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Sunaga M, Takei Y, Kato Y, Tagawa M, Suto T, Hironaga N, Sakurai N, Fukuda M. The Characteristics of Power Spectral Density in Bipolar Disorder at the Resting State. Clin EEG Neurosci 2023; 54:574-583. [PMID: 34677105 DOI: 10.1177/15500594211050487] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bipolar disorder (BD) is a common psychiatric disorder, but its pathophysiology is not fully elucidated. The current study focused on its electrophysiological characteristics, especially power spectral density (PSD). Resting state with eyes opened magnetoencephalography data were collected from 21 patients with BD and 22 healthy controls. The whole brain's PSD was calculated from source reconstructed waveforms at each frequency band (delta: 1-3 Hz, theta: 4-7 Hz, alpha: 8-12 Hz, low beta: 13-19 Hz, high beta: 20-29 Hz, and gamma: 30-80 Hz). We compared PSD values on the marked vertices at each frequency band between healthy and patient groups using a Mann-Whitney rank test to examine the relationship between significantly different PSD and clinical measures. The PSD in patients with BD was significantly decreased in lower frequency bands, mainly in the default mode network (DMN) areas (bilateral medial prefrontal cortex, bilateral precuneus, left inferior parietal lobe, and right temporal cortex in the alpha band) and salience network areas (SAL; left anterior insula [AI] at the delta band, anterior cingulate cortex at the theta band, and right AI at the alpha band). No significant differences in PSD were observed at low beta and high beta. PSD was not correlated with age or other clinical scales. Altered PSDs of the DMN and SAL were observed in the delta, theta, and alpha bands. These alterations contribute to the vulnerability of BD through the disturbance of self-referential mental activity and switching between the default mode and frontoparietal networks.
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Affiliation(s)
- Masakazu Sunaga
- Gunma Prefectural Psychiatric Medical Center, Isesaki, Japan
| | - Yuichi Takei
- Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yutaka Kato
- Gunma University Graduate School of Medicine, Maebashi, Japan
- Tsutsuji Mental Hospital, Tatebayashi, Japan
| | - Minami Tagawa
- Gunma Prefectural Psychiatric Medical Center, Isesaki, Japan
- Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tomohiro Suto
- Gunma Prefectural Psychiatric Medical Center, Isesaki, Japan
| | | | - Noriko Sakurai
- Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masato Fukuda
- Gunma University Graduate School of Medicine, Maebashi, Japan
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2
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Predicting psychosis-spectrum diagnoses in adulthood from social behaviors and neighborhood contexts in childhood. Dev Psychopathol 2020; 32:465-479. [PMID: 31014409 DOI: 10.1017/s095457941900021x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research showing that risk for schizophrenia, bipolar disorder with psychosis, and other psychosis-spectrum diagnoses in adulthood is multidetermined has underscored the necessity of studying the additive and interactive factors in childhood that precede and predict future disorders. In this study, risk for the development of psychosis-spectrum disorders was examined in a 2-generation, 30-year prospective longitudinal study of 3,905 urban families against a sociocultural backdrop of changing economic and social conditions. Peer nominations of aggression, withdrawal, and likeability and national census information on neighborhood-level socioeconomic disadvantage in childhood, as well as changes in neighborhood socioeconomic conditions over the lifespan, were examined as predictors of diagnoses of schizophrenia, bipolar disorder, and other psychosis-spectrum disorders in adulthood relative to developing only nonpsychotic disorders or no psychiatric disorders. Individuals who were both highly aggressive and highly withdrawn were at greater risk for other psychosis-spectrum diagnoses when they experienced greater neighborhood disadvantage in childhood or worsening neighborhood conditions over maturation. Males who were highly aggressive but low on withdrawal were at greater risk for schizophrenia diagnoses. Childhood neighborhood disadvantage predicted both schizophrenia and bipolar diagnoses, regardless of childhood social behavior. Results provided strong support for multiple-domain models of psychopathology, and suggest that universal preventive interventions and social policies aimed at improving neighborhood conditions may be particularly important for decreasing the prevalence of psychosis-spectrum diagnoses in the future.
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Masi G, Berloffa S, Muratori P, Mucci M, Viglione V, Villafranca A, Inguaggiato E, Levantini V, Placini F, Pfanner C, D’Acunto G, Lenzi F, Liboni F, Milone A. A Naturalistic Study of Youth Referred to a Tertiary Care Facility for Acute Hypomanic or Manic Episode. Brain Sci 2020; 10:brainsci10100689. [PMID: 33003515 PMCID: PMC7600970 DOI: 10.3390/brainsci10100689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Bipolar Disorders (BD) in youth are a heterogeneous condition with different phenomenology, patterns of comorbidity and outcomes. Our aim was to explore the effects of gender; age at onset (prepubertal- vs. adolescent-onset) of BD; and elements associated with attention deficit hyperactivity disorder (ADHD) and Substance Use Disorder (SUD) comorbidities, severe suicidal ideation or attempts, and poorer response to pharmacological treatments. Method: 117 youth (69 males and 57 females, age range 7 to 18 years, mean age 14.5 ± 2.6 years) consecutively referred for (hypo)manic episodes according to the Diagnostic and Statistical Manual of Mental Disorders, 54th ed (DSM 5) were included. Results: Gender differences were not evident for any of the selected features. Prepubertal-onset BD was associated with higher rates of ADHD and externalizing disorders. SUD was higher in adolescent-onset BD and was associated with externalizing comorbidities and lower response to treatments. None of the selected measures differentiated patients with or without suicidality. At a 6-month follow up, 51.3% of the patients were responders to treatments, without difference between those receiving and not receiving a psychotherapy. Clinical severity at baseline and comorbidity with Conduct Disorder (CD) and SUD were associated with poorer response. Logistic regression indicated that baseline severity and number of externalizing disorders were associated with a poorer outcome. Conclusions: Disentangling broader clinical conditions in more specific phenotypes can help timely and focused preventative and therapeutic interventions.
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Affiliation(s)
- Gabriele Masi
- Correspondence: ; Tel.: +39-050-886-111; Fax: +39-050-886-301
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Muratori F, Santocchi E, Calderoni S. Psychiatric assessment. HANDBOOK OF CLINICAL NEUROLOGY 2020; 174:217-238. [PMID: 32977880 DOI: 10.1016/b978-0-444-64148-9.00016-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies have consistently reported an increased prevalence of psychiatric comorbidity (PC) in individuals with neurodevelopmental disorders (NDDs) compared with typically developing controls, with high rates of anxiety disorders in autism spectrum disorders and challenging behaviors in children and adolescent with intellectual disability. Psychiatric assessment in this population should include multiple sources of information, derived from multiple contexts and using multiple methods, with accurate detection of contributing and trigger factors. It is important to focus on detecting change from the child's baseline functioning and to use, when possible, ad hoc instruments for assessing PC in the NDD population. Modifications in the setting and assessment procedures should be scheduled based on the child's age, developmental level, and sensory sensitivities. Simultaneously, validated screening instruments, which dimensionally assess the symptomatology of several NDDs and psychiatric disorders, are warranted to not only assist in the identification of PCs in NDDs but also discriminate among different NDDs. Changes from DSM-IV-TR to DSM-5 have had an impact on the diagnosis of several disorders in children and adolescents and, subsequently, on the current diagnostic tools, requiring appropriate and prompt modifications of the available instruments.
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Affiliation(s)
- Filippo Muratori
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisa Santocchi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Calderoni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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5
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Difficulties associated with the diagnosis of bipolar affective disorder in a 16-year-old boy treated in the past for ADHD and ODD – case study. CURRENT PROBLEMS OF PSYCHIATRY 2020. [DOI: 10.2478/cpp-2020-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Aim: The aim of this article is to discuss the difficulties and complexities of the bipolar affective disorder (BPAD) diagnostic process in an adolescent. The case of suspected occurrence of bipolar affective disorder in an adolescent who was diagnosed with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in childhood was presented.
Case report: A 16-year-old boy was treated in the past for ADHD and ODD. The reason for the current admission to the pediatric psychiatry ward was the behavioral change that disturbed the caregivers: he has become more restless, irritable, explosive. A few nights prior to hospitalization, he was very agitated, chaotic, physically and verbally aggressive.
At admission he was disorganized, tense, in strong hand manipulation anxiety. He displayed alternating attention and loquacity. His statements were chaotic, his thinking accelerated. He displayed grandiose delusions. He was uncritical.
After the treatment, mood, psychomotor drive and circadian rhythms stabilisation were achieved. Discharged from the ward with the recommendation of further outpatient treatment and continuation of psychotherapeutic interactions.
Conclusions:
1.
The diagnosis of bipolar affective disorder in adolescents is a complex and difficult process. The expression of symptoms of this disorder during adolescence is different than in adults.
2.
Differential diagnosis of bipolar affective disorder for a 16-year-old boy should also consider both past ADHD and ODD and their possible sequelae should be taken into account, as well as the risk of abnormal personality development.
3.
Due to the high dynamics of changes associated with the adolescence period, further pharmacological treatment of bipolar affective disorder should be combined with psychotherapeutic interventions.
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Passarotti AM, Balaban L, Colman LD, Katz LA, Trivedi N, Liu L, Langenecker SA. A Preliminary Study on the Functional Benefits of Computerized Working Memory Training in Children With Pediatric Bipolar Disorder and Attention Deficit Hyperactivity Disorder. Front Psychol 2020; 10:3060. [PMID: 32116872 PMCID: PMC7014966 DOI: 10.3389/fpsyg.2019.03060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/26/2019] [Indexed: 12/25/2022] Open
Abstract
Twenty-nine pediatric patients (age range, 10–16 years) with working memory (WM) deficits, including children with pediatric bipolar disorder (PBD) with and without attention-deficit hyperactivity disorder (ADHD) comorbidity and children with ADHD, underwent a Cogmed WM training program. For both patient groups, WM performance on Cogmed tasks and on the Digit Span test improved significantly after training. Moreover, the PBD group improved on Trails Making Test A and on the Inhibition Scale, the Behavior Regulation Index, and the Global Executive Composite of the Behavioral Rating Inventory of Executive Function. The ADHD group improved significantly on the Trails Making Test B, the Spatial Span Test, and the Reading Fluency Test of the Woodcock–Johnson III, as well as on depressive symptoms. The present findings suggest that working memory training is beneficial not only in youths with ADHD but also in youths with PBD. They also show evidence of near and far transfer of WM improvement in these patients, although in different ways for the two patient groups. Future studies examining the mechanisms of cognitive remediation in pediatric patients will aid in creating tailored illness-specific cognitive interventions.
