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Boudjerida A, Guilé JM, Breton JJ, Benarous X, Cohen D, Labelle R. A Delphi consensus among experts on assessment and treatment of disruptive mood dysregulation disorder. Front Psychiatry 2024; 14:1166228. [PMID: 38260796 PMCID: PMC10800807 DOI: 10.3389/fpsyt.2023.1166228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
Objective The aim of this study was to explore consensus among clinicians and researchers on how to assess and treat Disruptive Mood Dysregulation Disorder (DMDD). Methods The Delphi method was used to organize data collected from an initial sample of 23 child psychiatrists and psychologists. Three rounds of closed/open questions were needed to achieve the objective. Results Fifteen experts in the field completed the whole study. Finally, 122 proposals were validated and 5 were rejected. Globally, consensus was more easily reached on items regarding assessment than on those regarding treatment. Specifically, experts agreed that intensity, frequency, and impact of DMDD symptoms needed to be measured across settings, including with parents, siblings, peers, and teachers. While a low level of consensus emerged regarding optimal pharmacological treatment, the use of psychoeducation, behavior-focused therapies (e.g., dialectical behavior therapy, chain analysis, exposure, relaxation), and systemic approaches (parent management training, family therapy, parent-child interaction therapy) met with a high degree of consensus. Conclusion This study presents recommendations that reached a certain degree of consensus among researchers and clinicians regarding the assessment and treatment of youths with DMDD. These findings may be useful to clinicians working with this population and to researchers since they also highlight non-consensual areas that need to be further investigated.
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Affiliation(s)
- Assia Boudjerida
- Department of Psychology and Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
| | - Jean-Marc Guilé
- Department Head, Child and Adolescent Psychiatry, EPSM Somme and CHU Amiens, Picardie Jules Verne University, Amiens, France
| | - Jean-Jacques Breton
- Department of Psychiatry, Rivière-des-Prairies Mental Health Hospital, Université de Montréal, Montréal, QC, Canada
| | - Xavier Benarous
- Department of Child and Adolescent Psychopathology CHU Amiens-Picardie, Amiens, France
| | - David Cohen
- Department Head, Child and Adolescent Psychiatry, Public Assistance-Hospitals of Paris, APHP, Pitié-Salpêtrière Hospital Group and National Center for Scientific Research-Joint Research Unit, Institute for Intelligent and Robotic Systems Sorbonne Université, Paris, France
| | - Réal Labelle
- Department of Psychology and Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
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Wozniak J, DiSalvo M, Farrell A, Joshi G, Uchida M, Faraone SV, Cook E, Biederman J. Long term outcomes of pediatric Bipolar-I disorder: A prospective follow-up analysis attending to full syndomatic, subsyndromal and functional types of remission. J Psychiatr Res 2022; 151:667-675. [PMID: 35667335 PMCID: PMC10043808 DOI: 10.1016/j.jpsychires.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/24/2021] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine patterns of remission of pediatric bipolar I (BP-I) disorder attending to syndromatic, symptomatic, and functional outcomes from childhood to adolescent and young adult years. METHODS We analyzed data from a six-year prospective follow-up study of youths aged 6-17 years with BP-I disorder. Subjects were comprehensively assessed at baseline and subsequently at four, five, and six years thereafter. Assessments included structured diagnostic interviews and measures of psychosocial and educational functioning. Patterns of remission were calculated attending to whether syndromatic, symptomatic, and functional remission were achieved. RESULTS Kaplan-Meier failure functions revealed that the probability of functional recovery from pediatric BP-I disorder was very low. Of the 88 youths assessed, only 6% (N = 5) of the sample were euthymic with normal functioning during the year prior to their last follow-up assessment (average follow-up time = 5.8 ± 1.8 years). CONCLUSIONS These results provide compelling evidence of the high level of persistence of pediatric BP-I disorder. Symptomatic and functional remission were uncommon and most subjects continued to demonstrate high morbidity into late adolescence and early adulthood.
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Affiliation(s)
- Janet Wozniak
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Maura DiSalvo
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Abigail Farrell
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Gagan Joshi
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mai Uchida
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Stephen V Faraone
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Emmaline Cook
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Biederman
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Horwitz SM, Hoagwood KE, Guo F, Arnold LE, Taylor HG, Young AS, Youngstrom EA, Fristad MA, Birmaher B, Findling RL. Predictors of Hospitalization in a Cohort of Children with Elevated Symptoms of Mania. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:171-180. [PMID: 32556647 PMCID: PMC8112451 DOI: 10.1007/s10488-020-01059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Describe hospitalization rates in children with elevated symptoms of mania and determine predictors of psychiatric hospitalizations during the 96 month follow-up. Eligible 6-12.9 year olds and their parents visiting 9 outpatient mental health clinics were invited to be screened with the Parent General Behavior Inventory 10-item Mania Scale. Of 605 children with elevated symptoms of mania eligible for follow-up, 538 (88.9%) had ≥ 1 of 16 possible follow-up interviews and are examined herein. Multivariate Cox regression indicated only four factors predicted hospitalizations: parental mental health problems (HR 1.80; 95% CI 1.21, 2.69); hospitalization prior to study entry (HR 3.03; 95% CI 1.80, 4.43); continuous outpatient mental health service use (HR 3.73; 95% CI 2.40, 5.50); and low parental assessment of how well treatment matched child's needs (HR 3.97; 95% CI 2.50, 6.31). Parental perspectives on mental health services should be gathered routinely, as they can signal treatment failures.
