# Bipolar Disorder VII: Family History and Its Relationship With Suicide Attempts, Severity, and the Prophylactic Effect of Lithium Treatment in a Long-Term Follow-Up Study of Bipolar Disorder

## TL;DR

This study shows that bipolar disorder patients with a family history of affective disorders experience more severe symptoms, earlier suicide attempts, and reduced lithium treatment effectiveness.

## Contribution

The study identifies a distinct clinical course of bipolar disorder linked to family history of affective disorders, including lithium response and suicide risk patterns.

## Key findings

- Patients with a family history of affective disorders had earlier age of onset and more frequent depressive episodes.
- Suicide attempts were more common and occurred earlier in patients with a family history of affective disorders.
- Lithium treatment was less effective in patients with a family history of affective disorders.

## Abstract

Family history (FH) of affective disorders (ADs) is important for the course of bipolar disorder (BD).

In a long-term study (mean 25 years), 192 patients with BD diagnosed by DSM-IV criteria were recruited from lithium dispensaries. Differences between patients with and without an FH of ADs were studied.

Patients with an FH of AD had poorer lithium response (p = .027), earlier age of onset (AOO) (p < .001), were younger (p = .009), made suicide attempts (SAs) earlier after onset (p = .012), and had more episodes/year (p = .017) and depressive episodes/year (p = .010) before SA. SAs were more common (p = .028) in patients with an FH of AD. SAs were more common (p = .001) before lithium treatment, and SAs (p < .001) were only present in patients with an FH of AD within the first 5 years after AOO. Patients with an FH of AD had more episodes (p = .009), episodes/year (p = .002), depressive episodes (p < .001), and depressive episodes/year (p < .001) during their lifetime. Before lithium, episodes (p = .009), depressive episodes (p = .006), and depressive episodes/year (p = .010) were more common in patients with an FH of AD. Manic episodes (p = .020) were more common in patients with no FH of AD. On lithium, episodes (p = .010), episodes/year (p = .001), depressive episodes (p < .001), and depressive episodes/year (p < .001) were more common in patients with an FH of AD. FH of suicide was present only among patients with an FH of AD (p < .001).

BD patients with an FH of AD have a more severe form of BD with a special effect on SAs, AOO, episodes, and lithium response in BD.

Patients with a family history (FH) of affective disorders (ADs) had poorer lithium response, earlier age of onset (AOO), were younger, performed suicide attempts (SAs) earlier, had higher episodes/year and depressive episodes/year before SA. SAs were more common in patients, before lithium and only present 5 years after AOO. Patients had more episodes, episodes/year, depressive episodes, and depressive episodes/year during lifetime. Before lithium, episodes/year, depressive episodes, and depressive episodes/year were more common in patients. Manic episodes were more common in nonpatients. On lithium, episodes, episodes/year, depressive episodes, and depressive episodes/year were more common in patients. FH of suicide was only present among patients.

Patients with a family history (FH) of affective disorders (ADs) had poorer lithium response, earlier age of onset (AOO), were younger, performed suicide attempts (SAs) earlier, had higher episodes/year and depressive episodes/year before SA. SAs were more common in patients, before lithium and only present 5 years after AOO. Patients had more episodes, episodes/year, depressive episodes, and depressive episodes/year during lifetime. Before lithium, episodes/year, depressive episodes, and depressive episodes/year were more common in patients. Manic episodes were more common in nonpatients. On lithium, episodes, episodes/year, depressive episodes, and depressive episodes/year were more common in patients. FH of suicide was only present among patients.