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We also highlight some of the environmental risk factors that may increase the likelihood of transition from an ‘at-risk’ or high-risk state to bipolar disorder.Last, we briefly discuss the implications of study findings for early intervention strategies and comment on such issues as genetic counselling and primary and early secondary prevention programmes.
It is noteworthy that higher rates of comorbidity were evident in the studies that recruited via self-referral than in those including bilineal families and families where the non-proband parent also had a non-affective psychiatric illness (see Box 1 for a synopsis of terminology).
Enters the study through their relationship with the proband; they may be an affected or well participant, depending on the study design, but not the initial contact for entering into the genetic study of a family Not only does the strategy for recruiting parents and/or offspring vary, but studies differ in the inclusion of any control groups.
The mean age of offspring groups included in studies also varies widely (from 3 to 17 years), rendering direct interview assessment of offspring difficult in the youngest samples and placing excessive reliance on retrospective assessment of any early childhood psychopathology in the older recruits.
Likewise, the nature of the control group also influences findings.
Bipolar disorder is also a highly heritable disorder, with up to 85% of the variance in risk determined by genetic factors, and a positive family history remains the strongest predictive factor for development of the illness.
Meta-analyses have shown that, compared with other children, the offspring of a parent with bipolar disorder have an eight- to tenfold increase in their lifetime risk for developing the disorder, a threefold lifetime risk for a major psychiatric disorder and a one-in-two risk for any mental illness (Lapalme 1997; Del Bello 2001; Rasic 2014).
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We note that longitudinal follow-up of both affected and unaffected high-risk siblings from an early age may reveal clinical, biological and/or environmental factors that predict which high-risk family members ultimately develop bipolar disorder.
Prospective studies can potentially clarify the ‘illness trajectory’ by exposing the temporal relationship between any childhood difficulties or non-mood problems and later affective pathology and/or development of a bipolar disorder.