Relatives Of Bipolar Patients Research Articles

Study of the impulsivity in bipolar parent

Introduction Impulsivity, as defined by Barratt in 1983, is the inability to associate a behavior to context or consequences. It refers to a variety of risky behaviors, inappropriate to the situation and can lead to undesirable consequences. It is well-established that impulsivity is strongly related to bipolar disorder. Currently, we speak of impulsivity trait present even in bipolar patients in euthymia given the hereditary nature of bipolar disorder. In this study, we are interested in assessing impulsiveness in healthy relatives of bipolar patients. Methodology Impulsivity was measured using BARRAT scale [the Barratt impulsiveness Scale-11 (BIS-11)] in 30 healthy subjects who are first degree relatives of bipolar patients treated in Razi hospital; and comparing the results to 30 subjects, witnesses matched for age and sex with no personal or family history of psychiatric disorders. Results The impulsivity score among parents of bipolar patients was significantly higher compared to controls especially for motor impulsivity with average scores 19.15 versus 16.94, respectively. The general impulsivity score among parents of bipolar patients was 61.53±13.83 versus an average score in controls of 47.20±18.26. Limits The small sample size did not allow conclusive results. The difficulties in determining the mental history of the control group (to check the absence of a family history of bipolar disorder).

Behavioral response inhibition in psychotic disorders: Diagnostic specificity, familiality and relation to generalized cognitive deficit

Difficulty inhibiting context-inappropriate behavior is a common deficit in psychotic disorders. The diagnostic specificity of this impairment, its familiality, and its degree of independence from the generalized cognitive deficit associated with psychotic disorders remain to be clarified. Schizophrenia, schizoaffective and bipolar patients with history of psychosis (n=523), their available first-degree biological relatives (n=656), and healthy participants (n=223) from the multi-site B-SNIP study completed a manual Stop Signal task. A nonlinear mixed model was used to fit logistic curves to success rates on Stop trials as a function of parametrically varied Stop Signal Delay. While schizophrenia patients had greater generalized cognitive deficit than bipolar patients, their deficits were similar on the Stop Signal task. Further, only bipolar patients showed impaired inhibitory control relative to healthy individuals after controlling for generalized cognitive deficit. Deficits accounted for by the generalized deficit were seen in relatives of schizophrenia and schizoaffective patients, but not in relatives of bipolar patients. In clinically stable patients with psychotic bipolar disorder, impaired inhibitory behavioral control was a specific cognitive impairment, distinct from the generalized neuropsychological impairment associated with psychotic disorders. Thus, in bipolar disorder with psychosis, a deficit in inhibitory control may contribute to risk for impulsive behavior. Because the deficit was not familial in bipolar families and showed a lack of independence from the generalized cognitive deficit in schizophrenia spectrum disorders, it appears to be a trait related to illness processes rather than one tracking familial risk factors.

An investigation into the relationship between first-degree relatives of bipolar affective disorder and (idiopathic) epilepsy in a sub-Saharan African population

ObjectivePhenomenological, neuro-biological and pharmacological investigations linked bipolar affective disorders with epilepsy. Similarly, a large community-based epidemiological study of epileptic patients reported that 12% of the participants had bipolar symptoms, a rate 7× higher than in control. Bipolar and epileptic disorders are epiphenomena of an underlying genetic susceptibility. This study aimed to determine the relationship between first-degree relatives of bipolar and epileptic patients in a sub-Saharan African population. MethodIn this case-control study, we used a socio-demographic and clinical variables questionnaire to assess random convenient samples of 50 control, 40 and 60 first-degree relatives of bipolar and epileptic patients, respectively at Federal Neuro-psychiatric Hospital (FNPH), Maiduguri. Relatives of epileptic patients and the control completed the mood disorder questionnaire (MDQ). Two consultant psychiatrists made the diagnosis of epilepsy using the ILAE criteria, in relatives of bipolar patients and the control. Participants in both groups had no EEG.We analysed the data obtained, using EPI-info 7 to report averages and associations between categorical variables with Chi-square test, and analysis of variance (ANOVA) for parametric data(statistical significance set at p=0.5, two-tailed). ResultsThe rate of epilepsy among relatives of bipolar disorder compared with control was 15.2% vs. 2.0% (χ2=46.08, p<0.001), and that of bipolar among relatives of epileptics compared with control was 14.5% vs. 2.1% (χ2=31.2, p<0.001). Educational status showed significant relationship across two groups (χ2=24.19, p=0.0001). Using ANOVA, age showed significant relationship among relatives of bipolar and epileptic patients (F=5.769, p=0.0039). ConclusionDespite its limitations, this preliminary study contributes to literature on the relationship between epilepsy and bipolar affective disorder in sub-Saharan Africa.