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Affiliation(s)
- Alessandra M Passarotti
- Department of Psychology, The University of Illinois at Chicago, Chicago, IL, United States.,Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, IL, United States
| | - Livia Balaban
- Department of Psychology, Adler University, Chicago, IL, United States
| | - Liza D Colman
- Health Science Center, Texas Tech University, Lubbock, TX, United States
| | - Lindsay A Katz
- Department of Psychology, Roosevelt University, Chicago, IL, United States
| | - Nidhi Trivedi
- The Chicago School of Professional Psychology, Chicago, IL, United States
| | - Li Liu
- School of Public Health, The University of Illinois at Chicago, Chicago, IL, United States
| | - Scott A Langenecker
- Department of Psychiatry, College of Medicine, University of Utah, Salt Lake City, UT, United States
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7
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Gnanavel S, Sharma P, Kaushal P, Hussain S. Attention deficit hyperactivity disorder and comorbidity: A review of literature. World J Clin Cases 2019; 7:2420-2426. [PMID: 31559278 PMCID: PMC6745333 DOI: 10.12998/wjcc.v7.i17.2420] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/10/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset in early childhood. It is a clinically heterogenous condition with comorbidity posing a distinct challenge to diagnosing and managing these children and adolescents. This review aims to provide an overview of comorbidity with ADHD including other neurodevelopmental disorders, learning disorders, externalising and internalising disorders. Challenges in screening for, diagnosing and managing comorbidity with ADHD are summarised. Also, methodological challenges and future directions in research in this interesting field are highlighted.
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Affiliation(s)
- Sundar Gnanavel
- Child Mental Health Services, Tees, Esk and Wear Valleys NHS Foundation Trust, Durham DH1 4LW, United Kingdom
| | - Pawan Sharma
- Department of Psychiatry, Patan Academy of Health Sciences, Patan 44700, Nepal
| | - Pulkit Kaushal
- Northumberland, Tyne and Wear NHS foundation Trust, Newcastle NE3 3XT, United Kingdom
| | - Sharafat Hussain
- Northumberland, Tyne and Wear NHS foundation Trust, Newcastle NE3 3XT, United Kingdom
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8
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Donfrancesco R, Di Trani M, Andriola E, Leone D, Torrioli MG, Passarelli F, DelBello MP. Bipolar Disorder in Children With ADHD: A Clinical Sample Study. J Atten Disord 2017; 21:715-720. [PMID: 25015582 DOI: 10.1177/1087054714539999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the impact of early-onset bipolar disorder (pediatric bipolar disorder [PBD]) on ADHD. METHOD We compared ADHD symptom severity, ADHD subtype distribution, and rates of comorbid and familial psychiatric disorders between 49 ADHD children with comorbid PBD and 320 ADHD children without PBD. RESULTS Children with ADHD and PBD showed higher scores in the Hyperactive and Inattentive subscales of the ADHD Rating Scale, than children with ADHD alone. The frequency of combined subtype was significantly higher in ADHD children with PBD, than in those with ADHD alone. ADHD children with PBD showed a higher rate of familial psychiatric disorders than ADHD children without PBD. The rate of conduct disorder was significantly greater in children with PBD and ADHD compared with children with ADHD alone. CONCLUSION ADHD along with PBD presents with several characteristics that distinguish it from ADHD alone, suggesting that these may be distinct disorders.
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9
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Ong ML, Youngstrom EA, Chua JJX, Halverson TF, Horwitz SM, Storfer-Isser A, Frazier TW, Fristad MA, Arnold LE, Phillips ML, Birmaher B, Kowatch RA, Findling RL. Comparing the CASI-4R and the PGBI-10 M for Differentiating Bipolar Spectrum Disorders from Other Outpatient Diagnoses in Youth. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:611-623. [PMID: 27364346 PMCID: PMC5685560 DOI: 10.1007/s10802-016-0182-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We compared 2 rating scales with different manic symptom items on diagnostic accuracy for detecting pediatric bipolar spectrum disorder (BPSDs) in outpatient mental health clinics. Participants were 681 parents/guardians of eligible children (465 male, mean age = 9.34) who completed the Parent General Behavior Inventory-10-item Mania (PGBI-10 M) and mania subscale of the Child and Adolescent Symptom Inventory-Revised (CASI-4R). Diagnoses were based on KSADS interviews with parent and youth. Receiver operating characteristic (ROC) analyses and diagnostic likelihood ratios (DLRs) determined discriminative validity and provided clinical utility, respectively. Logistic regressions tested for incremental validity in the CASI-4R mania subscale and PGBI-10 M in predicting youth BPSD status above and beyond demographic and common diagnostic comorbidities. Both CASI-4R and PGBI-10 M scales significantly distinguished BPSD (N = 160) from other disorders (CASI-4R: Area under curve (AUC) = .80, p < 0.0005; PGBI-10 M: AUC = 0.79, p < 0.0005) even though scale items differed. Both scales performed equally well in differentiating BPSDs (Venkatraman test p > 0.05). Diagnostic likelihood ratios indicated low scores on either scale (CASI: 0-5; PGBI-10 M: 0-6) cut BPSD odds to 1/5 of those with high scores (CASI DLR- = 0.17; PGBI-10 M DLR- = 0.18). High scores on either scale (CASI: 14+; PGBI-10 M: 20+) increased BPSD odds about fourfold (CASI DLR+ = 4.53; PGBI-10 M DLR+ = 3.97). Logistic regressions indicated the CASI-4R mania subscale and PGBI-10 M each provided incremental validity in predicting youth BPSD status. The CASI-4R is at least as valid as the PGBI-10 M to help identify BPSDs, and can be considered as part of an assessment battery to screen for pediatric BPSDs.
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Affiliation(s)
- Mian-Li Ong
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC, 27599-3270, USA
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC, 27599-3270, USA.
| | - Jesselyn Jia-Xin Chua
- Department of Psychology, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore
| | - Tate F Halverson
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC, 27599-3270, USA
| | - Sarah M Horwitz
- Department of Child and Adolescent Psychiatry, New York University, New York, NY, USA
| | | | - Thomas W Frazier
- Cleveland Clinic Foundation, 2049 E 100th St, Cleveland, OH, 44195, USA
| | - Mary A Fristad
- Department of Psychology, Ohio State University, Columbus, OH, 43210, USA
| | - L Eugene Arnold
- Research Unit on Pediatric Psychopharmacology, Ohio State University, Columbus, OH, 43210, USA
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Robert A Kowatch
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Robert L Findling
- Department of Psychiatry, Kennedy Krieger Institute, John Hopkins University, Baltimore, MD, 21218, USA
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10
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Sharma A, Neely J, Camilleri N, James A, Grunze H, Le Couteur A. Incidence, characteristics and course of narrow phenotype paediatric bipolar I disorder in the British Isles. Acta Psychiatr Scand 2016; 134:522-532. [PMID: 27744649 DOI: 10.1111/acps.12657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To estimate the surveillance incidence of first-time diagnosis of narrow phenotype bipolar I disorder (NPBDI) in young people under 16 years by consultants in child and adolescent psychiatry (CCAP) in the British Isles and describe symptoms, comorbidity, associated factors, management strategies and clinical outcomes at 1-year follow-up. METHOD Active prospective surveillance epidemiology was utilised to ask 730 CCAP to report cases of NPBDI using the child and adolescent psychiatry surveillance system. RESULTS Of the 151 cases of NPBDI reported, 33 (age range 10-15.11 years) met the DSM-IV analytical case definition with 60% having had previously undiagnosed mood episodes. The minimum 12-month incidence of NPBDI in the British Isles was 0.59/100 000 (95% CI 0.41-0.84). Irritability was reported in 72% cases and comorbid conditions in 51.5% cases with 48.5% cases requiring admission to hospital. Relapses occurred in 56.67% cases during the 1-year follow-up. CONCLUSIONS These rates suggest that the first-time diagnosis of NPBDI in young people <16 years of age by CCAP in the British Isles is infrequent; however, the rates of relapse and admission to hospital warrant close monitoring.
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Affiliation(s)
- A Sharma
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Neely
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - N Camilleri
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Tees, Esk and Wear Valley NHS Foundation Trust, Darlington, UK
| | - A James
- Highfield Unit, Warneford Hospital, Oxford, UK
| | - H Grunze
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
| | - A Le Couteur
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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11
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Zeni CP, Tramontina S, Aguiar BW, Salatino-Oliveira A, Pheula GF, Sharma A, Stertz L, Moreira Maia CR, Hutz M, Kapczinski FP, Rohde LA. BDNF Val66Met polymorphism and peripheral protein levels in pediatric bipolar disorder and attention-deficit/hyperactivity disorder. Acta Psychiatr Scand 2016; 134:268-74. [PMID: 27209073 DOI: 10.1111/acps.12587] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Frontiers between pediatric bipolar disorder (PBD) and attention-deficit/hyperactivity disorder (ADHD) are not well defined. Few studies have addressed potentially different neurobiological factors between the two disorders. Brain-derived neurotrophic factor (BDNF) has been increasingly recognized for its etiologic and prognostic role in adult bipolar disorder (BD) studies. This study aimed to examine the BDNF gene polymorphism and potential alterations in BDNF serum levels in the pediatric ADHD patients with or without comorbid BD illness. METHOD We assessed the non-synonymous single-nucleotide polymorphism in the BDNF gene (rs6265/Val66Met) and its serum levels in children and adolescents with BD comorbid with ADHD (BD + ADHD) and ADHD alone. Children and adolescents were assessed for psychiatric diagnoses using the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL). RESULTS Using Analysis of covariance (ancova) we detected a significant group effect (patients with BD + ADHD had higher serum levels than those with ADHD - F80,3 = 8.73, P = 0.005). CONCLUSION Although the Val66Met polymorphism at the BDNF gene does not seem to play a significant role in children and adolescents with BD or ADHD, BDNF serum levels deserve further attention in future research on neurobiological aspects of BD and ADHD.
