Child and adolescent anxiety as a risk factor for bipolar disorder: A systematic review of longitudinal studies

Refining Criteria for a Neurodevelopmental Subphenotype of Bipolar Disorders: A FondaMental Advanced Centers of Expertise for Bipolar Disorders Study

BACKGROUND

Bipolar disorder (BD) is a complex and heterogeneous psychiatric disorder. It has been suggested that neurodevelopmental factors contribute to the etiology of BD, but a specific neurodevelopmental phenotype (NDP) of the disorder has not been identified. Our objective was to define and characterize an NDP in BD and validate its associations with clinical outcomes, polygenic risk scores, and treatment responses.

METHODS

We analyzed the FondaMental Advanced Centers of Expertise for Bipolar Disorders cohort of 4468 patients with BD, a validation cohort of 101 patients with BD, and 2 independent replication datasets of 274 and 89 patients with BD. Using factor analyses, we identified a set of criteria for defining NDP. Next, we developed a scoring system for NDP load and assessed its association with prognosis, neurological soft signs, polygenic risk scores for neurodevelopmental disorders, and responses to treatment using multiple regressions, adjusted for age and gender with bootstrap replications.

RESULTS

Our study established an NDP in BD consisting of 9 clinical features: advanced paternal age, advanced maternal age, childhood maltreatment, attention-deficit/hyperactivity disorder, early onset of BD, early onset of substance use disorders, early onset of anxiety disorders, early onset of eating disorders, and specific learning disorders. Patients with higher NDP load showed a worse prognosis and increased neurological soft signs. Notably, these individuals exhibited a poorer response to lithium treatment. Furthermore, a significant positive correlation was observed between NDP load and polygenic risk score for attention-deficit/hyperactivity disorder, suggesting potential overlapping genetic factors or pathophysiological mechanisms between BD and attention-deficit/hyperactivity disorder.

CONCLUSIONS

The proposed NDP constitutes a promising clinical tool for patient stratification in BD.

Who transitions to bipolar disorder? A comparison of major depressive disorder, anxiety, and ADHD

BACKGROUND

Diagnostic delays in Bipolar Disorder (BD) are common and may contribute to worse outcomes. While most studies focus on depression as a primary precursor, both anxiety and attention deficit disorders are also frequent initial diagnoses. In the current study, we utilized a large, diverse electronic health record (EHR) dataset to quantify the rates and correlates of conversion to BD from these major precursor diagnoses.

METHODS

Our study analyzed a comprehensive ten-year EHR dataset from Johns Hopkins Medicine, a diverse urban medical center, to assess and compare the rates and correlates of conversion to BD from Major Depressive Disorder (MDD), anxiety disorders, and ADHD. Risk factors for transition were assessed as time-varying variables in proportional hazards models.

RESULTS

Of the 21,341 patients initially included, 1232 later transitioned to a diagnosis of BD. Adjusted-one-year conversion rates for patients with MDD, anxiety disorders, and ADHD were 4.2 %, 3.4 %, and 4.0 %, respectively, with ten-year rates at 11.4 %, 9.4 %, and 10.9 %, respectively. Age (19-29 years), treatment setting (emergency and inpatient), and psychotropic medications were associated with conversion to BD across all precursor diagnoses. Severe and psychotic forms of MDD were among the strongest risk factors for transitioning to BD. Although risk factors for convertion were similar, transition rates were lower in children, particularly in indivudals with ADHD, who showed a higher rate of BD conversion in adults.

CONCLUSIONS

The highest risk of transitioning to BD was observed in patients initially diagnosed with MDD, though significant risk was also noted in those with initial diagnoses of anxiety disorders and adult ADHD.

Family intimacy and depression: a comparative study among adolescents in Finland

BACKGROUND

Substantial research has demonstrated the strong influence of family factors on adolescent depressive symptoms. However, the mechanisms underlying this relationship, particularly the moderating effects of sex and sexual orientation, remain unclear.

OBJECTIVES

This study aimed to investigate the direct and indirect effects of family intimacy on depressive symptoms among adolescents, while examining the mediating role of social inclusion and anxiety disorders. Furthermore, it explored how these effects are moderated by sex and sexual orientation.

METHOD

Data from the nationwide School Health Promotion Study in Finland were used (N = 155,166; adolescents aged 14-17 years). The analysis included a multiple mediation model to evaluate the pathways linking family intimacy to depressive symptoms, through social inclusion and anxiety disorders. Moderation analyses were conducted to explore the moderating effects of sex and sexual orientation on these pathways.

RESULTS

Family intimacy had a significant direct negative effect on depressive symptoms. Social inclusion and anxiety disorders were identified as mediators, with social inclusion serving as a significant buffer to depression. Moderation analysis revealed that these effects were stronger for non-heterosexual adolescents and varied by sex, with females showing a stronger impact of social inclusion on depressive symptoms, whereas males were more influenced by the pathway through anxiety disorders.

CONCLUSION

The findings highlight the crucial roles of social inclusion and family intimacy in mitigating depressive symptoms among adolescents. Interventions should prioritize enhancing social inclusion, particularly for non-heterosexual adolescents, and tailor strategies based on sex differences to optimize outcomes.