Snipping at the Endophenotypic Space

Snipping at the Endophenotypic Space

2748 – Affective temperaments among patients with familial bipolar I disorder and their unaffected first-degree relatives

Introduction Given the concept of bipolar spectrum which extends across the family, healthy relatives of bipolar patients, which are a population at high risk for developing mood disorders, may have temperamental deregulations. Objective To compare the mean scores of affective temperaments among patients with familial bipolar I disorder and their unaffected first-degree relatives. Methods This was a cross-sectional study, concerning 50 families of bipolar I disorder which have at least two patients with bipolar I disorder (DSM-IV-TR). We have included 80 clinically recovered patients with bipolar I disorder and 120 unaffected first-degree relatives. The affective temperaments were assessed by Tunisian version of TEMPS-A. Dominant affective temperament is the temperament witch score was more than 2 SD of mean scores. Results Mean scores of cyclothymic and hyperthymic temperaments were higher in bipolar I patients than in their healthy relatives. The difference was significant for only hyperthymic temperament (p=0.038) but it was not significant after adjustment for age, sex and school level. The rate of dominant affective temperament was not differed between bipolar I patients (26.3%) and their healthy relatives (20%). Investigating the role of family, we showed a significant association with depressive (p Conclusions Our findings suggest that patient with family bipolar I disorder and their unaffected first-degree relatives had a temperamental deregulation which confirms the concept that affective temperaments are a potential phenotype of bipolar condition.

Prevalence of adult attention deficit hyperactivity disorder in the relatives of patients with bipolar disorder

Objective. We hypothesized that relatives of bipolar patients would have increased rate of attention deficit hyperactivity disorder (ADHD) and subsyndromal manifestations compared to demographically matched relatives of healthy controls. Method. Forty consecutive patients with bipolar disorder were recruited from inpatient and outpatient units of Sisli Etfal Teaching and Research Hospital, Psychiatry Department. Seventy-three first-degree relatives of bipolar disorder group were included. A control group of first-degree relatives of individuals without DSM-IV Axis I psychopathology were also recruited. The Turkish version of the Structural Clinical Interview for DSM-IV, Wender Utah Rating Scale, Turgay's Adult ADD/ADHD DSM-IV based Diagnostic and Rating Scale were administered to participants. Results. Overall rate of adult ADHD in RBD group was significantly higher than RC group (9.6 vs. 1.5%; P = 0.04). Participants with adult ADHD in the RBD group had significantly higher rate of alcohol abuse compared to those without adult ADHD (14.3 vs. 1.5%; P = 0.05). Rates of OCD and dysthimia were significantly higher in the subjects with ADHD in the RBD group than the subjects without ADHD (28.6 vs. 4.5%; P = 0.02, 14.3 vs. 1.5%; P = 0.05 respectively). Conclusion. Our findings indicate that relatives of bipolar patients have a risk for suffering from ADHD, and support the hypothesis that relatives of bipolar patients are at a risk for developing attentional and behavioral problems.

P01-247 - Experiences of family caregivers of patients with bipolar disorder

BackgroundAttention to caregiving consequences has been mainly restricted to bipolar disorder, although studies suggest that relatives of bipolar patients also experience considerable distress.AimThe purpose of this study was to explore the lived experiences from family member caregiver with bipolar disorder patient.MethodsIn a qualitative research of phenomenological methodology, the family member's caregivers of bipolar disorder in farshian psychiatric hospital in Hamedan (Iran) were selected by purposive sampling in the year 2010. By reaching data saturation the number of participant was 12. Data were gathered through in-depth interviews and analyzed by “Van manen” method.ResultsAnalysis of the interviews revealed six major themes: emotional impact, physical impact, social impact, Financial Impact, Disruption of family functioning and social support needs.ConclusionsHighlight the need for family-oriented mental health services to be developed and for further research to identify the specific nursing interventions that are effective in helping to sustain family caregiving.

Experiences of family caregivers of patients with bipolar disorder

AbstractIntroduction: Attention to caregiving consequences has been mainly restricted to bipolar disorder, although studies suggest that relatives of bipolar patients also experience considerable distress. The purpose of this study was to explore the lived experiences of family member caregivers of bipolar disorder patients.Methods: In a qualitative research of phenomenological methodology, family member caregivers of bipolar disorder patients in Farshchian Psychiatric Hospital in Hamedan (Iran) were selected by purposive sampling in the year 2010. By reaching data saturation, the number of participants was 12. Data were gathered through in‐depth interviews and analyzed by van Manen method.Results: Analysis of the interviews revealed six major themes: fears and anxiety for the future, psychosomatic impact, feeling isolated and loneliness, financial impact, change in lifestyle and family functioning, and lack of support and knowledge.Discussion: This study highlights the need for family‐oriented mental health services to be developed and for further research to identify the specific nursing interventions that are effective in helping to sustain family caregiving.