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Affiliation(s)
- C P Zeni
- Juvenile Bipolar Disorder Outpatient Program (Programa para Crianças e Adolescentes com Transtorno Bipolar - ProCAB), Child and Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - S Tramontina
- Juvenile Bipolar Disorder Outpatient Program (Programa para Crianças e Adolescentes com Transtorno Bipolar - ProCAB), Child and Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - B W Aguiar
- Bipolar Disorder Unit, Molecular Psychiatry Unit, National Institute for Translational Medicine, CNPq, Porto Alegre, Brazil
| | - A Salatino-Oliveira
- Department of Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - G F Pheula
- Juvenile Bipolar Disorder Outpatient Program (Programa para Crianças e Adolescentes com Transtorno Bipolar - ProCAB), Child and Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - A Sharma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - L Stertz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA.,Bipolar Disorder Unit, Molecular Psychiatry Unit, National Institute for Translational Medicine, CNPq, Porto Alegre, Brazil
| | - C R Moreira Maia
- ADHD Outpatient Program (PRODAH), Child and Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - M Hutz
- Department of Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - F P Kapczinski
- Bipolar Disorder Unit, Molecular Psychiatry Unit, National Institute for Translational Medicine, CNPq, Porto Alegre, Brazil
| | - L A Rohde
- Juvenile Bipolar Disorder Outpatient Program (Programa para Crianças e Adolescentes com Transtorno Bipolar - ProCAB), Child and Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,ADHD Outpatient Program (PRODAH), Child and Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, Porto Alegre, Brazil
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12
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Commonalities in EEG Spectral Power Abnormalities Between Women With ADHD and Women With Bipolar Disorder During Rest and Cognitive Performance. Brain Topogr 2016; 29:856-866. [PMID: 27464584 PMCID: PMC5054048 DOI: 10.1007/s10548-016-0508-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/13/2016] [Indexed: 11/28/2022]
Abstract
While attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) denote distinct psychiatric conditions, diagnostic delineation is impeded by considerable symptomatic overlap. Direct comparisons across ADHD and BD on neurophysiological measures are limited. They could inform us on impairments that are specific to or shared between the disorders and, therefore, potential biomarkers that may aid in the identification of the diagnostic boundaries. Our aim was to test whether quantitative EEG (QEEG) identifies differences or similarities between women with ADHD and women with BD during resting-state and task conditions. QEEG activity was directly compared between 20 ADHD, 20 BD and 20 control women during an eyes-open resting-state condition (EO) and a cued continuous performance task (CPT-OX). Both ADHD (t38 = 2.50, p = 0.017) and BD (t38 = 2.54, p = 0.018) participants showed higher absolute theta power during EO than controls. No significant differences emerged between the two clinical groups. While control participants showed a task-related increase in absolute theta power from EO to CPT-OX (t19 = −3.77, p = 0.001), no such change in absolute theta power was observed in the ADHD (t19 = −0.605, p = 0.553) or BD (t19 = 1.82, p = 0.084) groups. Our results provide evidence for commonalities in brain dysfunction between ADHD and BD. Absolute theta power may play a role as a marker of neurobiological processes in both disorders.
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Abstract
Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder with a prevalence of 1·4-3·0%. It is more common in boys than girls. Comorbidity with childhood-onset neurodevelopmental disorders and psychiatric disorders is substantial. ADHD is highly heritable and multifactorial; multiple genes and non-inherited factors contribute to the disorder. Prenatal and perinatal factors have been implicated as risks, but definite causes remain unknown. Most guidelines recommend a stepwise approach to treatment, beginning with non-drug interventions and then moving to pharmacological treatment in those most severely affected. Randomised controlled trials show short-term benefits of stimulant medication and atomoxetine. Meta-analyses of blinded trials of non-drug treatments have not yet proven the efficacy of such interventions. Longitudinal studies of ADHD show heightened risk of multiple mental health and social difficulties as well as premature mortality in adult life.
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Affiliation(s)
- Anita Thapar
- Child & Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK.
| | - Miriam Cooper
- Child & Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK
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Kitsune GL, Kuntsi J, Costello H, Frangou S, Hosang GM, McLoughlin G, Asherson P. Delineating ADHD and bipolar disorder: A comparison of clinical profiles in adult women. J Affect Disord 2016; 192:125-33. [PMID: 26724691 DOI: 10.1016/j.jad.2015.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 11/30/2015] [Accepted: 12/20/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Overlapping symptoms can make the diagnostic differentiation of attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) challenging in adults using current clinical assessments. This study sought to determine if current clinical measures delineate ADHD from BD in adults, comparing relative levels of ADHD, BD and emotional lability (EL) symptoms. METHODS Sixty adult women with ADHD, BD or controls were compared on self-report and interview measures for ADHD symptoms, mania, depression, EL, and impairment. RESULTS ADHD interview measures and self-ratings of ADHD symptoms best discriminated between ADHD and BD. Self-report measures of EL and depression showed non-specific enhancement in both clinical groups. BD-specific items may distinguish BD from ADHD if a retrospective time-frame is adopted. CONCLUSIONS Using measures which capture specific symptoms of ADHD and chronicity/episodicity of symptoms facilitates the delineation of ADHD from BD in adult women.
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Affiliation(s)
- Glenn L Kitsune
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), London, UK
| | - Jonna Kuntsi
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), London, UK
| | - Helen Costello
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), London, UK
| | - Sophia Frangou
- Clinical Neurosciences Studies Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Georgina M Hosang
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Gráinne McLoughlin
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), London, UK
| | - Philip Asherson
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), London, UK.
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Jenkins MM, Youngstrom EA. A randomized controlled trial of cognitive debiasing improves assessment and treatment selection for pediatric bipolar disorder. J Consult Clin Psychol 2016; 84:323-33. [PMID: 26727411 DOI: 10.1037/ccp0000070] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined the efficacy of a new cognitive debiasing intervention in reducing decision-making errors in the assessment of pediatric bipolar disorder (PBD). METHOD The study was a randomized controlled trial using case vignette methodology. Participants were 137 mental health professionals working in different regions of the United States (M = 8.6 ± 7.5 years of experience). Participants were randomly assigned to a (a) brief overview of PBD (control condition), or (b) the same brief overview plus a cognitive debiasing intervention (treatment condition) that educated participants about common cognitive pitfalls (e.g., base-rate neglect, search satisficing) and taught corrective strategies (e.g., mnemonics, Bayesian tools). Both groups evaluated 4 identical case vignettes. Primary outcome measures were clinicians' diagnoses and treatment decisions. The vignette characters' race or ethnicity was experimentally manipulated. RESULTS Participants in the treatment group showed better overall judgment accuracy, p < .001, and committed significantly fewer decision-making errors, p < .001. Inaccurate and somewhat accurate diagnostic decisions were significantly associated with different treatment and clinical recommendations, particularly in cases where participants missed comorbid conditions, failed to detect the possibility of hypomania or mania in depressed youths, and misdiagnosed classic manic symptoms. In contrast, effects of patient race were negligible. CONCLUSIONS The cognitive debiasing intervention outperformed the control condition. Examining specific heuristics in cases of PBD may identify especially problematic mismatches between typical habits of thought and characteristics of the disorder. The debiasing intervention was brief and delivered via the Web; it has the potential to generalize and extend to other diagnoses as well as to various practice and training settings.
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Wang LJ, Shyu YC, Yuan SS, Yang CJ, Yang KC, Lee TL, Lee SY. Attention-deficit hyperactivity disorder, its pharmacotherapy, and the risk of developing bipolar disorder: A nationwide population-based study in Taiwan. J Psychiatr Res 2016; 72:6-14. [PMID: 26519764 DOI: 10.1016/j.jpsychires.2015.10.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/19/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED In this study, we aimed to evaluate the relationship between attention-deficit/hyperactivity disorder (ADHD) during childhood and subsequent diagnoses of bipolar disorder (BD), as well as to determine whether the pharmacotherapy for ADHD (methylphenidate and atomoxetine) influence the risks of developing BD. A nationwide cohort of patients newly diagnosed with ADHD (n = 144,920) and age- and gender-matching controls (n = 144,920) were found in Taiwan's National Health Insurance database from January 2000 to December 2011. Both patients and controls were observed until December 31, 2011. To determine the effect that the duration of methylphenidate and atomoxetine exposure had on BD, the difference in the risk of developing BD was compared among non-users, short-term users (≤ 365 days), and long-term users (>365 days). In comparison to the control group, the ADHD group showed a significantly increased risk of developing BD (ADHD: 2.1% vs. CONTROLS 0.4%; aHR: 7.85, 95% CI: 7.09-8.70), and had a younger mean age at the time of first diagnosis (ADHD: 12.0 years vs. CONTROLS 18.8 years). Compared to ADHD patients that had never taken methylphenidate, patients with long-term use of methylphenidate were less likely to be diagnosed with BD (aOR: 0.72, 95% CI: 0.65-0.80). However, the duration of exposure to atomoxetine did not have a significant relationship to a BD diagnosis. The results suggested that a previous diagnosis of ADHD was a powerful indicator of BD, particularly juvenile-onset BD. Nevertheless, the exact mechanisms of the relationships among ADHD, its pharmacotherapy, and BD require further clarification in the future.
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Affiliation(s)
- Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Institute of Molecular Biology, Academia Sinica, Nankang, Taipei, Taiwan
| | - Shin-Sheng Yuan
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Chun-Ju Yang
- Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan; Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kang-Chung Yang
- Genome and Systems Biology Degree Program, National Taiwan University, Taipei, Taiwan; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Tung-Liang Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan.
