Family history points to more severe bipolar disorder

By Eleanor McDermid, Senior medwireNews Reporter

A family history of mood disorders is associated with more severe symptoms at presentation and a poorer clinical course in patients with bipolar disorder, show findings from the STEP-BD study.

A total of 2600 patients from the STEP-BP (Systematic Treatment Enhancement Program for Bipolar Disorder) study completed a questionnaire on family history, with 1963 (75.5%) saying they had a first-degree family member with a history of mania or depression.

The findings from these patients confirm many previously reported associations. Patients with a family history of mood disorders were significantly younger than those without at symptom onset, at 21 versus 23 years for mania, and 17 versus 20 years for depression. They had experienced significantly more manic or depressed phases and were more likely to have attempted suicide, at 40% versus 33%.

In addition, more patients with than without a positive family history met the criteria for rapid cycling, at 51% versus 40%.

Also in line with previous research, patients with a family history were more likely than those without to have comorbid anxiety disorders. “Indeed, a shared genetic etiology has been suggested between mood and anxiety disorders,” say researchers Niki Antypa and Alessandro Serretti, from the University of Bologna in Italy.

As well as having more severe symptoms at presentation, patients with a positive family history had greater severity of certain symptoms during 1 year of follow-up. All depressive symptoms tended to be more severe, with this reaching significance for reduced energy and concentration, and for suicidality. Most manic symptoms were also more severe, significantly so for racing thoughts and distraction.

“All of these ‘mental activation’ symptoms reflect cognitive functions that are often impaired in [bipolar disorder],” say the researchers in the Journal of Affective Disorders.

Having more severe symptoms adversely affected patients’ quality of life; those with a positive family history had significantly lower scores than those without on the Quality of Life Enjoyment and Satisfaction Short Form, both at baseline (40.8 vs 43.2) and during follow-up (42.4 vs 44.6).

“If these observations are robust, systematic monitoring of cognitive symptomatology and tailored treatment, perhaps through cognitive remediation techniques, could improve functional outcome in bipolar patients with [a family history] of mood disorders,” conclude the researchers.

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