Familial severe psychiatric history affects treatment of bipolar disorder patients

Patients with bipolar disorder who have multiple family members with severe mental disorders, are more difficult to treat and require more medicine. But if they receive an intensive course of treatment, the effect of this is just as good as for patients who do not have a family history of severe mental disorders.

Bipolar disorder is a serious mental disorder which affects >1 procent of the population during their lifetimes. Now, a new study from Aarhus University and Aarhus University Hospital Psychiatry - in collaboration with a number of American hospitals led by Massachusetts General Hospital in Boston - follows in the wake of previous studies in showing that patients with bipolar disorder have many family members who also suffer from severe mental disorders.

Treatment should be intensified

However, the new element in the study is that the course of the disorder is more complicated for patients who have e.g. a parent or sibling with a severe mental disorder. They had more depressive and manic episodes and more suicide attempts during their lifetime, while at the same time requiring a more intensive course of treatment with more medicine.

The positive finding is that this extra effort in relation to treatment resulted in patients who both had and didn't have close relatives with severe mental disorders responding equally well to the treatment."

Ole Köhler-Forsberg, Medical Doctor and Ph.D., from Aarhus University and Aarhus University Hospital - Psychiatry

The findings have just been published in the scientific journal Journal of Affective Disorders.

At the start of the study, patients with bipolar disorder self-reported the number of first-degree relatives with severe mental disorders. Of the participants, 85 per cent had at least one, and twenty per cent had five or more. Among the most frequent disorders were depression, alcohol abuse and bipolar disorder.

"We also found that a higher number of family relatives with severe mental disorders was linked to a lower level of education, lower income and earlier debut of the disorder. This suggests that mental disorders in the family also affect the lives of the patients in a very broad and general sense which goes beyond the disorder itself," says Ole Köhler-Forsberg.

The results are based on two large American randomised controlled trials with a total of 757 participants. The study is the first of its kind to include such a large group of patients and also to follow these patients over 24 weeks while they were treated with one of four different treatments.

"Future studies could take a closer look at how mental disorders in the family affect the patient, but also at the entire family and the lives of relatives, and whether efforts to help e.g. the children of people with mental disorders should begin earlier," says the researcher.

Background for the results:

The study is based on two large clinical studies which were conducted at eleven hospitals in the USA. Patients were treated with one of four possible treatment methods. At the beginning of the study, the patients indicated who and how many of their first-degree relatives had a severe mental disorder. The study was carried out in collaboration with eleven American hospitals, primarily Massachusetts General Hospital and Harvard University in Boston, USA.

Source:
Journal reference:

Köhler-Forsberg, O., et al. (2020) Familial severe psychiatric history in bipolar disorder and correlation with disease severity and treatment response. Journal of Affective Disorders. doi.org/10.1016/j.jad.2020.03.157.

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