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The Nature of the Familial Risk for Psychosis in Bipolar Disorder

Kendler, Kenneth S. LU ; Abrahamsson, Linda LU ; Sundquist, Jan LU and Sundquist, Kristina LU (2024) In Schizophrenia Bulletin 50(1). p.157-165
Abstract

Background and Hypothesis: To clarify whether the familial liability to psychosis associated with bipolar disorder (BD) is nonspecific or has a greater effect on risk for psychosis in cases with prominent mood symptoms and/or a remitting course. Study Design: We examined, in 984 809 offspring raised in intact families in Sweden, born 1980-1996 and followed-up through 2018, by multivariable Cox proportional hazards regression, risk in offspring of parents with BD for 7 psychotic disorders: Psychotic MD (PMD), psychotic BD (PBD), schizoaffective disorder (SAD), acute psychoses, psychosis NOS, delusional disorder (DD) and schizophrenia (SZ). Diagnoses were obtained from national registers. Study Results: In the offspring of BD parents, the... (More)

Background and Hypothesis: To clarify whether the familial liability to psychosis associated with bipolar disorder (BD) is nonspecific or has a greater effect on risk for psychosis in cases with prominent mood symptoms and/or a remitting course. Study Design: We examined, in 984 809 offspring raised in intact families in Sweden, born 1980-1996 and followed-up through 2018, by multivariable Cox proportional hazards regression, risk in offspring of parents with BD for 7 psychotic disorders: Psychotic MD (PMD), psychotic BD (PBD), schizoaffective disorder (SAD), acute psychoses, psychosis NOS, delusional disorder (DD) and schizophrenia (SZ). Diagnoses were obtained from national registers. Study Results: In the offspring of BD parents, the hazard ratios (HR) for these 7 disorders formed an inverted U-shaped curve, rising from 2.98 for PMD, to peak at 4.49 for PBD and 5.25 for SAD, and then declining to a HR of 3.48 for acute psychoses and 3.22 for psychosis NOS, to a low of 2.19 for DD and 2.33 for SZ. A similar pattern of risks was seen in offspring of mothers and fathers affected with BD and in offspring predicted from age at onset in their BD parent. Conclusions: The BD-Associated risk for psychosis impacts most strongly on mood disorders, moderately on episodic psychotic syndromes, and least on chronic psychotic disorders. These results support prior clinical studies suggesting a qualitative difference in the familial substrate for psychosis occurring in BD and SZ.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Schizophrenia Bulletin
volume
50
issue
1
pages
9 pages
publisher
Oxford University Press
external identifiers
  • pmid:37440202
  • scopus:85181165152
ISSN
0586-7614
DOI
10.1093/schbul/sbad097
language
English
LU publication?
yes
id
065277b2-5d79-4a08-85ed-cf1873cdfe41
date added to LUP
2024-02-06 14:50:43
date last changed
2024-04-23 16:04:33
@article{065277b2-5d79-4a08-85ed-cf1873cdfe41,
  abstract     = {{<p>Background and Hypothesis: To clarify whether the familial liability to psychosis associated with bipolar disorder (BD) is nonspecific or has a greater effect on risk for psychosis in cases with prominent mood symptoms and/or a remitting course. Study Design: We examined, in 984 809 offspring raised in intact families in Sweden, born 1980-1996 and followed-up through 2018, by multivariable Cox proportional hazards regression, risk in offspring of parents with BD for 7 psychotic disorders: Psychotic MD (PMD), psychotic BD (PBD), schizoaffective disorder (SAD), acute psychoses, psychosis NOS, delusional disorder (DD) and schizophrenia (SZ). Diagnoses were obtained from national registers. Study Results: In the offspring of BD parents, the hazard ratios (HR) for these 7 disorders formed an inverted U-shaped curve, rising from 2.98 for PMD, to peak at 4.49 for PBD and 5.25 for SAD, and then declining to a HR of 3.48 for acute psychoses and 3.22 for psychosis NOS, to a low of 2.19 for DD and 2.33 for SZ. A similar pattern of risks was seen in offspring of mothers and fathers affected with BD and in offspring predicted from age at onset in their BD parent. Conclusions: The BD-Associated risk for psychosis impacts most strongly on mood disorders, moderately on episodic psychotic syndromes, and least on chronic psychotic disorders. These results support prior clinical studies suggesting a qualitative difference in the familial substrate for psychosis occurring in BD and SZ.</p>}},
  author       = {{Kendler, Kenneth S. and Abrahamsson, Linda and Sundquist, Jan and Sundquist, Kristina}},
  issn         = {{0586-7614}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{157--165}},
  publisher    = {{Oxford University Press}},
  series       = {{Schizophrenia Bulletin}},
  title        = {{The Nature of the Familial Risk for Psychosis in Bipolar Disorder}},
  url          = {{http://dx.doi.org/10.1093/schbul/sbad097}},
  doi          = {{10.1093/schbul/sbad097}},
  volume       = {{50}},
  year         = {{2024}},
}