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Maire J, Galéra C, Meyer E, Salla J, Michel G. Is emotional lability a marker for attention deficit hyperactivity disorder, anxiety and aggression symptoms in preschoolers? Child Adolesc Ment Health 2017; 22:77-83. [PMID: 32680322 DOI: 10.1111/camh.12168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emotional lability (EL) is frequent in school-aged children with attention deficit hyperactivity disorder (ADHD) and is associated with more frequent comorbidities and more severe impairment. However, little research has investigated the association between EL, ADHD and comorbid symptoms in preschoolers. This study assessed dimensional EL in preschoolers and its link with ADHD symptoms (e.g. hyperactivity-impulsivity and inattention) and behavioural and emotional problems (e.g. aggression and anxiety). METHOD One hundred and fifty-four preschoolers aged 3-6 years old were rated on questionnaires by parents. EL was assessed with the index from the Conners Rating Scale-Revised and behavioural and emotional problems with an adapted version of the Social Behavior Questionnaire. Multiple linear regressions analyses were conducted. RESULTS Higher EL was associated with higher hyperactivity-impulsivity, inattention, anxiety and aggression problems. After controlling for other behavioural and emotional problems and sociodemographic variables, EL remained associated with hyperactivity-impulsivity and anxiety. CONCLUSIONS Emotional lability seems to be a potential marker for ADHD symptoms with internalizing problems in preschoolers and could be a target for diagnosis and early interventions. This finding should be treated with caution as the study was limited by the low response rate of the participants and consequently the small sample size.
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Affiliation(s)
- Jenna Maire
- Department Health and Achievement in the Young, Center for Research Bordeaux Population Health, INSERM U1219, 33076, Bordeaux Cedex, France
| | - Cédric Galéra
- Department Health and Achievement in the Young, Center for Research Bordeaux Population Health, INSERM U1219, 33076, Bordeaux Cedex, France
| | - Eric Meyer
- Department Health and Achievement in the Young, Center for Research Bordeaux Population Health, INSERM U1219, 33076, Bordeaux Cedex, France
| | - Julie Salla
- Department Health and Achievement in the Young, Center for Research Bordeaux Population Health, INSERM U1219, 33076, Bordeaux Cedex, France
| | - Grégory Michel
- Department Health and Achievement in the Young, Center for Research Bordeaux Population Health, INSERM U1219, 33076, Bordeaux Cedex, France
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Effect of Methylphenidate on Emotional Dysregulation in Children With Attention-Deficit/Hyperactivity Disorder + Oppositional Defiant Disorder/Conduct Disorder. J Clin Psychopharmacol 2017; 37:220-225. [PMID: 28225747 DOI: 10.1097/jcp.0000000000000668] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Emotional dysregulation (ED) is a frequent feature of attention-deficit/hyperactivity disorder (ADHD). It can be observed as a dysregulation profile or a deficient emotional self-regulation (DESR) profile. Oppositional defiant disorder/conduct disorder (ODD/CD) comorbidity is prevalent in ADHD and known to be related with ED. The first-line treatment of ADHD includes psychostimulants, but their effects on ED are not well studied. This study aimed to evaluate the outcomes of methylphenidate (MPH) treatment on ED in ADHD + ODD/CD cases. METHODS A total of 118 ADHD + ODD/CD patients with a mean age of 9.0 ± 1.9 years were treated with MPH for 1 year. Also, parents of cases were recruited for a parent-training program, which initiated after first month of MPH treatment. Symptom severity was assessed at baseline and 12th month by Turgay Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parent Form, Children Depression Inventory, Child Behavior Checklist 4-18 years, and Parental Acceptance and Rejection Questionnaire-Mother Form. RESULTS Emotional dysregulation (DESR + DP) was present in 85.6% of cases. Conduct disorder was significantly higher in patients with DP, whereas ODD was significantly higher in the DESR and non-ED groups (P < 0.0001). Symptoms of ADHD and ED were significantly improved with 1-year of MPH treatment (P < 0.05). The improvement in ED was independent of improvement in ADHD symptoms and parent training (P < 0.05). CONCLUSIONS Emotional dysregulation is highly prevalent in disruptive behavioral disorders as ODD and CD, which are comorbid with ADHD. The MPH treatment is effective on ED independently from other clinical determinants.
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Leibenluft E. Pediatric Irritability: A Systems Neuroscience Approach. Trends Cogn Sci 2017; 21:277-289. [PMID: 28274677 PMCID: PMC5366079 DOI: 10.1016/j.tics.2017.02.002] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/27/2017] [Accepted: 02/02/2017] [Indexed: 02/03/2023]
Abstract
Irritability, defined as an increased propensity to exhibit increased anger relative to one's peers, is a common clinical problem in youth. Irritability can be conceptualized as aberrant responses to frustration (where frustration is the emotional response to blocked goal attainment) and/or aberrant 'approach' responses to threat. Irritable youth show hyper-reactivity to threat mediated by dysfunction in amygdala, medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), insula, striatum, and association cortex. Irritable youth also show abnormalities in reward learning, cognitive control, and responses to frustration. These abnormalities are mediated by circuitry that includes the inferior frontal gyrus (iFG), striatum, ACC, and parietal cortex. Effective treatments for irritability are lacking, but pathophysiological research could lead to more precisely targeted interventions.
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Affiliation(s)
- Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
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Lahey BB, Krueger RF, Rathouz PJ, Waldman ID, Zald DH. A hierarchical causal taxonomy of psychopathology across the life span. Psychol Bull 2017; 143:142-186. [PMID: 28004947 PMCID: PMC5269437 DOI: 10.1037/bul0000069] [Citation(s) in RCA: 249] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We propose a taxonomy of psychopathology based on patterns of shared causal influences identified in a review of multivariate behavior genetic studies that distinguish genetic and environmental influences that are either common to multiple dimensions of psychopathology or unique to each dimension. At the phenotypic level, first-order dimensions are defined by correlations among symptoms; correlations among first-order dimensions similarly define higher-order domains (e.g., internalizing or externalizing psychopathology). We hypothesize that the robust phenotypic correlations among first-order dimensions reflect a hierarchy of increasingly specific etiologic influences. Some nonspecific etiologic factors increase risk for all first-order dimensions of psychopathology to varying degrees through a general factor of psychopathology. Other nonspecific etiologic factors increase risk only for all first-order dimensions within a more specific higher-order domain. Furthermore, each first-order dimension has its own unique causal influences. Genetic and environmental influences common to family members tend to be nonspecific, whereas environmental influences unique to each individual are more dimension-specific. We posit that these causal influences on psychopathology are moderated by sex and developmental processes. This causal taxonomy also provides a novel framework for understanding the heterogeneity of each first-order dimension: Different persons exhibiting similar symptoms may be influenced by different combinations of etiologic influences from each of the 3 levels of the etiologic hierarchy. Furthermore, we relate the proposed causal taxonomy to transdimensional psychobiological processes, which also impact the heterogeneity of each psychopathology dimension. This causal taxonomy implies the need for changes in strategies for studying the etiology, psychobiology, prevention, and treatment of psychopathology. (PsycINFO Database Record
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Affiliation(s)
| | | | - Paul J Rathouz
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine
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55
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Hafeman D, Bebko G, Bertocci MA, Fournier JC, Chase HW, Bonar L, Perlman SB, Travis M, Gill MK, Diwadkar VA, Sunshine JL, Holland SK, Kowatch RA, Birmaher B, Axelson D, Horwitz SM, Arnold LE, Fristad MA, Frazier TW, Youngstrom EA, Findling RL, Phillips ML. Amygdala-prefrontal cortical functional connectivity during implicit emotion processing differentiates youth with bipolar spectrum from youth with externalizing disorders. J Affect Disord 2017; 208:94-100. [PMID: 27756046 PMCID: PMC5154789 DOI: 10.1016/j.jad.2016.09.064] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/31/2016] [Accepted: 09/06/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Both bipolar spectrum disorders (BPSD) and attention deficit hyperactivity disorder (ADHD) present with emotion-regulation deficits, but require different clinical management. We examined how the neurobiological underpinnings of emotion regulation might differentiate youth with BPSD versus ADHD (and healthy controls, HCs), specifically assessing functional connectivity (FxC) of amygdala-prefrontal circuitry during an implicit emotion processing task. METHODS We scanned a subset of the Longitudinal Assessment of Manic Symptoms (LAMS) sample, a clinically recruited cohort with elevated behavioral and emotional dysregulation, and age/sex-ratio matched HCs. Our sample consisted of 22 youth with BPSD, 30 youth with ADHD/no BPSD, and 26 HCs. We used generalized psychophysiological interaction (gPPI) to calculate group differences to emerging emotional faces vs. morphing shapes in FxC between bilateral amygdala and ventral prefrontal cortex/anterior cingulate cortex. RESULTS FxC between amygdala and left ventrolateral prefrontal cortex (VLPFC) in response to emotions vs. shapes differed by group (p=.05): while BPSD showed positive FxC (emotions>shapes), HC and ADHD showed inverse FxC (emotions<shapes). A group x emotion interaction was found in amygdala-subgenual cingulate FxC (p=.025), explained by differences in FxC in response to negative emotions. While BPSD showed positive FxC, HC showed inverse FxC; ADHD were intermediate. Amygdala-subgenual FxC was also positively associated with depressive symptoms and stimulant medication. LIMITATIONS Co-morbidity and relatively small sample size. CONCLUSIONS Youth with BPSD showed abnormally positive FxC between amygdala and regions in the ventral prefrontal cortex during emotion processing. In particular, the amygdala-VLPFC finding was specific to BPSD, and not influenced by other diagnoses or medications.