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Affiliation(s)
- Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, 1 Park Avenue, New York, NY, 10016, USA.
| | - Kimberly Eaton Hoagwood
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, 1 Park Avenue, New York, NY, 10016, USA
| | - Fei Guo
- Department of Population Health, New York University School of Medicine, 1 Park Avenue, New York, NY, 10016, USA
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, McCampbell Hall, 1581 Dodd Drive, Columbus, OH, USA
| | - H Gerry Taylor
- Nationwide Children's Hospital Research Institute and Department of Pediatrics, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina, Davie Hall, Chapel Hill, NC, 27599-3270, USA
| | - Mary A Fristad
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 1670 Upham Hall Suite 460G, Columbus, OH, 43210-1250, USA
| | - Boris Birmaher
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA, 15213, USA
| | - Robert L Findling
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, 23298-0308, USA
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Leaberry KD, Rosen PJ, Fogleman ND, Walerius DM, Slaughter KE. Comorbid Internalizing and Externalizing Disorders Predict Lability of Negative Emotions Among Children With ADHD. J Atten Disord 2020; 24:1989-2001. [PMID: 28992752 DOI: 10.1177/1087054717734647] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: A subset of children with ADHD experience more frequent, sudden, and intense shifts toward negative emotions. The current study utilized ecological momentary assessment (EMA) to provide a valid assessment of the impact of comorbid internalizing and externalizing disorders on negative emotional lability (EL) among children with ADHD. Method: Parents of 58, 8- to 12-year-old children with ADHD were administered a diagnostic interview to assess for ADHD and for the presence of comorbid disorders. Parents completed EMA-based ratings of their child's negative emotions three times daily for a total of 28 days. Results: Children with a comorbid internalizing disorder or children with comorbid oppositional defiant disorder (ODD) experienced significantly greater EMA-derived negative EL than children without comorbid disorders over time. Children with multiple comorbidities experienced greater EL than children with single comorbidities. Conclusion: Overall, this study suggested that both comorbid ODD and comorbid internalizing disorders contribute to negative EL among children with ADHD.
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Walsh RFL, Sheppard B, Cui L, Brown C, Van Meter A, Merikangas KR. Comorbidity and patterns of familial aggregation in attention-deficit/hyperactivity disorder and bipolar disorder in a family study of affective and anxiety spectrum disorders. J Psychiatr Res 2020; 130:355-361. [PMID: 32882577 DOI: 10.1016/j.jpsychires.2020.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/03/2020] [Accepted: 08/14/2020] [Indexed: 01/03/2023]
Abstract
The aim of this study is to examine the familial aggregation of Attention-deficit/hyperactivity disorder (ADHD) and its cross-transmission with bipolar disorder (BD) in a community-based family study of mood spectrum disorders. A clinically-enriched community sample of 562 probands recruited from the greater Washington, DC metropolitan area and their 698 directly interviewed relatives were included in analyses. Inclusion criteria were English speaking and consent to contact at least two first-degree relatives. Standard family study methodology was used and DSM-IV classified mental disorders were ascertained through a best-estimate procedure based on direct semi-structured interviews and multiple family history reports. There was specificity of familial aggregation of both bipolar I disorder (BD I) and bipolar II disorder (BD II) (i.e., BD I OR = 6.08 [1.66, 22.3]; BD II OR = 2.98 [1.11, 7.96]) and ADHD (ADHD OR = 2.13 [1.16, 3.95]). However, there was no evidence for cross-transmission of BD and ADHD in first degree relatives (i.e., did not observe increased rates of BD in relatives of those with ADHD and vice versa; all ps > 0.05). The specificity of familial aggregation of ADHD and BD alongside the absence of shared familial risk are consistent with the notion that the comorbidity between ADHD and BD may be attributable to diagnostic artifact, could represent a distinct BD suptype characterized by childhood-onset symptoms, or the possibility that attention problems serve as a precursor or consequence of BD.
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Affiliation(s)
- Rachel F L Walsh
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Intramural Research Program, Building 35A, Room 2E410, MSC 3720, Bethesda, MD, 20892, USA.
| | - Brooke Sheppard
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Intramural Research Program, Building 35A, Room 2E410, MSC 3720, Bethesda, MD, 20892, USA; Department of Epidemiology, Johns Hopkins' Bloomberg School of Public Health, 615 North Wolfe Street, W6508, Baltimore, MD, 21205, USA
| | - Lihong Cui
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Intramural Research Program, Building 35A, Room 2E410, MSC 3720, Bethesda, MD, 20892, USA
| | - Cortlyn Brown
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Intramural Research Program, Building 35A, Room 2E410, MSC 3720, Bethesda, MD, 20892, USA
| | - Anna Van Meter
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Intramural Research Program, Building 35A, Room 2E410, MSC 3720, Bethesda, MD, 20892, USA; The Feinstein Institutes for Medical Research, The Zucker Hillside Hospital, Division of Psychiatry Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Intramural Research Program, Building 35A, Room 2E410, MSC 3720, Bethesda, MD, 20892, USA.
