Beyond the window of risk? Psychiatric and functional outcome in adult bipolar offspring, a longitudinal study

BD is a mood disorder characterized by episodes of depression and (hypo)mania
alternated (in most patients) by periods of euthymic mood and is known for its
recurrent and often chronic display with high interpersonal and societal
impact, such as partner violence, job loss, and suicide. BD affects 1-2% of the
population. One of the key challenges in the field of bipolar disorder (BD) is
early recognition. The early trajectories of the illness are non-specific and
often result in a diagnostic delay of 5-10 years. Since the peak age of onset
of BD is between adolescence and young adulthood , there is a lost opportunity
for adequate treatment during a crucial time window for interpersonal and
psychosocial development (e.g., educational performance, first work
experience). As in two-thirds of the BD patients the illness onsets with one or
multiple episodes of unipolar depression (UD), a particular diagnostic
challenge is to identify individuals with UD who are at risk for BD and those
who are not.
To date, the strongest risk factor for BD is a positive family history for BD.
Children of patients with BD (bipolar offspring) are therefore an ideal
population to study early trajectories of BD, especially when studied in a
longitudinal perspective. Worldwide only six longitudinal bipolar offspring
studies exist. In the past decades, these six studies have revealed important
insights on the risk and early trajectories of BD. Studies show that the risk
to develop BD ranges from 10-20% and most often debuts with a (mild) depressive
episode. Bipolar offspring are in general at high-risk to develop mood
disorders (>50%) and lifetime risk for psychopathology is estimated at 60-75%.
However, none of these studies had the opportunity to follow bipolar offspring
beyond the age of 30 years old. This is problematic as the first manic episode
can still emerge during middle adulthood. Existing risk estimates and early
trajectories of BD may therefore be incomplete. Therefore, much uncertainty
exists with regards to BD prevalence, switch rates from UD to BD and associated
risk factors in bipolar offspring. More knowledge regarding the risk
determinants for switching to mania can help us to develop more specific
treatment algorithms or risk calculators for healthcare professionals.
Therefore we will study the onset and development of BD in adult bipolar
offspring now aged 32-42 years of age applying a longitudinal design.
To our knowledge, there are no studies on functioning in bipolar offspring
reaching adult age. This is important to put prior findings of high rates of
psychopathology in perspective, especially since recent studies show that
regardless of current psychopathology or history of psychiatric diagnoses in
adulthood, childhood psychopathology, even sub-syndromal, is associated with an
adverse transition into adulthood in terms of health, legal system, personal
finances and social functioning.

To provide insights into 1) the risk to develop BD and other psychiatric
disorders after age 30, and 2) explore functional outcome at adult age and
study the link between (early)psychiatric outcome and functional outcome.
Moreover, compare the functional outcomes to a group of healthy control in the
same age range.

Longitudinal study

This is a non-therapeutic study. The burden of the study for participants is
considered low. The burden includes time during the on-site assessment
including interviews (approximately 2.5 hours) and filling out questionnaires
(approximately 1.5 hours) and participation in the smartphone study including
experience sampling (5 times a day for 14 consecutive days, 1-2 minutes) and
passive behavioural monitoring (14 consecutive days).