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Cordeiro ML, Farias AC, Whybrow PC, Felden EPG, Cunha A, da Veiga V, Benko CR, McCracken JT. Receiver Operating Characteristic Curve Analysis of Screening Tools for Bipolar Disorder Comorbid With ADHD in Schoolchildren. J Atten Disord 2020; 24:1403-1412. [PMID: 26721636 DOI: 10.1177/1087054715620897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: We compared Child Behavior Checklist (CBCL)-AAA (Attention Problems, Aggressive Behavior, and Anxious/Depressed) and Parent-Young Mania Rating Scale (P-YMRS) profiles in Brazilian children with ADHD, pediatric-onset bipolar disorder (PBD), and PBD + ADHD. Method: Following analyses of variance or Kruskal-Wallis tests with multiple-comparison Least Significant Difference (LSD) or Dunn's Tests, thresholds were determined by Mann-Whitney U Tests and receiver operating characteristic (ROC) plots. Results: Relative to ADHD, PBD and PBD + ADHD groups scored higher on the Anxious/Depressed, Thought Problems, Rule-Breaking, and Aggressive Behavior subscales and Conduct/Delinquency Diagnostic Scale of the CBCL; all three had similar attention problems. The PBD and PBD + ADHD groups scored higher than the ADHD and healthy control (HC) groups on all CBCL problem scales. The AAA-profile ROC had good diagnostic prediction of PBD + ADHD. PBD and PBD-ADHD were associated with (similarly) elevated P-YMRS scores. Conclusion: The CBCL-PBD and P-YMRS can be used to screen for manic behavior and assist in differential diagnosis.
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Affiliation(s)
- Mara L Cordeiro
- University of California, Los Angeles, USA.,Pelé Pequeno Príncipe Research Institute, Curitiba, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - Antonio C Farias
- Pelé Pequeno Príncipe Research Institute, Curitiba, Brazil.,Children's Hospital Pequeno Príncipe, Curitiba, Brazil
| | | | | | | | | | - Cássia R Benko
- Pelé Pequeno Príncipe Research Institute, Curitiba, Brazil
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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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Evaluation of Bipolar Disorder in Children and Adolescents Referred to a Mood Service: Diagnostic Pathways and Manic Dimensions. J Psychiatr Pract 2016; 22:429-441. [PMID: 27824775 DOI: 10.1097/pra.0000000000000187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Few studies have examined pediatric mental health services for early-onset bipolar disorder (BD). The goal of this study was to describe diagnostic pathways and manic dimensions in BD among referred children and adolescents. METHODS Data were obtained from a review of the charts of 814 subjects, 2 to 17 years of age, with a complaint of mood disturbances who were referred between 2003 and 2012 to a university-based child and adolescent clinic that specializes in mood disorders. After screening, eligible participants (N=494) were systematically assessed and followed to determine diagnoses on the basis of criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision in accordance with the best-estimate approach. Manic symptoms were subjected to principal component analysis to investigate the dimensional bipolar profile of the sample. RESULTS Among the total help-seeking sample, approximately one third of the participants dropped out at intake and, after an average follow-up of 1.7 years, one third had been determined to meet criteria for BD and one third did not fulfill operational criteria for BD. The diagnostic status was changed in 35% of patients: approximately 10% were false positive (going from any bipolar diagnosis to a nonbipolar diagnosis) and approximately 25% were false negative (going from a nonbipolar diagnosis to any bipolar diagnosis). Most patients who converted to a bipolar diagnosis were initially labeled with major depressive disorder or attention-deficit/hyperactivity disorder and had a longer follow-up period. Relevant manic dimensions were elation, grandiosity, and disruption, which explained 41.4% of total variance. CONCLUSIONS Regular reappraisal and follow-up of children and adolescents with mood disturbances provides a window for detection of BD (eg, of core manic dimensions). A coordinated and hierarchical connection among pediatric mental health services with different degrees of specialization is recommended.
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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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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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Rizzutti S, Schuch V, Augusto BM, Coimbra CC, Pereira JPC, Bueno OFA. Neuropsychological Profiles Correlated with Clinical and Behavioral Impairments in a Sample of Brazilian Children with Attention-Deficit Hyperactivity Disorder. Front Psychiatry 2015; 6:163. [PMID: 26635638 PMCID: PMC4661035 DOI: 10.3389/fpsyt.2015.00163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/29/2015] [Indexed: 01/10/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder that implies several-step process, and there is no single test to diagnose both ADHD and associated comorbidities, such as oppositional-defiant disorder (ODD), anxiety disorder, depression, and certain types of learning disabilities. The purpose of the present study was to examine correlations between behavioral and clinical symptoms by administering an extensive neuropsychological battery to a sample of children and adolescents from a developing country. The sample was divided into three groups: non-ADHD, ADHD-non-comorbid, and ADHD + comorbidity. A full neuropsychological battery and clinical assessment found that 105 children met DSM-5 criteria, of whom 46.6% had the predominantly inattentive presentation, 37.3% had combined presentation, and 16% were predominantly hyperactive/impulsive presentation. The internal correlation between neuropsychological tests did not reach statistical significance in the comparison between ADHD and non-ADHD cases (p < 0.17). Clinical ADHD cases, including both + comorbidity and non-comorbid groups, performed substantially worse on continuous performance test (CPT), working memory. Comparing ADHD-non-comorbid and ADHD + comorbidity groups, the latter did significantly worse on inhibitory control, time processing, and the level of perseveration response on CPT indexes, as well as on working memory performance and child behavior checklist (CBCL) tests particularly the CBCL-deficient emotional self-regulation test in the ADHD + comorbidity group. Children diagnosed as ODD or with conduct disorder showed close correlations between clinical CBCL profiles and externalized symptoms. Our findings suggest that ADHD + comorbidity and ADHD non-comorbid cases may be differentiated by a number of neuropsychological measures, such as processing speed, inhibitory control, and working memory, that may reflect different levels of involvement of the hot and cool executive domains, which are more impaired in cases of severe symptomatic-externalized behavior and emotional regulation problems. Therefore, profiles based on clinical and behavioral findings can help clinicians select better strategies for detecting neuropsychological impairment in Brazilian children with ADHD.