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Affiliation(s)
- Danella Hafeman
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh,Corresponding author. 3811 O’Hara St, Pittsburgh, PA 15213, Phone: 412 246 5820; fax: 412 246 5230
| | - Genna Bebko
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - Michele A. Bertocci
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - Jay C. Fournier
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - Henry W. Chase
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - Lisa Bonar
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - Susan B. Perlman
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - Michael Travis
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - Mary Kay Gill
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | | | | | - Scott K Holland
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati
| | | | - Boris Birmaher
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - David Axelson
- Child Psychiatry, New York University School of Medicine
| | | | | | | | | | | | - Robert L. Findling
- University Hospitals Case Medical Center/Case Western Reserve University,Psychiatry, Johns Hopkins University
| | - Mary L. Phillips
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh,Psychological Medicine, Cardiff University
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56
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Qian Y, Chang W, He X, Yang L, Liu L, Ma Q, Li Y, Sun L, Qian Q, Wang Y. Emotional dysregulation of ADHD in childhood predicts poor early-adulthood outcomes: A prospective follow up study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 59:428-436. [PMID: 27744214 DOI: 10.1016/j.ridd.2016.09.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 07/28/2016] [Accepted: 09/30/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUD Emotional dysregulation (EDR) is commonly seen in individuals with attention deficit hyperactive disorder (ADHD). But few are known about the influence of EDR on early-adulthood outcomes. AIMS To detect the relationship between emotional dysregulation (EDR) in childhood and the outcomes in early-adulthood of participants with attention deficit hyperactive disorder (ADHD). METHODS AND PROCEDURES Han Chinese children who met DSM-IV ADHD criteria were followed up into early adulthood. The subjects were divided into two groups (with or without EDR) according to the emotion control subscale of Behavior Rating Scale of Executive Function in childhood. In the follow-up interview, their clinical outcomes were assessed by the Conner's Adult ADHD Diagnostic Interview and the Structured Clinical Interview for DSM-IV-TR Axis I and II Disorders. Information on after-school tutoring and suspension of schooling was also collected as indices of educational outcomes. OUTCOMES AND RESULTS We followed up 68 out of 90 individuals when they reached early adulthood. Data analysis showed that EDR predicted HI symptoms of ADHD both in childhood (OR=10.28, p<0.01) and in early-adulthood (OR=4.07, p=0.01). And EDR in childhood had trend to predicted adult ODD (X2=3.93, p=0.05). The suspension of schooling was also predicted by EDR (OR=9.31, p=0.04). CONCLUSIONS AND IMPLICATIONS This study illustrated that EDR of children with ADHD, independent of co-occurring ODD, predicted poor long-term clinical and educational outcome in early-adulthood.
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Affiliation(s)
- Ying Qian
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China
| | - WeiLi Chang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoxiao He
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China
| | - Li Yang
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China
| | - Lu Liu
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China
| | - Quangang Ma
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yueling Li
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China
| | - Li Sun
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China
| | - Qiujin Qian
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China.
| | - Yufeng Wang
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China.
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Van Cauwenberge V, Sonuga-Barke EJS, Hoppenbrouwers K, Van Leeuwen K, Wiersema JR. Regulation of emotion in ADHD: can children with ADHD override the natural tendency to approach positive and avoid negative pictures? J Neural Transm (Vienna) 2016; 124:397-406. [PMID: 27744615 DOI: 10.1007/s00702-016-1631-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Valerie Van Cauwenberge
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium.
| | - Edmund J S Sonuga-Barke
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
- School of Psychology, University of Southampton, Shackleton Building (B44), Highfield Campus, Southampton, SO17 1BJ, UK
| | - Karel Hoppenbrouwers
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 Blok d-Bus 7001, 3000, Louvain, Belgium
| | - Karla Van Leeuwen
- Department of Parenting and Special Education, KU Leuven, Leopold Vanderkelenstraat 32-Bus 3765, 3000, Louvain, Belgium
| | - Jan R Wiersema
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
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58
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Gupta S, Anderson R, Holt RI. Greater variation in affect is associated with lower fasting plasma glucose. Heliyon 2016; 2:e00160. [PMID: 27699281 PMCID: PMC5037241 DOI: 10.1016/j.heliyon.2016.e00160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 08/24/2016] [Accepted: 09/09/2016] [Indexed: 11/30/2022] Open
Abstract
Background Depression and bipolar illness are associated with a 2–3 fold increase in the prevalence of diabetes. However, it is unknown whether variation in mood affects glucose metabolism. The aim of this study was to assess whether changes in affect were related to fasting plasma glucose and glycated haemoglobin. Methods 379 men and 441 women who took part in the 2003 Health Survey for England and had valid data for GHQ12 and fasting blood glucose were included. Mood variability was assessed by the General Health Questionnaire 12 (GHQ12). Fasting plasma glucose and glycated haemoglobin (HbA1c) were measured by standard laboratory methodology and their relationship to variability assessed using linear regression. Results There was a significant inverse relationship between fasting blood glucose, but not HbA1c, and variability score (R2 = 0.327, p = 0.02) after adjusting for sociodemographic factors, anthropometric measurements, lifestyle, and use of medication. Conclusion This study has shown an inverse association between changes in affect and fasting plasma glucose. This unexpected finding suggests that the association between affect and glucose is more complex than previously thought. Fasting blood glucose may reflect the operation of homeostatic mechanisms that are disturbed in certain mental states and are associated, therefore, with altered risk of diabetes and related metabolic conditions. This may have implications for the management of those with such conditions and with mental disorders.
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Affiliation(s)
- Sunjai Gupta
- Institute of Psychiatry, Psychology and Neurology, Kings College, De Crespigny Park, London SE5 8AF, UK
| | | | - Richard Ig Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, UK
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Abstract
Children/adolescents with attention-deficit/hyperactivity disorder (ADHD) may have a poor or inadequate response to psychostimulants or be unable to tolerate their side-effects; furthermore, stimulants may be inappropriate because of co-existing conditions. Only one non-stimulant ADHD pharmacotherapy, the noradrenaline transporter inhibitor atomoxetine, is currently approved for use in Europe. We review recent advances in understanding of the pathophysiology of ADHD with a focus on the roles of catecholamine receptors in context of the α2A-adrenergic receptor agonist guanfacine extended release (GXR), a new non-stimulant treatment option in Europe. Neuroimaging studies of children/adolescents with ADHD show impaired brain maturation, and structural and functional anomalies in brain regions and networks. Neurobiological studies in ADHD and medication response patterns support involvement of monoaminergic neurotransmitters (primarily dopamine and noradrenaline). Guanfacine is a selective α2A-adrenergic receptor agonist that has been shown to improve prefrontal cortical cognitive function, including working memory. The hypothesized mode of action of guanfacine centres on direct stimulation of post-synaptic α2A-adrenergic receptors to enhance noradrenaline neurotransmission. Preclinical data suggest that guanfacine also influences dendritic spine growth and maturation. Clinical trials have demonstrated the efficacy of GXR in ADHD, and it is approved as monotherapy or adjunctive therapy to stimulants in Canada and the USA (for children and adolescents). GXR was approved recently in Europe for the treatment of ADHD in children and adolescents for whom stimulants are not suitable, not tolerated or have been shown to be ineffective. GXR may provide particular benefit for children/adolescents who have specific co-morbidities such as chronic tic disorders or oppositional defiant disorder (or oppositional symptoms) that have failed to respond to first-line treatment options.
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60
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Vidal-Ribas P, Brotman MA, Valdivieso I, Leibenluft E, Stringaris A. The Status of Irritability in Psychiatry: A Conceptual and Quantitative Review. J Am Acad Child Adolesc Psychiatry 2016; 55:556-70. [PMID: 27343883 PMCID: PMC4927461 DOI: 10.1016/j.jaac.2016.04.014] [Citation(s) in RCA: 298] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/27/2016] [Accepted: 04/29/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Research and clinical interest in irritability have been on the rise in recent years. Yet several questions remain about the status of irritability in psychiatry, including whether irritability can be differentiated from other symptoms, whether it forms a distinct disorder, and whether it is a meaningful predictor of clinical outcomes. In this article, we try to answer these questions by reviewing the evidence on how reliably irritability can be measured and its validity. METHOD We combine a narrative and systematic review and meta-analysis of studies. For the systematic review and meta-analysis, we searched studies in PubMed and Web of Science based on preselected criteria. A total of 163 articles were reviewed, and 24 were included. RESULTS We found that irritability forms a distinct dimension with substantial stability across time, and that it is specifically associated with depression and anxiety in longitudinal studies. Evidence from genetic studies reveals that irritability is moderately heritable, and its overlap with depression is explained mainly by genetic factors. Behavioral and neuroimaging studies show that youth with persistent irritability exhibit altered activations in the amygdala, striatum, and frontal regions compared with age-matched healthy volunteers. Most knowledge about the treatment of irritability is based on effects of treatment on related conditions or post hoc analyses of trial data. CONCLUSION We identify a number of research priorities including innovative experimental designs and priorities for treatment studies, and conclude with recommendations for the assessment of irritability for researchers and clinicians.
