Table 1. Studies using categorical measures of disturbances in reality testing (DRT) in offspring of parents with bipolar disorder (O-BD).

Study	Measure	N	Age		Comparison group(s)	Type of study	Summary of findings
Akdemir and Gökler 2008 (88)	K-SADS-PL	69	6–17 years		O-BD (n = 36)  O-Well (n = 33)	Cross-sectional	2.8% (1/36) of O-BD had a psychotic disorder compared to 0% of O-Well, but this difference was not statistically significant
Akiskalet al. 1985(92)	Washington University/Feighner Criteria similar to DSM-III	136	6–24 years		O-BD (n = 68)  O-Well (n = 68)	Cross-sectional	16.2% (11/68) of O-BD patients showed ‘bizarre behavior of psychotic proportions’ (including psychotic mania and psychotic depression) and 11.8% (8/68) presented with acute versus intermittent affective onset with psychosis compared to 0% of O-Well
							Did not report tests of significant differences
Cullenet al. 2011 (71)a	SCID-II	167	4, 7, 11, 15, and 22 years of age at Times 1–5		O-BD (n = 42)  O-MDD (n = 73)  O-Well (n = 52)	Longitudinal	There were no significant differences between offspring risk groups for cluster A personality disorders
Duffy et al. 2007 (65)	K-SADS-PL	188	8–25 years		O-BD of LR parents (n = 67)  O-BD of LNR parents (n = 60)  O-Well (n = 61)	Prospective over 0–9 years	8.3% (5/60) of O-BD-LNR parents had significantly more pre-psychotic conditions such as cluster A trait disorders compared to 1.5% (1/67) of O-BD-LR and 0% of O-Well; and 1.7% (1/60) of O-BD-LNR had schizoaffective disorder or psychosis-NOS compared to 0% of O-BD-LR and 0% of O-Well (not significant)
Erlenmeyer-Kimling et al. 1995(86)	SADS-L RDC	188	≥18 years		O-affective (O-Aff; n = 41 O-BD or O-MDD  O-SZ (n = 54)  O-Well (n = 93)	Cross-sectional	11.1% (2/18) of O-BD developed psychosis, and in both cases, the parents had BD with psychosis
							Did not report psychosis in comparison groups
							No significant group differences between O-Aff and O-Well on cluster A personality disorders
Erlenmeyer-Kimling et al. 1997(89)	SADS-L RDC	287	≥18 years		O-Aff (n = 67; did not specify BD versus MDD)   O-SZ (n = 84)  O-Well (n = 136)	Cross-sectional	9.0% (9/67) of O-Aff had schizoaffective disorder, SZ type compared to 1.2% (1/84) of O-SZ and 0% of O-Well; this was only significantly different compared to O-Well, but they reported that O-Aff unipolar versus BD distinction did not significantly affect these results
Grigoroui-Serbănescu et al. 1989(87)	K-SADS-E	144	10–17 years		O-BD (n = 72)  O-Well (n = 72)	Cross-sectional	12.5% (9/72) of O-BD had four different personality disorders, one of which was cluster A schizotypal personality disorder, compared to 2.8% (2/72) of O-Well; this difference was reported to be significant
Kashaniet al. 1985(60)	DICA DICA-P	50	7–17 years		O-BD (n = 9)  O-MDD (n = 41)	Cross-sectional	0% of O-BD had schizoid personality disorder compared to 7.3% (3/41) of O-MDD
							Did not report tests of significant differences
Klimes-Dougan et al., in press (17)a	CBCL	192	4, 7, 11, 15, and 22 years of age at Times 1–5		O-BD (n = 48)  O-MDD (n = 84)  O-Well (n = 60)	Longitudinal	14.6% (7/48) of O-BD had significantly more clinical levels (T ≥ 70) of thought problems at two or more time points, compared to 7.1% (6/84) of O-MDD and 0% of O-Well
Maziade et al. 2008(61)	K-SADS SCID	54	7–22 years		O-BD (n = 26)  O-SZ (n = 28)	Cross-sectional	0% of O-BD had diagnoses of psychotic disorders (e.g., SZ) or cluster A personality disorders
							Did not report tests of significant differences
Nurnberger et al. 2012(85)a	DIGS WASH-U-KSADS	232		12–21 years	O-BD (n = 141)  O-Well (n = 91)	Cross-sectional	3.5% (5/141) of O-BD had a psychosis-type disorder (schizoaffective disorder) and 5.7% (8/141) of O-BD had any psychotic symptom, compared to 0% of O-Well, but these differences were not significant
Schubert and McNeil 2003(91)	SCID	166		22 years	O-BD (n = 16)  O-Other high risk (n = 59)   O-Well(n = 91)	Cross-sectional	0% of O-BD had psychosis and 6.3% (1/16) offspring had a cluster A disorder (did not distinguish whether this was an O-BD or an O-MDD)
							Did not report tests of significance differences
Weintraub 1987(90)	SADS SCID	544		‘School-age’	O-BD(n = 134)  O-SZ (n = 80)   O-MDD(n = 154)  O-Well(n = 176)	Prospective over 3 years	1.5% (2/134) of O-BD had SZ when followed up at age 18 compared to 2/5% (2/80) of O-SZ, 10% (1/80) of O-MDD, and 0% of O-Well
							Did not report tests of significant differences

CBCL = Child Behavior Checklist; DICA = Diagnostic Interview for Children and Adolescents (P = Parent version); DIGS = Diagnostic Interview for Genetic Studies; K-SADS = The Kiddie Schedule for Affective Disorders and Schizophrenia (PL = Present and Lifetime version; WASH-U = Washington University version; E = Epidemiological version); NOS = not otherwise specified; O-Aff = offspring of a parent with an affective disorder (MDD or BD); O-BD-LNR = offspring of a parent with a nonpositive response to lithium; O-BD-LR = offspring of a parent with BD with a positive response to lithium; O-BD = offspring of a parent with bipolar disorder (BD); O-MDD = offspring of a parent with major depressive disorder (MDD); O-Other = offspring of a parent with a psychiatric disorder other than bipolar disorder; O-SZ = offspring of a parent with schizophrenia; O-Well = offspring of psychiatrically well parents; RDC = Research Diagnostic Criteria; SADS = Schedule for Affective Disorders and Schizophrenia (L = Lifetime version); SCID = Structured Clinical Interview for the DSM-IV.

^aAlso reviewed in Table 2.