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Affiliation(s)
- Sueli Rizzutti
- Psychobiology Department, Universidade Federal de São Paulo , São Paulo , Brazil
| | - Viviane Schuch
- Psychobiology Department, Universidade Federal de São Paulo , São Paulo , Brazil
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7
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Pan PM, Salum GA, Gadelha A, Moriyama T, Cogo-Moreira H, Graeff-Martins AS, Rosario MC, Polanczyk GV, Brietzke E, Rohde LA, Stringaris A, Goodman R, Leibenluft E, Bressan RA. Manic symptoms in youth: dimensions, latent classes, and associations with parental psychopathology. J Am Acad Child Adolesc Psychiatry 2014; 53:625-634.e2. [PMID: 24839881 PMCID: PMC4477846 DOI: 10.1016/j.jaac.2014.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 01/16/2014] [Accepted: 03/18/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of the study was to define the latent structure of parent-reported manic symptoms and their association with functional impairment and familial risk in a community sample of Brazilian children. METHOD We screened for manic symptoms in a community sample of 2,512 children 6 to 12 years of age. Parents of children with "episodes of going abnormally high" completed a detailed mania section (n = 479; 19.1%). Confirmatory factor analysis (CFA) tested a solution with "Under-Control (UC)" and "Exuberant (EX)" dimensions, investigating the severity (threshold) and factor loading of each symptom. We also used latent class analysis (LCA) to evaluate the latent categorical structure of manic symptoms. Associations of these latent constructs with psychiatric comorbidity, psychosocial impairment, and family history of psychopathology were tested. RESULTS The 2-dimensional model fit the data well. Only the UC dimension was associated with psychiatric morbidity, psychosocial impairment, and a family history of mania, depression, or suicide attempts. Both UC and EX items discriminated subjects with "episodes of going abnormally high," but EX items lay at the mild end of the severity spectrum, whereas UC items lay at the severe end. The LCA yielded a small group of children with high levels of manic symptoms and a distinct profile of psychiatric comorbidity and impairment ("high-symptom group"). CONCLUSION In a large, community-based sample, we found a 2-dimensional latent structure for parent-reported manic symptoms in youth, and demonstrated familial associations between the UC dimension and affective disorders. Both UC and EX items are clinically useful, but their contributions vary with symptom severity.
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Affiliation(s)
- Pedro Mario Pan
- Federal University of São Paulo and the National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Brazil.
| | | | - Ary Gadelha
- Federal University of São Paulo and the National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Brazil
| | - Tais Moriyama
- Federal University of São Paulo and the National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Brazil
| | - Hugo Cogo-Moreira
- Federal University of São Paulo and the National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Brazil
| | | | - Maria Conceição Rosario
- Federal University of São Paulo and the National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Brazil
| | | | - Elisa Brietzke
- Federal University of São Paulo and the National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Brazil
| | | | | | | | | | - Rodrigo Affonseca Bressan
- Federal University of São Paulo and the National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Brazil
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Peruzzolo TL, Tramontina S, Rohde LA, Zeni CP. Pharmacotherapy of bipolar disorder in children and adolescents: an update. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35:393-405. [DOI: 10.1590/1516-4446-2012-0999] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 01/22/2013] [Indexed: 01/01/2023]
Affiliation(s)
| | - Silzá Tramontina
- Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; UFRGS, Brazil
| | - Luis Augusto Rohde
- Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; UFRGS, Brazil; National Science and Technology Institute for Children and Adolescents, Brazil
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Rocha TBM, Zeni CP, Caetano SC, Kieling C. Mood disorders in childhood and adolescence. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35 Suppl 1:S22-31. [DOI: 10.1590/1516-4446-2013-s106] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Age-grouped differences in bipolar mania. Compr Psychiatry 2012; 53:1110-7. [PMID: 22682679 DOI: 10.1016/j.comppsych.2012.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 04/11/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE This review of published studies compares scores on individual items of mania rating scales that systematically recorded symptom severity in persons diagnosed with bipolar disorder to identify age-grouped differences. METHODS An extensive literature search identified item scores from mania rating scales, with a particular emphasis on baseline Young Mania Rating Scale (YMRS) item scores in published double-blind, placebo-controlled studies of bipolar I manic disorder. These baseline YMRS item scores were assessed as a proportion of the total YMRS score and compared by age group. Additional YMRS item/total scores in subjects with bipolar spectrum disorders were added to expand the analysis. RESULTS Preadolescents with bipolar disorder had significantly higher YMRS item scores than adolescents on aggression, irritability, and motor activity. Young Mania Rating Scale baseline item scores relative to the YMRS total score revealed that adolescents diagnosed with bipolar I mania scored comparatively higher than did adults on YMRS aggression and irritability items, whereas adults with bipolar I manic disorder scored comparatively higher on the grandiosity and sexual interest items. Age-grouped findings from subjects diagnosed with bipolar I, II, and Not Otherwise Specified (NOS) disorders yielded similar age-grouped results. CONCLUSION In age-grouped YMRS item assessments of bipolar mania, anger dyscontrol was most prominent for youth, whereas disordered thought content was paramount for adults.