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Affective processing bias in youth with primary bipolar disorder or primary attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2015; 24:1349-59. [PMID: 25724546 PMCID: PMC6518415 DOI: 10.1007/s00787-015-0686-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/28/2015] [Indexed: 10/23/2022]
Abstract
High rates of comorbidity and overlapping diagnostic criteria between pediatric bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) contribute to diagnostic and treatment confusion. To advance what is known about both disorders, we compared effect of emotional stimuli on response control in children with primary BD, primary ADHD and typically developing controls (TDC). Participants included 7-17 year olds with either "narrow-phenotype" pediatric BD (n = 25), ADHD (n = 25) or TDC (n = 25). Groups were matched on participant age and FSIQ. The effect of emotional stimuli on response control was assessed using the Cambridge Neuropsychological Test Automated Battery Affective Go/No-Go task (CANTAB AGN). We found a group by target valence interaction on commission errors [F(2,71) = 5.34, p < 0.01, ƞ p (2) = 0.13] whereby ADHD, but not TDC participants, made more errors on negative than positive words [t(24) = -2.58, p < 0.05, r = 0.47]. In contrast, there was a nonsignificant trend for BD participants to make fewer errors on negative versus positive words compared to ADHD and TDC participants. Between-subjects effects showed that ADHD participants made more errors than TDC, but not BD participants. Our main finding advances what is known about the effect of emotional stimuli on response control in children with ADHD. Our results suggesting a positive affective processing bias in children with ADHD compliment emerging literature show that difficulties with emotional processing and regulation may be core features of ADHD. Further, given the observed pattern of results in children with ADHD compared to BD children, our behavioral results suggest the importance of examining differences in the brain-behavior mechanisms involved in affective processing in children with ADHD compared to BD children.
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Frías Á, Palma C, Farriols N. Comorbidity in pediatric bipolar disorder: prevalence, clinical impact, etiology and treatment. J Affect Disord 2015; 174:378-89. [PMID: 25545605 DOI: 10.1016/j.jad.2014.12.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Research on pediatric bipolar disorder (PBD) is providing a plethora of empirical findings regarding its comorbidity. We addressed this question through a systematic review concerning the prevalence, clinical impact, etiology and treatment of main comorbid disorders involved. METHOD A comprehensive database search was performed from 1990 to August 2014. Overall, 167 studies fulfilled the inclusion criteria. RESULTS Bipolar youth tend to suffer from comorbid disorders, with highest weighted mean prevalence rate arising from anxiety disorders (54%), followed by attention deficit hyperactivity disorder (ADHD) (48%), disruptive behavior disorders (31%), and substance use disorders (SUD) (31%). Furthermore, evidence indicates that ADHD and anxiety disorders negatively affect the symptomatology, neurocognitive profile, clinical course and the global functioning of PBD. Likewise, several theories have been posited to explain comorbidity rates in PBD, specifically common risk factors, one disorder being a risk factor for the other and nosological artefacts. Lastly, randomized controlled trials highlight a stronger therapeutic response to stimulants and atomoxetine (vs. placebo) as adjunctive interventions for comorbid ADHD symptoms. In addition, research focused on the treatment of other comorbid disorders postulates some benefits from mood stabilizers and/or SGA. LIMITATIONS Epidemiologic follow-up studies are needed to avoid the risk of nosological artefacts. Likewise, more research is needed on pervasive developmental disorders and anxiety disorders, especially regarding their etiology and treatment. CONCLUSIONS Psychiatric comorbidity is highly prevalent and is associated with a deleterious clinical effect on pediatric bipolarity. Different etiological pathways may explain the presence of these comorbid disorders among bipolar youth. Standardized treatments are providing ongoing data regarding their effectiveness for these comorbidities among bipolar youth.
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Affiliation(s)
- Álvaro Frías
- FPCEE Blanquerna, University of Ramon-Llull, Císterst 34, 08022 Barcelona, Spain; Adult Outpatient Mental Health Center, Hospital of Mataró, Mataró, Spain.
| | - Cárol Palma
- FPCEE Blanquerna, University of Ramon-Llull, Císterst 34, 08022 Barcelona, Spain; Adult Outpatient Mental Health Center, Hospital of Mataró, Mataró, Spain
| | - Núria Farriols
- FPCEE Blanquerna, University of Ramon-Llull, Císterst 34, 08022 Barcelona, Spain; Adult Outpatient Mental Health Center, Hospital of Mataró, Mataró, Spain
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Pavuluri M, May A. Differential Treatment of Pediatric Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder. Psychiatr Ann 2014. [DOI: 10.3928/00485713-20141003-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurobiological condition of childhood onset with the hallmarks of inattention, impulsivity, and hyperactivity. Inattention includes excessive daydreaming, disorganization, and being easily distracted. Impulsivity manifests as taking an action before fully thinking of the consequences. Hyperactivity includes an excessive rate of speech and motor activity. Complications of ADHD include academic failure, low self-esteem, poor work performance, substance abuse, criminal justice issues, and social problems. ADHD is predominately due to decreased activity in the frontal lobe. Dopamine and norepinephrine are the main neurotransmitters involved in the pathophysiology of ADHD. Pharmacological treatment of ADHD includes psychostimulants, norepinephrine reuptake inhibitors, α2 agonists, bupropion, and monoamine oxidase inhibitors. The most effective medications are the psychostimulants. Nonpharmacological treatment of ADHD includes coaching, providing structure, academic accommodations, and work accommodations.
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Affiliation(s)
- Gyula Bokor
- Department of Psychiatry, Taunton State Hospital, Taunton, MA, USA
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Bechdolf A, Ratheesh A, Cotton SM, Nelson B, Chanen AM, Betts J, Bingmann T, Yung AR, Berk M, McGorry PD. The predictive validity of bipolar at-risk (prodromal) criteria in help-seeking adolescents and young adults: a prospective study. Bipolar Disord 2014; 16:493-504. [PMID: 24797824 DOI: 10.1111/bdi.12205] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 01/20/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There are no established tools to identify individuals at risk for developing bipolar disorder. We developed a set of ultra-high-risk criteria for bipolar disorder [bipolar at-risk (BAR)]. The primary aim of the present study was to determine the predictive validity of the BAR criteria. METHODS This was a 12-month prospective study that was conducted at Orygen Youth Health Clinical Program, a public mental health program for young people aged 15-24 years in metropolitan Melbourne, Australia. At intake, BAR screen-positive individuals and a matched group of individuals who did not meet BAR criteria were observed over a period of 12 months. The BAR criteria include general criteria such as being in the peak age range for the onset of the disorder, as well as sub-threshold mania, depression plus cyclothymic features, and depression plus genetic risk. Conversion to first-episode mania/hypomania was defined by the presence of DSM-IV manic symptoms for more than four days, in line with the DSM-IV definition of hypomania/mania. RESULTS A total of 559 help-seeking patients were screened. Of the eligible participants, 59 (10.6%) met BAR criteria. Thirty-five participants were included in the BAR group and 35 matched participants were selected to be in the control group. During the follow-up, five BAR patients out of 35 (14.3%) converted to first-episode hypomania/mania as opposed to none in the non-BAR group [χ(2) (1) = 5.38, p = 0.020]. Four out of these five converters had a DSM-IV diagnosis of bipolar I or bipolar II disorder. CONCLUSIONS These findings support the possibility of identification of persons prior to the onset of mania/hypomania. The proposed criteria need further evaluation in larger, prospective studies with longer follow-up periods.
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Affiliation(s)
- Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban, Academic Hospital of Charite Medicine Berlin, Berlin, Germany; Orygen Youth Health Research Centre; Centre for Youth Mental Health, University of Melbourne, Parkville, Vic., Australia; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
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Comparison of clinical characteristics of bipolar and depressive disorders in Korean clinical sample of youth: a retrospective chart review. Eur Child Adolesc Psychiatry 2014; 23:307-16. [PMID: 23963644 DOI: 10.1007/s00787-013-0461-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 08/03/2013] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to compare the clinical characteristics of bipolar disorder I, II (BD I and II) and not otherwise specified (BD NOS) to those of major depressive disorder (MDD) in a clinical sample of Korean children and adolescents. This study was a cross-sectional review of longitudinal observational data. Two psychiatrists retrospectively reviewed the medical records of 198 children and adolescents (age 6-18) that were diagnosed as having bipolar or depressive disorders from March 2010 to February 2012 at Department of Psychiatry of Asan Medical Center, Seoul, Korea. Every subject's diagnoses were reviewed and confirmed. BD I, II and MDD were assessed according to the Diagnostic and Statistical Manual-IV criteria. BD NOS was defined based on the criteria for the Course and Outcome of Bipolar Youth study. Comparisons were made in demographic information, clinical characteristics, family history, and psychiatric comorbidities at baseline and during observation. Among 198 subjects, 20 (10.1 %) subjects were diagnosed as having BD I, 10 (5.1 %) as BD II, 25 (12.6 %) as BD NOS and 143 (73.7 %) as MDD. BD depression was associated with mood change while taking an antidepressant, familial bipolarity, aggressive behaviors, and atypical features. Comorbid obsessive-compulsive disorder tended to be higher in BD NOS than in MDD. Presence of psychosocial stressors was more common in MDD than in BD depression. In children and adolescents, bipolar depression is distinct from unipolar depression in family history, comorbidity, and clinical characteristics.
