Hostname: page-component-7c8c6479df-5xszh Total loading time: 0 Render date: 2024-03-30T07:36:11.634Z Has data issue: false hasContentIssue false

Evidence that bipolar disorder is the poor outcome fraction of a common developmental phenotype: an 8-year cohort study in young people

Published online by Cambridge University Press:  11 June 2009

M. J. A. Tijssen
Affiliation:
Department of Psychiatry, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
J. van Os
Affiliation:
Department of Psychiatry, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands Division of Psychological Medicine, Institute of Psychiatry, London, UK
H.-U. Wittchen
Affiliation:
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany Max Planck Institute of Psychiatry, Clinical Psychology and Epidemiology Unit, Munich, Germany
R. Lieb
Affiliation:
Max Planck Institute of Psychiatry, Clinical Psychology and Epidemiology Unit, Munich, Germany Institute of Psychology, Epidemiology and Health Psychology, University of Basel, Switzerland
K. Beesdo
Affiliation:
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
R. Mengelers
Affiliation:
Department of Psychiatry, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
L. Krabbendam
Affiliation:
Department of Psychiatry, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
M. Wichers*
Affiliation:
Department of Psychiatry, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
*
*Address for correspondence: Dr M. Wichers, Department of Psychiatry, Maastricht University, PO Box 616 (Vijverdal), 6200 MD Maastricht, The Netherlands. (Email: m.wichers@sp.unimaas.nl)

Abstract

Background

Reported rates of bipolar syndromes are highly variable between studies because of age differences, differences in diagnostic criteria, or restriction of sampling to clinical contacts.

Method

In 1395 adolescents aged 14–17 years, DSM-IV (hypo)manic episodes (manic and hypomanic episodes combined), use of mental health care, and five ordinal subcategories representing the underlying continuous score of (hypo)manic symptoms (‘mania symptom scale’) were measured at baseline and approximately 1.5, 4 and 10 years later using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI).

Results

Incidence rates (IRs) of both (hypo)manic episodes and (hypo)manic symptoms (at least one DSM-IV core symptom) were far higher (714/105 person-years and 1720/105 person-years respectively) than traditional estimates. In addition, the risk of developing (hypo)manic episodes was very low after the age of 21 years [hazard ratio (HR) 0.031, 95% confidence interval (CI) 0.0050–0.19], independent of childhood disorders such as attention deficit hyperactivity disorder (ADHD). Most individuals with hypomanic and manic episodes were never in care (87% and 62% respectively) and not presenting co-morbid depressive episodes (69% and 60% respectively). The probability of mental health care increased linearly with the number of symptoms on the mania symptom scale. The incidence of the bipolar categories, in particular at the level of clinical morbidity, was strongly associated with previous childhood disorders and male sex.

