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Cichoń L, Janas-Kozik M, Chełmecka E, Wilczyński KM, Jelonek I, Rybakowski JK. Does the clinical picture of bipolar disorder in the pediatric population depend on sex? J Affect Disord 2024; 363:501-506. [PMID: 39029674 DOI: 10.1016/j.jad.2024.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/02/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND In the current literature the influence of sex on the clinical presentation of the bipolar disorder (BD) in adults has been indicated. It was of the interest whether such a phenomenon is also present in the pediatric population. METHODS The authors collected retrospective clinical data in 288 patients hospitalized on the psychiatry ward aged 10-17 years; 80.2 % females and 19.8 % males. RESULTS No sex differences were observed in the age of onset, the time from the onset of symptoms to the diagnosis of BD, the number of symptoms during hospital stay, or family history of psychiatric disorder (U Mann-Whitney's p > 0.05). In males the most frequently recorded first episode of BD was mania or hypomania (51 %), and in females, a depressive episode (51 %). The main reason for the hospitalization in boys was episodes of mania (63 %), then mixed episodes (30 %), and depression (7 %). Whereas girls were most often hospitalized due to mixed episodes (52 %), less frequently depression (22 %), and mania (26 %). Co-morbid psychiatric disorders were found more often in boys than in girls (63 % vs 45 %; χ2p-value>0.05). The co-occurrence of the dissocial personality, borderline, tic disorders, pervasive developmental disorders and hyperkinetic disorders was different in both sexes. LIMITATIONS The main limitations of the study are the very high proportion of female subjects and the retrospective character of the study. CONCLUSIONS It seems that the clinical presentation of BD in the pediatric population can somewhat depend on the sex of the patients.
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Affiliation(s)
- Lena Cichoń
- Medical University of Silesia in Katowice, Department of Developmental Age Psychiatry and Psychotherapy, John Paul II Pediatric Centre in Sosnowiec, Poland.
| | - Małgorzata Janas-Kozik
- Medical University of Silesia in Katowice, Department of Developmental Age Psychiatry and Psychotherapy, John Paul II Pediatric Centre in Sosnowiec, Poland
| | - Elżbieta Chełmecka
- Medical University of Silesia in Katowice, Department of Medical Statistics, Faculty of Pharmaceutical Sciences in Sosnowiec, Poland
| | - Krzysztof M Wilczyński
- Medical University of Silesia in Katowice, Department of Developmental Age Psychiatry and Psychotherapy, John Paul II Pediatric Centre in Sosnowiec, Poland
| | - Ireneusz Jelonek
- Medical University of Silesia in Katowice, Department of Developmental Age Psychiatry and Psychotherapy, John Paul II Pediatric Centre in Sosnowiec, Poland
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznań University of Medical Sciences, Poland
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Faraone SV, Newcorn JH, Wozniak J, Joshi G, Coffey B, Uchida M, Wilens T, Surman C, Spencer TJ. In Memoriam: Professor Joseph Biederman's Contributions to Child and Adolescent Psychiatry. J Atten Disord 2024; 28:550-582. [PMID: 39315575 PMCID: PMC10947509 DOI: 10.1177/10870547231225818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To provide an overview of Joe Biederman's contributions to child and adolescent psychiatry. METHOD Nine colleagues described his contributions to: psychopharmacology, comorbidity and genetics, pediatric bipolar disorder, autism spectrum disorders, Tourette's and tic disorders, clinical and neuro biomarkers for pediatric mood disorders, executive functioning, and adult ADHD. RESULTS Joe Biederman left us with many concrete indicators of his contributions to child and adolescent psychiatry. He set up the world's first pediatric psychopharmacology clinic and clinical research program in child adolescent psychiatry. As a young faculty member he began a research program that led to many awards and eventual promotion to full professor at Harvard Medical School. He was for many years the most highly cited researcher in ADHD. He achieved this while maintaining a full clinical load and was widely respected for his clinical acumen. CONCLUSION The world is a better place because Joe Biederman was here.
