Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-20T06:02:48.454Z Has data issue: false hasContentIssue false
  • English
  • Français

Confirmatory test of two factors and four subtypes of bipolar disorder based on lifetime psychiatric co-morbidity

Published online by Cambridge University Press:  31 March 2015

P. O. Monahan ,
T. Stump ,
W. H. Coryell ,
J. Harezlak ,
G. A. Marcoulides ,
H. Liu ,
C. M. Steeger ,
P. B. Mitchell ,
H. C. Wilcox  and
L. A. Hulvershorn
...Show all authors
P. O. Monahan*
Affiliation:
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
T. Stump
Affiliation:
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
W. H. Coryell
Affiliation:
Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
J. Harezlak
Affiliation:
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
G. A. Marcoulides
Affiliation:
Research Methods & Statistics Program, Graduate School of Education, University of California–Riverside, Riverside, CA, USA
H. Liu
Affiliation:
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
C. M. Steeger
Affiliation:
Department of Psychology, College of Arts and Letters, University of Notre Dame, Notre Dame, IN, USA
P. B. Mitchell
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Black Dog Institute, Sydney, NSW, Australia
H. C. Wilcox
Affiliation:
Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
L. A. Hulvershorn
Affiliation:
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
A. L. Glowinski
Affiliation:
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
P. A. Iyer-Eimerbrink
Affiliation:
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
M. McInnis
Affiliation:
Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, MI, USA
J. I. Nurnberger Jr
Affiliation:
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
*
*Address for correspondence: P. O. Monahan, Ph.D., Department of Biostatistics, Indiana University, 410 West 10th Street, Suite 3000, Indianapolis, IN 46202-3002, USA. (Email: pmonahan@iu.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The first aim was to use confirmatory factor analysis (CFA) to test a hypothesis that two factors (internalizing and externalizing) account for lifetime co-morbid DSM-IV diagnoses among adults with bipolar I (BPI) disorder. The second aim was to use confirmatory latent class analysis (CLCA) to test the hypothesis that four clinical subtypes are detectible: pure BPI; BPI plus internalizing disorders only; BPI plus externalizing disorders only; and BPI plus internalizing and externalizing disorders.

Method

A cohort of 699 multiplex BPI families was studied, ascertained and assessed (1998–2003) by the National Institute of Mental Health Genetics Initiative Bipolar Consortium: 1156 with BPI disorder (504 adult probands; 594 first-degree relatives; and 58 more distant relatives) and 563 first-degree relatives without BPI. Best-estimate consensus DSM-IV diagnoses were based on structured interviews, family history and medical records. MPLUS software was used for CFA and CLCA.

Results

The two-factor CFA model fit the data very well, and could not be improved by adding or removing paths. The four-class CLCA model fit better than exploratory LCA models or post-hoc-modified CLCA models. The two factors and four classes were associated with distinctive clinical course and severity variables, adjusted for proband gender. Co-morbidity, especially more than one internalizing and/or externalizing disorder, was associated with a more severe and complicated course of illness. The four classes demonstrated significant familial aggregation, adjusted for gender and age of relatives.

Conclusions

The BPI two-factor and four-cluster hypotheses demonstrated substantial confirmatory support. These models may be useful for subtyping BPI disorders, predicting course of illness and refining the phenotype in genetic studies.

Keywords

Bipolar disorderco-morbidityconfirmatory factor analysisconfirmatory latent class analysissubtypes
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 10 , July 2015 , pp. 2181 - 2196
Copyright
Copyright © Cambridge University Press 2015 