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Affiliation(s)
- Pablo Vidal-Ribas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
| | - Melissa A Brotman
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Isabel Valdivieso
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Argyris Stringaris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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Attention-deficit hyperactivity disorder and children's emotion dysregulation: A meta-analysis. Clin Psychol Rev 2016; 46:106-23. [DOI: 10.1016/j.cpr.2016.04.011] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 02/07/2023]
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Cornacchio D, Crum KI, Coxe S, Pincus DB, Comer JS. Irritability and Severity of Anxious Symptomatology Among Youth With Anxiety Disorders. J Am Acad Child Adolesc Psychiatry 2016; 55:54-61. [PMID: 26703910 PMCID: PMC5340317 DOI: 10.1016/j.jaac.2015.10.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/23/2015] [Accepted: 10/26/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Most research on irritability and child psychopathology has focused on depressive disorders, bipolar disorder, and/or oppositional defiant disorder (ODD). Less is known about relationships between child anxiety and irritability and moderators of such associations. METHOD Structural equation modeling (SEM) was used to examine associations between anxiety severity and irritability in a large sample of treatment-seeking youth with anxiety disorders (N = 663, aged 7-19 years, mean = 12.25 years), after accounting for comorbid depressive disorders and ODD. Additional analyses examined whether associations were moderated by child gender, age, and generalized anxiety disorder (GAD) status. RESULTS There was a direct link between child anxiety and irritability even after accounting for comorbid depressive disorders and ODD. Links between child anxiety and irritability were robust across child gender and age. Furthermore, relationships between child anxiety and irritability were comparable across youth with and without GAD, suggesting that the anxiety-irritability link is relevant across child anxiety disorders and not confined to youth with GAD. CONCLUSION Findings add to an increasing body of evidence linking child irritability to a range of internalizing and externalizing psychopathologies, and suggest that child anxiety assessment should systematically incorporate irritability evaluations. Moreover, youth in clinical settings displaying irritability should be assessed for the presence of anxiety. Treatments for childhood anxiety may do well to incorporate new treatment modules as needed that specifically target problems of irritability.
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Affiliation(s)
- Danielle Cornacchio
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami
| | - Kathleen I. Crum
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami
| | - Stefany Coxe
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami
| | - Donna B. Pincus
- Center for Anxiety and Related Disorders (CARD), Boston University, Boston
| | - Jonathan S. Comer
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami
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63
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Steinberg EA, Drabick DAG. A Developmental Psychopathology Perspective on ADHD and Comorbid Conditions: The Role of Emotion Regulation. Child Psychiatry Hum Dev 2015; 46:951-66. [PMID: 25662998 DOI: 10.1007/s10578-015-0534-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Research investigating attention-deficit/hyperactivity disorder (ADHD) and co-occurring disorders such as oppositional defiant disorder, conduct disorder, anxiety, and depression has surged in popularity; however, the developmental relations between ADHD and these comorbid conditions remain poorly understood. The current paper uses a developmental psychopathology perspective to examine conditions commonly comorbid with ADHD during late childhood through adolescence. First, we present evidence for ADHD and comorbid disorders. Next, we discuss emotion regulation and its associations with ADHD. The role of parenting behaviors in the development and maintenance of emotion regulation difficulties and comorbid disorders among children with ADHD is explored. An illustrative example of emotion regulation and parenting over the course of development is provided to demonstrate bidirectional relations among these constructs. We then present an integrated conceptual model of emotion regulation as a shared risk process that may lead to different comorbid conditions among children with ADHD. Implications and directions for future research are presented.
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Affiliation(s)
- Elizabeth A Steinberg
- Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA.
| | - Deborah A G Drabick
- Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA
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64
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Maciejewski DF, van Lier PAC, Branje SJT, Meeus WHJ, Koot HM. A 5-Year Longitudinal Study on Mood Variability Across Adolescence Using Daily Diaries. Child Dev 2015; 86:1908-21. [PMID: 26464350 DOI: 10.1111/cdev.12420] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study explored the development of mood variability in 474 Dutch adolescents (56.8% male, 90.1% medium to high socioeconomic status) from a community sample, followed from ages 13 to 18 years. Three times per year, adolescents reported on daily happiness, anger, sadness, and anxiety for 5 days using Internet diaries (15 assessment weeks; from 2006 to 2010). Mood variability scores were calculated as means of absolute differences between consecutive days. Results showed that happiness, anger, and sadness variability continuously declined across adolescence, while anxiety variability increased initially, then decreased, and then increased toward late adolescence. Despite females experiencing higher happiness and sadness variability, the rate of change across adolescence was similar for both sexes. Implications for normative emotional development and future studies are discussed.
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Affiliation(s)
| | - Pol A C van Lier
- VU University Amsterdam.,EMGO Institute for Health and Care Research
| | | | | | - Hans M Koot
- VU University Amsterdam.,EMGO Institute for Health and Care Research
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Dougherty LR, Smith VC, Bufferd SJ, Kessel E, Carlson GA, Klein DN. Preschool irritability predicts child psychopathology, functional impairment, and service use at age nine. J Child Psychol Psychiatry 2015; 56:999-1007. [PMID: 26259142 PMCID: PMC4531384 DOI: 10.1111/jcpp.12403] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Little is known about the predictive validity and clinical significance of chronic irritability during early childhood. This prospective, longitudinal study examined associations of preschool chronic irritability with psychiatric disorders, functional impairment, and service use at age nine in a large community sample. METHODS Four hundred and forty-six children were assessed at age three and again at age nine. Child psychopathology and functional impairment were assessed at age three with the Preschool Age Psychiatric Assessment (PAPA) with parents and at age nine with the Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with parents and children. Items from the PAPA were used to create a dimensional measure of chronic irritability at age three. At age nine, mothers, fathers, and youth completed the Child Depression Inventory (CDI) and the Screen for Anxiety Related Disorders (SCARED). RESULTS Chronic irritability at age three predicted any current and lifetime anxiety disorders at age nine, current and lifetime generalized anxiety disorder, and current separation anxiety, after controlling for baseline anxiety disorders. In addition, preschool irritability predicted increases in anxiety and disruptive behavior disorder symptoms on the K-SADS, and maternal and paternal reports of depressive and anxiety symptoms on the CDI and SCARED. Lastly, preschool irritability predicted greater functional impairment and outpatient treatment use, even after controlling for all psychiatric disorders at baseline. CONCLUSIONS Findings underscore the central role of irritability in developmental psychopathology and support the importance of early detection and interventions targeting preschool irritability.
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Affiliation(s)
- Lea R Dougherty
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Victoria C Smith
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Sara J Bufferd
- Department of Psychology, California State University San Marcos, San Marcos, CA, USA
| | - Ellen Kessel
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Gabrielle A Carlson
- Department of Psychiatry, School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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66
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Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder defined by persistent inattention and/or hyperactivity and impulsivity. These symptoms occur more frequently and are more severe in individuals with ADHD compared with those at a similar developmental level without ADHD, and can be conceptualized as deficits in executive functioning (EF). EF includes domains of metacognition and inhibition, which influence the ability to regulate responses elicited by emotional stimuli. EF deficits can lead to emotional lability (EL), which is characterized by sudden changes in emotion and behaviors of inappropriately high intensity that may include sudden bouts of anger, dysphoria, sadness, or euphoria. EL is common and estimated to occur in about 3.3-10% of the population. Recent estimates of EL prevalence in children and adolescents with ADHD range from 38 to 75%. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition does not include EL in diagnostic criteria for ADHD, but does include ADHD-associated features of low frustration tolerance, irritability, or mood lability. The neurobiological basis of EL is not well understood, but brain imaging studies support dividing EF into "cool" cognitive networks encompassing attention and planning activities, and "hot" motivational networks involved in temporal discounting, reward processing, and reward anticipation. Dysfunction in "hot" networks is thought to be related to EL. EL symptoms are associated with more severe ADHD and co-morbidities, have significant impact on functioning, and may respond to treatment with medications frequently used to treat ADHD. Treatment outcomes and areas for future research are discussed.
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67
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Copeland WE, Brotman MA, Costello EJ. Normative Irritability in Youth: Developmental Findings From the Great Smoky Mountains Study. J Am Acad Child Adolesc Psychiatry 2015. [PMID: 26210332 PMCID: PMC4515775 DOI: 10.1016/j.jaac.2015.05.008] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The goal of this study is to examine the developmental epidemiology of normative irritability and its tonic and phasic components in a longitudinal community sample of youth. METHOD Eight waves of data from the prospective, community Great Smoky Mountains Study (6,674 assessments of 1,420 participants) were used, covering children in the community 9 to 16 years of age. Youth and 1 parent were interviewed using the Child and Adolescent Psychiatric Assessment to assess tonic (touchy/easily annoyed, irritable mood, angry or resentful) and phasic (temper tantrums or anger outbursts) components of irritability, including frequency, duration, onset, and cross-context variability. RESULTS At any given point in childhood/adolescence, 51.4% (standard error [SE] = 1.4) of participants reported phasic irritability, 28.3% (SE = 1.2) reported tonic irritability, and 22.8% (SE = 1.1) reported both. These prevalence levels decreased with age but did not vary by sex. The overlap between tonic and phasic irritability was high (odds ratio = 5.8, 95% CI = 3.3-10.5, p < .0001), with little evidence of tonic occurring without phasic irritability. Both tonic and phasic irritability predicted one another over time, supporting both heterotypic and homotypic continuity. Low levels of either tonic or phasic irritability increased risk for disrupted functioning including service use, school suspensions, parental burden, and emotional symptoms both concurrently and at 1-year follow-up. CONCLUSION Irritability is relatively common, decreases with age but does not vary by sex, and at almost any level is associated with increased risk of disrupted functioning. Its relative components frequently overlap, although irritable outbursts are more common than irritable mood. Irritability appears to be a high-priority transdiagnostic marker for screening children in need of clinical attention.