Neurocognitive Functioning as Intermediary Phenotype and Predictor of Psychosocial Functioning Across the Psychosis Continuum

Neurocognitive functioning may represent an indicator of genetic risk and poor outcome in both schizophrenia and bipolar disorder. In this study, shared and nonshared characteristics in the cognitive domain in both disorders were analyzed to determine to what degree neurocognitive functioning may represent a predictor of the familial vulnerability and poor functioning that schizophrenia spectrum disorders and bipolar disorder share. Neurocognition, psychopathology, and psychosocial functioning were assessed in samples of patients with a schizophrenia spectrum disorder (n = 345) and bipolar disorder (n = 76) meeting DSM-IV criteria, first-degree relatives of both patient groups (n = 331 and n = 37, respectively), and healthy controls (n = 260 and n = 61, respectively). Multiple regression models were used to investigate the effect of group status on neurocognition and to explore associations between cognition, symptoms, and psychosocial functioning in the 2 groups. The schizophrenia spectrum study sample was recruited between September 2004 and January 2008, and the bipolar study sample was recruited between June 2004 and July 2007. Cognitive deficits were more severe and more generalized in patients with a schizophrenia spectrum disorder compared to patients with bipolar disorder; cognitive alterations were present in relatives of patients with schizophrenia spectrum disorders but not in relatives of bipolar patients. The association between neurocognitive dysfunction and psychosocial functioning was more generalized in schizophrenia spectrum disorders than in bipolar disorder; for both disorders, associations were only partly mediated by symptoms. The evidence for cognitive dysfunction as a marker of familial vulnerability is stronger for schizophrenia than for bipolar disorder. Although the presence of multiple cognitive deficits is shared by the 2 groups, the severity of cognitive deficits and its consequences appear to partly differ between schizophrenia and bipolar disorder, which is in line with a model that implies the specific presence of a neurodevelopmental impairment in the former but not in the latter.

S29-01 - Family psychoeducation for bipolar disorder

IntroductionEvery mood episode is a stressful event for the whole family. Caregivers of bipolar patients experience a significant burden. Similarly, psychosocial stressors play a negative role in the illness outcome. In recent years, several non-pharmacologic interventions have shown prophylactic efficacy when added to pharmacotherapy.ObjectivesTo highlight the need to include the family in the treatment of bipolar patients; to present the efficacy of a group psychoeducation focused on the relatives of bipolar patients; to determine which patients are more likely to benefit from caregiver psychoeducation.Methods113 medicated euthymic bipolar outpatients were selected for a 15-month randomized controlled trial about the efficacy of caregivers group psychoeducation.ResultsCaregiver psychoeducation reduced subjective burden of the relatives and prevented recurrences of the patients, particularly (hypo)mania. The data also highlighted the need to introduce the intervention as soon as possible.ConclusionsFamily psychoeducation has a positive impact on caregivers and also on the course of the illness, stressing the participation of relatives as an important part in the therapeutic approach of bipolar disorder.

From psychoanalysis to epidemiology: autobiographical notes

From psychoanalysis to epidemiology: autobiographical notes

An Acceptance-Based Psychoeducation Intervention to Reduce Expressed Emotion in Relatives of Bipolar Patients

Expressed emotion (EE) is a robust predictor of outcome in bipolar disorder. Despite decades of research, interventions to reduce EE levels have had only modest effects. This study used an expanded model of EE to develop an intervention. Research has demonstrated a strong link between attributions and EE in families of patients with psychiatric disorders. There is also substantial research to suggest that anger can drive blaming attributions. Combining these ideas, this study built on previous psychoeducation interventions through the addition of an acceptance component designed to decrease anger and blaming attributions among family members of those with bipolar disorder. Twenty-eight family members attended a 1-day or 2-evening multifamily group workshop and completed a follow-up assessment 1 week later. At follow-up, participants demonstrated more knowledge about bipolar disorder. Anger, blaming attributions, and number of criticisms remained unchanged. Results of this study are consistent with others in that it is difficult to change EE. Implications for future clinical research in this area are addressed.