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

Adida, M, Clark, L, Pomietto, P, Kaladjian, A, Besnier, N, Azorin, JM, Jeanningros, R, Goodwin, GM (2008). Lack of insight may predict impaired decision making in manic patients. Bipolar Disorders 10, 829–837.CrossRefGoogle ScholarPubMed
Adler, M, Liberg, B, Andersson, S, Isacsson, G, Hetta, J (2008). Development and validation of the Affective Self Rating Scale for manic, depressive, and mixed affective states. Nordic Journal of Psychiatry 62, 130–135.CrossRefGoogle ScholarPubMed
Akiskal, HS, Hantouche, EG, Bourgeois, ML, Azorin, JM, Sechter, D, Allilaire, JF, Chatenêt-Duchêne, L, Lancrenon, S (2001). Toward a refined phenomenology of mania: combining clinician-assessment and self-report in the French EPIMAN study. Journal of Affective Disorders 67, 89–96.Google Scholar
Bauer, MS, Crits-Christoph, P, Ball, WA, Dewees, E, McAllister, T, Alahi, P, Cacciola, J, Whybrow, PC (1991). Independent assessment of manic and depressive symptoms by self-rating. Scale characteristics and implications for the study of mania. Archives of General Psychiatry 48, 807–812.Google Scholar
Berk, M, Malhi, GS, Cahill, C, Carman, AC, Hadzi-Pavlovic, D, Hawkins, MT, Tohen, M, Mitchell, PB (2007). The Bipolar Depression Rating Scale (BDRS): its development, validation and utility. Bipolar Disorders 9, 571–579.Google Scholar
Birmaher, B, Kennah, A, Brent, D, Ehmann, M, Bridge, J, Axelson, D (2002). Is bipolar disorder specifically associated with panic disorder in youths? Journal of Clinical Psychiatry 63, 414–419.Google Scholar
Bräunig, P, Shugar, G, Krüger, S (1996). An investigation of the Self-Report Manic Inventory as a diagnostic and severity scale for mania. Comprehensive Psychiatry 37, 52–55.Google Scholar
Cassano, GB, Mula, M, Rucci, P, Miniati, M, Frank, E, Kupfer, DJ, Oppo, A, Calugi, S, Maggi, L, Gibbons, R, Fagiolini, A (2009). The structure of lifetime manic–hypomanic spectrum. Journal of Affective Disorders 112, 59–70.Google Scholar
Cassidy, F, Carroll, BJ (2003). Symptom factors and clinical subtypes in mania. American Journal of Psychiatry 160, 392.Google Scholar
Cassidy, F, Pieper, CF, Carroll, BJ (2001). Subtypes of mania determined by grade of membership analysis. Neuropsychopharmacology 25, 373–383.Google Scholar
Cassidy, F, Yatham, LN, Berk, M, Grof, P (2008). Pure and mixed manic subtypes: a review of diagnostic classification and validation. Bipolar Disorders 10, 131–143.Google Scholar
Cavanagh, J, Schwannauer, M, Power, M, Goodwin, GM (2009). A novel scale for measuring mixed states in bipolar disorder. Clinical Psychology and Psychotherapy 16, 497–509.CrossRefGoogle ScholarPubMed
Chang, K, Steiner, H, Ketter, T (2003). Studies of offspring of parents with bipolar disorder. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics 123, 26–35.Google Scholar
Chang, KD, Steiner, H, Ketter, TA (2000). Psychiatric phenomenology of child and adolescent bipolar offspring. Journal of the American Academy of Child and Adolescent Psychiatry 39, 453–460.CrossRefGoogle ScholarPubMed
Cheng, R, Juo, SH, Loth, JE, Nee, J, Iossifov, I, Blumenthal, R, Sharpe, L, Kanyas, K, Lerer, B, Lilliston, B, Smith, M, Trautman, K, Gilliam, TC, Endicott, J, Baron, M (2006). Genome-wide linkage scan in a large bipolar disorder sample from the National Institute of Mental Health Genetics Initiative suggests putative loci for bipolar disorder, psychosis, suicide, and panic disorder. Molecular Psychiatry 11, 252–260.CrossRefGoogle Scholar
Clark, SL, Muthén, B, Kaprio, J, D'Onofrio, BM, Viken, R, Rose, RJ (2013). Models and strategies for factor mixture analysis: an example concerning the structure underlying psychological disorders. Structural Equation Modeling 20, 681–703.Google Scholar