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Affiliation(s)
- Stephen V Faraone
- State University of New York Upstate Medical University, Syracuse, USA
| | | | - Janet Wozniak
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Gagan Joshi
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Mai Uchida
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Timothy Wilens
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Craig Surman
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Thomas J Spencer
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
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Alcantarilla L, López-Castro M, Betriu M, Torres A, Garcia C, Solé E, Gelabert E, Roca-Lecumberri A. Risk factors for relapse or recurrence in women with bipolar disorder and recurrent major depressive disorder in the perinatal period: a systematic review. Arch Womens Ment Health 2023; 26:737-754. [PMID: 37718376 DOI: 10.1007/s00737-023-01370-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/08/2023] [Indexed: 09/19/2023]
Abstract
It is well known that the perinatal period supposes a considerable risk of relapse for women with bipolar disorder (BD) and recurrent major depressive disorder (rMDD), with the consequences that this entails. Therefore, the authors sought to provide a critical appraisal of the evidence related to specific risk factors for this population with the aim of improving the prevention of relapses during pregnancy and postpartum. The authors conducted a systematic review assessing 18 original studies that provided data on risk factors for relapse or recurrence of BD and/or rMDD in the perinatal period (pregnancy and postpartum). Recurrences of BD and rMDD are more frequent in the postpartum period than in pregnancy, with the first 4-6 weeks postpartum being especially complicated. In addition, women with BD type I are at higher risk than those with BD type II and rMDD, and the most frequent presentation of perinatal episodes of both disorders is a major depressive episode. Other risk factors consistently repeated were early age of onset of illnesses, severity criteria, primiparity, abrupt discontinuation of treatment, and personal or family history of perinatal affective episodes. This review shows that there are common and different risk factors according to the type of disorder and to perinatal timing (pregnancy or postpartum) that should be known for an adequate prevention of relapses.
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Affiliation(s)
- Laura Alcantarilla
- Perinatal Mental Health Unit CLINIC_BCN, Hospital Clínic de Barcelona, Barcelona, Spain
- Psychiatry Service, Hospital de Sagunto, Valencia, Spain
| | - María López-Castro
- Perinatal Mental Health Unit CLINIC_BCN, Hospital Clínic de Barcelona, Barcelona, Spain
- Psychiatry Service, Sant Pau's Biomedical Research Institute (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Betriu
- Perinatal Mental Health Unit CLINIC_BCN, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Anna Torres
- Perinatal Mental Health Unit CLINIC_BCN, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Cristina Garcia
- Perinatal Mental Health Unit CLINIC_BCN, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Eva Solé
- Perinatal Mental Health Unit CLINIC_BCN, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Estel Gelabert
- Department of Clinical Psychology and Health, Autonomous University of Barcelona, Barcelona, Spain
| | - Alba Roca-Lecumberri
- Perinatal Mental Health Unit CLINIC_BCN, Hospital Clínic de Barcelona, Barcelona, Spain.
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Yapıcı Eser H, Taşkıran AS, Ertınmaz B, Mutluer T, Kılıç Ö, Özcan Morey A, Necef I, Yalçınay İnan M, Öngür D. Anxiety disorders comorbidity in pediatric bipolar disorder: a meta-analysis and meta-regression study. Acta Psychiatr Scand 2020; 141:327-339. [PMID: 31899546 DOI: 10.1111/acps.13146] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/26/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Anxiety disorders (AD) are known for its comorbidity and negative impact on the course of adult bipolar disorder (BD). However, there is limited research on AD comorbidity in pediatric BD (PBD). Here, we aimed to conduct a meta-analysis and meta-regression study about the comorbidity and covariates of AD and PBD. METHOD We systematically searched relevant articles published until May 2019, as defined in PRISMA guidelines. Variables for associated features and prevalence of AD were extracted. RESULTS Thirty-seven articles represented data for the analysis. Lifetime any AD comorbidity was 44.7%; panic disorder (PD) was 12.7%; generalized anxiety disorder (GAD) was 27.4%; social phobia was 20.1%; separation anxiety disorder (SAD) was 26.1%; and obsessive-compulsive disorder (OCD) was 16.7%. Childhood-onset studies reported higher GAD and SAD comorbidity, while adolescent-onset studies reported higher PD, OCD, and social phobia. Age of onset, gender, comorbidity of ADHD, substance use, oppositional defiant disorder and conduct disorder affected each anxiety disorders' comorbidity with PBD differently. CONCLUSION Anxiety disorders are highly comorbid with PBD. Early-onset PBD increases the risk of AD. Biopsychosocial aspects of this comorbidity and its course needs to be evaluated further.