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Affiliation(s)
| | - Melissa A Brotman
- Emotion and Development Branch at the National Institute of Mental Health, Bethesda, MD
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68
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Tseng WL, Thomas LA, Harkins E, Pine DS, Leibenluft E, Brotman MA. Neural correlates of masked and unmasked face emotion processing in youth with severe mood dysregulation. Soc Cogn Affect Neurosci 2015; 11:78-88. [PMID: 26137973 DOI: 10.1093/scan/nsv087] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 06/26/2015] [Indexed: 01/29/2023] Open
Abstract
Reproducibility of results is important in improving the robustness of conclusions drawn from research, particularly in functional magnetic resonance imaging (fMRI). In this study, we aim to replicate a previous study on the neural correlates of face emotion processing above and below awareness level using an independent sample of youth with severe mood dysregulation (SMD) and healthy volunteers (HV). We collected fMRI data in 17 SMD and 20 HV, using an affective priming paradigm with masked (17 ms) and unmasked (187 ms) faces (angry, happy, neutral, blank oval). When processing masked and unmasked angry faces, SMD patients exhibited increased activation in the parahippocampal gyrus (PHG) and superior temporal gyrus relative to HV. When processing masked and unmasked happy faces, SMD patients showed decreased activation in the insula, PHG and thalamus compared with HV. During masked face processing in general across emotions, youth with SMD showed greater ventromedial prefrontal cortex (vmPFC) activation relative to HV. Perturbed activation in emotion processing areas (e.g. insula, PHG, superior temporal gyrus and thalamus) manifests as hyper-sensitivity toward negative emotions and hypo-sensitivity toward positive emotions may be important in the etiology and maintenance of irritability, aggression and depressive symptoms in SMD. vmPFC dysfunction may mediate over-reactivity to face emotions associated with irritability.
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Affiliation(s)
- Wan-Ling Tseng
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA and
| | - Laura A Thomas
- War Related Illness and Injury Study Center, Veterans Affairs Medical Center, Washington, DC, USA
| | - Elizabeth Harkins
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA and
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA and
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA and
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA and
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Savage J, Verhulst B, Copeland W, Althoff RR, Lichtenstein P, Roberson-Nay R. A genetically informed study of the longitudinal relation between irritability and anxious/depressed symptoms. J Am Acad Child Adolesc Psychiatry 2015; 54:377-84. [PMID: 25901774 PMCID: PMC4407138 DOI: 10.1016/j.jaac.2015.02.010] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 02/09/2015] [Accepted: 02/25/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Little is known about the longitudinal genetic and environmental association between juvenile irritability and symptoms of anxiety and depression. This study's goal was to assess the relationship between these constructs across a critical developmental period spanning childhood to young adulthood. METHOD Parents (n = 1,348 twin pairs) from the Swedish Twin Study of Child and Adolescent Development completed the Child/Adult Behavior Checklist (CBCL/ABCL) about their twin children. Data were collected during a prospective, 4-wave study starting in childhood (ages 8-9 years) and ending in young adulthood (ages 19-20 years). An irritability score and an anxious/depressed score were computed from CBCL/ABCL item endorsements. Genetically informative cross-lagged models were used to estimate the genetic and environmental relationship between these 2 constructs across time. RESULTS Our models suggested that irritability more strongly predicted anxious/depressed symptoms than vice versa, consistent with a causal role of irritability on anxiety/depression at older ages. This relationship was significant only in late childhood/early adolescence. Additive genetic and unique environmental factors were significant contributors to both irritability and anxious/depressed symptoms and were both specific to and shared between these 2 constructs. The same common environmental factors influenced both constructs, although these factors accounted for a smaller amount of variance than genetic or unique environmental factors. CONCLUSION This study adds to our understanding of the developmental relationship between irritability and anxious/depressed symptoms and the contribution of genes and environmental factors to their association across development. Findings suggest the need to monitor for emergence of internalizing symptoms in irritable children and their potential need for therapeutic intervention.
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Affiliation(s)
- Jeanne Savage
- Virginia Commonwealth University, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA
| | - Brad Verhulst
- Virginia Commonwealth University, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA
| | - William Copeland
- Duke University Medical Center, Center for Developmental Epidemiology, Durham, NC
| | | | | | - Roxann Roberson-Nay
- Virginia Commonwealth University, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA.
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Treatment of children with attention-deficit/hyperactivity disorder (ADHD) and irritability: results from the multimodal treatment study of children with ADHD (MTA). J Am Acad Child Adolesc Psychiatry 2015; 54:62-70.e3. [PMID: 25524791 PMCID: PMC4284308 DOI: 10.1016/j.jaac.2014.10.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/12/2014] [Accepted: 10/17/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Clinically impairing irritability affects 25% to 45% of children with attention-deficit/hyperactivity disorder (ADHD); yet, we know little about what interventions are effective in treating children with ADHD and co-occurring irritability. We used data from the Multimodal Treatment Study of Children With ADHD (MTA) to address 3 aims: to establish whether irritability in children with ADHD can be distinguished from other symptoms of oppositional defiant disorder (ODD); to examine whether ADHD treatment is effective in treating irritability; and to examine how irritability influences ADHD treatment outcomes. METHOD Secondary analyses of data from the MTA included multivariate analyses, and intent-to-treat random-effects regression models were used. RESULTS Irritability was separable from other ODD symptoms. For treating irritability, systematic stimulant treatment was superior to behavioral management but not to routine community care; a combination of stimulants and behavioral treatment was superior to community care and to behavioral treatment alone, but not to medication alone. Irritability did not moderate the impact of treatment on parent- and teacher-reported ADHD symptoms in any of the 4 treatment groups. CONCLUSION Treatments targeting ADHD symptoms are helpful for improving irritability in children with ADHD. Moreover, irritability does not appear to influence the response to treatment of ADHD. CLINICAL TRIAL REGISTRATION INFORMATION Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA); http://www.clinicaltrials.gov; NCT00000388.
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71
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Potter AS, Schaubhut G, Shipman M. Targeting the nicotinic cholinergic system to treat attention-deficit/hyperactivity disorder: rationale and progress to date. CNS Drugs 2014; 28:1103-13. [PMID: 25349138 PMCID: PMC4487649 DOI: 10.1007/s40263-014-0208-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common chronic neurobehavioral disorder related to clinically significant levels of inattention, hyperactivity, and/or impulsivity. ADHD begins in childhood and symptoms persist into adulthood for the majority of those with the disorder. Associated features of ADHD include emotion dysregulation and cognitive impairments, which contribute to the considerable functional impairments in this disorder. Current approved treatments are reasonably effective; however, a significant need remains for new pharmacotherapies, both for individuals who do not achieve a full therapeutic response and for symptoms that are under-treated including cognition and emotion regulation. The striking relationship between ADHD and cigarette smoking and the known effects of nicotine on cognition has spurred research into the therapeutic potential of nicotinic agents for ADHD. Although there are no approved medications for ADHD that target nicotinic acetylcholine receptor (nAChR) function, results from many trials of nicotinic drugs are available and reviewed in this article. ADHD symptoms were reduced in the majority of published studies of nicotine and novel α4β2 nicotinic agonists in adult ADHD. The drugs were generally well tolerated, with mild to moderate side effects reported, which were largely consistent with cholinergic stimulation and included nausea, dizziness, and gastrointestinal distress. Within-subject crossover study designs were used in the majority of positive studies. This design may be particularly useful in ADHD trials because it minimizes variability in this notoriously heterogeneous diagnostic group. In addition, many studies found evidence for a beneficial effect of nicotinic stimulation on cognitive and emotional domains. Thus, targeting nAChRs in ADHD appears to have a modest clinical benefit in adult ADHD. Continued refinement of nAChR agonists with greater specificity and fewer side effects may lead to even more effective nAChR agonists for ADHD. Future clinical trials in ADHD should include direct measures of neuropsychological performance and emotion regulation.
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Affiliation(s)
- Alexandra S Potter
- Clinical Neuroscience Research Unit, University of Vermont College of Medicine, 1 South Prospect Street, Burlington, VT, 05401, USA,
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72
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Maciejewski DF, van Lier PAC, Neumann A, Van der Giessen D, Branje SJT, Meeus WHJ, Koot HM. The development of adolescent generalized anxiety and depressive symptoms in the context of adolescent mood variability and parent-adolescent negative interactions. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2014; 42:515-26. [PMID: 23982435 DOI: 10.1007/s10802-013-9797-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study explored the influence of adolescent mood variability on the symptom development of generalized anxiety and depression in the context of parent-adolescent negative interactions. Participants were 456 adolescents (55.7 % male) from a community sample, who were followed from age 13 to 16 years. During 4 annual assessments, adolescents reported on their generalized anxiety and depressive symptoms, and both parents and adolescents on levels of negative interactions with each other. Within each study year, adolescents rated their daily mood states during 5 consecutive days for 3 times per year (total of 9 weeks). The absolute differences between mood states on consecutive days were summed to construct a mood variability score. Results showed that high levels of adolescent mood variability predicted increases in generalized anxiety and depressive symptoms across the studied period. No influence of negative interactions on anxiety and depression development was found, but positive predictive links from mood variability to negative interactions at age 14 and 15 appeared. The study underscores the role of adolescent mood variability in the development of symptoms of generalized anxiety and depression during adolescence, but found little evidence for an influence of parent-adolescent negative interactions on internalizing problem development.
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73
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Barahmand U, Haji A. The impact of intolerance of uncertainty, worry and irritability on quality of life in persons with epilepsy: Irritability as mediator. Epilepsy Res 2014; 108:1335-44. [DOI: 10.1016/j.eplepsyres.2014.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/06/2014] [Accepted: 07/14/2014] [Indexed: 10/25/2022]
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74
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Abstract
Emotional lability, or sudden strong shifts in emotion, commonly occurs in youth with attention-deficit/hyperactivity disorder. Although these symptoms are impairing and disruptive, relatively little research has addressed their treatment, likely due to the difficulty of reliable and valid assessment. Promising signals for symptom improvement have come from recent studies using stimulants in adults, children and adolescents. Similarly, neuroimaging studies have begun to identify neurobiological mechanisms underlying stimulants' impact on emotion regulation capacities. Here, we review these recent clinical and neuroimaging findings, as well as neurocognitive models for emotional lability in ADHD, issues of relevance to prescribers and the important role of psychiatric comorbidity with treatment choices.