Daneluzzo, E, Arduini, L, Rinaldi, O, Di Domenico, M, Petruzzi, C, Kalyvoka, A, Rossi, A (2002). PANSS factors and scores in schizophrenic and bipolar disorders during an index acute episode: a further analysis of the cognitive component. Schizophrenia Research 56, 129–136.CrossRefGoogle ScholarPubMed
DelBello, MP, Geller, B (2001). Review of studies of child and adolescent offspring of bipolar parents. Bipolar Disorders 3, 325–334.CrossRefGoogle ScholarPubMed
DelBello, MP, Strakowski, SM, Sax, KW, McElroy, SL, Keck, PE Jr, West, SA, Kmetz, GF (1999). Familial rates of affective and substance use disorders in patients with first-episode mania. Journal of Affective Disorders 56, 55–60.Google Scholar
Dilsaver, SC, Chen, YR, Shoaib, AM, Swann, AC (1999). Phenomenology of mania: evidence for distinct depressed, dysphoric, and euphoric presentations. American Journal of Psychiatry 156, 426–430.Google Scholar
Duffy, A, Grof, P, Grof, E, Zvolsky, P, Alda, M (1998). Evidence supporting the independent inheritance of primary affective disorders and primary alcoholism in the families of bipolar patients. Journal of Affective Disorders 50, 91–96.CrossRefGoogle ScholarPubMed
Erkiran, M, Sönmez, G, Evren, C, Aytaçlar, S, Oral, T (2008). The factor analytic symptom structure of manic episode and its relationship with affective temperaments [article in Turkish]. Turkish Journal of Psychiatry 19, 157–166.Google Scholar
Evans, L, Akiskal, HS, Keck, PE, McElroy, SL Jr, Sadovnick, AD, Remick, RA, Kelsoe, JR (2005). Familiality of temperament in bipolar disorder: support for a genetic spectrum. Journal of Affective Disorders 85, 153–168.Google Scholar
Faraone, SV, Su, J, Tsuang, MT (2004). A genome-wide scan of symptom dimensions in bipolar disorder pedigrees of adult probands. Journal of Affective Disorders 82 (Suppl. 1), S71–S78.Google Scholar
Feinman, JA, Dunner, DL (1996). The effect of alcohol and substance abuse on the course of bipolar affective disorder. Journal of Affective Disorders 37, 43–49.Google Scholar
Finch, WH, Bronk, KC (2011). Conducting confirmatory latent class analysis using MPlus. Structural Equation Modeling 18, 132–151.CrossRefGoogle Scholar
Garno, JL, Goldberg, JF, Ramirez, PM, Ritzler, BA (2005). Bipolar disorder with comorbid cluster B personality disorder features: impact on suicidality. Journal of Clinical Psychiatry 66, 339–345.CrossRefGoogle ScholarPubMed
Gershon, ES, Berrettini, W, Nurnberger, J Jr, Goldin, LR (1987). Genetics of affective illness. In Psychopharmacology: The Third Generation of Progress (ed. Meltzer, H. Y.), pp. 481–491. Raven Press: New York.Google Scholar
Gershon, ES, Hamovit, J, Guroff, JJ, Dibble, E, Leckman, JF, Sceery, W, Targum, SD, Nurnberger, JI Jr, Goldin, LR, Bunney, WE Jr (1982). A family study of schizoaffective, bipolar I, bipolar II, unipolar, and normal control probands. Archives of General Psychiatry 39, 1157–1167.Google Scholar
Gershon, ES, McKnew, D, Cytryn, L, Hamovit, J, Schreiber, J, Hibbs, E, Pellegrini, D (1985). Diagnoses in school-age children of bipolar affective disorder patients and normal controls. Journal of Affective Disorders 8, 283–291.Google Scholar
González-Pinto, A, Ballesteros, J, Aldama, A, Pérez de Heredia, JL, Gutierrez, M, Mosquera, F, González-Pinto, A (2003). Principal components of mania. Journal of Affective Disorders 76, 95–102.Google Scholar
Goodwin, FK, Jamison, KR (1990). Manic–Depressive Illness. Oxford University Press: New York.Google Scholar
Goodwin, RD, Hamilton, SP (2002). The early-onset fearful panic attack as a predictor of severe psychopathology. Psychiatry Research 109, 71–79.Google Scholar
Gupta, SC, Sinha, VK, Praharaj, SK, Gandotra, S (2009). Factor structure of manic symptoms. Australian and New Zealand Journal of Psychiatry 43, 1141–1146.CrossRefGoogle ScholarPubMed
Hamburg, MA, Collins, FS (2010). The path to personalized medicine. New England Journal of Medicine 363, 301–304.Google Scholar