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11
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Reich W, Neuman RJ, Volk HE, Joyner CA, Todd RD. Comorbidity Between ADHD and Symptoms of Bipolar Disorder in a Community Sample of Children and Adolescents. Twin Res Hum Genet 2012. [DOI: 10.1375/twin.8.5.459] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe prevalence and frequency of comorbidity of possible bipolar disorder was examined with attention-deficit hyperactivity disorder (ADHD) in a nonreferred population of twins. Children and adolescents aged 7 to 18 years with a history of manic symptoms were identified from a population-based twin sample obtained from state birth records (n = 1610). The sample was enriched for ADHD; however, there was also a random control sample (n = 466), which allowed a look at the population prevalence of the disorder. Juveniles with threshold or below threshold manic episodes were further assessed for comorbidity with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) and population-defined ADHD subtypes (from latent class analysis) using Fisher's exact test. Nine juveniles who exhibited DSM-IV manic (n = 1), hypomanic (n = 2) or below threshold episodes (n = 6) were identified. The population prevalence of broadly defined mania in the random sample was 0.2%. The possible manic episodes showed significant comorbidity with population-defined severe combined and talkative ADHD subtypes. It can be concluded that there is a significant association of bipolar symptoms with two population-defined subtypes of ADHD. Episodes of possible bipolar disorders as defined by DSM-IV are uncommon in this nonreferred sample. Children and adolescents with ADHD appear to be only modestly at increased risk for bipolar disorders.
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12
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Halperin JM, Rucklidge JJ, Powers RL, Miller CJ, Newcorn JH. Childhood CBCL bipolar profile and adolescent/young adult personality disorders: a 9-year follow-up. J Affect Disord 2011; 130:155-61. [PMID: 21056910 PMCID: PMC3059383 DOI: 10.1016/j.jad.2010.10.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 09/23/2010] [Accepted: 10/10/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND To assess the late adolescent psychiatric outcomes associated with a positive Child Behavior Checklist-Juvenile Bipolar Disorder Phenotype (CBCL-JBD) in children diagnosed with ADHD and followed over a 9-year period. METHODS Parents of 152 children diagnosed as ADHD (ages 7-11 years) completed the CBCL. Ninety of these parents completed it again 9 years later as part of a comprehensive evaluation of Axis I and II diagnoses as assessed using semi-structured interviews. As previously proposed, the CBCL-JBD phenotype was defined as T-scores of 70 or greater on the Attention Problems, Aggression, and Anxiety/Depression subscales. RESULTS The CBCL-JBD phenotype was found in 31% of those followed but only 4.9% of the sample continued to meet the phenotype criteria at follow-up. Only two of the sample developed Bipolar Disorder by late adolescence and only one of those had the CBCL-JBD profile in childhood. The proxy did not predict any Axis I disorders. However, the CBCL-JBD proxy was highly predictive of later personality disorders. LIMITATIONS Only a subgroup of the original childhood sample was followed. Given this sample was confined to children with ADHD, it is not known whether the prediction of personality disorders from CBCL scores would generalize to a wider community or clinical population. CONCLUSIONS A positive CBCL-JBD phenotype profile in childhood does not predict Axis I Disorders in late adolescence; however, it may be prognostic of the emergence of personality disorders.
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Affiliation(s)
- Jeffrey M Halperin
- Department of Psychology, Queens College of the City University of New York, NY 11367, United States.
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13
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Zappitelli MC, Bordin IA, Hatch JP, Caetano SC, Zunta-Soares G, Olvera RL, Soares JC. Lifetime psychopathology among the offspring of Bipolar I parents. Clinics (Sao Paulo) 2011; 66:725-30. [PMID: 21789371 PMCID: PMC3109366 DOI: 10.1590/s1807-59322011000500003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 01/20/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recent studies have demonstrated high rates of psychopathology in the offspring of parents with bipolar disorder. The aim of this study was to identify psychiatric diagnoses in a sample of children of bipolar parents. METHOD This case series comprised 35 children and adolescents aged 6 to 17 years, with a mean age of 12.5 ± 2.9 years (20 males and 15 females), who had at least one parent with bipolar disorder type I. The subjects were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version (K-SADS-PL). Family psychiatric history and demographics were also evaluated. RESULTS Of the offspring studied, 71.4% had a lifetime diagnosis of at least one psychiatric disorder (28.6% with a mood disorder, 40% with a disruptive behavior disorder and 20% with an anxiety disorder). Pure mood disorders (11.4%) occurred less frequently than mood disorders comorbid with attention deficit hyperactivity disorder (17.1%). Psychopathology was commonly reported in second-degree relatives of the offspring of parents with bipolar disorder (71.4%). CONCLUSIONS Our results support previous findings of an increased risk for developing psychopathology, predominantly mood and disruptive disorders, in the offspring of bipolar individuals. Prospective studies with larger samples are needed to confirm and expand these results.
