Psychiatry Update: Parental History, Pediatric Bipolar Disorder, and More

Rates of ADHD comorbidity were significantly higher among patients with pediatric bipolar disorder who had a parent with bipolar disorder than those who did not in a recent study. The patients also showed a trend toward significance of earlier symptom onset, but rates of suicide attempts, rapid cycling, and psychosis were not higher than in patients who did not have a parent with bipolar disorder. Patients with pediatric bipolar disorder who have a parent with bipolar disorder may represent a distinct endophenotype.

In a recent meta-analysis, delay discounting was found to be a robust transdiagnostic process across a range of psychiatric disorders. Significantly steeper discounting was observed for patients with a psychiatric disorder compared with controls. The largest effect sizes were found for bipolar disorder and borderline personality disorder. Small to medium effect sizes were found for bulimia nervosa, binge-eating disorder, major depressive disorder, and schizophrenia. Significantly shallower discounting was exhibited by anorexia nervosa. The findings suggest that delay discounting decision-making may be a viable target for treatment interventions.

Neurodevelopmental factors might play a significant role in cognitive deficits in patients with bipolar disorder and do not support the notion of progressive cognitive decline in most patients. Researchers performed a comprehensive meta‐analysis of studies that reported longitudinal neurocognitive performance among patients within the year of their diagnosis or among patients with late‐life disease. No evidence for deterioration in neurocognitive functioning was observed among patients with recent‐onset or late‐life disease. None of the moderators were shown to be significant.

In a study designed to clarify predictors of clinical course in patients with bipolar disorder, female sex, a family history of psychiatric conditions, and greater illness severity all were significantly associated with bipolar disorder-II. Patients with bipolar disorder-II had more frequent recent depressive episodes and substance abuse/dependence than those with bipolar disorder-I and were older at illness onset and first treatment. Patients with bipolar disorder-I were more likely to have higher depressive, manic, anxiety, and symptoms severity. The substantial clinical differences may help characterization of the subgroups.

Among adults with bipolar disorder and poor medication adherence, older patients (age ≥55 years) had significantly lower anxiety disorder comorbidity, depressive symptom severity scores, and self-stigma scores than younger patients (age <55 years). In analyses that evaluated change over time in the Tablets Routine Questionnaire between older and younger patients by treatment arm (a customized adherence enhancement intervention for promoting bipolar medication adherence and a bipolar disorder–specific educational program), there was a significant finding of interaction between time, age-group, and treatment arm. Older adults in a bipolar disorder–specific program did less well in medication adherence than younger adults over time.

Support was found for cognitive remediation/functional remediation (CR/FR) producing cognitive and functional improvements in patients with bipolar disorder in a systematic review. CR/FR paradigms that targeted various cognitive and functional domains showed specificity of training focus to outcomes. Effect sizes were in the medium-large range, suggesting that patients who have bipolar disorder respond to treatment at or above the level reported in patients who have psychotic disorders.