dementia on the maternal side. He currently presents a depressive episode associates associated with a significant increase in alcohol consumption. The patient has presented prominent impulsive traits since adolescence that have been aggravated in recent years. This lack of impulse control is described as one of the most relevant factors in relapses in alcohol consumption. Multiple studies correlate the lack of impulse control with a worse prognosis in both alcohol dependence (greater probability of relapses and resistance to treatment) and depression (increased suicide risk). Likewise, an increase in cognitive impulsivity has been observed during depressive episodes, characterized by an inability to inhibit behaviors that have already begun and poor planning capacity, which could lead to a worsening of alcohol abuse.ConclusionsImpulsivity traits are related to a worse prognosis in dual pathology due to alcohol and depression, and may present common etiopathogenic mechanisms.DisclosureNo significant relationships.

A network analysis of rest-activity rhythms in young people with emerging bipolar disorders

AimsActigraphy studies of individuals with bipolar disorders (BD) suggest that illness progression may be associated with a range of progressive disruptions in 24-hour rest-activity rhythms (RAR). However, those longitudinal studies were undertaken in older adults with extended histories or illness and treatment rather than young people with emerging BD. To our knowledge, this is the first study to use network modelling to examine the statistical associations between clinical phenotypes of BD and different subsets of RAR markers. MethodsThis study of adolescents and young adults (mean age 22 years; 69% female) uses network modelling to examine which self-rated or actigraphic markers of RAR are more strongly associated with full threshold BD (referred to as Stage 2; N = 15) compared with BD-at risk syndromes (subthreshold presentations referred to as Stage 1; N = 25). ResultsNetwork analysis demonstrated that some RAR are associated with both stage of BD and a family history of BD (such as longer sleep duration and higher levels of daytime impairment). Markers of circadian rhythmicity indicated that regulation of this system is weaker in Stage 2 compared with Stage 1 of BD. LimitationsThe small subgroup samples may have undermined the ability to detect some associations between phenotypes and RAR. ConclusionsNetwork modelling may offer a useful strategy for visualizing and analysing patterns of association between RAR and clinical phenotypes defined by stage of illness, familial loading or symptom profile. This could prove useful in understanding the underlying pathophysiology of sleep-wake cycle and circadian rhythm disturbances in BD.

Diagnosis of disruptive mood dysregulation disorder in offsprings of bipolar parents

BackgroundDisruptive mood dysregulation disorder (DMDD) was introduced in (DSM-5) as a new diagnostic category to get control on the exaggerated diagnosis of bipolar disorder in children and adolescents which was elevated more than 40 times in the last decade. Few studies were done recently to explore the role of family history of bipolar disorder in the occurrence of DMDD in children and adolescents. Unfortunately, there is limited number of studies about the familial transmission of DMDD.The aim of this study is to examine the presence of a relation between DMDD and the presence of a family history of bipolar disorder through comparing the diagnosis of DMDD in offspring of parents with (a) bipolar disorder and (b) a control group.ResultsThe distribution of psychiatric disorders among the studied groups highlighted that DMDD and depressive disorder are significantly present in the offsprings of bipolar parents more than in the offsprings of control parents. DMDD is significantly present among offsprings of bipolar parents aged ≤ 11 years old (p = 0.008*). Also, DMDD is significantly (p = 0.02) present among male offsprings of bipolar parents. Also, depressive disorder is significantly (p = 0.002) present among female offsprings of control parents. While significant comorbidity between DMDD and depressive disorders (p = 0.018*) was detected.ConclusionsThis study revealed that DMDD and depressive disorders are significantly present in the offsprings of bipolar parents higher than in the offsprings of control parents. DMDD is significantly present among the offsprings of bipolar parents aged ≤ 11 years old.The relation between sex and affective disorders among the offsprings was also assessed revealing that DMDD is significantly present among male offsprings of bipolar parents. Also, depressive disorders are significantly present among female offsprings of control parents.Potential implicationsThis study has several clinical implications. This study draws attention to the importance of the careful assessment of the offsprings of bipolar patients to check the presence of different childhood psychiatric disorders such as DMDD. Also, symptoms of temper outbursts and persistent irritability in childhood require the necessary of psychiatric evaluation not only for the patients but also for their families. In addition, this study highlights the need for accurate updated diagnostic instruments to differentiate between these overlapping symptoms.As regards implications for future research, following-up of children diagnosed with DMDD to recognize the prognostic outcome of this new diagnostic category is necessary.