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Abstract
BACKGROUND Childhood bipolar disorder remains a controversial but increasingly diagnosed disorder that is associated with significant impairment, chronic course and treatment resistance. Therefore, the search for prodromes or early markers of risk for later childhood bipolar disorder may be of great importance for prevention and/or early identification. METHODS Literature searches were conducted to identify reviews, case reports and empirical papers addressing the issue of prodromes of childhood bipolar disorder. RESULTS A total of 54 articles were found that related to bipolar prodromes, risk factors for later childhood bipolar disorder, childhood risk for adult bipolar disorder, mania manifestations in early childhood, and neuropsychological and biological markers of childhood bipolar disorder. A review of articles suggest (a) childhood bipolar prodromes may be detectable prior to the onset of the disorder, (b) prodromal symptoms may display episodicity during childhood, (c) there is evidence of possible endophenotypic markers such as deficits in executive function, sustained attention, and emotion labeling, (d) there is a potential association with functional, structural, and biochemical alterations evident in brain structures involved in mood regulation, (e) a link between childhood bipolar disorder with early tempermental markers, such as emotional regulation and behavioral disinhibition and (f) there is some early but promising evidence of effective psychotherapeutic preventions. CONCLUSIONS There has been very limited investigation of early prodromes of childhood bipolar disorder. Based on the promising findings of prodromes as well as high-risk states and possible endophenotypic markers, more controlled and targeted investigations into the early markers of bipolar disorder appear warranted and potentially fruitful. Until such longitudinal studies with appropriate controls are conducted, specific markers for bipolar prodromes will remain elusive, although evidence suggests they are manifest in at least some subgroups. The finding of promising psychotherapeutic prevention programs underscores the need to find specific and sensitive markers of bipolar prodromes in childhood.
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Affiliation(s)
- Joan L Luby
- Washington University School of Medicine, St. Louis, MO 63110, USA.
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15
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Parens E, Johnston J. Controversies concerning the diagnosis and treatment of bipolar disorder in children. Child Adolesc Psychiatry Ment Health 2010; 4:9. [PMID: 20219111 PMCID: PMC2846895 DOI: 10.1186/1753-2000-4-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 03/10/2010] [Indexed: 11/22/2022] Open
Abstract
This commentary grows out of an interdisciplinary workshop focused on controversies surrounding the diagnosis and treatment of bipolar disorder (BP) in children. Although debate about the occurrence and frequency of BP in children is more than 50 years old, it increased in the mid 1990s when researchers adapted the DSM account of bipolar symptoms to diagnose children. We offer a brief history of the debate from the mid 90s through the present, ending with current efforts to distinguish between a small number of children whose behaviors closely fit DSM criteria for BP, and a significantly larger number of children who have been receiving a BP diagnosis but whose behaviors do not closely fit those criteria. We agree with one emerging approach, which gives part or all of that larger number of children a new diagnosis called Severe Mood Dysregulation or Temper Dysregulation Disorder with Dysphoria.Three major concerns arose about interpreting the DSM criteria more loosely in children than in adults. If clinicians offer a treatment for disorder A, but the patient has disorder B, treatment may be compromised. Because DSM's diagnostic labels are meant to facilitate research, when they are applied inconsistently, such research is compromised. And because BP has a strong genetic component, the label can distract attention from the family or social context.Once a BP diagnosis is made, concerns remain regarding the primary, pharmacological mode of treatment: data supporting the efficacy of the often complex regimens are weak and side effects can be significant. However, more than is widely appreciated, data do support the efficacy of the psychosocial treatments that should accompany pharmacotherapy. Physicians, educators, and families should adopt a multimodal approach, which focuses as much on the child's context as on her body. If physicians are to fulfill their ethical obligation to facilitate truly informed consent, they must be forthcoming with families about the relevant uncertainties and complexities.
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Affiliation(s)
- Erik Parens
- The Hastings Center, Garrison, NY 10524, USA.
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Lus G, Mukaddes NM. Co-morbidity of bipolar disorder in children and adolescents with attention deficit/hyperactivity disorder (ADHD) in an outpatient Turkish sample. World J Biol Psychiatry 2010; 10:488-94. [PMID: 19401947 DOI: 10.1080/15622970902929876] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aimed to assess the prevalence of bipolar disorder (BPD) in children and adolescents with attention deficit hyperactivity disorder (ADHD), and to compare the clinical characteristics of a group with ADHD with a group with co-morbidity of ADHD and BPD. The study includes 121 individuals, aged 6-16 years, with a diagnosis of ADHD. Co-morbidity of BPD was evaluated using the Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime version (K-SADS-PL) and the Parent-Young Mania Rating Scale (P-YMRS). The Child Behavior Checklist (CBCL) was used to assess psychopathology in two groups. Ten children (8.3%) in the ADHD sample received the additional diagnosis of BPD. The ADHD + BPD group had significantly higher scores than the ADHD group on withdrawn, anxiety/depression, social problems, thought problems, attention problems, aggression, externalization, total score items of CBCL, and on the P-YMRS. It could be concluded that BPD is not a rare co-morbid condition in children with diagnosis of ADHD and subjects with this co-morbidity show more severe psychopathology than subjects with pure ADHD. Differential diagnosis of BPD disorder in subjects with ADHD seems crucial in establishing an effective treatment program, and therefore improving mental health outcomes.
