Premorbid school performance in twins concordant and discordant for bipolar disorder

R. Vonk, A. C. Van Der Schot, G. C.M. Van Baal, C. J. Van Oel, W. A. Nolen, R. S. Kahn

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Although the genetic risk to develop bipolar disorder is present from conception, the first frank symptoms of the illness generally become evident in late adolescence or early adulthood. However, except for pediatric bipolar disorder (PBD), it is still unclear when the first signs of the illness in adults become apparent and whether these are related to the genetic risk to develop bipolar disorder. This study examined whether underperformance at school precedes the onset of the illness and is a genetically related risk marker for developing bipolar disorder. Methods: Information on school performance was obtained using objective archival data from 53 bipolar twin pairs (24 monozygotic (MZ), 29 dizygotic (DZ)) and 42 healthy matched control twin pairs (23 MZ, 19 DZ). Results: Affected twin pairs completed significantly fewer years of education than did control twin pairs with no difference between bipolar patients and their non-bipolar cotwins. The underperformance at school in the affected twin pairs occurred in early adolescence at a significantly younger age than the control twin pairs and preceded the onset of the first frank episode of bipolar disorder by thirteen years. Median age at onset of underperformance was not different in the patients and their non-bipolar cotwins. The association between liability of bipolar disease and age of first underperformance was significant and could be explained by genetic factors. Limitations: The sample is not a population based twin sample. Conclusion: Underperformance at school during early adolescence may be a genetic marker for the vulnerability to develop bipolar disorder.

Original languageEnglish
Pages (from-to)294-303
Number of pages10
JournalJournal of Affective Disorders
Issue number3
StatePublished - Feb 2012
Externally publishedYes


  • Bipolar disorder
  • Genetics
  • School performance
  • Twins


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