Conclusions

This study showed, for the first time, that experiencing (hypo)manic symptoms is a common adolescent phenomenon that infrequently predicts mental health care use. The findings suggest that the onset of bipolar disorder can be elucidated by studying the pathway from non-pathological behavioural expression to dysfunction and need for care.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akiskal, HS, Bourgeois, ML, Angst, J, Post, R, Möller, H-J, Hirschfeld, R (2000). Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. Journal of Affective Disorders 59, S5–S30.CrossRefGoogle ScholarPubMed
Allardyce, J, Suppes, T, van Os, J (2007). Dimensions and the psychosis phenotype. International Journal of Methods in Psychiatric Research 16 (Suppl. 1), S34S40.CrossRefGoogle ScholarPubMed
Angst, J (1998). The emerging epidemiology of hypomania and bipolar II disorder. Journal of Affective Disorders 50, 143151.CrossRefGoogle ScholarPubMed
Angst, J, Gamma, A, Benazzi, F, Ajdacic, V, Eich, D, Rössler, W (2003). Diagnostic issues in bipolar disorder. European Neuropsychopharmacology 13 (Suppl. 2), S43S50.CrossRefGoogle ScholarPubMed
Angst, J, Marneros, A (2001). Bipolarity from ancient to modern times: conception, birth and rebirth. Journal of Affective Disorders 67, 3–19.CrossRefGoogle ScholarPubMed
Bebbington, P, Ramana, R (1995). The epidemiology of bipolar affective disorder. Social Psychiatry and Psychiatric Epidemiology 30, 279292.CrossRefGoogle ScholarPubMed
Birmaher, B, Axelson, D (2006). Course and outcome of bipolar spectrum disorder in children and adolescents: a review of the existing literature. Development and Psychopathology 18, 10231035.CrossRefGoogle ScholarPubMed
Carlson, GA, Bromet, EJ, Sievers, S (2000). Phenomenology and outcome of subjects with early- and adult-onset psychotic mania. American Journal of Psychiatry 157, 213219.CrossRefGoogle ScholarPubMed
Carlson, GA, Kashani, JH (1988). Manic symptoms in a non-referred adolescent population. Journal of Affective Disorders 15, 219226.CrossRefGoogle Scholar
Castle, DJ, Murray, RM (1991). The neurodevelopmental basis of sex differences in schizophrenia. Psychological Medicine 21, 565575.CrossRefGoogle ScholarPubMed
Costello, EJ, Mustillo, S, Erkanli, A, Keeler, G, Angold, A (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry 60, 837844.CrossRefGoogle ScholarPubMed
Cougnard, A, Marcelis, M, Myin-Germeys, I, de Graaf, R, Vollebergh, W, Krabbendam, L, Lieb, R, Wittchen, HU, Henquet, C, Spauwen, J, van Os, J (2007). Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis? A psychosis proneness-persistence model. Psychological Medicine 37, 513527.CrossRefGoogle ScholarPubMed
Dominguez, MDG, Wichers, M, Lieb, R, Wittchen, HU, van Os, J (in press). Evidence that onset of clinical psychosis is the outcome of progressively more persistent subclinical psychotic experiences: an 8-year cohort study. Schizophrenia Bulletin.Google Scholar
Egeland, JA, Hostetter, AM, Pauls, DL, Sussex, JN (2000). Prodromal symptoms before onset of manic-depressive disorder suggested by first hospital admission histories. Journal of the American Academy of Child and Adolescent Psychiatry 39, 12451252.CrossRefGoogle ScholarPubMed
Faraone, SV, Biederman, J, Milberger, S (1995). How reliable are maternal reports of their children's psychopathology? One-year recall of psychiatric diagnoses of ADHD children. Journal of the American Academy of Child and Adolescent Psychiatry 34, 10011008.CrossRefGoogle ScholarPubMed
First, MB (2006). Beyond clinical utility: broadening the DSM-V research appendix to include alternative diagnostic constructs. American Journal of Psychiatry 163, 16791681.CrossRefGoogle ScholarPubMed
Ghaemi, SN, Ko, JY, Goodwin, FK (2002). ‘Cade's disease’ and beyond: misdiagnosis, antidepressant use, and a proposed definition for bipolar spectrum disorder. Canadian Journal of Psychiatry 47, 125134.CrossRefGoogle Scholar
Hanssen, M, Bak, M, Bijl, R, Vollebergh, W, van Os, J (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology 44, 181191.CrossRefGoogle ScholarPubMed
Henin, A, Biederman, J, Mick, E, Hirschfeld-Becker, DR, Sachs, GS, Wu, Y, Yan, L, Ogutha, J, Nierenberg, AA (2007). Childhood antecedent disorders to bipolar disorder in adults: a controlled study. Journal of Affective Disorders 99, 5157.CrossRefGoogle ScholarPubMed