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Affiliation(s)
- Gozde Lus
- Child Psychiatry Department, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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Rizzutti S, Sinnes EG, Scaramuzza LF, Freitas L, Pinheiro D, Palma SM, Mello CB, Miranda MC, Bueno OFA, Muszkat M. Clinical and neuropsychological profile in a sample of children with attention deficit hyperactivity disorders. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 66:821-7. [PMID: 19099119 DOI: 10.1590/s0004-282x2008000600009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 08/08/2008] [Indexed: 11/22/2022]
Abstract
UNLABELLED The aim of this study was to evaluate clinical and neuropsychological findings in children with suspicion of attention deficity hyperactivity disorder (ADHD). The assessment involved 150 children aged 7 to 14 referred to NANI at UNIFESP. RESULTS 75 children (55 M and 20 F) fulfilled the criteria for ADHD, among which 35 were of the inattentive type, 28 of combined type and 12 were hyperactive/impulsive. There was negative correlation between the digit score and the Corsi test. Children with hyperactivity and impulsivity had a low performance for functional memory. Children with oppositional defiant disorder presented pattern changes in adaptability when there was a change in the rhythm the stimuli were presented and lower adaptation to time variability (Hit RT), in addition to higher rates of omission in the continuous performance test. CONCLUSION This study suggests multiple interrelations between the scores of neuropsychological battery useful for detailed delimitation of the clinical profile of children with ADHD.
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Affiliation(s)
- Sueli Rizzutti
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo SP, Brazil.
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Zeni CP, Tramontina S, Ketzer CR, Pheula GF, Rohde LA. Methylphenidate combined with aripiprazole in children and adolescents with bipolar disorder and attention-deficit/hyperactivity disorder: a randomized crossover trial. J Child Adolesc Psychopharmacol 2009; 19:553-61. [PMID: 19877980 DOI: 10.1089/cap.2009.0037] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In clinical samples, juvenile bipolar disorder (JBPD) is frequently accompanied by co-morbid attention-deficit/hyperactivity disorder (ADHD). Clinical trials assessing combined psychopharmacological interventions in this population are scarce, and methylphenidate (MPH) may worsen manic symptoms. We conducted a randomized crossover trial with MPH and placebo (2 weeks each) combined with aripiprazole in children and adolescents (n = 16; 8-17 years old) with JBPD and ADHD who had a significant response in manic symptoms with aripiprazole but still presented clinically significant symptoms of ADHD. ADHD, manic, and depressive symptoms were assessed by means of standard scales. Fourteen out of the 16 subjects completed the trial. No significant differences between the effects of methylphenidate and placebo were detected in ADHD (F(1, 43.22) = 0.00; p = 0.97) or manic (F(1, 40.19) = 0.93; p = 0.34) symptoms. Significant improvement in depressive symptoms was observed in the MPH group (F(1,19.03) = 7.75; p = 0.01) according to a secondary self-reported outcome measure. One patient using aripiprazole and MPH discontinued the trial due to the onset of a severe mixed episode. No other significant adverse events were observed. Although MPH did not worsen manic symptoms, it was not more effective than placebo in improving ADHD symptoms in children and adolescents with JBPD co-morbid with ADHD stabilized with aripiprazole. Further investigations are warranted. This study is registered at www.clinicaltrials.gov under the identifier NCT00305370.
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Affiliation(s)
- Cristian Patrick Zeni
- Juvenile Bipolar Disorder Outpatient Program (ProCAB), Division of Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul , Brasil
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Petresco S, Gutt EK, Krelling R, Lotufo Neto F, Rohde LAP, Moreno RA. The prevalence of psychopathology in offspring of bipolar women from a Brazilian tertiary center. BRAZILIAN JOURNAL OF PSYCHIATRY 2009; 31:240-6. [DOI: 10.1590/s1516-44462009000300009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 07/07/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: No previous study has assessed the occurrence of psychopathology in offspring of bipolar women from South America. The objective of this study was to assess the prevalence of psychopathology in offspring of bipolar mothers from Brazil compared with two control groups. METHOD: Children and adolescents aged 6 to 18 years of bipolar disorders mothers (n = 43), mothers with other mild to moderate mental disorders (n = 53) and mothers without any psychiatric disorder (n = 53) were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia present and lifetime version, the Child Behavior Checklist and the Youth Self-Report. Raters were blind to the mothers' diagnoses, who were interviewed by means of the Structured Clinical Interview. RESULTS: Bipolar offspring had twice the chance of having one or more lifetime Axis I diagnoses [prevalence ratio = 2.11 (95% CI: 1.30-3.42) and p = 0.003] and 2.8 higher risk of having a lifetime anxiety disorder [prevalence ratio = 2.83 (95% CI: 1.39-5.78) e p = 0.004] than the offspring of mothers with no mental disorder. In addition, significantly higher scores on Child Behavior Checklist thought problems and Youth Self-Report social problems, as well as anxiety/depression and internalizing problems were observed. CONCLUSION: Our results confirm previous findings suggesting higher psychiatric problems in offspring of bipolar mothers and extend them to the Brazilian society
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Diler RS, Uguz S, Seydaoglu G, Avci A. Mania profile in a community sample of prepubertal children in Turkey. Bipolar Disord 2008; 10:546-53. [PMID: 18452451 DOI: 10.1111/j.1399-5618.2008.00580.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mania in youth is increasingly recognized and accompanied by substantial psychiatric and psychosocial morbidity. There are no data on prepubertals in the general population and we aimed to search for mania symptoms and its clinical correlations in a community sample of prepubertal Turkish children. METHODS Among all children (n = 56,335) aged 7-11 in Adana, Turkey, 2,468 children (48% girls) were randomly included. Parents completed Child Behavior Checklist (CBCL) 4-18 and Parent-Young Mania Rating Scale (P-YMRS). Cut-off scores of 17 and 27 on total P-YMRS were defined as efficient (probable-mania group) and specific (mania group), respectively, for bipolar profile. We searched for clinical correlations and used logistic regression to show how well each CBCL subscale predicted the presence of mania and probable-mania, after adjusting for any demographic differences. RESULTS Parent-Young Mania Rating Scale scores were > or =17 but <27 (probable-mania) in 155 (6.3%) children and > or =27 (mania) in 32 (1.3%) children. Elevated mood, increased activity levels, and poor insight were the most frequent manic symptoms in our sample. Children with probable-mania and mania had higher scores on all CBCL subscales and the CBCL-Pediatric Bipolar Disorder (CBCL-PBD) profile (sum of attention, aggression, and anxiety/depression subscales). Logistic regression analysis revealed only thought problems on CBCL that predicted probable-mania and mania. CONCLUSION Our study shows that mania profile is common in the community sample of Turkish prepubertal children and does not support the thought that mania is rare outside the US. We need further population-based studies that will use diagnostic interviews and multiple informants.
