Conclusions

In the offspring of bipolar patients, a broad spectrum of psychopathology can be observed:

1. Childhood depression is at high risk for bipolar transformation.

2. Childhood anxiety disorders may represent precursors of bipolar I disorder, or alternative clinical expression of bipolar II disorder.

3. ADHD, especially when the parent has a combined ADHD-bipolar disorder diagnosis, is a marker for early-onset bipolar disorder.

4. ''Classical'' episodic euphoric mania is rare in prepubertal children, unless the parent has a lithium-responding bipolar disorder.

5. Most children diagnosed as bipolar manifest stormy, ultra-rapid-cycling course. Loaded family history for bipolar disorder represents a family marker for this early-onset severe phenotype of bipolar disorder.

6. Temperamental excesses along mood-labile and overconfident lines are often precursors of bipolarity in children.

7. Cyclothymia may predict major depression with suicidality in teens, many of whom have bipolar disorder.

8. Environmental factors represent nonspecific parameters in the precipitation and aggravation of the course of bipolar disorders in children and adolescents.

9. The early detection of prodromal symptoms or signs in this high-risk population offers a window of opportunity for preventive and therapeutic interventions, which may be improved by further longitudinal studies exploring premorbid cognitive and physiological endophenotypes and structural/functional brain abnormalities.

Bipolar Disorder Uncovered

Bipolar Disorder Uncovered

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