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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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7
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Parry P, Allison S, Bastiampillai T. The geography of a controversial diagnosis: A bibliographic analysis of published academic perspectives on 'paediatric bipolar disorder'. Clin Child Psychol Psychiatry 2019; 24:529-545. [PMID: 30905170 DOI: 10.1177/1359104519836700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The hypothesis that bipolar disorder presents before puberty with atypical mania has proved to be controversial. Published academic perspectives on the validity of Paediatric Bipolar Disorder (PBD) appear to vary between the United States and the rest of the world. METHODS We examined the perspectives of articles citing four seminal articles. The citing articles were grouped as either supportive or non-supportive of the PBD hypothesis, and the perspectives of the articles by US authors were compared with those by non-US authors. RESULTS There were 787 citing articles commenting on PBD, mostly published in US-based journals. Most authors were affiliated with several US institutions. Among the 624 articles with US authorship, the majority (83%) supported PBD. Of the 163 articles by non-US authors, most (60%) supported the traditional view that bipolar disorders are rare before mid-adolescence. Published academic perspectives in favour of the PBD hypothesis are mostly concentrated in several US institutions. CONCLUSION There is majority support for PBD among citing articles from the United States, whereas the traditional perspective predominates in articles from most other countries.
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Affiliation(s)
- Peter Parry
- 1 School of Clinical Medicine - Children's Health Queensland Clinical Unit, University of Queensland, Australia.,2 College of Medicine and Public Health, Flinders University, Australia
| | - Stephen Allison
- 2 College of Medicine and Public Health, Flinders University, Australia
| | - Tarun Bastiampillai
- 2 College of Medicine and Public Health, Flinders University, Australia.,3 Mind and Brain Theme, South Australian Health and Medical Research Institute, Australia
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8
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Karacetin G, Arman AR, Fis NP, Demirci E, Ozmen S, Hesapcioglu ST, Oztop D, Tufan AE, Tural U, Aktepe E, Aksu H, Ardic UA, Basgul S, Bilac O, Coskun M, Celik GG, Demirkaya SK, Dursun OB, Durukan I, Fidan T, Gencoglan S, Gokcen C, Gokten ES, Gorker I, Gormez V, Gundogdu OY, Gurkan CK, Herguner S, Kandemir H, Kilic BG, Kilincaslan A, Mutluer T, Nasiroglu S, Ozcan OO, Ozturk M, Sapmaz SY, Suren S, Sahin N, Tahiroglu AY, Toros F, Unal F, Vural P, Yazici IP, Yazici KU, Yildirim V, Yulaf Y, Yuce M, Yuksel T, Akdemir D, Altun H, Ayik B, Bilgic A, Bozkurt OH, Cakir ED, Ceri V, Demir NU, Dinc G, Irmak MY, Karaman D, Kinik MF, Mazlum B, Memik NC, Ozdemir DF, Sinir H, Tasdelen BI, Taskin B, Ugur C, Uran P, Uysal T, Uneri OS, Yilmaz S, Yilmaz SS, Acikel B, Aktas H, Alaca R, Alic BG, Almbaidheen M, Ari FP, Aslan C, Atabay E, Ay MG, Aydemir H, Ayranci G, Babadagi Z, Bayar H, Bayhan PC, Bayram O, Bektas ND, Berberoglu KK, Bostan R, Cakan Y, Canli MA, Cansiz MA, Ceylan C, Coskun N, Coskun S, Demir I, Demir N, Demirdogen EY, Dogan B, Donmez YE, Donder F, Efe A, Eray S, Erbilgin S, Erden S, Ersoy EG, Eseroglu T, Firat SK, Gok EE, Goksoy SC, Guler G, Gules Z, Gunay G, Gunes S, Gunes A, Guven G, Horozcu H, Irmak A, Isik U, Kahraman O, Kalayci BM, Karaaslan U, Karadag M, Kilic HT, Kilicaslan F, Kinay D, Koc EB, Kocael O, Mutlu RK, San Z, Nalbant K, Okumus N, Ozbek F, Ozdemir FA, Ozdemir H, Ozgur BG, Ozkan S, Ozyurt EY, Polat B, Polat H, Sekmen E, Sertcelik M, Sevgen FH, Sevince O, Shamkhalova U, Suleyman F, Simsek NE, Tanir Y, Tekden M, Temtek S, Topal M, Topal Z, Turk T, Ucar HN, Ucar F, Uygun D, Uzun N, Vatansever Z, Yazgili NG, Yildiz DM, Yildiz N, Ercan ES. Prevalence of Childhood Affective disorders in Turkey: An epidemiological study. J Affect Disord 2018; 238:513-521. [PMID: 29936389 DOI: 10.1016/j.jad.2018.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/24/2018] [Accepted: 05/13/2018] [Indexed: 12/17/2022]
Abstract
AIM To determine the prevalence of affective disorders in Turkey among a representative sample of Turkish population. METHODS This study was conducted as a part of the "The Epidemiology of Childhood Psychopathology in Turkey" (EPICPAT-T) Study, which was designed by the Turkish Association of Child and Adolescent Mental Health. The inclusion criterion was being a student between the second and fourth grades in the schools assigned as study centers. The assessment tools used were the K-SADS-PL, and a sociodemographic form that was designed by the authors. Impairment was assessed via a 3 point-Likert type scale independently rated by a parent and a teacher. RESULTS A total of 5842 participants were included in the analyses. The prevalence of affective disorders was 2.5 % without considering impairment and 1.6 % when impairment was taken into account. In our sample, the diagnosis of bipolar disorder was lacking, thus depressive disorders constituted all the cases. Among depressive disorders with impairment, major depressive disorder (MDD) (prevalence of 1.06%) was the most common, followed by dysthymia (prevalence of 0.2%), adjustment disorder with depressive features (prevalence of 0.17%), and depressive disorder-NOS (prevalence of 0.14%). There were no statistically significant gender differences for depression. Maternal psychopathology and paternal physical illness were predictors of affective disorders with pervasive impairment. CONCLUSION MDD was the most common depressive disorder among Turkish children in this nationwide epidemiological study. This highlights the severe nature of depression and the importance of early interventions. Populations with maternal psychopathology and paternal physical illness may be the most appropriate targets for interventions to prevent and treat depression in children and adolescents.