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Affiliation(s)
- Jonathan Posner
- New York State Psychiatric Institute, New York, NY,Columbia College of Physicians and Surgeons, New York, NY
| | - Erica Kass
- Columbia College of Physicians and Surgeons, New York, NY
| | - Leslie Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
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75
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Bertocci MA, Bebko G, Olino T, Fournier J, Hinze AK, Bonar L, Almeida JRC, Perlman SB, Versace A, Travis M, Gill MK, Demeter C, Diwadkar VA, White R, Schirda C, Sunshine JL, Arnold LE, Holland SK, Kowatch RA, Birmaher B, Axelson D, Youngstrom EA, Findling RL, Horwitz SM, Fristad MA, Phillips ML. Behavioral and emotional dysregulation trajectories marked by prefrontal-amygdala function in symptomatic youth. Psychol Med 2014; 44:2603-2615. [PMID: 24468022 PMCID: PMC4344801 DOI: 10.1017/s0033291714000087] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neuroimaging measures of behavioral and emotional dysregulation can yield biomarkers denoting developmental trajectories of psychiatric pathology in youth. We aimed to identify functional abnormalities in emotion regulation (ER) neural circuitry associated with different behavioral and emotional dysregulation trajectories using latent class growth analysis (LCGA) and neuroimaging. METHOD A total of 61 youth (9-17 years) from the Longitudinal Assessment of Manic Symptoms study, and 24 healthy control youth, completed an emotional face n-back ER task during scanning. LCGA was performed on 12 biannual reports completed over 5 years of the Parent General Behavior Inventory 10-Item Mania Scale (PGBI-10M), a parental report of the child's difficulty regulating positive mood and energy. RESULTS There were two latent classes of PGBI-10M trajectories: high and decreasing (HighD; n=22) and low and decreasing (LowD; n=39) course of behavioral and emotional dysregulation over the 12 time points. Task performance was >89% in all youth, but more accurate in healthy controls and LowD versus HighD (p<0.001). During ER, LowD had greater activity than HighD and healthy controls in the dorsolateral prefrontal cortex, a key ER region, and greater functional connectivity than HighD between the amygdala and ventrolateral prefrontal cortex (p's<0.001, corrected). CONCLUSIONS Patterns of function in lateral prefrontal cortical-amygdala circuitry in youth denote the severity of the developmental trajectory of behavioral and emotional dysregulation over time, and may be biological targets to guide differential treatment and novel treatment development for different levels of behavioral and emotional dysregulation in youth.
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Affiliation(s)
- Michele A Bertocci
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Genna Bebko
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Thomas Olino
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Jay Fournier
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Amanda K Hinze
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Lisa Bonar
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Jorge RC Almeida
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
- Alpert Medical School, Brown University
| | - Susan B Perlman
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Amelia Versace
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Michael Travis
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Christine Demeter
- University Hospitals Case Medical Center/Case Western Reserve University
| | - Vaibhav A Diwadkar
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University
| | - Richard White
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University
| | - Claudiu Schirda
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | | | | | - Scott K Holland
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati
| | | | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | | | - Eric A Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill
| | - Robert L Findling
- University Hospitals Case Medical Center/Case Western Reserve University
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - Sarah M Horwitz
- Department of Child Psychiatry, New York University School of Medicine
| | | | - Mary L Phillips
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
- Department of Psychological Medicine, Cardiff University
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76
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Abstract
There are two divergent viewpoints on the phenomenology and outcome of bipolar I (BP I) disorder in youth. Disparities evolved as unintended consequences from investigators' inconsistencies both in translating the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, DSM-III-R, and DSM-IV criteria and in operationalizing them differently in their standardized assessments. Rates of conservatively diagnosed BP I are lower both in community studies of youths than in adults and from liberally defined BP I in youths. Rates of co-occurring attention-deficit hyperactivity disorder (ADHD) are lower in conservatively than liberally defined children and adolescents with BP I. Rates of both BP I and of ADHD are lower in offspring of BP I probands, and outcome more closely approximates that of adults with BP I in conservatively versus liberally defined children and teens with BP I. Both perspectives can claim evidence for reliability and validity that support their positions. However, the samples are so different that it is difficult to compare studies conducted from these different perspectives.
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Affiliation(s)
- Gabrielle A. Carlson
- Division of Child and Adolescent Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York 11794
| | - Daniel N. Klein
- Department of Psychology, Stony Brook University, Stony Brook, New York 11794
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77
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Hulvershorn LA, Mennes M, Castellanos FX, Di Martino A, Milham MP, Hummer TA, Roy AK. Abnormal amygdala functional connectivity associated with emotional lability in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2014; 53:351-61.e1. [PMID: 24565362 PMCID: PMC3961844 DOI: 10.1016/j.jaac.2013.11.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 09/05/2013] [Accepted: 12/12/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE A substantial proportion of children with attention-deficit/hyperactivity disorder (ADHD) also display emotion regulation deficits manifesting as chronic irritability, severe temper outbursts, and aggression. The amygdala is implicated in emotion regulation, but its connectivity and relation to emotion regulation in ADHD has yet to be explored. The purpose of this study was to examine the relationship between intrinsic functional connectivity (iFC) of amygdala circuits and emotion regulation deficits in youth with ADHD. METHOD Bilateral amygdala iFC was examined using functional magnetic resonance imaging in 63 children with ADHD, aged 6 to 13 years. First, we examined the relationship between amygdala IFC and parent ratings of emotional lability (EL) in children with ADHD. Second, we compared amygdala iFC across subgroups of children with ADHD and high EL (n = 18), ADHD and low EL (n = 20), and typically developing children (TDC), all with low EL (n = 19). RESULTS Higher EL ratings were associated with greater positive iFC between the amygdala and rostral anterior cingulate cortex in youth with ADHD. EL scores were also negatively associated with iFC between bilateral amygdala and posterior insula/superior temporal gyrus. Patterns of amygdala-cortical iFC in ADHD participants with low EL were not different from the comparison group, and the effect sizes for these comparisons were smaller than those for the trend-level differences observed between the high-EL and TDC groups. CONCLUSIONS In children with ADHD and a range of EL, deficits in emotion regulation were associated with altered amygdala-cortical iFC. When comparing groups that differed on ADHD status but not EL, differences in amygdala iFC were small and nonsignificant, highlighting the specificity of this finding to emotional deficits, independent of other ADHD symptoms.
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Affiliation(s)
| | - Maarten Mennes
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, New York University Child Study Center. Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen Medical Centre
| | - F. Xavier Castellanos
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, New York University Child Study Center. Nathan Kline Institute for Psychiatric Research
| | - Adriana Di Martino
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, New York University Child Study Center
| | - Michael P. Milham
- Nathan Kline Institute for Psychiatric Research. Center for the Developing Brain, Child Mind Institute
| | - Tom A. Hummer
- Indiana University School of Medicine, Riley Hospital for Children
| | - Amy Krain Roy
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, New York University Child Study Center. Fordham University
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78
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Abstract
Although it has long been recognized that many individuals with attention deficit hyperactivity disorder (ADHD) also have difficulties with emotion regulation, no consensus has been reached on how to conceptualize this clinically challenging domain. The authors examine the current literature using both quantitative and qualitative methods. Three key findings emerge. First, emotion dysregulation is prevalent in ADHD throughout the lifespan and is a major contributor to impairment. Second, emotion dysregulation in ADHD may arise from deficits in orienting toward, recognizing, and/or allocating attention to emotional stimuli; these deficits implicate dysfunction within a striato-amygdalo-medial prefrontal cortical network. Third, while current treatments for ADHD often also ameliorate emotion dysregulation, a focus on this combination of symptoms reframes clinical questions and could stimulate novel therapeutic approaches. The authors then consider three models to explain the overlap between emotion dysregulation and ADHD: emotion dysregulation and ADHD are correlated but distinct dimensions; emotion dysregulation is a core diagnostic feature of ADHD; and the combination constitutes a nosological entity distinct from both ADHD and emotion dysregulation alone. The differing predictions from each model can guide research on the much-neglected population of patients with ADHD and emotion dysregulation.
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Affiliation(s)
- Philip Shaw
- Section on Neurobehavioral Clinical Research, Social and Behavioral Research Branch, Division of Intramural Research Programs, National Human Genome Research Institute, Building 31, B1 B37, Bethesda, 20892, Maryland, USA. Phone 301 451 4010,Intramural Program of the National Institute of Mental Health. Building 10, Bethesda, 20892, Maryland, USA
| | - Argyris Stringaris
- King's College London, Institute of Psychiatry, Denmark Hill, London, UK
| | - Joel Nigg
- Division of Psychology, Department of Psychiatry, Oregon Health and Science University, Portland, Oregon
| | - Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, Division of Intramural Research Programs, National Institute of Mental Health, Bethesda, MD, USA
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79
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Douglas J, Scott J. A systematic review of gender-specific rates of unipolar and bipolar disorders in community studies of pre-pubertal children. Bipolar Disord 2014; 16:5-15. [PMID: 24305108 DOI: 10.1111/bdi.12155] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 07/20/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Gender-specific rates of unipolar and bipolar disorders are well established for cases with post-pubertal onset. However, there is less certainty about these rates in pre-pubertal children. We undertook a systematic review of community studies that report gender-specific rates for unipolar and bipolar disorders in young children, particularly cases of major depression and mania. METHOD Computer databases (Medline, EMBASE, Index to Theses, and PsychInfo) were searched for non-clinical observational studies using recognized diagnostic criteria to identify unipolar and bipolar disorders in children aged ≤ 12 years. A meta-analysis was undertaken to calculate pooled odds ratios (ORs) for caseness for major depression by gender. The limited data on bipolar disorder were summarized. RESULTS Analysis of 12 studies (>15,000 children), indicated that the community prevalence of unipolar disorders was higher in boys (1.3%) than in girls (0.8%). Rates of major depression were low (0.61%), but boys were significantly more likely to meet diagnostic criteria than girls (OR = 1.61; 95% confidence interval: 1.11-2.35). Five studies, assessing >5,000 children, identified only one case with a probable diagnosis of mania. CONCLUSIONS This systematic review suggests that boys aged ≤ 12 years are significantly more likely to experience major depression than girls. However, in younger children, community rates of major depression are low, and it is frequently suggested (but not proven) that most cases are comorbid. The absence of mania suggests either that childhood bipolar phenotypes do not resemble post-pubertal onset cases or that there are problems of case ascertainment.