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Affiliation(s)
- H Yapıcı Eser
- School of Medicine, Department of Psychiatry, Koç University, İstanbul, Turkey.,Research Center for Translational Medicine, Koç University, İstanbul, Turkey
| | - A S Taşkıran
- School of Medicine, Department of Psychiatry, Koç University, İstanbul, Turkey.,Child Mind Institute, New York, NY, USA
| | - B Ertınmaz
- School of Medicine, Koç University, İstanbul, Turkey
| | - T Mutluer
- School of Medicine, Department of Psychiatry, Koç University, İstanbul, Turkey
| | - Ö Kılıç
- Koç University Hospital, İstanbul, Turkey
| | | | - I Necef
- Koç University Hospital, İstanbul, Turkey
| | | | - D Öngür
- Harvard Medical School, Boston, MA, USA.,McLean Hospital, Belmont, MA, USA
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Estrada-Prat X, Van Meter AR, Camprodon-Rosanas E, Batlle-Vila S, Goldstein BI, Birmaher B. Childhood factors associated with increased risk for mood episode recurrences in bipolar disorder-A systematic review. Bipolar Disord 2019; 21:483-502. [PMID: 31025494 PMCID: PMC6768757 DOI: 10.1111/bdi.12785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bipolar Disorder (BD) is a recurrent illness associated with high morbidity and mortality. The frequency of mood episode recurrence in BD is highly heterogeneous and significantly impacts the person's psychosocial functioning and well-being. Understanding the factors associated with mood recurrences could inform the prognosis and treatment. The objective of this review is to summarize the literature on factors, present during childhood, that influence recurrence. METHODOLOGY A systematic review of PubMed (1946-2017) and PsycINFO (1884-2017) databases was conducted to identify candidate studies. Search terms included bipolar disorder, episodes, predictors, recurrences, and course. Study characteristics, risk for bias, and factors associated with recurrence were coded by two raters according to predetermined criteria. RESULTS Twenty child studies and 28 adult studies that retrospectively evaluated childhood variables associated with mood recurrences were included. Early age of onset, low socioeconomic status, comorbid disorders, inter-episode subsyndromal mood symptoms, BD-I/II subtypes, presence of stressors, and family history of BD were associated with higher number of recurrences. LIMITATIONS Risk factors and mood recurrences were assessed and defined in different ways, limiting generalizability. CONCLUSION Multiple factors are associated with increased risk of mood episode recurrence in BD. Interventions targeting modifiable factors could reduce the impact of BD. For example, treatment of comorbid disorders and subsyndromal mood symptoms, coupled with appropriate cognitive behavioral and family-focused therapies could ameliorate risk related to many clinical factors. When coupled with social services to address environmental factors, the number of episodes could be reduced and the course of BD significantly improved.
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Affiliation(s)
- Xavier Estrada-Prat
- Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona, Spain
| | - Anna R. Van Meter
- The Feinstein Institute for Medical Research, The Zucker Hillside Hospital, Department of Psychiatry Research, Glen Oaks, NY
| | - Ester Camprodon-Rosanas
- Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona, Spain
- Children and Adolescent Mental Health Research Group. Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Santiago Batlle-Vila
- Institut de Neuropsiquiatria i Addiccions, Centre de Salut Mental Infantil i Juvenil Sant Martí-La Mina i Ciutat Vella, Parc de Salut Mar, Barcelona, Spain
| | - Benjamin I. Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Van Meter A, Guinart D, Bashir A, Sareen A, Cornblatt BA, Auther A, Carrión RE, Carbon M, Jiménez-Fernández S, Vernal DL, Walitza S, Gerstenberg M, Saba R, Cascio NL, Correll CU. Bipolar Prodrome Symptom Scale - Abbreviated Screen for Patients: Description and validation. J Affect Disord 2019; 249:357-365. [PMID: 30807937 DOI: 10.1016/j.jad.2019.02.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/04/2019] [Accepted: 02/11/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE There is no standard method for assessing symptoms of the prodrome to bipolar disorder (BD), which has limited progress toward early identification and intervention. We aimed to validate the Bipolar Prodrome Symptom Scale-Abbreviated Screen for Patients (BPSS-AS-P), a brief self-report derived from the validated, clinician-rated Bipolar Prodrome Symptom Interview and Scale-Full Prospective (BPSS-FP), as a means to screen and identify people for whom further evaluation is indicated. METHOD Altogether, 134 participants (aged 12-18 years) were drawn from a study of the pre-syndromal stage of mood and psychotic disorders. All participants had chart diagnoses of a mood- or psychosis-spectrum disorder. Participants were interviewed with the BPSS-FP and completed measures of mania and non-mood psychopathology. Prior to being interviewed, patients completed the BPSS-AS-P. Scores on the BPSS-AS-P were determined by summing the severity and frequency ratings for each item. RESULTS BPSS-AS-P scores were highly reliable (Cronbach's alpha = 0.94) and correlated with the interview-based BPSS-FP Mania Symptom Index (r = 0.55, p < .0001). BPSS-AS-P scores had good convergent validity, correlating with the General Behavior Inventory-10M (r = 0.65, p < .0001) and Young Mania Rating Scale; r = 0.48, p < .0001). The BPSS-AS-P had good discriminant validity, not being correlated with scales measuring positive and negative symptoms of psychotic disorders (p-values = 0.072-0.667). LIMITATIONS Findings are limited by the cross-sectional nature of the study by the fact that the participants were all treatment-seeking. Future studies need to evaluate the predictive validity of the BPSS-AS-P for identifying those who develop BD in a community sample. CONCLUSION BPSS-AS-P has promise as a screening tool for people at risk for BD. Adopting the BPSS-AS-P would support the goal of characterizing the prodrome systematically in order to facilitate research and clinical care.