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Affiliation(s)
- Gul Karacetin
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Ayse Rodopman Arman
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Nese Perdahli Fis
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Esra Demirci
- Erciyes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kayseri, Turkey.
| | - Sevgi Ozmen
- Erciyes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kayseri, Turkey.
| | - Selma Tural Hesapcioglu
- Karadeniz Technical University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Trabzon, Turkey.
| | - Didem Oztop
- Erciyes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kayseri, Turkey.
| | - Ali Evren Tufan
- Abant Izzet Baysal University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bolu, Turkey.
| | - Umit Tural
- Kocaeli University, Department of Psychiatry, Kocaeli, Turkey.
| | - Evrim Aktepe
- Suleyman Demirel University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Isparta, Turkey.
| | - Hatice Aksu
- Adnan Menderes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Aydin, Turkey.
| | - Ulku Akyol Ardic
- Denizli State Hospital, Child and Adolescent Psychiatry, Denizli, Turkey.
| | - Senem Basgul
- Hasan Kalyoncu University, Department of Psychology, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Oznur Bilac
- Manisa Mental Health and Diseases Hospital Child and Adolescent Psychiatry, Manisa, Turkey.
| | - Murat Coskun
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Gonca Gul Celik
- Cukurova University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Adana, Turkey.
| | - Sevcan Karakoc Demirkaya
- Adnan Menderes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Aydin, Turkey.
| | - Onur Burak Dursun
- Ataturk University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Erzurum, Turkey.
| | - Ibrahim Durukan
- University of Health Sciences Gulhane Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Tulin Fidan
- Osmangazi University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Eskisehir, Turkey.
| | - Salih Gencoglan
- Yuzuncu Yil University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Van, Turkey.
| | - Cem Gokcen
- Gaziantep University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Gaziantep, Turkey.
| | - Emel Sari Gokten
- University of Health Sciences, Bursa Yuksek Ihtisas Hospital, Child and Adolescent Psychiatry, Bursa, Turkey.
| | - Isık Gorker
- Trakya University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Edirne, Turkey.
| | - Vahdet Gormez
- Istanbul Medeniyet University, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Ozlem Yildiz Gundogdu
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Cihat Kagan Gurkan
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Sabri Herguner
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya, Turkey.
| | - Hasan Kandemir
- Harran University Faculty of Medicine, Child and Adolescent Psychiatry Department, Sanliurfa, Turkey.
| | - Birim Gunay Kilic
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Ayse Kilincaslan
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Tuba Mutluer
- Van Training and Research Hospital, Department of Child and Adolescent Psychiatry, Van, Turkey.
| | - Serhat Nasiroglu
- Sakarya University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Sakarya, Turkey.
| | - Ozlem Ozel Ozcan
- Inonu University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Malatya, Turkey.
| | - Mucahit Ozturk
- Hasan Kalyoncu University, Department of Psychology, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Sermin Yalin Sapmaz
- Celal Bayar University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Manisa, Turkey.
| | - Serkan Suren
- Samsun Medical Park Hospital, Child and Adolescent Psychiatry, Samsun, Turkey.
| | - Nilfer Sahin
- Mugla Sitki Kocman University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mugla, Turkey.
| | - Aysegul Yolga Tahiroglu
- Cukurova University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Adana, Turkey.
| | - Fevziye Toros
- Mersin University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mersin, Turkey.
| | - Fatih Unal
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Pinar Vural
- Uludag University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bursa, Turkey.
| | | | - Kemal Utku Yazici
- Firat University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Elazig, Turkey.
| | - Veli Yildirim
- Mersin University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mersin, Turkey.
| | - Yasemin Yulaf
- Private Practice, Child and Adolescent Psychiatry, Tekirdag, Turkey.