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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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Lecardeur L, Benarous X, Milhiet V, Consoli A, Cohen D. [Management of bipolar 1 disorder in children and adolescents]. Encephale 2014; 40:143-53. [PMID: 24656684 DOI: 10.1016/j.encep.2014.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/17/2014] [Indexed: 11/15/2022]
Abstract
Lifetime prevalence of child and adolescent bipolar 1 disorder (BD1) is nearly 0.1 %. Even though it is not a frequent disorder in young people, there is an increased interest for this disorder at this age, because of the poor outcome, the severe functional impairments and the major risk of suicide. Diagnosis is complex in view of the more frequent comorbidities, the variability with an age-dependant clinical presentation, and the overlap in symptom presentation with other psychiatric disorders (e.g. disruptive disorders in prepubertal the child and schizophrenia in the adolescent). The presentation in adolescents is very similar to that in adults and in prepubertal children chronic persistent irritability and rapid mood oscillation are often at the foreground. For a while, such presentations were considered as BD-not otherwise specified (BD-NOS), which can explain the outburst of the prevalence of bipolar disorder in children in the US. Longitudinal studies that look for the outcome of such emotional dysregulations have not revealed an affiliation with bipolar disorder spectrum, but with depressive disorders in adulthood. The diagnosis of Disruptive Mood Dysregulation Disorder was proposed in the DSM-5 to identify these children and to prevent confusion with bipolar disorder. The goals of the pharmacological and psychosocial treatments are to control or ameliorate the symptoms, to avoid new episodes or recurrences, to improve psychosocial functioning and well-being, and to prevent suicide. In the US, lithium and four atypical antipsychotics have been approved by the FDA for 10 to 13-year-olds (risperidone, olanzapine, aripiprazole and quetiapine). In France, only lithium salts (after the age of 16) and aripiprazole (after the age of 13) are recommended. Psychosocial treatments, such as a familial or individual approach are developing.
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Affiliation(s)
- L Lecardeur
- Équipe mobile de soins intensifs, centre Esquirol, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France; CNRS, UMR 6301 ISTCT, ISTS group, GIP CYCERON, 14074 Caen, France; CEA, DSV/I2BM, UMR 6301 ISTCT, 14074 Caen, France; Université de Caen Basse-Normandie, UMR 6301 ISTCT, 14074 Caen, France.
| | - X Benarous
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - V Milhiet
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - A Consoli
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - D Cohen
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France; CNRS UMR 7222, institut des systèmes intelligents et robotiques, université Pierre-et-Marie-Curie, 75252 Paris cedex 05, France
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Narvaez JC, Zeni CP, Coelho RP, Wagner F, Pheula GF, Ketzer CR, Trentini CM, Tramontina S, Rohde LA. Does comorbid bipolar disorder increase neuropsychological impairment in children and adolescents with ADHD? BRAZILIAN JOURNAL OF PSYCHIATRY 2014; 36:53-9. [DOI: 10.1590/1516-4446-2013-1085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 07/07/2013] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Luis A. Rohde
- UFRGS, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents
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Pendergast LL, Youngstrom EA, Merkitch KG, Moore KA, Black CL, Abramson LY, Alloy LB. Differentiating bipolar disorder from unipolar depression and ADHD: the utility of the general behavior inventory. Psychol Assess 2014; 26:195-206. [PMID: 24295236 PMCID: PMC4100327 DOI: 10.1037/a0035138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Adolescence and early adulthood are the peak ages for the onset of unipolar and bipolar mood disorders. Moreover, for most individuals with attention-deficit/hyperactivity disorder (ADHD), symptoms and impairment begin in childhood but persist well into adolescence and adulthood (e.g., Barkley, 2010). Thus, adolescence and early adulthood represent a developmental window wherein individuals can be affected by mood disorders, ADHD, or both. Because treatment protocols for unipolar depression (UPD), bipolar disorder (BD), and ADHD are quite different, it is crucial that assessment instruments used among adolescents and young adults differentiate between these disorders. The primary objectives of this study were to evaluate the predictive and diagnostic validity of General Behavior Inventory (GBI; Depue et al., 1981) scores in discriminating BD from UPD and ADHD. Participants were drawn from adolescent (n = 361) and young adult (n = 614) samples. Based on findings from logistic regression and receiver-operating characteristics analyses, the diagnostic efficiency of the GBI scales range from fair (discriminating UPD from BD) to good (discriminating BD participants from nonclinical controls). Multilevel diagnostic likelihood ratios are also provided to facilitate individual decision making.
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Affiliation(s)
- Laura L Pendergast
- Department of Psychological, Organizational, and Leadership Studies in Education, Temple University
| | - Eric A Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill
| | | | | | | | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin-Madison
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Renk K, White R, Lauer BA, McSwiggan M, Puff J, Lowell A. Bipolar disorder in children. PSYCHIATRY JOURNAL 2014; 2014:928685. [PMID: 24800202 PMCID: PMC3994906 DOI: 10.1155/2014/928685] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 12/21/2013] [Indexed: 12/31/2022]
Abstract
Although bipolar disorder historically was thought to only occur rarely in children and adolescents, there has been a significant increase in children and adolescents who are receiving this diagnosis more recently (Carlson, 2005). Nonetheless, the applicability of the current bipolar disorder diagnostic criteria for children, particularly preschool children, remains unclear, even though much work has been focused on this area. As a result, more work needs to be done to further the understanding of bipolar symptoms in children. It is hoped that this paper can assist psychologists and other health service providers in gleaning a snapshot of the literature in this area so that they can gain an understanding of the diagnostic criteria and other behaviors that may be relevant and be informed about potential approaches for assessment and treatment with children who meet bipolar disorder criteria. First, the history of bipolar symptoms and current diagnostic criteria will be discussed. Next, assessment strategies that may prove helpful for identifying bipolar disorder will be discussed. Then, treatments that may have relevance to children and their families will be discussed. Finally, conclusions regarding work with children who may have a bipolar disorder diagnosis will be offered.
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Affiliation(s)
- Kimberly Renk
- University of Central Florida, P.O. Box 161390, Orlando, FL 32816, USA
| | - Rachel White
- University of Central Florida, P.O. Box 161390, Orlando, FL 32816, USA
| | - Brea-Anne Lauer
- University of Central Florida, P.O. Box 161390, Orlando, FL 32816, USA
| | - Meagan McSwiggan
- University of Central Florida, P.O. Box 161390, Orlando, FL 32816, USA
| | - Jayme Puff
- University of Central Florida, P.O. Box 161390, Orlando, FL 32816, USA
| | - Amanda Lowell
- University of Central Florida, P.O. Box 161390, Orlando, FL 32816, USA
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Collins AM. Childhood Attention-Deficit/Hyperactivity Disorder and Bipolar Mania: Neurobiology of Symptoms and Treatments. J Nurse Pract 2014. [DOI: 10.1016/j.nurpra.2013.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Andersen SM, Randers A, Jensen CM, Bisgaard C, Steinhausen HC. Preceding diagnoses to young adult bipolar disorder and schizophrenia in a nationwide study. BMC Psychiatry 2013; 13:343. [PMID: 24359146 PMCID: PMC3898215 DOI: 10.1186/1471-244x-13-343] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 12/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this comparative study was to investigate the type and frequency of diagnoses preceding adult bipolar disorder (BD) and schizophrenia (SZ). METHODS A follow-back study of all preceding diagnoses in all patients aged 21-34 years with a primary, first time diagnosis of BD (N = 784) or SZ (N = 1667) in 2008 to 2010. Data were taken from the Danish Psychiatric Central Research Register (DPCRR) including ICD-10 and ICD-8 diagnoses. RESULTS The numbers of patients with any preceding diagnoses amounted to 69.3% in BD and 76.6% in SZ with affective disorders (excluding BD) being the most frequent preceding diagnosis (46.6 vs. 28.0%), followed by psychoses (PSY) other than SZ (14.2 vs. 41.5%, p < .001), and substance use disorders (SUD) (16.1 vs. 26.9%, p < .001). Reactions to severe stress were equally frequent in both samples (26.3 vs. 26.6%) as were personality disorders (21.8 vs. 22.4%) and ADHD (4.2 vs. 3.5%), whereas rates of conduct disorders (1.7 vs. 3.1%) were rather low in both samples. Very few of the preceding diagnoses had their onset in childhood and adolescence. Overall patients with SZ had a minor but statistically significant earlier onset of any psychiatric disorder compared to BD (mean age: 23.3 vs. 22.5, p < .001). Regression analyses indicated that BD was associated with an increased risk of having experienced preceding affective disorders and ADHD, while SZ was associated with an increased risk of preceding substance use disorders, psychosis, anxiety disorders, and personality disorders. CONCLUSIONS Specific developmental trajectories of preceding disorders were delineated for BD and SZ with affective disorders being more specific for BD and both SUD and PSY more specific to SZ. There are different patterns of vulnerability in terms of preceding diagnosis in young adults with BD and SZ.
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Affiliation(s)
- Søren Martin Andersen
- Department of Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Mølleparkvej 10, DK 9000 Aalborg, Denmark.
| | - Anne Randers
- Department of Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Mølleparkvej 10, DK 9000 Aalborg, Denmark
| | - Christina Mohr Jensen
- Research Unit for Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Bisgaard
- Research Unit for Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Hans-Christoph Steinhausen
- Research Unit for Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark,Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Basel, Switzerland,Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
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Larsson H, Rydén E, Boman M, Långström N, Lichtenstein P, Landén M. Risk of bipolar disorder and schizophrenia in relatives of people with attention-deficit hyperactivity disorder. Br J Psychiatry 2013; 203:103-6. [PMID: 23703314 PMCID: PMC3730113 DOI: 10.1192/bjp.bp.112.120808] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is associated with bipolar disorder and schizophrenia, and it has been suggested that combined bipolar disorder and ADHD is aetiologically distinct from the pure disorders. AIMS To clarify whether ADHD shares genetic and environmental factors with bipolar disorder and schizophrenia. METHOD By linking longitudinal Swedish national registers, we identified 61 187 persons with ADHD (the proband group) and their first- and second-degree relatives, and matched them with a control group of people without ADHD and their corresponding relatives. Conditional logistic regression was used to determine the risks of bipolar disorder and schizophrenia in the relatives of the two groups. RESULTS First-degree relatives of the ADHD proband group were at increased risk of both bipolar disorder (odds ratio (OR) = 1.84-2.54 for parents, offspring and full siblings) and schizophrenia (OR = 1.71-2.22 for parents, offspring and full siblings). The risks of bipolar disorder and schizophrenia among second-degree relatives were substantially lower than among full siblings. CONCLUSIONS These findings suggest that the co-occurrence of ADHD and bipolar disorder as well as ADHD and schizophrenia is due to shared genetic factors, rather than representing completely aetiologically distinct subsyndromes.