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Affiliation(s)
- Anna Van Meter
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Daniel Guinart
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Asjad Bashir
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Aditya Sareen
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Barbara A Cornblatt
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Andrea Auther
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Ricardo E Carrión
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Maren Carbon
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Sara Jiménez-Fernández
- Child and Adolescent Mental Health Unit, Jaén Medical Center, Jaén, Spain; Department of Psychiatry, University of Granada, Granada, Spain
| | - Ditte L Vernal
- Research Unit for Child- and Adolescent Psychiatry, Aalborg University Hospital, North Denmark Region, Denmark
| | - Susanne Walitza
- Psychiatric University Hospital Zurich, Department of Child and Adolescent Psychiatry and Psychotherapy, Zurich, Switzerland
| | - Miriam Gerstenberg
- Psychiatric University Hospital Zurich, Department of Child and Adolescent Psychiatry and Psychotherapy, Zurich, Switzerland
| | - Riccardo Saba
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Nella Lo Cascio
- Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany.
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Ashare RL, Wetherill RR. The Intersection of Sex Differences, Tobacco Use, and Inflammation: Implications for Psychiatric Disorders. Curr Psychiatry Rep 2018; 20:75. [PMID: 30094593 PMCID: PMC7018440 DOI: 10.1007/s11920-018-0946-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Tobacco use, sex differences, and psychiatric disorders are associated with altered immune function. There are also sex differences in tobacco use and psychiatric disorders. This review summarizes findings from the small, but growing literature examining sex differences in the effects of tobacco use on inflammation and the implications for psychiatric disorders. RECENT FINDINGS We identified four studies that tested the interaction between sex and tobacco/nicotine on inflammation. Although males and females generally exhibited differential tobacco-induced immune responses, the pattern varied depending on the sample (rodents vs. humans) and the method to evaluate inflammation. Evidence suggests that sex modulates the effects of tobacco smoke on inflammation. Many inflammation markers associated with sex differences and tobacco use are related to psychiatric disorders. We propose a model in which sex, tobacco use, and inflammation interact to increase risk for psychiatric disorders. Future studies are needed to examine the mechanisms that explain this relationship.
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Affiliation(s)
- Rebecca L. Ashare
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA
| | - Reagan R. Wetherill
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA
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High Risk for Severe Emotional Dysregulation in Psychiatrically Referred Youth with Autism Spectrum Disorder: A Controlled Study. J Autism Dev Disord 2018; 48:3101-3115. [DOI: 10.1007/s10803-018-3542-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Van Meter AR, Burke C, Youngstrom EA, Faedda GL, Correll CU. The Bipolar Prodrome: Meta-Analysis of Symptom Prevalence Prior to Initial or Recurrent Mood Episodes. J Am Acad Child Adolesc Psychiatry 2016; 55:543-55. [PMID: 27343882 DOI: 10.1016/j.jaac.2016.04.017] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/09/2016] [Accepted: 05/02/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to meta-analyze the prevalence of symptoms before an initial mood episode of bipolar disorder (BD) and the prevalence of subthreshold symptoms before a BD mood episode recurrence, to facilitate early identification and prevention. METHOD Systematic literature reviews were conducted in PsycINFO and PubMed for prospective or retrospective studies reporting on the prevalence and longest duration of symptoms before an initial or recurrent mood episode of BD. Random effects meta-regression explored whether geographic location, age, percentage of female individuals, and study quality moderated the overall prevalence. RESULTS In 11 studies (n = 1,078), the prodrome preceding an initial mood episode lasted 27.1 ± 23.1 months (range, 4.6-130 months). In 10 studies (n = 1,000), the subthreshold symptoms preceding a recurrent mood episode lasted 1.0 ± 0.9 months (range, 0.5-1.3 months). The most common symptoms were largely consistent with diagnostic criteria symptoms associated with the subsequent mood polarity for both the initial prodrome and the period prior to a recurrent mood episode. Few moderators of symptom prevalences emerged, and significant heterogeneity remained. CONCLUSION The initial prodromal period is sufficiently long and characterized by symptoms of the subsequent mood episode to make early identification and intervention programs feasible. Conversely, the period of subthreshold symptoms before a recurrent mood episode is short, mandating adequate psychoeducation of patients and families, monitoring of changes in sleep and activity, plus sufficiently frequent follow-up visits to identify patients before a mood episode recurrence. Future prospective investigations, designed to address the identified shortcomings in the extant literature, are needed to identify more clinically applicable information.