Harvey, PD, Endicott, JM, Loebel, AD (2008). The factor structure of clinical symptoms in mixed and manic episodes prior to and after antipsychotic treatment. Bipolar Disorders 10, 900–906.Google Scholar
Helzer, JE, Winokur, G (1974). A family interview study of male manic depressives. Archives of General Psychiatry 31, 73–77.Google Scholar
Henry, C, M'baïlara, K, Poinsot, R, Falissard, B (2007). Construction and validation of a dimensional scale for mood disorders: Multidimensional Assessment of Thymic States (MAThyS) [article in French]. Encephale 33, 768–774.Google Scholar
Hu, L-T, Bentler, PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling 6, 1–55.Google Scholar
Johnson, JG, Cohen, P, Brook, JS (2000). Associations between bipolar disorder and other psychiatric disorders during adolescence and early adulthood: a community-based longitudinal investigation. American Journal of Psychiatry 157, 1679–1681.Google Scholar
Joo, EJ, Greenwood, TA, Schork, N, McKinney, RA, Sadovnick, AD, Remick, RA, Keck, PE, McElroy, SL, Kelsoe, JR (2010). Suggestive evidence for linkage of ADHD features in bipolar disorder to chromosome 10p14. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 153B, 260–268.CrossRefGoogle ScholarPubMed
Kendler, KS, Heath, AC, Neale, MC, Kessler, RC, Eaves, LJ (1993). Alcoholism and major depression in women: a twin study of the causes of comorbidity. Archives of General Psychiatry 50, 690–698.Google Scholar
Kessler, RC, Ormel, J, Petukhova, M, McLaughlin, KA, Green, JG, Russo, LJ, Stein, DJ, Zaslavsky, AM, Aguilar-Gaxiola, S, Alonso, J, Andrade, L, Benjet, C, de Girolamo, G, de Graaf, R, Demyttenaere, K, Fayyad, J, Haro, JM, Hu, CY, Karam, A, Lee, S, Lepine, JP, Matchsinger, H, Mihaescu-Pintia, C, Posada-Villa, J, Sagar, R, Ustün, TB (2011). Development of lifetime comorbidity in the World Health Organization World Mental Health Surveys. Archives of General Psychiatry 68, 90–100.CrossRefGoogle ScholarPubMed
Krüger, S, Quilty, L, Bagby, M, Lippold, T, Bermpohl, F, Bräunig, P (2010). The Observer-Rated Scale for Mania (ORSM): development, psychometric properties and utility. Journal of Affective Disorders 122, 179–183.Google 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, 623–631.Google Scholar
Liang, KY, Zeger, SL (1986). Longitudinal data analysis using generalized linear models. Biometrika 73, 13–22.CrossRefGoogle Scholar
Lindenmayer, JP, Bossie, CA, Kujawa, M, Zhu, Y, Canuso, CM (2008). Dimensions of psychosis in patients with bipolar mania as measured by the positive and negative syndrome scale. Psychopathology 41, 264–270.Google Scholar
Lo, Y, Mendell, N, Rubin, DB (2001). Testing the number of components in a normal mixture. Biometrika 88, 767–778.CrossRefGoogle Scholar
Lubke, GH, Muthén, B (2005). Investigating population heterogeneity with factor mixture models. Psychological Methods 10, 21–39.CrossRefGoogle ScholarPubMed
MacKinnon, DF, Xu, J, McMahon, FJ, Simpson, SG, Stine, OC, McInnis, MG, DePaulo, JR (1998). Bipolar disorder and panic disorder in families: an analysis of chromosome 18 data. American Journal of Psychiatry 155, 829–831.Google Scholar
MacKinnon, DF, Zandi, PP, Cooper, J, Potash, JB, Simpson, SG, Gershon, E, Nurnberger, J, Reich, T, DePaulo, JR (2002). Comorbid bipolar disorder and panic disorder in families with a high prevalence of bipolar disorder. American Journal of Psychiatry 159, 30–35.Google Scholar
MacQueen, GM, Hajek, T, Alda, M (2005). The phenotypes of bipolar disorder: relevance for genetic investigations. Molecular Psychiatry 10, 811–826.Google Scholar
Maier, W, Merikangas, K (1996). Co-occurrence and cotransmission of affective disorders and alcoholism in families. British Journal of Psychiatry 30 (Suppl.), 93–100.Google Scholar
McMahon, FJ, Simpson, SG, McInnis, MG, Badner, JA, MacKinnon, DF, DePaulo, JR (2001). Linkage of bipolar disorder to chromosome 18q and the validity of bipolar II disorder. Archives of General Psychiatry 58, 1025–1031.Google Scholar