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Affiliation(s)
- Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
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Abstract
The clinical confusion surrounding childhood ADHD and bipolar disorder centers on overlaps between severe ADHD with mood lability and mania/hypomania. Perplexity has been exacerbated by the removal of mood symptoms from the diagnostic criteria for ADHD and a lack of stringent criteria for a manic/hypomanic episode. This review summarizes current knowledge of the relationship between ADHD and bipolar disorder, the rates with which ADHD and bipolar disorder coexist in youth of differing ages, their presence in community, clinical, and high risk samples, and their longitudinal course. Treatment studies are reviewed, highlighting findings in comorbid cases, which support the efficacy of stimulants and other agents for ADHD without worsening mood symptoms, and efficacy of second generation antipsychotics for bipolar disorder. In conclusion, a lack of clarity regarding the diagnostic boundaries between childhood ADHD and bipolar disorder remains, however, treatments targeting symptoms of each disorder when comorbid, provide some efficacy.
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Affiliation(s)
- Caroly Pataki
- Keck School of Medicine of the University of Southern California, 546 16th Street, Santa Monica, CA 90402, USA.
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Negative emotion interference during a synonym matching task in pediatric bipolar disorder with and without attention deficit hyperactivity disorder. J Int Neuropsychol Soc 2013; 19:601-12. [PMID: 23398984 DOI: 10.1017/s135561771300012x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study examined whether processing of emotional words impairs cognitive performance in acutely ill patients with pediatric bipolar disorder (PBD), with or without comorbid attention-deficit hyperactivity disorder (ADHD), relative to healthy controls (HC). Forty youths with PBD without ADHD, 20 youths with PBD and ADHD, and 29 HC (mean age = 12.97 ± 3.13) performed a Synonym Matching task, where they decided which of two probe words was the synonym of a target word. The three words presented on each trial all had the same emotional valence, which could be negative, positive, or neutral. Relative to HC both PBD groups exhibited worse accuracy for emotional words relative to neutral ones. This effect was greater with negative words and observed regardless of whether PBD patients had comorbid ADHD. In the PBD group without ADHD, manic symptoms correlated negatively with accuracy for negative words, and positively with reaction time (RT) for all word types. Our findings suggest a greater disruptive effect of emotional valence in both PBD groups relative to HC, reflecting the adverse effect of altered emotion processing on cognitive function in PBD. Future studies including an ADHD group will help clarify how ADHD symptoms may affect emotional interference independently of PBD.
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Seymour KE, Pescosolido MF, Reidy BL, Galvan T, Kim KL, Young M, Dickstein DP. Emotional face identification in youths with primary bipolar disorder or primary attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2013; 52:537-546.e3. [PMID: 23622855 PMCID: PMC4418014 DOI: 10.1016/j.jaac.2013.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 02/28/2013] [Accepted: 03/15/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) are often comorbid or confounded; therefore, we evaluated emotional face identification to better understand brain/behavior interactions in children and adolescents with either primary BD, primary ADHD, or typically developing controls (TDC). METHOD Participants included individuals 7 to 17 years of age (overall sample mean age 12.40 ± 3.01 years), with "narrow-phenotype" pediatric BD (n = 30) or ADHD (n = 38), or typically developing controls (TDC) with no psychiatric disorders themselves or in their first-degree relatives (n = 41). In the BD group, comorbid diagnoses were allowed; however, youth in the ADHD group were excluded for comorbid mood or anxiety disorders. Patient groups were not excluded for psychotropic medication use. Emotional face identification was assessed using the computerized Diagnostic Analysis of Non-Verbal Accuracy (DANVA). RESULTS Participants with BD made significantly more identification errors on child happy faces than either TDCs (p = .03) or participants with ADHD (p = .01). Furthermore, youth with BD (0.33 ± 0.55) were more likely than youth with ADHD (0.11 ± 0.31) to make errors on low-intensity child happy faces (p = .05) but not high-intensity happy faces (p = NS). Participants with BD and ADHD made significantly more total errors in child face labeling than did TDCs, although participants with BD and ADHD did not differ from one another. CONCLUSION Our data suggest that youths with BD have specific alterations in emotional face identification of happy faces, an important finding that supports theories that response to positively valenced emotional stimuli may be especially salient in BD. Clinical trial registration information-Brain Imaging and Computer Games in Children With Either Bipolar Disorder, ADHD, Anxiety or Healthy Controls (BBPP); http://clinicaltrials.gov/; NCT01570426.
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Affiliation(s)
- Karen E Seymour
- Bradley Hospital's Pediatric Mood, Imaging, and NeuroDevelopmental (PediMIND) Program and the Alpert Medical School of Brown University, RI 02915, USA.
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Demeter CA, Youngstrom EA, Carlson GA, Frazier TW, Rowles BM, Lingler J, McNamara NK, Difrancesco KE, Calabrese JR, Findling RL. Age differences in the phenomenology of pediatric bipolar disorder. J Affect Disord 2013; 147:295-303. [PMID: 23219057 DOI: 10.1016/j.jad.2012.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 11/05/2012] [Accepted: 11/06/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The primary purpose of this study was to explore whether age differences in the phenomenology of bipolar disorders from 4 to 17 years of age exist. METHODS Outcome measures included questionnaires pertaining to mood symptoms, psychosocial functioning, and family history of psychiatric illness. Phenomenology was examined in two diagnostic groups: syndromal bipolar disorder (bipolar I or II) and subsyndromal bipolar disorder (bipolar disorder not otherwise specified or cyclothymia) and across six age cohorts: 4-6, 7-8, 9-10, 11-13, and 14-17 years. Analyses examined linear and non-linear age effects on clinician-rated measures of mood and psychosocial functioning. RESULTS Participants were 535 outpatients (339 males) ages 4-17 years. The proportion diagnosed with comorbid ADHD was significantly lower in the oldest age group. Age groups showed significant moderate decreases in motor activity, aggression, and irritability with age. Many symptoms of depression showed significant increases with age. BP I cases showed much higher manic symptoms, and BP I and BP II cases indicated slightly to moderately higher depressive symptoms, compared to subsyndromal cases. These patterns held after adjusting for comorbid ADHD, and age did not interact with syndrome status. There were also age differences in total scores for measures of mood symptoms and psychosocial functioning. LIMITATIONS Mood ratings were completed based on the same interview that informed the research diagnoses. Also, mood episode at time of interview was not captured. CONCLUSIONS These findings affirm the existence of bipolar disorder from pre-school children through adolescence, with a similar clinical presentation across a wide developmental age span.
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Affiliation(s)
- Christine A Demeter
- Department of Psychiatry, Case Western Reserve University, University Hospitals of Cleveland, OH, United States.
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Consoli A, Cohen D. Symptomatologie d’allure maniaque chez l’enfant : problèmes diagnostiques et controverse actuelle. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.neurenf.2012.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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I know it when I quantify it: ecological momentary assessment and recurrence quantification analysis of emotion dysregulation in children with ADHD. ACTA ACUST UNITED AC 2013; 5:283-94. [PMID: 23338519 DOI: 10.1007/s12402-013-0101-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 01/04/2013] [Indexed: 10/27/2022]
Abstract
Two studies examined the feasibility, utility, and validity of Ecological Momentary Assessment (EMA) and Recurrence Quantification Analysis (RQA) in assessing emotion dysregulation in children with Attention-Deficit/Hyperactivity Disorder (ADHD). In Study 1, 11 parents of children with ADHD ages 8-11 completed EMA-based ratings of their children's mood three times daily for 28 days (84 ratings total) and questionnaires regarding their children's emotion dysregulation. RQA was used to quantify the temporal patterning of dysregulation of the children's mood. In Study 2, five children ages 8-11 completed EMA-based ratings of their mood three times daily for 28 days. Results supported the feasibility and validity of the parent report EMA protocol, with greater intensity, variability, and persistent patterning of variability associated with greater emotion dysregulation. Results did not support the validity of the child report protocol, as children were less likely to complete ratings when emotionally distressed and demonstrated substantial response bias.
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Arnold LE, Mount K, Frazier T, Demeter C, Youngstrom EA, Fristad MA, Birmaher B, Horwitz S, Findling RL, Kowatch R, Axelson D. Pediatric bipolar disorder and ADHD: family history comparison in the LAMS clinical sample. J Affect Disord 2012; 141:382-9. [PMID: 22464937 PMCID: PMC3574899 DOI: 10.1016/j.jad.2012.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 03/06/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transgenerational association of bipolar spectrum disorder (BPSD) and attention deficit/hyperactivity disorder (ADHD) has been reported, but inconclusively. METHOD Children ages 6-12 were systematically recruited at first outpatient visit at 9 clinics at four universities and reliably diagnosed; 621 had elevated symptoms of mania (>12 on the Parent General Behavior Inventory 10-Item Mania Scale); 86 had scores below 12. We analyzed baseline data to test a familial association hypothesis: compared to children with neither BPSD nor ADHD, those with either BPSD or ADHD would have parents with higher rates of both bipolar and ADHD symptoms, and parents of comorbid children would have even higher rates of both. RESULTS Of 707 children, 421 had ADHD without BPSD, 45 BPSD without ADHD, 117 comorbid ADHD+BPSD, and 124 neither. The rate of parental manic symptoms was similar for the comorbid and BPSD-alone groups, significantly greater than for ADHD alone and "neither" groups, which had similar rates. ADHD symptoms in parents of children with BPSD alone were significantly less frequent than in parents of children with ADHD (alone or comorbid), and no greater than for children with neither diagnosis. Family history of manic symptoms, but not ADHD symptoms, was associated with parent-rated child manic-symptom severity over and above child diagnosis. LIMITATIONS The sample was not epidemiologic, parent symptoms were based on family history questions, and alpha was 0.05 despite multiple tests. CONCLUSIONS These results do not support familial linkage of BPSD and ADHD; they are compatible with heritability of each disorder separately with coincidental overlap.