| | - Murat Yuce
- Ondokuz Mayis University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Samsun, Turkey.
| | - Tugba Yuksel
- Dicle University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey.
| | - Devrim Akdemir
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Hatice Altun
- Kahramanmaras Sutcu Imam University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kahramanmaras, Turkey..
| | - Basak Ayik
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Ayhan Bilgic
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya, Turkey.
| | - Ozlem Hekim Bozkurt
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Emine Demirbas Cakir
- Abant Izzet Baysal University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bolu, Turkey.
| | - Veysi Ceri
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Nagehan Ucok Demir
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Gulser Dinc
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Mustafa Yasin Irmak
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Dursun Karaman
- University of Health Sciences Gulhane Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Mehmet Fatih Kinik
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Betul Mazlum
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Nursu Cakin Memik
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Dilsad Foto Ozdemir
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Hayati Sinir
- Kahramanmaras Sutcu Imam University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kahramanmaras, Turkey..
| | - Bedia Ince Tasdelen
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Beril Taskin
- Private Doctor, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Cagatay Ugur
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Pınar Uran
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Taciser Uysal
- Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Izmir, Turkey.
| | - Ozden Sukran Uneri
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Savas Yilmaz
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya, Turkey.
| | - Sultan Seval Yilmaz
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Burak Acikel
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya, Turkey.
| | - Huseyin Aktas
- Dicle University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey.
| | - Rumeysa Alaca
- Dicle University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey.
| | - Betul Gul Alic
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Mahmoud Almbaidheen
- University of Health Sciences Gulhane Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Fatma Pinar Ari
- Osmangazi University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Eskisehir, Turkey.
| | - Cihan Aslan
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Ender Atabay
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Merve Gunay Ay
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Hilal Aydemir
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Gülseda Ayranci
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Zehra Babadagi
- Ondokuz Mayis University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Samsun, Turkey.
| | - Hasan Bayar
- Gaziantep University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Gaziantep, Turkey.
| | - Pelin Con Bayhan
- Inonu University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Malatya, Turkey.
| | - Ozlem Bayram
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya, Turkey.
| | - Nese Dikmeer Bektas
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Kivanc Kudret Berberoglu
- Trakya University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Edirne, Turkey.
| | - Recep Bostan
- Mersin University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mersin, Turkey.
| | - Yasemin Cakan
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Merve Arici Canli
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Mehmet Akif Cansiz
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Cansin Ceylan
- Trakya University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Edirne, Turkey.
| | - Nese Coskun
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Seyma Coskun
- Gaziantep University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Gaziantep, Turkey.
| | - Ibrahim Demir
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Nuran Demir
- Abant Izzet Baysal University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bolu, Turkey.
| | - Esen Yildirim Demirdogen
- Ataturk University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Erzurum, Turkey.
| | - Busra Dogan
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Yunus Emre Donmez
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Funda Donder
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Aysegul Efe
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Safak Eray
- Uludag University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bursa, Turkey.
| | - Seda Erbilgin
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Semih Erden
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Elif Gokce Ersoy
- Osmangazi University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Eskisehir, Turkey.
| | - Tugba Eseroglu
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Sumeyra Kina Firat
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Ezgi Eynalli Gok
- Cukurova University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Adana, Turkey.
| | - Seyda Celik Goksoy
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Gulen Guler
- Mersin University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mersin, Turkey.
| | - Zafer Gules
- Adnan Menderes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Aydin, Turkey.
| | - Gulay Gunay
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Serkan Gunes
- Mersin University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mersin, Turkey.
| | - Adem Gunes
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Gokcen Guven
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Havvana Horozcu
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Ayse Irmak
- Erciyes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kayseri, Turkey.
| | - Umit Isik
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya, Turkey.
| | - Ozlem Kahraman
- Erciyes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kayseri, Turkey.
| | - Bilge Merve Kalayci
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Umut Karaaslan
- Dicle University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey.
| | - Mehmet Karadag
- Gaziantep University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Gaziantep, Turkey.
| | - Hilal Tugba Kilic
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Fethiye Kilicaslan
- Harran University Faculty of Medicine, Child and Adolescent Psychiatry Department, Sanliurfa, Turkey.
| | - Duygu Kinay
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Esra Bulanik Koc
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Omer Kocael
- Uludag University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bursa, Turkey.
| | - Rahime Kadir Mutlu
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Zejnep San
- Erciyes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kayseri, Turkey.
| | - Kevser Nalbant
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Nilufer Okumus
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Fatih Ozbek
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Fatma Akkus Ozdemir
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Hanife Ozdemir
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Borte Gurbuz Ozgur
- Adnan Menderes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Aydin, Turkey.
| | - Selcuk Ozkan
- University of Health Sciences Gulhane Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Esra Yildirim Ozyurt
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Berna Polat
- Mersin University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mersin, Turkey.
| | - Hatice Polat
- Erciyes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kayseri, Turkey.
| | - Ebru Sekmen
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Mehmet Sertcelik
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Feyza Hatice Sevgen
- Kahramanmaras Sutcu Imam University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kahramanmaras, Turkey..