Hillegers, MHJ, Burger, H, Wals, M, Reichart, CG, Verhulst, FC, Nolen, WA, Ormel, J (2004). Impact of stressful life events, familial loading and their interaction on the onset of mood disorders: study in a high risk cohort of adolescent offspring of parents with bipolar disorder. British Journal of Psychiatry 185, 97–101.CrossRefGoogle Scholar
Joyce, PR (1984). Age of onset in bipolar affective disorder and misdiagnosis as schizophrenia. Psychological Medicine 14, 145149.CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS (2003). The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. Journal of Affective Disorders 73, 123131.CrossRefGoogle ScholarPubMed
Judd, LL, Schettler, PJ, Akiskal, HS (2002). The prevalence, clinical relevance, and public health significance of subthreshold depressions. Psychiatric Clinics of North America 25, 685698.CrossRefGoogle Scholar
Kaymaz, N, van Os, J, de Graaf, R, ten Have, M, Nolen, W, Krabbendam, L (2007). The impact of subclinical psychosis on the transition from subclinical mania to bipolar disorder. Journal of Affective Disorders 98, 5564.CrossRefGoogle ScholarPubMed
Kennedy, N, Boydell, J, Kalidindi, S, Fearon, P, Jones, PB, van Os, J, Murray, RM (2005 a). Gender differences in incidence and age at onset of mania and bipolar disorder over a 35-year period in Camberwell, England. American Journal of Psychiatry 162, 257262.CrossRefGoogle Scholar
Kennedy, N, Everitt, B, Boydell, J, van Os, J, Jones, PB, Murray, RM (2005 b). Incidence and distribution of first-episode mania by age: results from a 35-year study. Psychological Medicine 35, 855863.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593602.CrossRefGoogle ScholarPubMed
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, H-U, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry 51, 8–19.CrossRefGoogle ScholarPubMed
Krabbendam, L, van Os, J (2005). Schizophrenia and urbanicity: a major environmental influence – conditional on genetic risk. Schizophrenia Bulletin 31, 795799.CrossRefGoogle Scholar
Lapalme, M, Hodgins, S, LaRoche, C (1997). Children of parents with bipolar disorder: a metaanalysis of risk for mental disorders. Canadian Journal of Psychiatry 42, 623631.CrossRefGoogle ScholarPubMed
Leff, JP, Fischer, M, Bertelsen, A (1976). A cross-national epidemiological study of mania. British Journal of Psychiatry 129, 428442.CrossRefGoogle ScholarPubMed
Lewinsohn, P, Klein, DN, Seeley, JR (1995). Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. Journal of the American Academy of Child and Adolescent Psychiatry 34, 454463.CrossRefGoogle Scholar
Lewinsohn, PM, Seeley, JR, Klein, DN (2003). Bipolar disorders during adolescence. Acta Psychiatrica Scandinavica. Supplementum 108, 4750.CrossRefGoogle Scholar
Lieb, R, Isensee, B, von Sydow, K, Wittchen, H-U (2000). The Early Developmental Stages of Psychopathology study (EDSP): a methodological update. European Addiction Research 6, 170182.CrossRefGoogle ScholarPubMed
Lish, JD, Dime-Meenan, S, Whybrow, PC, Price, RA, Hirschfeld, RMA (1994). The National Depressive and Manic-depressive Association (DMDA) survey of bipolar members. Journal of Affective Disorders 31, 281294.CrossRefGoogle ScholarPubMed
Lloyd, T, Kennedy, N, Fearon, P, Kirkbride, J, Mallett, R, Leff, J, Holloway, J, Harrison, G, Dazzan, P, Morgan, K, Murray, RM, Jones, PB (2005). Incidence of bipolar affective disorder in three UK cities: results from the AESOP study. British Journal of Psychiatry 186, 126131.CrossRefGoogle ScholarPubMed
Merikangas, KR, Akiskal, HS, Angst, J, Greenberg, PE, Hirschfeld, RM, Petukhova, M, Kessler, RC (2007). Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication. Archives of General Psychiatry 64, 543552.CrossRefGoogle ScholarPubMed
Murray, CJL, Lopez, AD (1996). The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Harvard School of Public Health: Cambridge, MA.Google Scholar
Nierenberg, AA, Miyahara, S, Spencer, T, Wisniewski, SR, Otto, MW, Simon, N, Pollack, MH, Ostacher, MJ, Yan, L, Siegel, R, Sachs, GS (2005). Clinical and diagnostic implications of lifetime attention-deficit/hyperactivity disorder comorbidity in adults with bipolar disorder: data from the first 1000 STEP-BD participants. Biological Psychiatry 57, 14671473.CrossRefGoogle ScholarPubMed
Pfister, H, Wittchen, H-U (1995). M-CIDI Computer Program. Max-Planck-Institut für Psychiatrie, Klinisches Institut: Munich.Google Scholar
Rasanen, P, Tiihonen, J, Hakko, H (1998). The incidence and onset-age of hospitalized bipolar affective disorder in Finland. Journal of Affective Disorders 48, 6368.CrossRefGoogle ScholarPubMed
