Studies of anticipation in bipolar affective disorder

Kezia J. Lange, Melvin G. McInnis

Research output: Contribution to journalReview articlepeer-review

34 Scopus citations


Anticipation refers to the increase in disease severity or decrease in age of onset in successive generations. The concept evolved from the theories and dogma of degeneration that were pervasive in psychiatry and medicine in the late 9th century and into the early 20th century. The term was set aside with the criticism of geneticist Lionel Penrose, who argued that anticipation was the result of ascertainment biases. The renewed interest in anticipation followed the identification of its molecular genetic basis in the form of unstable trinucleotide repeats. Subsequently, several diseases have been studied clinically for the presence of anticipation. Although anticipation has been identified in many diseases, including bipolar disorder, only diseases showing a pattern of progressive neurodegeneration have been associated with unstable trinucleotide repeats. This review summarizes the research on anticipation in bipolar disorder and other secular trends in the patterns of the illness such as the cohort effect. The changing nature of bipolar disorder is likely to be a result of combined influences from several genes, some of which are likely to be in a state of flux, as well as environmental or cultural forces that converge to give the clinical picture of anticipation.

Original languageEnglish (US)
Pages (from-to)196-202
Number of pages7
JournalCNS spectrums
Issue number3
StatePublished - 2002
Externally publishedYes

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health


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