Youth who are at high risk for developing bipolar disorder often experience mood swings or depression well before they develop the full disorder. A report in the Journal of the Academy of Child and Adolescent Psychiatry suggests that a questionnaire completed by parents about their children can help to track their mood instability, providing important clues about the youth’s symptoms over time.
“Interventions that are successful in reducing mood instability may enhance long-term outcomes among high-risk youth,” wrote David J. Miklowitz, Ph.D., of the University of California, Los Angeles, and colleagues.
Miklowitz and colleagues analyzed data collected during a trial of youth aged 9 to 17 at high risk for bipolar disorder who were randomly assigned to four months of a family-focused therapy or enhanced usual care. As part of this trial, the parents were asked to regularly complete the Children’s Affective Lability Scale (CALS), scoring their child on how often he or she demonstrated a range of behaviors (for example, suddenly becoming tense or anxious, crying, or having bursts of silliness). Parents also filled out the Conflict Behavior Questionnaire—20 true/false items assessing the level of argumentativeness, frustration in communication, and relational distress between parents and children. Independent evaluators also regularly assessed the youth’s depression, mania, hypomania, and psychosocial functioning. The youth were followed for an average of two years.
Of the 114 participants included in the analysis, 57% met DSM-IV-TR and DSM-5 criteria for major depressive disorder, and 43% met DSM-5 criteria for other specified bipolar disorder. The researchers found that participants who were younger and had an earlier onset of symptoms, a diagnosis of other specified bipolar disorder, more severe mood symptoms, and lower psychosocial functioning were more likely to have higher parent-rated mood instability over time. Although the mood instability scores decreased over the follow-up period, there was no difference in the mood instability scores of the youth who received the family-focused therapy compared with those who received enhanced usual care. Youth with higher mood instability scores in one assessment had higher parent/child conflict reported during the follow-up assessment, the researchers noted.
“The parent-rated CALS scale is not a diagnostic instrument but is an efficient way of tracking symptom trajectories and psychosocial impairment in high-risk youth,” Miklowitz and colleagues wrote. “Because it only takes five minutes for parents to complete and is easily hand scored, it will be considerably easier for clinicians to administer than Adolescent Longitudinal Interval Follow-up Evaluations or Young Mania Rating Scale interviews, which are lengthier and require extensive training.”
They concluded, “The present study has implications for treatment planning for youth at high risk for [bipolar disorder]. … Future clinical trials should examine whether intervening specifically on mood instability in high-risk youth helps delay or prevent the onset of syndromal [bipolar disorder] and enhances psychosocial functioning in adulthood.”
For related information, see the American Journal of Psychiatry article “Early Intervention in Bipolar Disorder.”
(Image: iStock/kasayizgi)
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