Mitchell, PB, Hadzi-Pavlovic, D, Evoniuk, G, Calabrese, JR, Bowden, CL (2013). A factor analytic study in bipolar depression, and response to lamotrigine. CNS Spectrums 18, 214–224.Google Scholar
Morrison, JR (1974). Bipolar affective disorder and alcoholism. American Journal of Psychiatry 131, 1130–1133.Google ScholarPubMed
Morrison, JR (1975). The family histories of manic–depressive patients with and without alcoholism. Journal of Nervous and Mental Disease 160, 227–229.CrossRefGoogle ScholarPubMed
Muthén, B, Asparouhov, T (2006). Item response mixture modeling: application to tobacco dependence criteria. Addictive Behaviors 31, 1050–1066.Google Scholar
Muthén, LK, Muthén, BO (1998–2007). Mplus User's Guide, 5th edn. Muthén & Muthén: Los Angeles, CA.Google Scholar
Nunnally, JC, Bernstein, IH (1994). Psychometric Theory. McGraw-Hill: New York.Google Scholar
Nurnberger, JI Jr (2002). Implications of multifactorial inheritance for identification of genetic mechanisms in major psychiatric disorders [Erratum in: Psychiatric Genetics 2003, 13, 59]. Psychiatric Genetics 12, 121–126.CrossRefGoogle ScholarPubMed
Nurnberger, JI Jr, Berrettini, WH (1998). Psychiatric Genetics. Chapman & Hall: London.Google Scholar
Nurnberger, JI Jr, Hamovit, J, Hibbs, E, Pellegrini, D, Guroff, J, Maxwell, E, Smith, A, Gershon, ES (1988). A high-risk study of primary affective disorder: selection of subjects, initial assessment and 1- to 2-year follow-up. In Relatives at Risk for Mental Disorder (ed. Dunner, D. L., Gershon, E. S. and Barrett, J. E.), pp. 161–177. Raven Press: New York.Google Scholar
Nurnberger, JI Jr, Kuperman, S, Flury-Wetherill, L, Meyer, ET, Lawson, WB, MacKinnon, DF (2007). Genetics of comorbid mood disorder and alcohol dependence. Journal of Dual Diagnosis 3, 31–46.Google Scholar
Nurnberger, JI Jr, McInnis, M, Reich, W, Kastelic, E, Wilcox, HC, Glowinski, A, Mitchell, P, Fisher, C, Erpe, M, Gershon, ES, Berrettini, W, Laite, G, Schweitzer, R, Rhoadarmer, K, Coleman, VV, Cai, X, Azzouz, F, Liu, H, Kamali, M, Brucksch, C, Monahan, PO (2011). A high-risk study of bipolar disorder. Childhood clinical phenotypes as precursors of major mood disorders. Archives of General Psychiatry 68, 1012–1020.Google Scholar
Payne, JL, Potash, JB, DePaulo, JR Jr (2005). Recent findings on the genetic basis of bipolar disorder. Psychiatric Clinics of North America 28, 481–498.Google Scholar
Perugi, G, Maremmani, I, Toni, C, Madaro, D, Mata, B, Akiskal, HS (2001). The contrasting influence of depressive and hyperthymic temperaments on psychometrically derived manic subtypes. Psychiatry Research 101, 249–258.Google Scholar
Potash, JB, DePaulo, JR Jr (2000). Searching high and low: a review of the genetics of bipolar disorder. Bipolar Disorders 2, 8–26.Google Scholar
Sato, T, Bottlender, R, Kleindienst, N, Möller, HJ (2002). Syndromes and phenomenological subtypes underlying acute mania: a factor analytic study of 576 manic patients. American Journal of Psychiatry 159, 968–974.Google Scholar
Sato, T, Bottlender, R, Kleindienst, N, Schröter, A, Möller, HJ (2003). Dr. Sato and colleagues reply. American Journal of Psychiatry 160, 392–393.Google Scholar
Saunders, EF, Zhang, P, Copeland, JN, Mclnnis, MG, Zöllner, S (2009). Suggestive linkage at 9p22 in bipolar disorder weighted by alcohol abuse. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 150B, 1133–1138.CrossRefGoogle ScholarPubMed
Savitz, J, van der Merwe, L, Ramesar, R (2008). Personality endophenotypes for bipolar affective disorder: a family-based genetic association analysis. Genes, Brain, and Behavior 7, 869–876.Google Scholar
Schulze, TG, McMahon, FJ (2003). Genetic linkage and association studies in bipolar affective disorder: a time for optimism. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics 123C, 36–47.Google Scholar
