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Presenter: Mercedes E. Ramirez, M.D., University of Texas Health Science Center at San Antonio
Discussant / Mentor: Javier I. Escobar, M.D., MPH, UMDNJ-RWJMS

Childhood Antecedents of Bipolar Disorder with Psychosis in Latino subjects from the United States, Mexico and Central America

Authors :  Michael Escamilla, Mercedes Ramírez, Albana Dassori, Humberto Nicolini,
      Alfonso Ontiveros, Henriette Raventos, Alvaro Jerez; Rodrigo Muñoz, Ricardo Mendoza

Background:
Although several retrospective and longitudinal studies have been conducted to try to identify childhood psychiatric and medical antecedents in persons who go on to develop bipolar disorder, there have been few such studies conducted in Latino populations.  We reviewed retrospective data in 87 adult subjects with Bipolar Disorder, 126 subjects with Schizoaffective Bipolar Disorder, and 676 subjects with Schizophrenia, all from Latino populations in Mexico, Central America, and the United States, in order to determine possible childhood antecedents of bipolar disorder in these populations.

Method:
Subjects came from two genetic studies which recruited adult subjects with a hospital or clinic diagnosis of either schizophrenia or schizoaffective disorder, or who had a relative with a clinical diagnosis of schizophrenia or schizoaffective disorder.  After a direct interview (DIGS), family interview (FIGS), and available psychiatric records were collected for each subject, a best estimate consensus diagnostic process was completed.  Final DSMIV consensus diagnoses were as mentioned above (87 with Bipolar Disorder, 126 with Schizoaffective Bipolar Type Disorder, and 676 with Schizophrenia).  During the DIGS interview, subjects were asked about a number of childhood antecedents and comorbid disorders, including history of learning disorders or hyperactivity in childhood, history of migraine headaches, history of seizures, and history of perinatal problems or early developmental abnormalities.  We report the percentage of each type of subject who reported any of these disorders during their childhood years (i.e. prior to age 18). We also summarized how many subjects reported regularly drinking alcohol prior to age 18.

Results:
15% of bipolar subjects reported learning disorders/hyperactivity as children, (compared to 22% for schizoaffective bipolar subjects and 14% for schizophrenics).  17% of bipolar subjects reported either perinatal or early developmental problems (compared to 15% of the schizoaffectives and 11% of the schizophrenics).  5% of the bipolars reported regular alcohol use prior to age 18 (compared to 7 % of the schizoaffectives, and 3% of the schizophrenics).

Conclusions:
Bipolar Latino subjects retrospectively report high rates (greater than 10%) of learning disorder/hyperactivity, perinatal and early developmental problems, and 5% report regular alcohol use during childhood or adolescence.  Comparatively high rates of these childhood antecedents are found in schizoaffective bipolars and schizophrenic subjects. Schizoaffective bipolar subjects reported the highest rate of childhood disorders (22% reported either learning disorders or hyperactivity disorders).