Affective disorders in referred children and younger siblings of manic-depressives. Mode of onset and prospective course
H. S. Akiskal, J. Downs, P. Jordan, S. Watson, D. Daugherty and D. B. Pruitt
We studied 68 referred juvenile offspring or siblings of adult bipolar
patients. Mean age at onset of affective and related disturbances was 15.9
years (range, 6 to 24 years). Although four of the ten prepubertal children
had hypomanic features, full-blown manic psychosis did not appear before
puberty. In the sample at large, 12 were classified as dysthymic and ten as
cyclothymic. Eleven additional subjects with polysubstance abuse, who at
onset did not meet criteria for affective disorder, were reclassified as
having either a dysthymic or a cyclothymic disorder during follow-up. Of
the remaining patients--24 depressive, eight manic, and three mixed
state--71% experienced recurrences; mood-incongruent features, present in
four cases at onset, recurred in only one patient during subsequent
episodes. Overall, half the sample evidenced signs of bipolarity during a
mean prospective follow-up period of three years.