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Affiliation(s)
- Jessica Douglas
- Department of Paediatric Clinical Psychology, Children's Services, Addenbrooke's Hospital, Cambridge, UK; Institute of Neuroscience, University of Newcastle, Newcastle, UK
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80
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Krieger FV, Leibenluft E, Stringaris A, Polanczyk GV. Irritability in children and adolescents: past concepts, current debates, and future opportunities. BRAZILIAN JOURNAL OF PSYCHIATRY 2014; 35 Suppl 1:S32-9. [PMID: 24142126 DOI: 10.1590/1516-4446-2013-s107] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Irritability is defined as a low threshold to experience anger in response to frustration. It is one of the most common symptoms in youth and is part of the clinical presentation of several disorders. Irritability can present early in life and is a predictor of long-term psychopathology; yet, the diagnostic status of irritability is a matter of intense debate. In the present article, we address two main components of the debate regarding irritability in youth: the misdiagnosis of chronic irritability as pediatric bipolar disorder, and the proposal of a new diagnosis in the DSM-5, disruptive mood dysregulation disorder, whose defining symptoms are chronic irritability and temper outbursts.
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81
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Dougherty LR, Smith VC, Bufferd SJ, Stringaris A, Leibenluft E, Carlson GA, Klein DN. Preschool irritability: longitudinal associations with psychiatric disorders at age 6 and parental psychopathology. J Am Acad Child Adolesc Psychiatry 2013; 52:1304-13. [PMID: 24290463 PMCID: PMC3860177 DOI: 10.1016/j.jaac.2013.09.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 09/08/2013] [Accepted: 09/24/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE There is increasing scientific and clinical attention to chronic irritability in youth. However, little is known about the predictive validity and clinical significance of chronic irritability during early childhood. This prospective, longitudinal study examined associations of chronic irritability with psychiatric disorders and parental psychopathology in a large community sample of preschoolers. METHOD Four hundred sixty-two preschool-age children were assessed at 3 and 6 years of age. Child psychopathology was assessed at baseline (3 years) and follow-up (6 years) using a diagnostic interview, the Preschool Age Psychiatric Assessment, with parents. Items from the Preschool Age Psychiatric Assessment were used to create a dimensional measurement of chronic irritability. Parental psychopathology was assessed with a diagnostic interview at baseline. RESULTS Chronic irritability was concurrently associated with a wide range of psychiatric disorders and functional impairment at 3 and 6 years of age. Irritability at 3 years predicted depression, oppositional defiant disorder, and functional impairment at 6 years after controlling for baseline disorders. Irritability also was associated with parental depression and anxiety. CONCLUSIONS Findings underscore the central role of irritability in early-emerging mental health problems. They are consistent with longitudinal studies in older youth indicating that chronic irritability predicts later depression and anxiety and support the importance of early detection and interventions targeting preschool irritability.
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82
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Basten MMGJ, Althoff RR, Tiemeier H, Jaddoe VWV, Hofman A, Hudziak JJ, Verhulst FC, van der Ende J. The dysregulation profile in young children: empirically defined classes in the Generation R study. J Am Acad Child Adolesc Psychiatry 2013; 52:841-850.e2. [PMID: 23880494 PMCID: PMC3813902 DOI: 10.1016/j.jaac.2013.05.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 04/23/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Children with co-occurring internalizing and externalizing problems have higher levels of impairment and worse outcomes later in life, but it is unclear whether these children can be distinguished validly from children who have problems in a single domain. We used a person-centered statistical approach to examine whether a group of children with co-occurring internalizing and externalizing problems can be identified in a general-population sample of young children. METHOD This study included a population-based sample of 6,131 children, aged 5 through 7 years. Mothers (92.6%) reported emotional and behavioral problems using the Child Behavior Checklist/1.5-5 (CBCL). A latent profile analysis was performed on the CBCL syndrome scales. Identified classes were compared on early socioeconomic and parental risk factors using multinomial logistic regression. RESULTS We identified 4 classes, as follows: a class scoring high on all internalizing and externalizing scales (1.8%); a class with internalizing problems (5.3%); a class with externalizing problems and emotional reactivity (7.3%); and a class without problems (85.6%). The first class, with co-occurring problems, was associated with higher levels of maternal and paternal affective symptoms and hostility than the other 3 classes. CONCLUSIONS The class with co-occurring internalizing and externalizing problems appears to be highly similar to the CBCL Dysregulation Profile described in older children. This empirically based dysregulation profile offers a promise to the study of the development of poor self-regulation.
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Affiliation(s)
| | | | | | | | | | - James J. Hudziak
- Erasmus University Medical Center. University of Vermont College of Medicine
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83
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Birmaher B, Goldstein BI, Axelson DA, Monk K, Hickey MB, Fan J, Iyengar S, Ha W, Diler RS, Goldstein T, Brent D, Ladouceur CD, Sakolsky D, Kupfer DJ. Mood lability among offspring of parents with bipolar disorder and community controls. Bipolar Disord 2013; 15:253-63. [PMID: 23551755 PMCID: PMC3644367 DOI: 10.1111/bdi.12060] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 12/31/2012] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Early identification of bipolar disorder (BP) symptomatology is crucial for improving the prognosis of this illness. Increased mood lability has been reported in BP. However, mood lability is ubiquitous across psychiatric disorders and may be a marker of severe psychopathology and not specific to BP. To clarify this issue, this study examined the prevalence of mood lability and its components in offspring of BP parents and offspring of community control parents recruited through the Pittsburgh Bipolar Offspring Study. METHODS Forty-one school-age BP offspring of 38 BP parents, 257 healthy or non-BP offspring of 174 BP parents, and 192 offspring of 117 control parents completed a scale that was developed to evaluate mood lability in youth, i.e., the Children's Affective Lability Scale (CALS). RESULTS A factor analysis of the parental CALS, and in part the child CALS, revealed Irritability, Mania, and Anxiety/Depression factors, with most of the variance explained by the Irritability factor. After adjusting for confounding factors (e.g., parental and offspring non-BP psychopathology), BP offspring of BP parents showed the highest parental and child total and factor scores, followed by the non-BP offspring of BP parents, and then the offspring of the controls. CONCLUSIONS Mood lability overall and mania-like, anxious/depressed, and particularly irritability symptoms may be a prodromal phenotype of BP among offspring of parents with BP. Prospective studies are warranted to clarify whether these symptoms will predict the development of BP and/or other psychopathology. If confirmed, these symptoms may become a target of treatment and biological studies before BP develops.
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Affiliation(s)
- Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - David A Axelson
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kelly Monk
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary Beth Hickey
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jieyu Fan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Satish Iyengar
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Wonho Ha
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rasim S Diler
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tina Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David Brent
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cecile D Ladouceur
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dara Sakolsky
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David J Kupfer
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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84
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Marwaha S, Parsons N, Flanagan S, Broome M. The prevalence and clinical associations of mood instability in adults living in England: results from the Adult Psychiatric Morbidity Survey 2007. Psychiatry Res 2013; 205:262-8. [PMID: 23062775 DOI: 10.1016/j.psychres.2012.09.036] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 09/19/2012] [Accepted: 09/20/2012] [Indexed: 11/17/2022]
Abstract
Mood instability is underinvestigated but potentially clinically important. This study aimed to describe the prevalence of mood instability in adults living in England and test whether it is important in explaining the extent of symptoms of common mental disorders, suicidality and healthcare use. An analysis of data from the adult psychiatric morbidity survey 2007, a household survey of private households in England (N=7403), was completed. The prevalence of mood instability was 13.9%. In univariate analysis it was strongly associated with socio-demographic and clinical variables. In regression modelling mood instability was independently associated with non-psychotic psychopathology, increasing the odds by 9.89. It was also linked with suicidal ideas (odds ratios (OR): 2.04) but not suicidal acts, and associated with being in receipt of medication, counselling or therapy for mental health problems (OR: 1.88), independent of a diagnosis of borderline personality disorder. Mood instability is relatively common in the adult population, occurs frequently in common mental disorders and appears to be an important symptom in its own right. It is associated with two important measures in psychiatry, namely suicidal thinking and healthcare service use. It warrants more widespread recognition and further research is required to understand if, when and how to intervene.
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Affiliation(s)
- Steven Marwaha
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry CV4 7AL, UK.
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85
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Skirrow C, Hosang GM, Farmer AE, Asherson P. An update on the debated association between ADHD and bipolar disorder across the lifespan. J Affect Disord 2012; 141:143-59. [PMID: 22633181 DOI: 10.1016/j.jad.2012.04.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 04/05/2012] [Accepted: 04/05/2012] [Indexed: 12/12/2022]
Abstract
Diagnostic formulations for attention deficit hyperactivity disorder (ADHD) and bipolar disorder (BD) both include symptoms of distractibility, psychomotor agitation and talkativeness, alongside associated emotional features (irritability and emotional lability). Treatment studies suggest the importance of accurate delineation of ADHD and BD. However, boundaries between the two disorders are blurred by the introduction of broader conceptualisations of BD. This review attempts to elucidate whether associations between ADHD and BD are likely to be driven by superficial symptomatological similarities or by a more meaningful etiological relationship between the disorders. This is achieved by outlining findings on comorbidity, temporal progression of the disorders, familial co-variation, and neurobiology in ADHD and BD across the lifespan. Longitudinal studies fail to consistently show developmental trajectories between ADHD and BD. Comparative research investigating neurobiology is in its infancy, and although some similarities are seen between ADHD and BD, studies also emphasise differences between the two disorders. However, comorbidity and family studies appear to show that the two disorders occur together and aggregate in families at higher than expected rates. Furthermore close inspection of results from population studies reveals heightened co-occurrence of ADHD and BD even in the context of high comorbidity commonly noted in psychopathology. These results point towards a meaningful association between ADHD and BD, going beyond symptomatic similarities. However, future research needs to account for heterogeneity of BD, making clear distinctions between classical episodic forms of BD, and broader conceptualisations of the disorder characterised by irritability and emotional lability, when evaluating the relationship with ADHD.