Reed, V, Gander, F, Pfister, H, Steiger, A, Sonntag, H, Trenkwalder, C, Hundt, W, Wittchen, H-U (1998). To what degree does the Composite International Diagnostic Interview (CIDI) correctly identify DSM-IV disorders? Testing validity issues in a clinical sample. International Journal of Methods in Psychiatric Research 7, 142155.CrossRefGoogle Scholar
Regeer, E, Krabbendam, L, de Graaf, R, ten Have, M, Nolen, W, van Os, J (in press). Berkson's bias and the mood dimensions of bipolar disorder. International Journal of Methods in Psychiatric Research.Google Scholar
Regeer, EJ, Krabbendam, L, de Graaf, R, ten Have, M, Nolen, WA, van Os, J (2006). A prospective study of the transition rates of subthreshold (hypo)mania and depression in the general population. Psychological Medicine 36, 619627.CrossRefGoogle ScholarPubMed
Regier, DA, Boyd, JH, Burke, JDJ, Rae, DS, Myers, JK, Kramer, M, Robins, LN, George, LK, Karno, M, Locke, BZ (1988). One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites. Archives of General Psychiatry 45, 977986.CrossRefGoogle ScholarPubMed
Simon, GE, VonKorff, M (1995). Recall of psychiatric history in cross-sectional surveys: implications for epidemiologic research. Epidemiologic Reviews 17, 221227.CrossRefGoogle ScholarPubMed
Spauwen, J, Krabbendam, L, Lieb, R, Wittchen, H-U, van Os, J (2006). Evidence that the outcome of developmental expression of psychosis is worse for adolescents growing up in an urban environment. Psychological Medicine 36, 407415.CrossRefGoogle Scholar
Spicer, CC, Hare, EH, Slater, E (1973). Neurotic and psychotic forms of depressive illness: evidence from age-incidence in a national sample. British Journal of Psychiatry 123, 535541.CrossRefGoogle ScholarPubMed
Statacorp (2005). STATA Statistical Software. Stata Corporation: College Station, TX.Google Scholar
Szádóczky, E, Papp, Z, Vitrai, J, Ríhmer, Z, Füredi, J (1998). The prevalence of major depressive and bipolar disorders in Hungary: results from a national epidemiologic survey. Journal of Affective Disorders 50, 153162.CrossRefGoogle ScholarPubMed
van Os, J, Linscott, RJ, Myin-Germeys, I, Delespaul, P, Krabbendam, L (2009). A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological Medicine 39, 179195.CrossRefGoogle ScholarPubMed
van Os, J, Verdoux, H (2003). Diagnosis and classification of schizophrenia: categories versus dimensions, distributions versus disease. In The Epidemiology of Schizophrenia (ed. Murray, R. M., Jones, P., Susser, E., van Os, J. and Cannon, M.), pp. 364410. Cambridge University Press: Cambridge.Google Scholar
Weissman, MM, Bland, RC, Canino, GJ, Faravelli, C, Greenwald, S, Hwu, H-G, Joyce, PR, Karam, EG, Lee, C-K, Lellouch, J, Lepine, J-P, Newman, SC, Rubio-Stipec, M, Wells, JE, Wickramaratne, PJ, Wittchen, H-U, Yeh, E-K (1996). Cross-national epidemiology of major depression and bipolar disorder. Journal of the American Medical Association 276, 293299.CrossRefGoogle ScholarPubMed
WHO (1990). Composite International Diagnostic Interview (CIDI), Version 1.0. World Health Organization: Geneva, Switzerland.Google Scholar
Wittchen, H-U (1994). Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. Journal of Psychiatric Research 28, 5784.CrossRefGoogle ScholarPubMed
Wittchen, H-U, Lachner, G, Wunderlich, U, Pfister, H (1998 a). Test–retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI). Social Psychiatry and Psychiatric Epidemiology 33, 568578.CrossRefGoogle ScholarPubMed
Wittchen, H-U, Mühlig, S, Pezawas, L (2003). Natural course and burden of bipolar disorders. International Journal of Neuropsychopharmacology 6, 145154.CrossRefGoogle ScholarPubMed
Wittchen, H-U, Perkonigg, A, Lachner, G, Nelson, CB (1998 b). Early Developmental Stages of Psychopathology study (EDSP): objectives and design. European Addiction Research 4, 1827.CrossRefGoogle ScholarPubMed
Wittchen, H-U, Pfister, H (1997). DIA-X-Interviews: Manual for the screening procedure and interview; Longitudinal Interview (DIA-X-Lifetime); Additional Book (DIA-X-Lifetime); Cross-sectional Interview (DIA-X-12 monthly version); Additional Book (DIA-X-12 monthly version); Computer program to execute the interviews (longitudinal and cross-sectional studies). Analysis program. Swets & Zeitlinger: Frankfurt, Germany.Google Scholar
Wittchen, H-U, Robins, LN, Cottler, LB, Sartorius, N, Burker, JD, Regier, D (1991). Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials. British Journal of Psychiatry 159, 645653, 658.CrossRefGoogle ScholarPubMed