Diagnosing bipolar disorders: Recent challenges from the studies of offspring

The initial steps towards creating the construct of bipolar disorder, as we apply it today, were taken after 1850. And it was naturally Kraepelin who formulated the concept more fully, even though not without opposition. Because of psychiatry's shared roots with neurology, the diagnosis has since been crafted mostly using symptoms. Influenced in particular by the advances of biological psychiatry, the "neoKraepelineans"revived some of Kraepelin's thinking since 1970s. Lately, with the confluence of multiple forces, the broadened notion of bipolar spectrum disorder was created. In recent years, the findings from longitudinal studies of children of bipolar and psychotic parents have been reported and point to the limitations of the symptom-based approach to diagnosis. It turns out that the early manifestations of bipolar disorder include a nonspecific variety of psychopathological manifestations, and evidence is accumulating that, in a sequence of stages, this panoply of symptoms develops into bipolar disorder. There is also growing confirmation that identifying the early stages of bipolar and psychotic disorders has important implications for successful treatment and stabilization. These observations pose a new and important challenge for the creators of improved versions of DSM and ICD.