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Affiliation(s)
- L. Eugene Arnold
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Ohio State University, Columbus, OH, United States
- Corresponding author. Tel.: +1 614 292 9780, +1 614 561 1429 (Cell).
| | - Katherine Mount
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Ohio State University, Columbus, OH, United States
- Corresponding author. Tel.: +1 614 293 9197; fax: +1 614 293 4949.
| | - Thomas Frazier
- Center for Pediatric Behavioral Health and Center for Autism, Cleveland Clinic, Cleveland, OH, United States
| | - Christine Demeter
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Case Western Reserve University, Cleveland, OH, United States
| | - Eric A. Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mary A. Fristad
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Ohio State University, Columbus, OH, United States
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Sarah Horwitz
- Department of Pediatrics and Stanford Health Policy, Stanford University School of Medicine, Stanford, CA, United States
| | - Robert L. Findling
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Case Western Reserve University, Cleveland, OH, United States
| | - Robert Kowatch
- Child and Adolescent Psychiatry, Ohio State University, and Nationwide Children’s Hospital, Columbus, OH, United States
| | - David Axelson
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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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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Affiliation(s)
- Sandy Kuiper
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, Australia
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Genevieve Curran
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, Australia
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Gin S Malhi
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, Australia
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
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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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Parents with bipolar disorder: Are disease characteristics good predictors of psychopathology in offspring? Eur Psychiatry 2012; 28:240-6. [DOI: 10.1016/j.eurpsy.2012.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 03/22/2012] [Accepted: 03/29/2012] [Indexed: 01/22/2023] Open
Abstract
AbstractPurposeTo investigate rates of psychopathology in the offspring of subjects with bipolar disorder (BP-offspring) compared to the offspring of healthy subjects (HC-offspring) in a Spanish sample and to study possible predictors of psychopathology in BP-offspring.SubjectsFifty BP-offspring from 36 families and 25 HC-offspring from 25 families.MethodsPsychopathology was compared in BP-offspring and HC-offspring. Factors associated with DSM-IV axis I disorders in BP-offspring were analyzed using logistic regression.ResultsHalf of BP-offspring fulfilled the diagnostic criteria for at least one axis I disorder with attention-deficit/hyperactivity disorder (30%), anxiety disorders (14%) and affective disorders (10%) as the most frequent. After controlling for having more than one sibling in the study, the odds ratio for BP-offspring presenting an axis I disorder was 15.02 when a biological parent had bipolar disorder with a lifetime history of psychotic symptoms and 3.34 when one parent had bipolar II disorder. Moreover, a higher Global Assessment of Functioning score in the biological co-parent was associated with a significantly lower frequency of axis I disorders in BP-offspring.Discussion and conclusionsPsychopathology in BP-offspring should be routinely assessed, with special emphasis on children from parents with specific disease characteristics (psychosis, BP II disorder) in order to establish an early diagnosis and appropriate interventions.
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Galanter CA, Hundt SR, Goyal P, Le J, Fisher PW. Variability among research diagnostic interview instruments in the application of DSM-IV-TR criteria for pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 2012; 51:605-21. [PMID: 22632620 DOI: 10.1016/j.jaac.2012.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 03/13/2012] [Accepted: 03/27/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The DSM-IV-TR criteria for a manic episode and bipolar disorder (BD) were developed for adults but are used for children. The manner in which clinicians and researchers interpret these criteria may have contributed to the increase in BD diagnoses given to youth. Research interviews are designed to improve diagnostic reliability and validity, but vary in how they incorporate DSM-IV-TR criteria for pediatric BD. METHOD We examined DSM-IV-TR criteria and the descriptive text for a manic episode and the mania sections of six commonly used pediatric diagnostic research interviews focusing on the following: interpretation of DSM-IV-TR, recommendations for administration, and scoring methods. RESULTS There are differences between the DSM-IV-TR manic episode criteria and descriptive text. Instruments vary in several ways including in their conceptualization of the mood criterion, whether symptoms must represent a change from the child's usual state, and whether B-criteria are required to co-occur with the A-criterion. Instruments also differ on recommendations for administration and scoring methods. CONCLUSIONS Given the differences between DSM-IV-TR manic episode criteria and explanatory text, it is not surprising that there is considerable variation between diagnostic instruments based on DSM-IV-TR. These differences likely lead to dissimilarities in subjects included in BD research studies and inconsistent findings across studies. The field of child psychiatry would benefit from more uniform methods of assessing symptoms and determining pediatric BD diagnoses. We discuss recommendations for changes to future instruments, interviews, assessment, and the DSM-5.
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Affiliation(s)
- Cathryn A Galanter
- State University of New York Downstate and the Kings County Hospital Center, 451 Clarkson Avenue, Brooklyn, NY 11203, USA.
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Passarotti AM, Pavuluri MN. Brain functional domains inform therapeutic interventions in attention-deficit/hyperactivity disorder and pediatric bipolar disorder. Expert Rev Neurother 2011; 11:897-914. [PMID: 21651336 DOI: 10.1586/ern.11.71] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A deeper understanding of how the relationships between impulsivity, reward systems and executive function deficits may be similar or different in attention-deficit/hyperactivity disorder (ADHD) and pediatric bipolar disorder (PBD) is fundamental for better defining phenotypy in these two developmental illnesses, and moving towards improved treatment and intervention. We focus our article on recent neurocognitive and neuroimaging data examining the behavioral and neural aspects of poor behavior regulation, response inhibition and reward systems in ADHD and PBD. In light of recent research evidence, we propose that the common behavioral manifestations of impulsivity in ADHD and PBD may indeed originate from different neural mechanisms mediated by altered reward systems. In order to define and differentiate these mechanisms, unlike previous approaches, our theoretical model examines the interface of the dorsal frontostriatal circuit, involved in behavior regulation, and the ventral frontostriatal circuit, which is involved in reward-related and affect processes. Preliminary evidence suggests that the neural systems involved in impulsivity, reward systems and executive function engage differently in the two illnesses. In PBD, 'emotional impulsivity' is predominantly 'bottom-up' and emotionally/motivationally driven, and stems from ventral frontostriatal circuitry dysfunction. By contrast, in ADHD 'cognitive impulsivity' is predominantly 'top-down' and more 'cognitively driven', and stems from dorsal frontostriatal dysfunction. We discuss this evidence in view of clinically relevant questions and implications for illness-based intervention. We conclude that the reward-related mechanisms underlying the interactions between executive function, behavior regulation and impulsivity in PBD and ADHD may be differentially compromised, and in accordance differently shape the clinical symptoms of impulsivity and goal-directed behavior.
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Affiliation(s)
- Alessandra M Passarotti
- Pediatric BRAIN Center, Institute for Juvenile Research, University of Illinois at Chicago, 1747, West Roosevelt Road, M/C 747, Chicago, IL 60612, USA.
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Arnold LE, Demeter C, Mount K, Frazier T, Youngstrom E, Fristad M, Birmaher B, Findling RL, Horwitz S, Kowatch R, Axelson DA. Pediatric bipolar spectrum disorder and ADHD: comparison and comorbidity in the LAMS clinical sample. Bipolar Disord 2011; 13:509-21. [PMID: 22017220 PMCID: PMC3201827 DOI: 10.1111/j.1399-5618.2011.00948.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare attention-deficit hyperactivity disorder (ADHD), bipolar spectrum disorders (BPSDs), and comorbidity in the Longitudinal Assessment of Manic Symptoms (LAMS) study. METHODS Children ages 6-12 were recruited at first visit to clinics associated with four universities. A BPSD diagnosis required that the patient exhibit episodes. Four hypotheses were tested: (i) children with BPSD + ADHD would have a younger age of mood symptom onset than those with BPSD but no ADHD; (ii) children with BPSD + ADHD would have more severe ADHD and BPSD symptoms than those with only one disorder; (iii) global functioning would be more impaired in children with ADHD + BPSD than in children with either diagnosis alone; and (iv) the ADHD + BPSD group would have more additional diagnoses. RESULTS Of 707 children, 421 had ADHD alone, 45 had BPSD alone, 117 had both ADHD and BPSD, and 124 had neither. Comorbidity (16.5%) was slightly less than expected by chance (17.5%). Age of mood symptom onset was not different between the BPSD + ADHD group and the BPSD-alone group. Symptom severity increased and global functioning decreased with comorbidity. Comorbidity with other disorders was highest for the ADHD + BPSD group, but higher for the ADHD-alone than the BPSD-alone group. Children with BPSD were four times as likely to be hospitalized (22%) as children with ADHD alone. CONCLUSIONS The high rate of BPSD in ADHD reported by some authors may be better explained as a high rate of both disorders in child outpatient settings rather than ADHD being a risk factor for BPSD. Co-occurrence of the two disorders is associated with poorer global functioning, greater symptom severity, and more additional comorbidity than for either single disorder.
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Affiliation(s)
- L. Eugene Arnold
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH
| | - Christine Demeter
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Katherine Mount
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH
| | - Thomas Frazier
- Center for Pediatric Behavioral Health and Center for Autism, Cleveland Clinic, Cleveland, OH
| | - Eric Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mary Fristad
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Robert L. Findling
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Sarah Horwitz
- Department of Pediatrics and Stanford Health Policy, Stanford University School of Medicine, Stanford, CA
| | - Robert Kowatch
- Division of Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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45
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Doerfler LA, Connor DF, Toscano PF. Aggression, ADHD symptoms, and dysphoria in children and adolescents diagnosed with bipolar disorder and ADHD. J Affect Disord 2011; 131:312-9. [PMID: 21168917 DOI: 10.1016/j.jad.2010.11.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 11/04/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study had two objectives: (1) examine characteristics of aggression in children and adolescents diagnosed with bipolar disorder and (2) determine whether the CBCL pediatric bipolar disorder profile differentiated youngsters with bipolar disorder from youngsters with ADHD. METHOD Children and adolescents referred to a pediatric psychopharmacology clinic were systematically evaluated for psychopathology using a psychiatrist-administered diagnostic interview, parent- and teacher-report rating scales assessing the child's behavior, and child-completed self-report scales. In this sample, 27 children and adolescents were diagnosed with bipolar disorder and 249 youngsters were diagnosed with ADHD without co-occurring bipolar disorder. These two groups were compared to determine whether there were significant differences on various measures of psychopathology. RESULTS Youngsters diagnosed with bipolar disorder were more verbally aggressive and exhibited higher levels of reactive aggression than youngsters with ADHD without co-occurring bipolar disorder. Youngsters with bipolar disorder also reported higher levels of depressive symptoms than youngsters with ADHD without bipolar disorder. The CBCL pediatric bipolar disorder profile did not accurately identify youngsters diagnosed with bipolar disorder. CONCLUSIONS The present findings present a picture of manic youngsters as verbally aggressive and argumentative, who respond with anger when frustrated. Youngsters diagnosed with bipolar disorder and ADHD exhibited significant levels of impulsive behavior and attention problems, but youngsters with bipolar disorder also exhibited significant levels of aggressive behavior and dysphoric mood. Finally, the CBCL pediatric bipolar disorder profile did not accurately identify youngsters who were diagnosed with bipolar disorder.