Schurhoff, F, Bellivier, F, Jouvent, R, Mouren-Simeoni, MC, Bouvard, M, Allilaire, JF, Leboyer, M (2000). Early and late onset bipolar disorders: two different forms of manic–depressive illness? Journal of Affective Disorders 58, 215–221.Google Scholar
Serretti, A, Rietschel, M, Lattuada, E, Krauss, H, Held, T, Nöthen, MM, Smeraldi, E (1999). Factor analysis of mania. Archives of General Psychiatry 56, 671–672.Google Scholar
Smoller, JW, Finn, CT (2003). Family, twin, and adoption studies of bipolar disorder. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics 123C, 48–58.Google Scholar
Sonne, SC, Brady, KT (1999). Substance abuse and bipolar comorbidity. In The Psychiatric Clinics of North America (ed. Akiskal, H. S. and Bewick, C. A.), pp. 609–627. W.B. Saunders Company: Philadelphia.Google Scholar
Strakowski, SM, DelBello, MP (2000). The co-occurrence of bipolar and substance use disorders. Clinical Psychology Review 20, 191–206.Google Scholar
Swann, AC, Bowden, CL, Calabrese, JR, Dilsaver, SC, Morris, DD (2002). Pattern of response to divalproex, lithium, or placebo in four naturalistic subtypes of mania. Neuropsychopharmacology 26, 530–536.Google Scholar
Swann, AC, Janicak, PL, Calabrese, JR, Bowden, CL, Dilsaver, SC, Morris, DD, Petty, F, Davis, JM (2001). Structure of mania: depressive, irritable, and psychotic clusters with different retrospectively-assessed course patterns of illness in randomized clinical trial participants. Journal of Affective Disorders 67, 123–132.Google Scholar
Swann, AC, Steinberg, JL, Lijffijt, M, Moeller, FG (2008). Impulsivity: differential relationship to depression and mania in bipolar disorder. Journal of Affective Disorders 106, 241–248.Google Scholar
Thompson, PM, Gonzalez, JM, Singh, V, Schoolfield, JD, Katz, MM, Bowden, CL (2010). Principal domains of behavioral psychopathology identified by the Bipolar Inventory of Signs and Symptoms Scale (BISS). Psychiatry Research 175, 221–226.Google Scholar
Todd, RD, Reich, W, Petti, TA, Joshi, P, DePaulo, JR, Nurnberger, J, Reich, T (1996). Psychiatric diagnoses in the child and adolescent members of extended families identified through adult bipolar affective disorder probands. Journal of the American Academy of Child and Adolescent Psychiatry 35, 664–671.Google Scholar
Tsuang, MT, Faraone, SV (1990). The Genetics of Mood Disorders. Johns Hopkins University Press: Baltimore.Google Scholar
Winokur, G, Coryell, W, Akiskal, HS, Maser, JD, Keller, MB, Endicott, J, Mueller, T (1995). Alcoholism in manic–depressive (bipolar) illness: familial illness, course of illness, and the primary–secondary distinction. American Journal of Psychiatry 152, 365–372.Google Scholar
Winokur, G, Coryell, W, Endicott, J, Keller, M, Akiskal, HS, Solomon, D (1996). Familial alcoholism in manic–depressive (bipolar) disease. American Journal of Medical Genetics 67, 197–201.Google Scholar
Winokur, G, Reich, T, Rimmer, J, Pitts, FN Jr (1970). Alcoholism. III. Diagnosis and familial psychiatric illness in 259 alcoholic probands. Archives of General Psychiatry 23, 104–111.Google Scholar
World Health Organization (2002). The World Health Report 2002. World Health Organization: Geneva.Google Scholar
Wozniak, J, Biederman, J, Monuteaux, MC, Richards, J, Faraone, SV (2002). Parsing the comorbidity between bipolar disorder and anxiety disorders: a familial risk analysis. Journal of Child and Adolescence Psychopharmacology 12, 101–111.Google Scholar
Yu, C-Y (2002). Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes. Doctoral Dissertation, University of California, Los Angeles (http://www.statmodel.com/download/Yudissertation.pdf).Google Scholar
Supplementary material: File

Monahan supplementary material

Monahan supplementary material 1

Download Monahan supplementary material(File)
File 147.5 KB