| | - Oguz Sevince
- Cukurova University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Adana, Turkey.
| | - Ulker Shamkhalova
- Cukurova University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Adana, Turkey.
| | - Funda Suleyman
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Nurcan Eren Simsek
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Yasar Tanir
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Mehmet Tekden
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Seyhan Temtek
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Melike Topal
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Zehra Topal
- Abant Izzet Baysal University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bolu, Turkey.
| | - Tugba Turk
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Halit Necmi Ucar
- Uludag University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bursa, Turkey.
| | - Filiz Ucar
- Ondokuz Mayis University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Samsun, Turkey.
| | - Duygu Uygun
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Necati Uzun
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya, Turkey.
| | - Zeynep Vatansever
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Neslihan Gokce Yazgili
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Dilsad Miniksar Yildiz
- Inonu University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Malatya, Turkey.
| | - Nazike Yildiz
- Trakya University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Edirne, Turkey.
| | - Eyup Sabri Ercan
- Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Izmir, Turkey.
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Fogleman ND, Leaberry KD, Rosen PJ, Walerius DM, Slaughter K. How do children with and without ADHD talk about frustration?: Use of a novel emotion narrative recall task. ACTA ACUST UNITED AC 2018; 10:297-307. [DOI: 10.1007/s12402-018-0255-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
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Coghill D. Attention-deficit hyperactivity disorder: should we believe the mass media or peer-reviewed literature? PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.29.8.288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Bailly's review describes the author's perspectives on the ‘intense controversies' surrounding attention-deficit hyperactivity disorder (ADHD) and its treatment with stimulant medications. Drawing on a range of literature sources, including the UK press, pharmaceutical industry websites and peer-reviewed scientific papers, he questions the validity of ADHD as a concept and disorder, the accuracy and reliability of diagnosis, the use of stimulant medications and the impact of advertising by the pharmaceutical industry. There are, however, additional sources and alternative interpretations.
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Birkle SM, Legenbauer T, Grasmann D, Holtmann M. Disruptive Affektregulations- störung: eine umstrittene neue Diagnose im DSM-5. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2017; 45:98-103. [DOI: 10.1024/1422-4917/a000496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Die Disruptive Affektregulationsstörung wurde in die 5. Auflage des DSM erstmals als Störungsbild aufgenommen. Den Anlass, eine eigenständige diagnostische Kategorie im Kapitel „Depressive Störungen“ für einen Verhaltensphänotyp aus chronischer, nichtepisodischer Reizbarkeit und häufigen plötzlichen Wutanfällen zu entwickeln, gab die transatlantische Kontroverse um das klinische Bild und die Prävalenz früh beginnender bipolarer Störungen. Die vorliegende Arbeit stellt erste vorliegende Arbeiten dar, die auf die neuen Kriterien zurückgreifen. Während die Abgrenzbarkeit der Disruptiven Affektregulationsstörung in Symptomatik und Verlauf von bipolaren Störungen gut gelingt, finden sich Hinweise auf starke Überlappungen mit oppositionell-gereizten Symptombildern. Für die anstehende Revision der ICD sollte daher diskutiert werden, keine neue Diagnose, sondern eher eine Zusatzcodierung einzuführen, die kennzeichnet, ob eine oppositionelle Störung auch reizbar-wütendes Verhalten umfasst. Unabhängig von der nosologischen Einordnung besteht die Herausforderung, den Verhaltensphänotyp hinsichtlich Ätiologie, Entwicklungspsychopathologie und Prognose besser zu verstehen und hilfreiche Behandlungsmöglichkeiten zu entwickeln.
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Affiliation(s)
- Sarah Maria Birkle
- LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Klinik für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik
| | - Tanja Legenbauer
- LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Klinik für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik
| | - Dörte Grasmann
- Verhaltenstherapie-Ambulanz für Kinder und Jugendliche, Klinische Psychologie und Psychotherapie, Goethe-Universität, Frankfurt am Main
| | - Martin Holtmann
- LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Klinik für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik
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12
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López FA, Childress A, Adeyi B, Dirks B, Babcock T, Scheckner B, Lasser RA, Shepski J, Arnold V. ADHD Symptom Rebound and Emotional Lability With Lisdexamfetamine Dimesylate in Children Aged 6 to 12 Years. J Atten Disord 2017; 21:52-61. [PMID: 23407278 DOI: 10.1177/1087054712474685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe symptom rebound in children with ADHD treated with lisdexamfetamine dimesylate (LDX) or placebo. METHOD During a 4-week, randomized, double-blind, placebo-controlled trial of LDX, parents/caregivers completed the Conners' Parent Rating Scale-Revised: Short Form symptom rating scale throughout the day. Response, rebound, and emotional lability (EL) were assessed post hoc based on predefined criteria. RESULTS Most participants given LDX ( n = 207) were responders throughout the day (50.7%-55.6%) versus placebo ( n = 72; 11.1%-22.2%). A total of seven (3.4%) LDX participants showed rebound in the afternoon and/or evening versus seven (9.7%) with placebo. In both groups, most incidences of rebound occurred in the evening. EL (mean) was higher in LDX rebounders and nonresponders (range = 4.2-9.0) versus LDX responders (range = 1.3-1.6) and versus placebo rebounders (range = 0.7-1.9). CONCLUSION ADHD symptom rebound occurred in few participants (3.3%) given LDX (accompanied by clinically significant EL). Overall, more participants given LDX versus placebo responded throughout the day.