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Affiliation(s)
- Caroline Skirrow
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, United Kingdom.
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86
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Banaschewski T, Jennen-Steinmetz C, Brandeis D, Buitelaar JK, Kuntsi J, Poustka L, Sergeant JA, Sonuga-Barke EJ, Frazier-Wood AC, Albrecht B, Chen W, Uebel H, Schlotz W, van der Meere JJ, Gill M, Manor I, Miranda A, Mulas F, Oades RD, Roeyers H, Rothenberger A, Steinhausen HC, Faraone SV, Asherson P. Neuropsychological correlates of emotional lability in children with ADHD. J Child Psychol Psychiatry 2012; 53:1139-48. [PMID: 22882111 PMCID: PMC3472099 DOI: 10.1111/j.1469-7610.2012.02596.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Emotional lability (EL) is commonly seen in patients with attention-deficit/hyperactivity disorder (ADHD). The reasons for this association remain currently unknown. To address this question, we examined the relationship between ADHD and EL symptoms, and performance on a range of neuropsychological tasks to clarify whether EL symptoms are predicted by particular cognitive and/or motivational dysfunctions and whether these associations are mediated by the presence of ADHD symptoms. METHODS A large multi-site sample of 424 carefully diagnosed ADHD cases and 564 unaffected siblings and controls aged 6-18 years performed a broad neuropsychological test battery, including a Go/No-Go Task, a warned four-choice Reaction Time task, the Maudsley Index of Childhood Delay Aversion and Digit span backwards. Neuropsychological variables were aggregated as indices of processing speed, response variability, executive functions, choice impulsivity and the influence of energetic and/or motivational factors. EL and ADHD symptoms were regressed on each neuropsychological variable in separate analyses controlling for age, gender and IQ, and, in subsequent regression analyses, for ADHD and EL symptoms respectively. RESULTS Neuropsychological variables significantly predicted ADHD and EL symptoms with moderate-to-low regression coefficients. However, the association between neuropsychological parameters on EL disappeared entirely when the effect of ADHD symptoms was taken into account, revealing that the association between the neuropsychological performance measures and EL is completely mediated statistically by variations in ADHD symptoms. Conversely, neuropsychological effects on ADHD symptoms remained after EL symptom severity was taken into account. CONCLUSIONS The neuropsychological parameters examined, herein, predict ADHD more strongly than EL. They cannot explain EL symptoms beyond what is already accounted for by ADHD symptom severity. The association between EL and ADHD cannot be explained by these cognitive or motivational deficits. Alternative mechanisms, including overlapping genetic influences (pleiotropic effects) and/or alternative neuropsychological processes need to be considered.
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Affiliation(s)
- Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
| | - Christine Jennen-Steinmetz
- Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany,Department of Child and Adolescent Psychiatry, University of Zürich, Switzerland
| | - Jan K. Buitelaar
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Center, Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
| | - Jonna Kuntsi
- King’s College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London, UK
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Joseph A. Sergeant
- Department of Clinical Neuropsychology, Free University Amsterdam, Netherlands
| | - Edmund J. Sonuga-Barke
- Developmental Brain Behaviour Laboratory, School of Psychology, University of Southampton, Southampton, UK,Department of Clinical & Experimental Psychology, Ghent University, Belgium
| | | | - Björn Albrecht
- Child and Adolescent Psychiatry, University of Göttingen, Germany
| | - Wai Chen
- Division of Clinical Neuroscience, School of Medicine, University of Southampton, Southampton, UK
| | - Henrik Uebel
- Child and Adolescent Psychiatry, University of Göttingen, Germany
| | - Wolff Schlotz
- Developmental Brain Behaviour Laboratory, School of Psychology, University of Southampton, Southampton, UK
| | | | - Michael Gill
- Department of Psychiatry, Trinity Centre for Health Sciences, St. James’s Hospital, Dublin, Ireland
| | - Iris Manor
- ADHD Unit, Geha Mental Health Centre, Petach-Tiqva, Israel
| | - Ana Miranda
- Department of Developmental and Educational Psychology, University of Valencia, Spain
| | - Fernando Mulas
- Neuropediatrics Unit, La Fé University Hospital, Valencia, Spain
| | - Robert D. Oades
- Clinic for Child and Adolescent Psychiatry, University of Duisburg-Essen, Germany
| | - Herbert Roeyers
- Department of Clinical & Experimental Psychology, Ghent University, Belgium
| | | | - Hans-Christoph Steinhausen
- Department of Child and Adolescent Psychiatry, University of Zürich, Switzerland,Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Switzerland,Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Stephen V. Faraone
- Departments of Psychiatry and of Neuroscience and Physiology. SUNY Upstate Medical University, USA
| | - Philip Asherson
- King’s College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London, UK
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87
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Age-grouped differences in bipolar mania. Compr Psychiatry 2012; 53:1110-7. [PMID: 22682679 DOI: 10.1016/j.comppsych.2012.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 04/11/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE This review of published studies compares scores on individual items of mania rating scales that systematically recorded symptom severity in persons diagnosed with bipolar disorder to identify age-grouped differences. METHODS An extensive literature search identified item scores from mania rating scales, with a particular emphasis on baseline Young Mania Rating Scale (YMRS) item scores in published double-blind, placebo-controlled studies of bipolar I manic disorder. These baseline YMRS item scores were assessed as a proportion of the total YMRS score and compared by age group. Additional YMRS item/total scores in subjects with bipolar spectrum disorders were added to expand the analysis. RESULTS Preadolescents with bipolar disorder had significantly higher YMRS item scores than adolescents on aggression, irritability, and motor activity. Young Mania Rating Scale baseline item scores relative to the YMRS total score revealed that adolescents diagnosed with bipolar I mania scored comparatively higher than did adults on YMRS aggression and irritability items, whereas adults with bipolar I manic disorder scored comparatively higher on the grandiosity and sexual interest items. Age-grouped findings from subjects diagnosed with bipolar I, II, and Not Otherwise Specified (NOS) disorders yielded similar age-grouped results. CONCLUSION In age-grouped YMRS item assessments of bipolar mania, anger dyscontrol was most prominent for youth, whereas disordered thought content was paramount for adults.
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88
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Abstract
Issues complicating the differential diagnosis of bipolar disorder in young people are discussed. They include: a) the subtype of bipolar disorder being considered; b) the person's age and stage of development; c) whether one views bipolar disorder more conservatively, requiring clear episodes that mark a distinct change from premorbid levels of function, or more liberally, focusing for instance on severe irritability/explosive outbursts as the mood change; d) who is reporting manic symptoms, and whether symptoms are past and must be recalled or current and more likely to be observed; e) impact of family history. The diagnosis of mania/bipolar I disorder may not become clear for a number of years. This is an impairing disorder, but so are the conditions from which it must be distinguished. Family history may increase the odds that certain symptoms/behaviors are manifestations of bipolar disorder but it does not make the diagnosis. Until there are biomarkers that can confirm the diagnosis, and treatments unique to the condition, it is wise to make a diagnosis of bipolar disorder in children and adolescents provisionally and keep an open mind to the likelihood that revisions may be necessary.
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Affiliation(s)
- GABRIELLE A. CARLSON
- Department of Psychiatry and Behavioral Sciences,
Stony Brook University School of Medicine, Putnam Hall-South Campus, Stony
Brook, NY 11794-8790, USA
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89
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Mood regulation in youth: research findings and clinical approaches to irritability and short-lived episodes of mania-like symptoms. Curr Opin Psychiatry 2012; 25:271-6. [PMID: 22569307 PMCID: PMC3660700 DOI: 10.1097/yco.0b013e3283534982] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Mood regulation problems, such as severe chronic irritability or short episodes of mania-like symptoms, are common, impairing and a topic of intense recent interest to clinicians, researchers and the Diagnostic and Statistical Manual (DSM)-5 process. Here, we review the most recent findings about these two presentations and discuss the approaches to their treatment. RECENT FINDINGS Longitudinal and genetic findings suggest that chronic irritability should be regarded as a mood problem that is distinct from bipolar disorder. A proportion of children with short (less than 4 days) episodes of mania-like symptoms seem to progress to classical (Type I or II) bipolar disorder over time in the US clinic samples. In a UK sample, such episodes were independently associated with psychosocial impairment. The evidence base for the treatment of either irritability or short-lived episodes of mania-like symptoms is still small. Clinicians should be cautious with extrapolating treatments from classical bipolar disorder to these mood regulation problems. Cognitive and behavioural therapy (CBT)-based approaches targeting general mood regulation processes may be effective for cases with severe irritability or short episodes of mania-like symptoms. SUMMARY There is increasing research evidence for the importance of mood regulation problems in the form of either irritability or short episodes of mania-like symptoms in youth. The evidence base for their drug treatment has yet to be developed. CBT-based interventions to modify the processes of mood regulation may be a useful and well tolerated intervention for patients with these presentations.
