Mood Instability in Youth at High Risk for Bipolar Disorder. Journal of the American Academy of Child and Adolescent Psychiatry Miklowitz, D. J., Weintraub, M. J., Singh, M. K., Walshaw, P. D., Merranko, J. A., Birmaher, B., Chang, K. D., Schneck, C. D. 2022


OBJECTIVE: Mood instability is associated with the onset of bipolar disorder (BD) in youth with a family history of the illness. In a clinical trial with youth at high risk for BD, we examined the association between mood instability and symptomatic, psychosocial, and familial functioning over an average of two years.METHOD: Youth (ages 9-17 yrs.) with major depressive disorder or other specified BD, current mood symptoms, and a family history of BD were rated by parents on a mood instability scale. Participants were randomly assigned to four months of family-focused therapy or enhanced care psychoeducation, both with medication management as needed. Independent evaluators rated youth every four to six months for up to four years on symptom severity and psychosocial functioning, while parents rated youths' mood instability and levels of family conflict.RESULTS: High risk youth (N=114; mean age 13.3+2.6 years; 72 female) were followed for an average of 104.3+65.8 weeks (range 0-255) following randomization. Youth with other specified BD (vs. major depressive disorder), younger age, earlier symptom onset, more severe mood symptoms, lower psychosocial functioning, and more familial conflict over time had higher mood instability ratings throughout the study period. Mood instability mediated the association between baseline diagnosis and mother/offspring conflict at follow-up (Z=2.88, p=0.004, alphabeta=0.19, 95% CI=0.06-0.32). Psychosocial interventions did not moderate these associations.CONCLUSION: A questionnaire measure of mood instability tracked closely with symptomatic, psychosocial, and family functioning in youth at high risk for BD. Interventions that are successful in reducing mood instability may enhance long-term outcomes among high risk youth.

View details for DOI 10.1016/j.jaac.2022.03.009

View details for PubMedID 35307538