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Affiliation(s)
- Frank A López
- 1 Children's Developmental Center, Winter Park, FL, USA
| | - Ann Childress
- 2 Center for Psychiatry and Behavioral Medicine, Las Vegas, NV, USA
| | - Ben Adeyi
- 3 Shire Development LLC, Wayne, PA, USA
| | | | | | | | - Robert A Lasser
- 4 Pharmanet/i3, an inVentiv Health clinical, Princeton, NJ, USA
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13
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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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14
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Factor PI, Reyes RA, Rosen PJ. Emotional Impulsivity in Children with ADHD Associated with Comorbid—Not ADHD—Symptomatology. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2014. [DOI: 10.1007/s10862-014-9428-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Sparks GM, Axelson DA, Yu H, Ha W, Ballester J, Diler RS, Goldstein B, Goldstein T, Hickey MB, Ladouceur CD, Monk K, Sakolsky D, Birmaher B. Disruptive mood dysregulation disorder and chronic irritability in youth at familial risk for bipolar disorder. J Am Acad Child Adolesc Psychiatry 2014; 53:408-16. [PMID: 24655650 PMCID: PMC4049528 DOI: 10.1016/j.jaac.2013.12.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 10/31/2013] [Accepted: 01/16/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Disruptive mood dysregulation disorder (DMDD) is a new diagnosis in the DSM-5. Youth with a family history of bipolar disorder (BD) are at increased risk for BD and non-bipolar psychopathology. No studies to date have examined rates of DMDD among offspring of parents with BD. This study examines the risk for DMDD in offspring of parents with BD compared to community controls and considers rates of chronic irritability (independent of a DMDD diagnosis) across diagnoses in youth with parents with BD. METHOD Modified DMDD criteria were applied post hoc to 375 offspring of parents with BD and 241 offspring, aged 6 to 17 years, of community control parents. We calculated odds ratios using generalized linear mixed models. In addition, we explored associations with a severe chronic irritability phenotype and various diagnoses in the high-risk cohort. RESULTS Offspring of parents with BD were more likely to meet criteria for DMDD than were the offspring of community control parents (Odds ratio [OR] = 8.3, 6.7% vs. 0.8%), even when controlling for demographic variables and comorbid parental diagnoses (OR = 5.4). They also had higher rates of chronic irritability compared to community controls (12.5% vs. 2.5%, χ(2) = 18.8, p < .005). Within the offspring of parents with BD, the chronic irritability phenotype was frequently present in offspring with diagnoses of BD, depression, attention-deficit/hyperactivity disorder, and disruptive behavior disorders. CONCLUSIONS Like other non-BD diagnoses, family history of BD increases the risk for DMDD. Severe chronic irritability and temper tantrums are the core features of DMDD, and are associated with mood and behavioral disorders in youth at risk for BD.
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Affiliation(s)
- Garrett M. Sparks
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - David A. Axelson
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Haifeng Yu
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Wonho Ha
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Javier Ballester
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Rasim S. Diler
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | | | - Tina Goldstein
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Mary Beth Hickey
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Cecile D. Ladouceur
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Kelly Monk
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Dara Sakolsky
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
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16
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Abstract
There are two divergent viewpoints on the phenomenology and outcome of bipolar I (BP I) disorder in youth. Disparities evolved as unintended consequences from investigators' inconsistencies both in translating the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, DSM-III-R, and DSM-IV criteria and in operationalizing them differently in their standardized assessments. Rates of conservatively diagnosed BP I are lower both in community studies of youths than in adults and from liberally defined BP I in youths. Rates of co-occurring attention-deficit hyperactivity disorder (ADHD) are lower in conservatively than liberally defined children and adolescents with BP I. Rates of both BP I and of ADHD are lower in offspring of BP I probands, and outcome more closely approximates that of adults with BP I in conservatively versus liberally defined children and teens with BP I. Both perspectives can claim evidence for reliability and validity that support their positions. However, the samples are so different that it is difficult to compare studies conducted from these different perspectives.