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Affiliation(s)
| | - Coty Burke
- University of North Carolina at Chapel Hill
| | | | - Gianni L Faedda
- Lucio Bini Mood Disorders Center, New York University Medical Center, and the Child Study Center, New York
| | - Christoph U Correll
- The Zucker Hillside Hospital, New York, Northwell Health System, and the Hofstra Northwell School of Medicine, East Garden City, NY
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10
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Van Meter AR, Burke C, Kowatch RA, Findling RL, Youngstrom EA. Ten-year updated meta-analysis of the clinical characteristics of pediatric mania and hypomania. Bipolar Disord 2016; 18:19-32. [PMID: 26748678 DOI: 10.1111/bdi.12358] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The phenomenology and diagnosis of pediatric bipolar disorder has been controversial. We aimed to update a 2005 meta analysis of the prevalence of manic symptoms in youth, in order to determine whether the picture of pediatric mania has changed as research on pediatric bipolar disorder has grown. METHODS We conducted literature reviews in PsycINFO and PubMed; studies with the prevalence of manic symptoms in youth were included. Two raters coded each study; kappa was 0.86-1.0. RESULTS Twenty studies were meta-analyzed (N = 2,226 youths). The most common symptoms across bipolar subtypes, using a random-effects model, were: increased energy 79%, irritability 77%, mood lability 76%, distractibility 74%, goal-directed activity 72%, euphoric/elated mood 64%, pressured speech 63%, hyperactive 62%, racing thoughts 61%, poor judgment 61%, grandiosity 57%, inappropriate laughter 57%, decreased need for sleep 56%, and flight of ideas 54%. Symptom rates were heterogeneous across samples; potential predictors were explored but no clear patterns were found. CONCLUSIONS Debate continues about the definitions of pediatric bipolar disorder; the results of this meta-analysis suggest that there is significant heterogeneity of symptom prevalence between studies, and that symptoms vary widely across individuals. Understanding the roots of this heterogeneity could broaden understanding of the complex clinical presentation of pediatric mania, and aid in diagnosis.
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Affiliation(s)
- Anna R Van Meter
- Ferkauf Graduate School of Psychology, Yeshiva University, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Coty Burke
- Department of Psychology and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert A Kowatch
- Department of Psychiatry and Behavioral Health, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Robert L Findling
- Department of Psychiatry and Behaviorial Science, The Johns Hopkins Hospital/Kennedy Krieger Institute, Baltimore, MD, USA
| | - Eric A Youngstrom
- Department of Psychology and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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11
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Singh MK, Ketter T, Chang KD. Distinguishing bipolar disorder from other psychiatric disorders in children. Curr Psychiatry Rep 2014; 16:516. [PMID: 25315116 DOI: 10.1007/s11920-014-0516-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pediatric onset bipolar disorder (BD) is a challenging diagnosis with potentially debilitating outcomes. This review aims to critically evaluate recently published literature relevant to the diagnosis of BD in youth, emphasizing interesting and important new findings characterizing pediatric BD and reporting updates in the diagnostic and statistical manual relevant to this disorder in youth. Challenges regarding the diagnosis of BD will be discussed, in addition to important distinctions with other childhood disorders, including other bipolar spectrum disorders; major depressive disorder; dysthymia; disruptive mood dysregulation disorder (DMDD); attention-deficit/hyperactivity disorder (ADHD) and other disruptive behavioral disorders; anxiety disorders, including post-traumatic stress disorder (PTSD); psychotic disorders; autism spectrum disorders; substance use disorders; and borderline personality disorder. The review concludes with a comment on past research limitations and future directions in the field.
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Affiliation(s)
- Manpreet K Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5719, USA,
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