Magazine article Clinical Psychiatry News

Study of Bipolar Amish Raises Contradictions. (Childhood Symptoms Not Constant)

Magazine article Clinical Psychiatry News

Study of Bipolar Amish Raises Contradictions. (Childhood Symptoms Not Constant)

Article excerpt

MIAMI BEACH -- Bipolar disorder in Amish children may manifest without hypersexuality or disruptive disorders, prospective data from a long-term study suggest.

"We also found the prodromal symptoms follow an episodic pattern in these children, just like bipolar disorder does in adults," Janice A. Egeland, Ph.D., said at a meeting on mood and anxiety disorders sponsored by the University of Miami and the Florida Psychiatric Society.

The findings contradict the belief of most U.S. psychiatrists that childhood symptoms are constant, she said. They also refute the notion that hypersexuality and disruptive disorders characterize bipolar disorder in children.

Researchers began an epidemiologic study of bipolar disorder in the Amish more than 26 years ago. Because there are many generations of families, each with an average of seven to eight children, the Amish are an ideal population for studying the genetic basis of the disorder.

In 1982, the first blood samples were drawn for pedigree studies. Two of 12 children in the first family studied were confirmed to have bipolar I disorder. All 12 have since married, with 113 children among them, said Dr. Egeland, professor of psychiatry and behavioral sciences at the University of Miami.

Dr. Egeland and her colleagues began prospectively comparing Amish children with an affected parent to those without one in 1987 to determine whether prodromal symptoms or risk factors are apparent at an early age. The Amish Study Care Program is ongoing, but analysis of 7 years of follow-up data from a 1990 sample is complete (Journal of the American Academy of Child and Adolescent Psychiatry, in press).

A total of 100 children from affected families were matched for age and gender with a sample of 110 children from families with unaffected parents. The investigators determined that 2% of the children in the affected families were at high risk for bipolar disorder; 8% had a moderate risk, and 9% had a low risk. An additional 19% were "tagged" for bipolar disorder, which means they were well at the time but had clinical features that hinted at possible bipolar disorder in the future. Therefore, a total of 38% of the children in this group were considered at risk. The other 62% of the children were considered well, with no risk for bipolar disorder.

In contrast, the evaluators found that 1% of children in the unaffected families were at high risk, 1% were at moderate risk, 8% were at low risk, and 7% were tagged for bipolar disorder. …

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