Family History Link Found in Bipolar Disorder

Ole Kohler-Forsberg

Familial psychiatric history could correlate with the risk of severe bipolar disorder activity in an individual.

An international team in Denmark and the US, led by Ole Köhler-Forsberg, Psychosis Research Unit, Aarhus University Hospital Psychiatry, assessed the impact family history has on mental disorders in first-degree relatives on the severity and course of bipolar disorder.

The investigators examined both the Bipolar CHOICE (Clinical Health Outcomes Initiative in Comparative Effectiveness) comparing lithium with quetiapine and the LiTMUS trial, which compared optimized treatment with and without lithium. Both trials were similar among bipolar disorder outpatients studying 4 different randomized treatment arms for 24 weeks.

In the trials, patients self-reported of 6 severe mental disorders among first-degree relatives.

The investigators performed ANOVA, as well as linear regression, regarding disease severity measures, sociodemographic and cardiometabolic markers and mixed effects linear regression to evaluate treatment response.

There were a total of 757 patients in the trials, 644 (85.1%) of which reported at least 1 first-degree relative with a severe mental disorder (mean = 2.8; SD = 2.2; range = 0-13). The most common disorders were depression (67.1%), alcohol abuse (51.0%), and bipolar disorder (47.0%).

The investigators found that familial psychiatric history correlated with several disease severity measures, including hospitalizations, suicide attempts, and earlier onset. Familial psychiatric history also correlated with sociodemographic markers like lower education and household income.

However, the investigators did not find a relationship between familial psychiatric history and cardiometabolic markers like cholesterol and waist circumference or cardiovascular risk scores such as the Framingham risk score.

Patients with familial psychiatric history also require more psychopharmacological treatment (P = 0.054), but responded similarly (all P >0.1) to all 4 treatment arms.

Earlier this year, investigators found that family involvement in psychotherapy sessions delayed onset of bipolar disorder in high-risk children and adolescents.

David Miklowitz, PhD, director of the Max Gray Child and Adolescent Mood Disorders Program of the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, and colleagues studied 127 children and teenagers to determine which of 2 types of treatment was more effective at delaying new and recurring bipolar symptoms.

Nearly 80% of the adolescents in a family-focused treatment recovered from their initial symptoms during the study period, while 65% in the educational group recovered.

The family-focused therapy involved high-risk children, parents or stepparents, and siblings. The treatment consisted of 12 sixty-minute sessions in 4 months of psychoeducation, communication enhancement training, and problem-solving skills training.

The enhanced care treatment also lasted 4 months and consisted of 3 weekly sixty-minute family psychoeducation sessions then three-monthly youth-only sessions focused on implementing a mood management plan.

Among the participants, 70.9% met the eight-week mood recovery criteria during follow-up, 18.1% did not, and 11% withdrew at baseline. For those in the family-focused treatment, 47 of the 61 participants (77%) recovered in a median of 24 weeks (95% CI, 17—33 weeks; P = .93) compared with 43 of 66 (65.2%) in the enhanced care group in 23 weeks (95% CI, 17—29 weeks; P = .93) (HR for FFT vs EC, 1.02; 95% CI, .67—1.54; P = .93).

The new study based in Denmark shows the value of family history for bipolar disorder.

“Our findings indicate that familial psychiatric history is common among outpatients with bipolar disorder and correlates with disease severity and sociodemographic measures,” the authors wrote. “Patients with a greater familial psychiatric load required more intense treatment but achieved similar treatment responses compared to patients without familial psychiatric history.”

The study, “Familial severe psychiatric history in bipolar disorder and correlation with disease severity and treatment response,” was published online in the Journal of Affective Disorders.