A newly published study by University of Pittsburgh scientists is praised by bipolar disorder researchers who say the study results will help bipolar parents realize they should watch for and act on early signs their children have the mental illness.

"Once they develop the illness, we have to make a decision to treat or not. [It] depends on whether the illness is affecting their lives, especially because children are [still] developing cognitively, socially and emotionally," said Dr. Boris Birmaher, lead author of the Pittsburgh Bipolar Offspring Study, funded by the National Institute of Mental Health and published in the March issue of Archives of General Psychiatry.

The study found it's likely parents may pass on a risk for the disorder. Compared with the offspring of control group parents, children with a bipolar parent had a 14-fold increased risk of having a bipolar spectrum disorder. There also was a two- to three-fold increase the children would have a mood or anxiety disorder. Furthermore, children from families in which both parents were bipolar were more likely to develop the disorder than those in families with one bipolar parent.

An estimated 1 percent of children and teens worldwide have the illness, which is characterized by large mood swings, said Dr. Birmaher, a professor of psychiatry at the University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic. He also is co-director of the institute's Child and Adolescent Bipolar Services.

The blind study begun eight years ago compared 388 children aged 6 to 18 of parents with either bipolar disorder-I or bipolar disorder-II to 251 children of demographically matched control parents. None of the control parents had bipolar disorder; rather they matched the study group in age, sex and neighborhood. Children were assessed directly for bipolar and other psychiatric disorders by researchers who did not know their parents' diagnoses.

"[The study] fits very nicely with what other groups have shown. ... This is important because it is probably the largest sample so it is very reassuring," said Dr. Jair Soares, director of the Center of Excellence for Research and Treatment of Bipolar Disorder and a professor of psychiatry at University of North Carolina.

"This research may allow us to corroborate [earlier findings]. It's important to disseminate in the community that if you are a child of a bipolar parent or you're bipolar and have children, your children are at higher risk, so it's important to watch carefully for problems. ... The sooner you diagnose and intervene the better."

For many years, it was believed that bipolar disorder only affected adults, said Dr. Eric Youngstrom, associate director of North Carolina's bipolar center.

"This study is another excellent example of recognizing ... the genetic risk is present from the moment of conception. The field has not done a good service to families by assuming the mood disorder will not be a problem until adulthood. ... We would do well to pay attention and try to help as early as possible," Dr. Youngstrom added.

Dr. Youngstrom was a co-author of a study in the March issue of Pediatrics on the quality of life for children with bipolar disorder. As part of its own pediatric bipolar research, a team from the University of North Carolina concluded that out of a total of 529 youths, with a mean age of 12 years, those with bipolar diagnoses reported a "significantly lower" quality of life than others being treated in two pediatric practices (for conditions including asthma, obesity, arthritis, depression and oxygen dependence). The study recommended attending to the overall problems the children encounter, as well as the mood symptoms.

"That's the reason we do these kinds of studies," Dr. Birmaher said. "We believe if we begin to see the first signs of illness, you can do something to prevent or at least diminish the illness very early in life. There are many things we don't know yet because we're just beginning to study the illness in children. ... We don't know exactly, for example, what will be the best treatment." It might be psychotherapy for the child and family, medication, or a combination of both, he said.

Dr. Birmaher said the study doesn't specifically address the genetic basis of bipolar disorder.

"The only thing we can say from the study is it runs in families for sure," he said. "There are older studies comparing identical twins that were raised apart and they showed one twin developing bipolar disorder. The others have very high risk to developing bipolar, too. This study shows a genetic component ... [but] not everything is genetic. Like everything in life, it is a combination of genes and environment.

"We think it's caused by a group of genes, many genes, but environment is important, too. If you have a propensity for diabetes but exercise instead of being a couch potato, you can still get diabetes but you diminish the risk. It's the same with hypertension. There are other diseases that are genetic, where environment is not important, but that is not the case in bipolar disorder. Environment is important, too."

Dr. Birmaher said the study will continue with researchers doing followups of both the children of bipolar parents and the children of the control group every other year for many years to come.