This report includes a study on patterns of prodromal psychiatric symptoms that may help identify young persons at increased risk of bipolar disorder; sibling bullying and risk of psychotic disorders; and a new smartphone app that tracks moods and predicts bipolar disorder episodes.
3 new studies on pediatric bipolar disorder (BD) highlight patterns of prodromal psychiatric symptoms that may help identify young persons at increased risk of bipolar disorder; sibling bullying and risk of psychotic disorders; and a new smartphone app that tracks moods and predicts bipolar disorder episodes.
Early signs of bipolar disorder fall into 2 patterns: a relatively characteristic “homotypic” pattern, consisting mainly of symptoms or other features associated with mood disorders, and a “heterotypic” pattern of other symptoms, including anxiety and disruptive behavior. A homotypic pattern consisted of affective or mood-associated symptoms that are related to, but fall short of, standard diagnostic criteria for bipolar disorder, including mood swings, relatively mild symptoms of excitement, or major depression, sometimes severe and with psychotic symptoms. Homotypic symptoms have low sensitivity and moderate to high specificity. The heterotypic pattern consisted of other types of prodromal symptoms, such as early anxiety and disorders of attention or behavior. This pattern had both low sensitivity and low specificity. Other factors lead to increased risk of developing bipolar disorder, including preterm birth, head injury, drug exposures (especially cocaine), physical or sexual abuse, and other forms of stress. Most of these risk factors have low sensitivity and specificity.
Clinical Implications for Study 1: “There was evidence of a wide range of symptoms, behavioral changes, and exposures with statistically significant associations with later diagnoses of bipolar disorder,” stated the authors, led by Marangoni, Ciro MD, of the Department of Mental Health at Mater Salutis Hospital in Legnato, Italy. The patterns of prodromal symptoms and risk factors may lead to new approaches to identifying children who are likely to develop bipolar disorder and might benefit from early treatment.
Source: Marangoni C, et al. Clinical and Environmental Risk Factors for Bipolar Disorder: Review of Prospective Studies.Harv Rev Psychiatry. 2018;26:1-7.
In a prospect cohort study, the Avon Longitudinal Study of Parents and Children, nearly 3600 children completed a detailed questionnaire on sibling bullying at age 12, and then subsequently filled out a standardized clinical examination assessing psychotic symptoms when they were 18. A total of 664 children were victims of sibling bullying; 486 children were "pure" bullies to their siblings and 771 children were bully-victims at age 12; a psychotic disorder had developed in 55 children by aged 18 years. Those involved in bullying several times a week were two to three times more likely to meet criteria for a psychotic disorder. Involvement in both sibling and peer bullying had more than four times the odds for a psychotic disorder.
Clinical Implications for Study 2: “Bullying by siblings has been until recently widely ignored as a trauma that may lead to serious mental health problems such as psychotic disorder. Children spend substantial time with their siblings in the confinement of their family home and if bullied and excluded, this can lead to social defeat and self-blame and serious mental health disorder, as shown here for the first time,” said senior author Dieter Wolke of the Department of Psychology at the University of Warwick in Coventry, UK.
Source: Dantchev S, Zammit S, Wolke D. Sibling bullying in middle childhood and psychotic disorder at 18 years: a prospective cohort study. Psychol Med. 2018;12:1-8. doi: 10.1017/S0033291717003841.
BiAffect monitors keyboard dynamics metadata, such as typing speed and rhythm, mistakes in texts, and the use of backspace and auto-correct. The metadata (not the content of the text) is analyzed using an artificial intelligence-based machine learning approach to identify digital biomarkers of bipolar episodes. To download the app, users first opt into a study to help researchers continue to search for digital biomarkers of bipolar disorder and to further refine and improve the app.
Clinical Implications for Study 3: “We are excited that our app is now available for anyone to download for free. We think that this crowd-sourced app-based study will soon lead to digital technologies that act as an ‘early alert system’ for young people with bipolar disorder to help them see manic and depressive episodes coming, and take action to mitigate the effects of those episodes. Just being aware of them is a step forward for the millions who live with this mood disorder,” said Peter Nelson, professor of computer science and dean of the University of Illinois at Chicago College of Engineering.
Source: BiAffect ResearchKit mood study University of Illinois https://itunes.apple.com/us/app/biaffect/id1355144276?mt=8