Psychological Medicine

Original Articles

A controlled family study of children with DSM-IV bipolar-I disorder and psychiatric co-morbidity

J. Wozniaka1a2 c1, S. V. Faraonea3, E. Micka2, M. Monuteauxa1a2, A. Covillea1 and J. Biedermana1a2

a1 Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD at Massachusetts General Hospital, Boston, MA, USA

a2 Department of Psychiatry at Harvard Medical School, Boston, MA, USA

a3 Departments of Psychiatry and Neuroscience & Physiology, SUNY Upstate Medical University, NY, USA


Background To estimate the spectrum of familial risk for psychopathology in first-degree relatives of children with unabridged DSM-IV bipolar-I disorder (BP-I).

Method We conducted a blinded, controlled family study using structured diagnostic interviews of 157 children with BP-I probands (n=487 first-degree relatives), 162 attention deficit hyperactivity disorder (ADHD) (without BP-I) probands (n=511 first-degree relatives), and 136 healthy control (without ADHD or BP-I) probands (n=411 first-degree relatives).

Results The morbid risk (MR) of BP-I disorder in relatives of BP-I probands (MR=0.18) was increased 4-fold [95% confidence interval (CI) 2.3–6.9, p<0.001] over the risk to relatives of control probands (MR=0.05) and 3.5-fold (95% CI 2.1–5.8, p<0.001) over the risk to relatives of ADHD probands (MR=0.06). In addition, relatives of children with BP-I disorder had high rates of psychosis, major depression, multiple anxiety disorders, substance use disorders, ADHD and antisocial disorders compared with relatives of control probands. Only the effect for antisocial disorders lost significance after accounted for by the corresponding diagnosis in the proband. Familial rates of ADHD did not differ between ADHD and BP-I probands.

Conclusions Our results document an increased familial risk for BP-I disorder in relatives of pediatric probands with DSM-IV BP-I. Relatives of probands with BP-I were also at increased risk for other psychiatric disorders frequently associated with pediatric BP-I. These results support the validity of the diagnosis of BP-I in children as defined by DSM-IV. More work is needed to better understand the nature of the association between these disorders in probands and relatives.

(Received January 29 2009)

(Revised September 03 2009)

(Accepted September 06 2009)

(Online publication November 06 2009)


c1 Address for correspondence: J. Wozniak, M.D., Massachusetts General Hospital, 55 Fruit St, Warren 705, Boston, MA 02114, USA. (Email: