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Thus, it can be argued that offspring studies provide one of the most reliable and valid means of identifying a sample of individuals at high risk for developing a severe mental disorder and can provide information on prodromal signs and symptoms and rates of transition from an ‘at-risk’ state to clinical ‘caseness’.In this article, we review how studies of the offspring of parents with bipolar disorder (familial-risk offspring) have enhanced our understanding of the evolution of this illness.
For example, proband parents identified from clinical settings and neurobiological studies had fewer lifetime comorbid diagnoses than those recruited through publicity campaigns, and their socioeconomic status was closer to that reported in community samples, patient contacts with psychiatric services and natural history studies.
This may be important, as the clinical presentation, longitudinal course and family history have been shown to differ between different forms of bipolar disorder in adults and failure to take these differences into account could explain discrepant findings (Del Bello 2001; Alda 2004). A best-estimate diagnostic procedure is often used in studies recruiting families who are already involved in neurobiological research, which has the advantage that it can partly overcome the problem of diagnostic instability over time.
This approach entails longitudinal and cross-sectional assessments as well as an exploration of any treatment history, a review of clinical notes and collection of collateral information from all available and appropriate informants.
Studies published over the past 20 years have reported comparable rates of lifetime DSM Axis 1 disorders and similar increases in the prevalence of affective and non-affective psychopathology in the offspring of parents with bipolar disorder compared with offspring of parents without it (controls).
However, areas of divergence include the spectrum and prevalence of the psychopathologies observed, the rates and types of comorbidity and the estimated ages at onset of bipolar or other disorders.