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Affiliation(s)
- Leonard A Doerfler
- Department of Psychology, Assumption College and Department of Psychiatry, University of Massachusettes Medical School, USA.
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Donfrancesco R, Miano S, Martines F, Ferrante L, Melegari MG, Masi G. Bipolar disorder co-morbidity in children with attention deficit hyperactivity disorder. Psychiatry Res 2011; 186:333-7. [PMID: 20692046 DOI: 10.1016/j.psychres.2010.07.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 07/05/2010] [Accepted: 07/08/2010] [Indexed: 11/30/2022]
Abstract
The present study aimed at: (1) exploring rate and clinical features of superimposed bipolar disorder (BD) in Italian children with attention deficit hyperactivity disorder (ADHD), compared with a community sample, matched for age and gender; (2) exploring predictors of BD in ADHD children, by comparing ADHD children with or without superimposed BD. We studied 173 consecutive drug-naïve outpatients with ADHD (156 males and 17 females, mean age of 9.2 ± 2.3years, age range 6-17.5 years), diagnosed with a clinical interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL)); the control group consisted of a community-based sample of 100 healthy children. The rate of children with a diagnosis of BD was higher in the ADHD group (29/173, 16.7%) compared with controls (1/100, 1%), (P<0.001). Among the 29 children with ADHD+BD, 16 (55.2%) had a Bipolar Disorder-Not Otherwise Specified (BD-NOS), and 11 (37.9%) showed ultrarapid cycling. Compared with children with ADHD without BD, they showed a higher rate of combined sub-type (21/29, 72.4%), a higher score at ADHD-Rating Scale (total score and hyperactivity subscale), higher rates of major depression, oppositional defiant disorder and conduct disorder. In summary, children with ADHD present a higher risk for developing a superimposed BD. The identification of clinical features with an increased risk of BD can improve diagnosis, prognosis and treatments.
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Torralva T, Gleichgerrcht E, Torrente F, Roca M, Strejilevich SA, Cetkovich M, Lischinsky A, Manes F. Neuropsychological functioning in adult bipolar disorder and ADHD patients: a comparative study. Psychiatry Res 2011; 186:261-6. [PMID: 20832868 DOI: 10.1016/j.psychres.2010.08.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 08/05/2010] [Accepted: 08/12/2010] [Indexed: 12/21/2022]
Abstract
Bipolar disorder (BD) and adult attention deficit hyperactivity disorder (ADHD) usually manifest with shared clinical symptoms, proving quite challenging to thoroughly differentiate one from another. Previous research has characterized these two disorders independently, but no study compared both pathologies from a neuropsychological perspective. The aim of this study was to compare the neuropsychological profile of adult ADHD and BD with each other and against a control group, in order to understand the way in which comprehensive cognitive assessment can contribute to their discrimination as distinct clinical entities as well as their differential diagnosis. All groups were successfully matched for age, sex, years of education, and premorbid IQ. Participants were assessed with an extensive neuropsychological battery evaluating multiple domains. Compared to controls, BD patients had a poorer performance on immediate verbal memory tasks. Both clinical groups exhibited significantly lower scores than controls on the recognition phase of verbal and non-verbal memory tasks, as well as on a task of executive functioning with high working memory demand. Noticeably, however, ADHD had significantly better performance than BD on the recognition phase of both the Rey list memory task and the Rey Figure. The better performance of ADHD patients over BD may reflect the crucial role of the executive component on their memory deficits and gives empirical support to further differentiate the neuropsychological profile of BD and adult ADHD patients in clinical practice.
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Merkel RL. Safety of stimulant treatment in attention deficit hyperactivity disorder: part II. Expert Opin Drug Saf 2011; 9:917-35. [PMID: 20615078 DOI: 10.1517/14740338.2010.503238] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Attention deficit hyperactivity disorder (ADHD) is the most common childhood psychiatric disorder and in at least 50% of cases persists into adulthood. Treatment of ADHD with stimulants is one of the oldest and most effective pharmacological treatments in psychiatry. Yet, there continues to be controversy over the safety of stimulant medications in the treatment of ADHD. AREAS COVERED IN THIS REVIEW This paper is a continuation of an earlier paper that reviewed the safety profile of newer stimulant agents, especially in relation to special populations. This part II reviews, through essentially an organ-system approach, the various clinical concerns that have been raised over the safety of stimulant medications. This includes neuropsychiatric, cardiovascular effects on growth and development, and a number of other less common concerns. WHAT THE READER WILL GAIN A thorough review of safety concerns in stimulants that emphasizes clinical information, case reports, open series or controlled trials relating to stimulant use in the treatment of ADHD. TAKE HOME MESSAGE While many safety concerns have been raised in the use of stimulants, the vast majority of treatment complications are either quickly reversible or easily manageable with appropriate clinical care. The negative consequences of untreated ADHD clearly outweigh the risks of the stimulant medicines when used in an appropriate and careful manner.
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Affiliation(s)
- Richard Lawrence Merkel
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22908, USA.
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Kessler RC, Ormel J, Petukhova M, McLaughlin KA, Green JG, Russo LJ, Stein DJ, Zaslavsky AM, Aguilar-Gaxiola S, Alonso J, Andrade L, Benjet C, de Girolamo G, de Graaf R, Demyttenaere K, Fayyad J, Haro JM, Hu CY, Karam A, Lee S, Lepine JP, Matchsinger H, Mihaescu-Pintia C, Posada-Villa J, Sagar R, Ustün TB. Development of lifetime comorbidity in the World Health Organization world mental health surveys. ACTA ACUST UNITED AC 2011; 68:90-100. [PMID: 21199968 DOI: 10.1001/archgenpsychiatry.2010.180] [Citation(s) in RCA: 322] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Although numerous studies have examined the role of latent variables in the structure of comorbidity among mental disorders, none has examined their role in the development of comorbidity. OBJECTIVE To study the role of latent variables in the development of comorbidity among 18 lifetime DSM-IV disorders in the World Health Organization World Mental Health Surveys. DESIGN Nationally or regionally representative community surveys. SETTING Fourteen countries. PARTICIPANTS A total of 21 229 survey respondents. MAIN OUTCOME MEASURES First onset of 18 lifetime DSM-IV anxiety, mood, behavior, and substance disorders assessed retrospectively in the World Health Organization Composite International Diagnostic Interview. RESULTS Separate internalizing (anxiety and mood disorders) and externalizing (behavior and substance disorders) factors were found in exploratory factor analysis of lifetime disorders. Consistently significant positive time-lagged associations were found in survival analyses for virtually all temporally primary lifetime disorders predicting subsequent onset of other disorders. Within-domain (ie, internalizing or externalizing) associations were generally stronger than between-domain associations. Most time-lagged associations were explained by a model that assumed the existence of mediating latent internalizing and externalizing variables. Specific phobia and obsessive-compulsive disorder (internalizing) and hyperactivity and oppositional defiant disorders (externalizing) were the most important predictors. A small number of residual associations remained significant after controlling the latent variables. CONCLUSIONS The good fit of the latent variable model suggests that common causal pathways account for most of the comorbidity among the disorders considered herein. These common pathways should be the focus of future research on the development of comorbidity, although several important pairwise associations that cannot be accounted for by latent variables also exist that warrant further focused study.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
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Leibenluft E. Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths. Am J Psychiatry 2011; 168:129-42. [PMID: 21123313 PMCID: PMC3396206 DOI: 10.1176/appi.ajp.2010.10050766] [Citation(s) in RCA: 319] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In recent years, increasing numbers of children have been diagnosed with bipolar disorder. In some cases, children with unstable mood clearly meet current diagnostic criteria for bipolar disorder, and in others, the diagnosis is unclear. Severe mood dysregulation is a syndrome defined to capture the symptomatology of children whose diagnostic status with respect to bipolar disorder is uncertain, that is, those who have severe, nonepisodic irritability and the hyperarousal symptoms characteristic of mania but who lack the well-demarcated periods of elevated or irritable mood characteristic of bipolar disorder. Levels of impairment are comparable between youths with bipolar disorder and those with severe mood dysregulation. An emerging literature compares children with severe mood dysregulation and those with bipolar disorder in longitudinal course, family history, and pathophysiology. Longitudinal data in both clinical and community samples indicate that nonepisodic irritability in youths is common and is associated with an elevated risk for anxiety and unipolar depressive disorders, but not bipolar disorder, in adulthood. Data also suggest that youths with severe mood dysregulation have lower familial rates of bipolar disorder than do those with bipolar disorder. While youths in both patient groups have deficits in face emotion labeling and experience more frustration than do normally developing children, the brain mechanisms mediating these pathophysiologic abnormalities appear to differ between the two patient groups. No specific treatment for severe mood dysregulation currently exists, but verification of its identity as a syndrome distinct from bipolar disorder by further research should include treatment trials.
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Affiliation(s)
- Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, NIMH, Bethesda, MD 20892-2670, USA.
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