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Affiliation(s)
- Rasim Somer Diler
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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CBCL-pediatric bipolar disorder phenotype: severe ADHD or bipolar disorder? J Neural Transm (Vienna) 2007; 115:155-61. [PMID: 17994189 DOI: 10.1007/s00702-007-0823-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 09/18/2007] [Indexed: 12/12/2022]
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Acculturation and mental health: Current findings and recommendations for future research. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.appsy.2007.07.016] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Aripiprazole in juvenile bipolar disorder comorbid with attention-deficit/hyperactivity disorder: an open clinical trial. CNS Spectr 2007; 12:758-62. [PMID: 17934380 DOI: 10.1017/s1092852900015443] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Juvenile bipolar disorder (JBD) is a highly impairing chronic mental health condition that affects children and adolescents' overall functioning. Comorbidity with attention-deficit/hyperactivity disorder (ADHD) is extremely prevalent and may determine worse response to treatment. Few investigations have addressed the use of recent atypical antipsychotics in JBD, although several guidelines suggest their use. METHODS We conducted a 6-week open trial with aripiprazole in 10 children and adolescents with JBD comorbid with ADHD to assess impact on mania and ADHD symptoms, respectively, by means of the Young Mania Rating Scale and the Swanson, Nolan and Pelham Scale, as well as on global functioning (Clinical Global Impressions-Severity), and adverse events. RESULTS Significant improvement in global functioning scores (F=3.17, P=.01, effect size=0.55), manic symptoms (F=5.63, P<.01; ES=0.93), and ADHD symptoms (t=3.42, P<.01;ES=1.05) were detected. Although an overall positive tolerability was reported, significant weight gain (F=3.07, P=.05) was observed. CONCLUSION Aripiprazole was effective in improving mania and ADHD symptoms, but neither JBD nor ADHD symptom remission was observed in most of the cases. Randomized placebo-controlled trials for JBD and ADHD are needed.
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Volk HE, Todd RD. Does the Child Behavior Checklist juvenile bipolar disorder phenotype identify bipolar disorder? Biol Psychiatry 2007; 62:115-20. [PMID: 16950211 DOI: 10.1016/j.biopsych.2006.05.036] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Revised: 05/25/2006] [Accepted: 05/31/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND A profile of Child Behavior Checklist(CBCL) T-scores>or=70 on the attention problems, aggression, and anxious/depressed subscales has been proposed to identify juvenile bipolar disorder(JBD). We tested this hypothesis in a population-based sample. METHODS Data for this analysis come from a birth-records-based twin sample having semi-structured interview and CBCL data (N=1,346). We compared prevalence of DSM-IV psychiatric disorders and suicidal behaviors in CBCL-JBD and non-CBCL-JBD subjects. Twin modeling assessed genetic and environmental contributions to CBCL-JBD. Associations with DRD4 and DAT1 were examined using chi-square tests. RESULTS The prevalence of CBCL-JBD was 2.5%. No subjects with CBCL-JBD met criteria for bipolar or other mood disorders. CBCL-JBD subjects had more oppositional defiant disorder (ODD), conduct disorder(CD), and attention deficit hyperactivity disorder(ADHD). The CBCL-JBD profile was uncommon in these disorders. CBCL-JBD subjects more frequently endorsed suicidal behaviors. The CBCL-JBD profile was heritable and associated with the number of DAT1 9-repeat 3' untranslated region alleles. CONCLUSIONS The CBCL-JBD phenotype does not correspond with a semi-structured interview assessment of JBD. ADHD, CD, and ODD are common in children with CBCL-JBD but do not account for the profile. Increased suicidal behaviors indicate substantial impairment in CBCL-JBD subjects.
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Affiliation(s)
- Heather E Volk
- Doctoral Program in Public Health Studies, Saint Louis University School of Public Health, Saint Louis, Missouri 63110, USA
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Diler RS, Uguz S, Seydaoglu G, Erol N, Avci A. Differentiating bipolar disorder in Turkish prepubertal children with attention-deficit hyperactivity disorder. Bipolar Disord 2007; 9:243-51. [PMID: 17430299 DOI: 10.1111/j.1399-5618.2007.00347.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) and bipolar disorder (BPD) in children are frequently comorbid conditions. Because the coexistence of ADHD and mania seriously complicates the course of the condition and the treatment of children, diagnosing or missing this comorbidity has important clinical implications. There are very few systematic studies on the subject in the literature and BPD in children is not recognized or studied in most countries other than the USA. We aimed to differentiate Turkish prepubertal children with ADHD from those with comorbid ADHD and BPD and compare their clinical characteristics. METHODS A total of 147 treatment- and drug-naïve children, aged 7 to 13 years, who had been consecutively referred to the ADHD clinic, were evaluated using the Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime version (K-SADS-PL). Parents completed the Child Behavior Checklist (CBCL) 4-18 and the Parent-Young Mania Rating Scale (P-YMRS) prior to the clinical interview. RESULTS Twelve children (8.2%) had comorbid bipolar disorder (ADHD + BPD). The ADHD + BPD group had significantly higher rates of depressive disorders, oppositional defiant disorder, panic disorder and a family history of bipolar disorder compared with the ADHD group. The ADHD + BPD group had significantly more problems on the CBCL scale (anxiety/depression, social problems, thought problems, aggression, externalization, and total score) and on the P-YMRS (all items except for insight) compared with the ADHD group. CONCLUSIONS We conclude that ADHD + BPD in Turkish children represents a clinical picture different to that of ADHD alone, in which the clinical characteristics resemble those of children reported in the literature. Further long-term follow-up studies are needed in larger clinical and community samples.