Anxiety symptoms and syndromes in bipolar children and adolescents

Anxiety disorders are relatively common in children and adolescents with bipolar disorder. Research to date indicates they may impact the onset, course, and treatment response of bipolar illness in children. Anxiety disorders often precede the onset of pediatric bipolar disorder. Family studies suggest first-degree relatives of bipolar patients are at increased risk for developing mood and anxiety disorders compared with relatives of individuals without mood disorders. Childhood adversity has been associated with higher rates of comorbid anxiety disorders and more severe illness course in bipolar patients. Preliminary study of the neurobiology of bipolar disorder with comorbid anxiety disorders suggests it may be neurophysiologically distinct from bipolar disorder without comorbid anxiety. Bipolar disorder with comorbid anxiety disorders has been associated with greater functional impairment and slower recovery. Prospective, longitudinal studies are needed to help us better understand the relationship between bipolar disorder and comorbid anxiety disorders so that opportunities for early intervention and effective treatment can be realized.

Genetics of bipolar disorder: a review

The present review provides a brief overview of both genetic epidemiological and molecular genetic studies of bipolar disorder. Twin studies have consistently shown an increased risk of bipolar disorder in monozygotic (identical) co-twins as compared to dizygotic (fraternal) co-twins of a proband with bipolar-I disorder, which indicates that a substantial proportion of the variance in the aetiology of bipolar disorder is likely to be attributable to genetic factors. The involvement of genetic factors in the development of bipolar disorder is also supported by the results of two adoption studies. According to family studies that included direct interviews of relatives as well as of a control group the risk ratio for bipolar disorder among relatives of bipolar patients has been estimated at around ten. However, family studies have revealed that the relatives of bipolar probands are not only at an increased risk for bipolar disorder, but also for unipolar depression. Regarding the morbidity risk for offspring of parents suffering from bipolar disorder, a meta-analysis revealed a 2.5-fold increased risk of developing any psychiatric disorder in children of bipolars as compared to those of non-psychiatric controls. Given the well-established familial aggregation of bipolar-I disorder as well as evidence that a substantial proportion of the variance in the aetiology of bipolar disorder is likely to be attributable to genetic factors, a series of linkage and association studies have attempted to identify the genes involved in the susceptibility to bipolar disorder. The findings of linkage studies are not consistent with the existence of a gene of major effect for the vulnerability for bipolar disorder, but several chromosomal regions have repeatedly been shown to be implicated. Two meta-analyses found evidence for susceptibility genes on chromosomes 8p22,9p22-21,10q21-22,13q32-34,14q24-32 and 22q11-22, as well as on regions on chromosome 18. Other regions of interest, identified by recent linkage studies are 6q16-22 and 12q23-24. Regarding candidate genes, for each of them there were usually some positive studies and generally an even greater number of negative replications. Meta-analyses of studies on these polymorphisms have provided some support for the implication of MAOA, COMT and 5HTT metabolism, all with modest effect sizes though. However, the strongest evidence currently supports the DAOA/G30 and the BDNF genes. The conflicting results obtained in psychiatry genetic research in the last decades are likely to be at least in part attributable to the heterogeneity of bipolar disorder. Therefore, the need to look for specific clinical indicators of bipolar disorder that could be used to identify more homogeneous subtypes of the disorder has frequently been highlighted. Recent studies that focused on early onset bipolar disorder or stratified the sample according to the age of onset have provided some interesting results. It is of interest that some of the regions identified in linkage studies of bipolar disorder overlap with regions implicated in schizophrenia and variations at the DAOA/G30 and the BDNF genes could predispose to both schizophrenia and bipolar disorder. The overlap in the biological basis between the two disorders could have implications for the classification of these major psychiatric disorders, which have been classified as distinct entities over the last 100 years.

The cyclothymic temperament in healthy controls and familially at risk individuals for mood disorder: endophenotype for genetic studies?

Background: The modern concept of affective disorders focuses increasingly on the study of subthreshold conditions on the border of manic or depressive episodes. Indeed, a spectrum of affective conditions spanning from temperament to clinical episodes has been proposed by the senior author. As bipolar disorder is a familial illness, an examination of cyclothymic temperament (CT) in controls and relatives of bipolar patients is of major relevance. Methods: We recruited a total sample of 177 healthy symptom-free volunteers. These controls were divided into three groups. The first one is comprised of 100 normal subjects with a negative familial affective history (NFH); the second of 37 individuals, with positive affective family history (PFH); and a third of 40 subjects, with at least one sib or first-degree kin with bipolar disorder type I according to the DSM-IV (BPR). The last two groups defined at risk individuals. We interviewed all subjects with CT, as described by the senior author. Results: We found a statistically significant difference in the rates of CT between the subjects in BPR versus others. CT was also more prevalent in the PFH compared with NFH. Additionally, the simple numeration of the CT traits exhibited gradation in the distribution of individuals inside the NFH, PFH and BPR. Finally, categorically defined CT and CT traits predominated in females. Limitation and conclusion: Although not all relatives of bipolar probands were studied, our results exhibit an aggregation of CT in families with affective disorder—and more specifically those with bipolar background. These results allow us to propose the importance of including CT for phenotypic characterization of bipolar disorder. Furthermore, our results support a spectrum concept of bipolar disorder, whereby CT is distributed in ascending order in the well-relatives of those with depressive and bipolar disorders. We submit that this temperament represents a behavioral endophenotype, serving as a link between molecular and behavioral genetics.

