Discuss Bipolar
Blog to discuss being Bipolar
Childhood adversities (CAs) have significant subadditive associations with the onset of psychiatric disorders throughout the life course, a US study has found.
Previous studies demonstrating significant associations between CAs and adult psychiatric disorders have largely examined single CAs. As CAs are highly clustered, this has led to an overestimation of the importance of individual CAs.
To determine the best multivariate model for associations between retrospectively reported CAs and first onset of psychiatric disorders, a team led by Ronald Kessler (Harvard Medical School, Boston, Massachusetts) analyzed CAs and lifetime Diagnostic and Statistical Manual of Mental Disorders-IV disorders assessed in the US National Comorbidity Survey Replication involving 9282 adults.
CAs proved to be highly prevalent and inter-correlated, with 53.4% of respondents reporting at least one CA, and 95.1% of those with parental neglect reporting multiple CAs. The researchers identified a maladaptive family functioning (MFF) cluster of CAs that correlated most strongly with mental health disorder onset. This cluster included parental mental illness, substance abuse disorder, and criminality; family violence; physical abuse; sexual abuse; and neglect. The best fitting multivariate model included terms for each type of CA, number of MFF CAs, and number of non-MFF CAs.
Multiple MFF CAs had significant subadditive associations with disorder onset. There was little specificity for particular CAs with particular disorders. Associations declined in magnitude with life course stage and number of previous lifetime disorders but increased with length of recall.
Using the best-fit model to calculate population attributable risk proportions, the researchers found that 44.6% of all childhood-onset psychiatric disorders and 25.9% to 32.0% of later-onset disorders were attributed to CAs.
Writing in the Archives of General Psychiatry, the researchers note: “The fact that associations increased with length of recall raises the possibility of recall bias inflating estimates.”
They conclude: “The multivariate structure of the associations between CAs and disorder onset is broadly subadditive… This subadditive pattern has important implications for intervention because it means that prevention or amelioration of only a single CA in youths exposed to many CAs is unlikely to have important preventive effects.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
People who develop bipolar disorder in childhood or adolescence are at greater risk for recurrence, chronicity of mood symptoms, and functional impairment than those who develop the mood disorder in adulthood, US study results confirm.
“Symptoms of bipolar disorder are increasingly recognized among children and adolescents,” explain Roy Perlis (Massachusetts General Hospital and Harvard Medical School, Boston, USA), and colleagues.
But they add: “Little is known about the course of bipolar disorder among adults who experience childhood onset of symptoms.”
To investigate, the researchers studied data on 3658 adult patients with bipolar I and II disorder who were participating the Systematic Treatment Enhancement Program for Bipolar Disorder ??” a multicenter clinical effectiveness study.
The participants were divided into three groups based on age at disease onset of less than 13 years (childhood or prepubertal onset), 13??”18 years (adolescent onset) and over 18 years (adult onset).
Baseline features and outcomes over 2 years of follow-up were compared among the three groups.
The team found that, compared with the 1187 patients with adult onset bipolar disorder, the 1068 patients with childhood or prepubertal onset of disease experienced, on average, an earlier recurrence of mood episodes after initial remission, fewer days of euthymia, and greater impairment in functioning and quality of life over follow-up.
Patients with adolescent onset bipolar disorder (n=1403) also had poorer outcomes than those with adult-onset disease, but better outcomes than those with childhood or prepubertal onset bipolar disorder.
Writing in the journal Bipolar Disorders, Perlic and team conclude: “These results… suggest that individuals with earlier onset [bipolar disorder] may be at risk for a more chronic as well as recurrent course in adulthood, with poorer functioning and quality of life.”
They add that the findings “underscore the need to develop better strategies for early identification and early interventions which achieve and maintain symptomatic remission and enhance functioning over the course of development.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
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