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Affiliation(s)
- Rasim Somer Diler
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Feldman R, Masalha S. The role of culture in moderating the links between early ecological risk and young children's adaptation. Dev Psychopathol 2007; 19:1-21. [PMID: 17241481 DOI: 10.1017/s0954579407070010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
To examine the effects of risk on infant development within cultural contexts, 141 dual-earner Israeli and Palestinian couples and their first-born child were observed at 5 months and again at 34 months. Eight ecological determinants were examined as potential risk factors, including the infant's observed and parent-reported difficult temperament; the mother's depressive symptoms, work-family interference, and experience of childbirth; the parents' marital satisfaction and social support; and observed maternal and paternal sensitivity. Symbolic play and behavior problems were assessed at 34 months. Culture-specific effects of risk and protective factors were found. Parent sensitivity facilitated symbolic competence to a greater extent in the Israeli group. Culture moderated the effects of maternal depression and family social support on toddlers' behavior problems. Maternal depressive symptoms had a negative impact on the behavior adaptation of Israeli children and social support buffered against behavior problems in the Arab group. Implications for research on risk and resilience and the role of culture in moderating the effects of ecological risk are discussed.
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Moraes CD, Silva FMBN, Andrade ÊRD. Diagnóstico e tratamento de transtorno bipolar e TDAH na infância: desafios na prática clínica. JORNAL BRASILEIRO DE PSIQUIATRIA 2007. [DOI: 10.1590/s0047-20852007000500005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O transtorno de humor bipolar (THB) e o transtorno do déficit de atenção e hiperatividade (TDAH) são enfermidades graves, de evolução crônica e que geram forte impacto social, familiar e educacional. Por compartilharem sintomas comuns e freqüentemente se apresentarem em comorbidade, o seu diagnóstico diferencial torna-se difícil, porém imprescindível, visto que medicamentos utilizados no tratamento do TDAH podem agravar a bipolaridade em crianças não tratadas. São encontradas taxas que variam de 49% a 87% de diagnóstico de TDAH em crianças e adolescentes com THB. Crianças com ambos os transtornos têm um curso geralmente mais grave. São indivíduos com taxas maiores de sintomas psicóticos, depressão, problemas escolares, hospitalização, ansiedade e comportamentos disruptivos. A criança com transtorno de humor bipolar TDAH deve iniciar o tratamento com estabilizadores de humor, visto que o impacto dos sintomas maníacos é maior do que o dos sintomas de TDAH. Se os sintomas de desatenção, impulsividade e hiperatividade persistem após a estabilização do humor, pode-se preconizar o tratamento para o TDAH com o uso de psicoestimulantes.
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Youngstrom E, Meyers O, Youngstrom JK, Calabrese JR, Findling RL. Comparing the effects of sampling designs on the diagnostic accuracy of eight promising screening algorithms for pediatric bipolar disorder. Biol Psychiatry 2006; 60:1013-9. [PMID: 17056395 DOI: 10.1016/j.biopsych.2006.06.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Revised: 06/12/2006] [Accepted: 06/14/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Past studies have used markedly different inclusion and exclusion criteria to form samples used to evaluate diagnostic tests, making it difficult to compare results across studies. The present investigation compared eight screening algorithms in the same sample but under two different design strategies. METHODS The DSM-IV diagnoses were based on a semi-structured diagnostic interview (KSADS) with the parent and youth sequentially. Raters were blind to index test scores. Participants were 216 youths with bipolar spectrum diagnoses and 284 youths with other Axis I diagnoses or no diagnosis. T-tests evaluated whether areas under the curve (AUC) from receiver operating characteristic analyses differed under the two design conditions. RESULTS All of the instruments discriminated bipolar cases better when inclusion and exclusion criteria duplicated those used in phenomenological research studies selecting narrow phenotypic cases (AUCs ranging from .90 to .81). The measures performed less well when more heterogeneous clinical presentations were included [AUCs ranging from .86 to .69, t(8) = 4.99, p = 001]. CONCLUSIONS Results indicate that checklists perform less well discriminating pediatric bipolar disorder under conditions that more closely resemble clinical practice. Test users must consider whether the sampling strategies and participant characteristics used to evaluate tests match the characteristics of their own patients.
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Affiliation(s)
- Eric Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3270, USA.