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90
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Gilbert KE. The neglected role of positive emotion in adolescent psychopathology. Clin Psychol Rev 2012; 32:467-81. [PMID: 22710138 DOI: 10.1016/j.cpr.2012.05.005] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 05/17/2012] [Accepted: 05/19/2012] [Indexed: 01/27/2023]
Abstract
Adolescence is a developmental period characterized by elevated stress, heightened risky behaviors, and increases in psychopathology. Emotion dysregulation is a hypothesized contributor to negative outcomes and to the onset of psychopathology during adolescence. However, the dysregulation of negative emotion has been the focus of research while the literature on positive emotion in adolescent psychopathology is limited. This review highlights both the development of normative and dysregulated positive emotion during adolescence. First, the literature on normative adolescent emotional development and on negative emotional regulation is briefly reviewed, followed by a discussion of current theories of positive emotion, which are grounded in the adult literature. From a developmental perspective, the dimension of approach motivation within positive emotion is emphasized throughout and frames the review. This conceptualization guides organization of literatures on normative experiences of positive emotion in adolescence and the role of dysregulated positive emotion in adolescent psychopathology, specifically adolescent depression, anxiety, bipolar disorder, externalizing disorders and eating disorders. Last, future directions in the study of adolescent positive emotion and its regulation and the implications of highlighting approach motivation in normative and dysregulated positive emotion in adolescence are detailed.
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Affiliation(s)
- Kirsten E Gilbert
- Yale University, Department of Psychology, PO Box 208205, New Haven, CT 06520, USA.
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91
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Holtmann M, Buchmann AF, Esser G, Schmidt MH, Banaschewski T, Laucht M. The Child Behavior Checklist-Dysregulation Profile predicts substance use, suicidality, and functional impairment: a longitudinal analysis. J Child Psychol Psychiatry 2011; 52:139-47. [PMID: 20854363 DOI: 10.1111/j.1469-7610.2010.02309.x] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent studies have identified a Child Behavior Checklist profile that characterizes children with severe affective and behavioral dysregulation (CBCL-dysregulation profile, CBCL-DP). In two recent longitudinal studies the CBCL-DP in childhood was associated with heightened rates of comorbid psychiatric disorders, among them bipolar disorder, an increased risk for suicidality, and marked psychosocial impairment at young-adult follow-up. This is the first study outside the US that examines the longitudinal course of the CBCL-DP. METHODS We studied the diagnostic and functional trajectories and the predictive utility of the CBCL-DP in the Mannheim Study of Children at Risk, an epidemiological cohort study on the outcome of early risk factors from birth into adulthood. A total of 325 young adults (151 males, 174 females) participated in the 19-year assessment. RESULTS Young adults with a higher CBCL-DP score in childhood were at increased risk for substance use disorders, suicidality and poorer overall functioning at age 19, even after adjustment for parental education, family income, impairment and psychiatric disorders at baseline. Childhood dysregulation was not related to bipolar disorder in young adulthood. The CBCL-DP was neither a precursor of a specific pattern of comorbidity nor of comorbidity in general. CONCLUSIONS Children with high CBCL-DP values are at risk for later severe, psychiatric symptomatology. The different developmental trajectories suggest that the CBCL-DP is not simply an early manifestation of a single disease process but might rather be an early developmental risk marker of a persisting deficit of self-regulation of affect and behavior.
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Affiliation(s)
- Martin Holtmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
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92
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Abstract
BACKGROUND In the DSM-IIIR in 1987, the category title for depressive and bipolar disorders was changed from affective disorders to mood disorders. Within a short period of time thereafter, mood swing and mood stabilizer became very commonly used terms in psychiatry with bipolar implications. METHODS Terms and definitions in recent texts, articles, and dictionaries pertaining to mood fluctuations have been reviewed. RESULTS The term mood was seldom part of psychiatric terminology until the late 1970s. Mood swing and mood stabilizer as used in the psychiatric literature are primarily nonspecific and often misleading concepts--particularly as a basis for treatment decisions. Affective fluctuations and shifts to irritability and/or anger in persons with personality and depressive disorders are being viewed by many in the mental health field as cyclically biphasic--between depressed to elated--which is clearly at variance with research findings. CONCLUSIONS More data-based research on mood variations is needed to authoritatively remedy this situation.
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Affiliation(s)
- Daniel J Safer
- Departments of Psychiatry and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Althoff RR, Verhulst FC, Rettew DC, Hudziak JJ, van der Ende J. Adult outcomes of childhood dysregulation: a 14-year follow-up study. J Am Acad Child Adolesc Psychiatry 2010; 49:1105-16. [PMID: 20970698 PMCID: PMC2965164 DOI: 10.1016/j.jaac.2010.08.006] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 08/10/2010] [Accepted: 08/11/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Using a general population sample, the adult outcomes of children who presented with severe problems with self-regulation defined as being concurrently rated highly on attention problems, aggressive behavior, and anxious-depression on the Child Behavior Checklist-Dysregulation Profile (CBCL-DP) were examined. METHOD Two thousand seventy-six children from 13 birth cohorts 4 to 16 years of age were drawn from Dutch birth registries in 1983. CBCLs were completed by parents at baseline when children from the different cohorts were 4 to 16 years of age and sampled every 2 years for the next 14 years. At year 14 the CBCL and DSM interview data were collected. Logistic regression was used to compare and contrast outcomes for children with and without dysregulation, as measured by the latent-class-defined CBCL-DP. Sex and age were covaried and concurrent DSM diagnoses were included in regression models. RESULTS Presence of childhood CBCL-DP at wave 1 was associated with increased rates of adult anxiety disorders, mood disorders, disruptive behavior disorders, and drug abuse 14 years later. After controlling for co-occurring disorders in adulthood, associations with anxiety and disruptive behavior disorders with the CBCL-DP remained, whereas the others were not significant. CONCLUSIONS A child reported to be in the CBCL-DP class is at increased risk for problems with regulating affect, behavior, and cognition in adulthood.
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94
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Pickles A, Aglan A, Collishaw S, Messer J, Rutter M, Maughan B. Predictors of suicidality across the life span: the Isle of Wight study. Psychol Med 2010; 40:1453-1466. [PMID: 19939326 DOI: 10.1017/s0033291709991905] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Data from a representative community sample were used to explore predictors of lifetime suicidality and to examine associations between distal adolescent and more proximal adult risks. METHOD Data are from a midlife follow-up of the Isle of Wight study, an epidemiological sample of adolescents assessed in 1968. Ratings of psychiatric symptoms and disorder, relationships and family functioning and adversity were made in adolescence; adult assessments included lifetime psychiatric history and suicidality, neuroticism and retrospective reports of childhood sexual abuse and harsh parenting. RESULTS A wide range of measures of childhood psychopathology, adverse experiences and interpersonal difficulties were associated with adult suicidality; associations were particularly strong for adolescent irritability, worry and depression. In multivariate analyses, substantial proportions of these effects could be explained by their association with adult psychopathology and neuroticism, but additional effects remained for adolescent irritability and worry. CONCLUSIONS Factors of importance for long-term suicidality risk are evident in adolescence. These include family and experiential adversities as well as psychopathology. In particular, markers of adolescent worry and irritability appeared both potent risks and ones with additional effects beyond associations with adult disorder and adult neuroticism.
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Affiliation(s)
- A Pickles
- Biostatistics, Health Methodology Research Group, Faculty of Medicine and Human Sciences, University of Manchester, Manchester, UK.
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95
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Stringaris A, Santosh P, Leibenluft E, Goodman R. Youth meeting symptom and impairment criteria for mania-like episodes lasting less than four days: an epidemiological enquiry. J Child Psychol Psychiatry 2010; 51:31-8. [PMID: 19686330 PMCID: PMC4286871 DOI: 10.1111/j.1469-7610.2009.02129.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about short-duration episodes of mania-like symptoms in youth. Here we determine the prevalence, morbid associations, and contribution to social impairment of a phenotype characterised by episodes during which symptom and impairment criteria for mania are met, but DSM-IV duration criteria are not (bipolar not otherwise specified; BP-NOS). METHODS A cross-sectional national survey of a sample (N = 5,326) of 8-19-year-olds from the general population using information from parents and youth. Outcome measures were prevalence rates and morbid associations assessed by the Developmental and Well-Being Assessment, and social impairment assessed by the impact scale of the Strengths and Difficulties Questionnaire. RESULTS While only seven individuals (.1%) met definite or probable DSM-IV criteria for BPI or BPII, the prevalence of BP-NOS was 10-fold higher, 1.1% by parent report and 1.5% by youth report. Parent-youth agreement was very low: kappa = .02, p > .05 for BP-NOS. Prevalence and episode duration for BP-NOS did not vary by age. BP-NOS showed strong associations with externalising disorders. After adjusting for a dimensional measure of general psychopathology, self-reported (but not parent-reported) BP-NOS remained associated with overall social impairment. CONCLUSIONS BP meeting full DSM-IV criteria is rare in youth. BP-NOS, defined by episodes shorter than those required by DSM-IV, but during which DSM-IV symptom and impairment criteria are met, is commoner and may be associated with social impairment that is beyond what can be accounted for by other psychopathology. These findings support the importance of research into these short episodes during which manic symptoms are met in youth but they also call into question the extent to which BP-NOS in youth is a variant of DSM-IV BP - superficially similar symptoms may not necessarily imply deeper similarities in aetiology or treatment response.
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Affiliation(s)
- Argyris Stringaris
- King's College London, Institute of Psychiatry, Department of Child and Adolescent Psychiatry, UK.
| | - Paramala Santosh
- Great Ormond Street Hospital, Department of Child and Adolescent Mental Health, London, UK
| | - Ellen Leibenluft
- Section of Bipolar Spectrum Disorders, Mood and Anxiety Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Robert Goodman
- King's College London, Institute of Psychiatry, Department of Child and Adolescent Psychiatry, London, UK
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