A REVIEW OF GENETIC FACTORS IN DEPRESSIVE AFFECTS

This paper contains a review of genetic factors in depressive affects. A large number of research findings have been reported for this purpose, the most important of these being the twin study. Monozygotic and dizygotic twins have been differentiated. It has been found that monozygotic twins have a higher concordance rate for affective illness than do dizygotic twins. Moreover, bipolar and unipolar illnesses were found in the relatives of unipolar patients only. Thus affective illness in the first degree of relatives of bipolar patients was more than 30%. Genetic transmission was also found in linkage relationship. Chromosomal studies have also been reported. Phenotypic variations have also been found to be responsible for affective illness. In conclusion, a better clinical, biochemical, and therapeutic investigation has been suggested for better understanding of genetic factors in affective illness.

Expressed emotion attitudes and individual psychopathology among the relatives of bipolar patients.

This study investigated the relationships between expressed emotion (EE) and individual psychopathology among 82 biological and non-biological relatives of 66 patients with bipolar I disorder. Relatives' psychopathology was assessed via the Structured Clinical Interview for DSM-III-R, Patient Version (SCID-P) and the General Behavior Inventory (GBI), a self-report measure of lifetime subsyndromal mood disturbances. We hypothesized that relatives who held high-EE critical, hostile, and/or overinvolved attitudes toward their bipolar family member, as measured via the Camberwell Family Interview, would be more likely to have DSM-III-R Axis I diagnoses on the SCID, as well as more mood and temperamental disturbances on the GBI, than those who held low-EE attitudes. The findings did not support a significant relationship between overall EE status and psychopathology in family members. However, relatives without significant Axis I pathology scored significantly higher than those with Axis I pathology on one measure of EE, emotional overinvolvement. The findings are discussed with reference to explanations for the genesis of high-EE attitudes.

Expressed emotion and attributions in the relatives of bipolar patients: An analysis of problem-solving interactions.

Expressed emotion and attributions in the relatives of bipolar patients: An analysis of problem-solving interactions.

Expressed emotion and attributions in the relatives of bipolar patients: an analysis of problem-solving interactions.

Among the relatives of schizophrenic and depressed patients, high expressed emotion (EE) attitudes are associated with "controllability attributions" about the causes of patients' symptoms and problem behaviors. However, previous studies have judged EE attitudes and causal attributions from the same assessment measure, the Camberwell Family Interview (CFI; C. E. Vaughn & J. P. Leff, 1976). The authors examined causal attributions among relatives of 47 bipolar patients, as spontaneously expressed to patients in family problem-solving interactions during a postillness period. Relatives rated high EE during the patients' acute episode (based on the CFI) were more likely than relatives rated low EE to spontaneously attribute patients' symptoms and negative behaviors to personal and controllable factors during the postillness interactional assessment. Thus, the EE-attribution linkage extends to the relatives of bipolar patients evaluated during a family interaction task.

Lithium ion transport and affective disorders within families of bipolar patients. Identification of a major gene locus.

We have identified a genetic polymorphism in which one allele results in elevated RBC lithium ion ratios and also contributes to vulnerability to some forms of affective disorders. Interindividual variability in the lithium ion ratio (the ratio of the RBC to the plasma lithium ion concentration) is determined by variability in a lithium ion ratio (the ratio of the RBC to the plasma lithium ion concentration) is determined by variability in a lithium-sodium ion counterflow mechanism. Segregation analyses were conducted on lithium ion ratios in vitro in members of 120 normal families and on both the lithium ion ratio and the history of affective disorder in first-degree relatives of 31 bipolar patients. These analyses provided evidence for an autosomal major gene locus that influences the lithium ion ratio both in members of normal families and in relatives of bipolar patients. The allele at the major locus resulting in elevated lithium ion ratios was associated with an increased likelihood of psychiatric hospitalization among relatives of bipolar patients.