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Youngstrom E, Meyers O, Youngstrom JK, Calabrese JR, Findling RL. Diagnostic and measurement issues in the assessment of pediatric bipolar disorder: Implications for understanding mood disorder across the life cycle. Dev Psychopathol 2006; 18:989-1021. [PMID: 17064426 DOI: 10.1017/s0954579406060494] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The goal of this paper is to review assessment research of bipolar disorder in children and adolescents. The review addresses numerous themes: the benefits and costs of involving clinical judgment in the diagnostic process, particularly with regard to diagnosis and mood severity ratings; the validity of parent, teacher, and youth self-report of manic symptoms; how much cross-situational consistency is typically shown in mood and behavior; the extent to which a parent's mental health status influences their report of child behavior; how different measures compare in terms of detecting bipolar disorder, the challenges in comparing the performance of measures across research groups, and the leading candidates for research or clinical use; evidence-based strategies for interpreting measures as diagnostic aids; how test performance changes when a test is used in a new setting and what implications this has for research samples as well as clinical practice; the role of family history of mood disorder within an assessment framework; and the implications of assessment research for the understanding of phenomenology of bipolar disorder from a developmental framework.
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Affiliation(s)
- Eric Youngstrom
- Department of Psychology, University of North Carolina, Chapel Hill, NC 27599, USA.
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Yatham LN, Kennedy SH, O'Donovan C, Parikh S, MacQueen G, McIntyre R, Sharma V, Silverstone P, Alda M, Baruch P, Beaulieu S, Daigneault A, Milev R, Young LT, Ravindran A, Schaffer A, Connolly M, Gorman CP. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disord 2005; 7 Suppl 3:5-69. [PMID: 15952957 DOI: 10.1111/j.1399-5618.2005.00219.x] [Citation(s) in RCA: 250] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Since the previous publication of Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines in 1997, there has been a substantial increase in evidence-based treatment options for bipolar disorder. The present guidelines review the new evidence and use criteria to rate strength of evidence and incorporate effectiveness, safety, and tolerability data to determine global clinical recommendations for treatment of various phases of bipolar disorder. The guidelines suggest that although pharmacotherapy forms the cornerstone of management, utilization of adjunctive psychosocial treatments and incorporation of chronic disease management model involving a healthcare team are required in providing optimal management for patients with bipolar disorder. Lithium, valproate and several atypical antipsychotics are first-line treatments for acute mania. Bipolar depression and mixed states are frequently associated with suicidal acts; therefore assessment for suicide should always be an integral part of managing any bipolar patient. Lithium, lamotrigine or various combinations of antidepressant and mood-stabilizing agents are first-line treatments for bipolar depression. First-line options in the maintenance treatment of bipolar disorder are lithium, lamotrigine, valproate and olanzapine. Historical and symptom profiles help with treatment selection. With the growing recognition of bipolar II disorders, it is anticipated that a larger body of evidence will become available to guide treatment of this common and disabling condition. These guidelines also discuss issues related to bipolar disorder in women and those with comorbidity and include a section on safety and monitoring.
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Affiliation(s)
- Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Hunt JI, Dyl J, Armstrong L, Litvin E, Sheeran T, Spirito A. Frequency of manic symptoms and bipolar disorder in psychiatrically hospitalized adolescents using the K-SADS Mania Rating Scale. J Child Adolesc Psychopharmacol 2005; 15:918-30. [PMID: 16379512 DOI: 10.1089/cap.2005.15.918] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to assess the frequency of manic symptoms and bipolar spectrum disorders in an adolescent inpatient psychiatric sample using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) Mania Rating Scale (MRS), parent and adolescent measures. METHOD A total of 391 consecutive admissions to a psychiatric inpatient unit were assessed using the K-SADS MRS, the Childhood Inventory of Psychiatric Syndromes (CHIPS), and other clinically relevant measures. RESULTS The frequency of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) manic symptoms in this population was generally high. However, only 19.6% received a consensus diagnosis of juvenile bipolar disorder. The K-SADS MRS discriminated bipolar from non-bipolar patients when parents rated symptoms but not when rated by adolescents. CONCLUSIONS This study of non-selected adolescents over a one-year period demonstrates that bipolar spectrum disorders in an inpatient population are common, and that the use of the KSADS MRS is effective in identifying this syndrome.
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Affiliation(s)
- Jeffrey I Hunt
- Brown Medical School, Providence, and Bradley Hospital, East Providence, Rhode Island 02915, USA.
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Abstract
BACKGROUND Specific features and diagnostic boundaries of childhood bipolar disorder (BD) remain controversial, and its differentiation from other disorders challenging, owing to high comorbidity with other common childhood disorders, and frequent lack of an episodic course typical of adult BD. METHODS We repeatedly examined children meeting DSM-IV criteria for BD (excluding episode-duration requirements) and analyzed their clinical records to evaluate age-at-onset, family history, symptoms, course, and comorbidity. RESULTS Of 82 juveniles (aged 10.6 +/- 3.6 years) diagnosed with BD, 90% had a family history of mood or substance-use disorders, but only 10% of patients had been diagnosed with BD. In 74%, psychopathology was recognized before age 3, usually as mood and sleep disturbances, hyperactivity, aggression, and anxiety. At onset, dysphoric-manic and mixed presentations were most common (48%), euphoric mania less (35%), and depression least (17%). Subtype diagnoses were: BP-I (52%) > BP-II (40%) > cyclothymia (7%). DSM episode-duration criteria were met in 52% of cases, and frequent shifts of mood and energy were common. LIMITATIONS Partly retrospective study of clinically diagnosed referred outpatients without a comparison group. CONCLUSIONS Pediatric BD is often mis- or undiagnosed, although it often manifests with mood lability and sleep disturbances early in life. DSM BD criteria inconsistent with clinical findings require revision for pediatric application.
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