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Affiliation(s)
- Gabrielle A. Carlson
- Division of Child and Adolescent Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York 11794
| | - Daniel N. Klein
- Department of Psychology, Stony Brook University, Stony Brook, New York 11794
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17
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Kim KL, Weissman AB, Puzia ME, Cushman GK, Seymour KE, Wegbreit E, Carskadon MA, Dickstein DP. Circadian Phase Preference in Pediatric Bipolar Disorder. J Clin Med 2014; 3:255-66. [PMID: 26237260 PMCID: PMC4449662 DOI: 10.3390/jcm3010255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/11/2014] [Accepted: 02/19/2014] [Indexed: 11/25/2022] Open
Abstract
Pediatric bipolar disorder (BD) rates have notably increased over the past three decades. Given the significant morbidity and mortality associated with BD, efforts are needed to identify factors useful in earlier detection to help address this serious public health concern. Sleep is particularly important to consider given the sequelae of disrupted sleep on normative functioning and that sleep is included in diagnostic criteria for both Major Depressive and Manic Episodes. Here, we examine one component of sleep—i.e., circadian phase preference with the behavioral construct of morningness/eveningness (M/E). In comparing 30 BD and 45 typically developing control (TDC) participants, ages 7–17 years, on the Morningness-Eveningness Scale for Children (MESC), no between-group differences emerged. Similar results were found when comparing three groups (BD−ADHD; BD+ADHD; TDC). Consistent with data available on circadian phase preference in adults with BD, however, we found that BD adolescents, ages 13 years and older, endorsed significantly greater eveningness compared to their TDC peers. While the current findings are limited by reliance on subjective report and the high-rate of comorbid ADHD among the BD group, this finding that BD teens demonstrate an exaggerated shift towards eveningness than would be developmentally expected is important. Future studies should compare the circadian rhythms across the lifespan for individuals diagnosed with BD, as well as identify the point at which BD youth part ways with their healthy peers in terms of phase preference. In addition, given our BD sample was overall euthymic, it may be that M/E is more state vs. trait specific in latency age youth. Further work would benefit from assessing circadian functioning using a combination of rating forms and laboratory-based measures. Improved understanding of sleep in BD may identify behavioral targets for inclusion in prevention and intervention protocols.
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Affiliation(s)
- Kerri L Kim
- PediMIND Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, RI 02915, USA.
| | - Alexandra B Weissman
- PediMIND Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, RI 02915, USA.
| | - Megan E Puzia
- PediMIND Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, RI 02915, USA.
| | - Grace K Cushman
- PediMIND Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, RI 02915, USA.
| | - Karen E Seymour
- PediMIND Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, RI 02915, USA.
| | - Ezra Wegbreit
- PediMIND Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, RI 02915, USA.
| | - Mary A Carskadon
- Chronobiology and Sleep Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, RI 02915, USA.
- Centre for Sleep Research, University of South Australia, Adelaide 5005, Australia.
| | - Daniel P Dickstein
- PediMIND Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, RI 02915, USA.
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18
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Childress AC, Arnold V, Adeyi B, Dirks B, Babcock T, Scheckner B, Lasser R, Lopez FA. The effects of lisdexamfetamine dimesylate on emotional lability in children 6 to 12 years of age with ADHD in a double-blind placebo-controlled trial. J Atten Disord 2014; 18:123-32. [PMID: 22740112 DOI: 10.1177/1087054712448252] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effect of lisdexamfetamine dimesylate (LDX) on emotional lability (EL) in children with ADHD. METHOD Post hoc analyses of a placebo-controlled trial of LDX-stratified children (aged 6-12 years) with ADHD to prominent and not prominent EL at baseline (score >3 or ≤3, respectively, on Conners' Parent Rating Scale [CPRS] items of anger, loss of temper, and irritability). Efficacy was assessed by change in CPRS EL scores and ADHD Rating Scale-IV (ADHD-RS-IV) total and subscale scores. Safety measures included treatment-emergent adverse events (TEAEs). RESULTS LDX showed improvement versus placebo (p < .0005) for EL item least squares (LS) mean change scores at endpoint and throughout the day. At baseline, 138 and 73 participants randomized to LDX treatment and having baseline and endpoint CPRS scores were categorized with CPRS-derived prominent and not prominent baseline EL, respectively; 41 and 31 participants randomized to placebo were categorized with CPRS-derived prominent and not prominent baseline EL, respectively. ADHD-RS-IV total and subscale scores decreased with LDX regardless of baseline EL severity. TEAEs included decreased appetite, insomnia, upper abdominal pain, headache, and irritability. CONCLUSION EL and ADHD symptoms improved with LDX regardless of baseline EL symptom severity. LDX demonstrated a safety profile consistent with long-acting psychostimulant use.
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Affiliation(s)
- Ann C Childress
- 1Center for Psychiatry and Behavioral Medicine, Las Vegas, NV, USA
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19
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Langberg JM, Froehlich TE, Loren REA, Martin JE, Epstein JN. Assessing children with ADHD in primary care settings. Expert Rev Neurother 2014; 8:627-41. [DOI: 10.1586/14737175.8.4.627] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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20
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Skirrow C, McLoughlin G, Kuntsi J, Asherson P. Behavioral, neurocognitive and treatment overlap between attention-deficit/hyperactivity disorder and mood instability. Expert Rev Neurother 2014; 9:489-503. [DOI: 10.1586/ern.09.2] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Braun CMJ, Delisle J, Suffren S, Bolduc M. Atypical left–right balance of visuomotor awareness in adult ADHD (combined type) on a test of executive function. Laterality 2013; 18:385-406. [DOI: 10.1080/1357650x.2012.695796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Abstract
The clinical confusion surrounding childhood ADHD and bipolar disorder centers on overlaps between severe ADHD with mood lability and mania/hypomania. Perplexity has been exacerbated by the removal of mood symptoms from the diagnostic criteria for ADHD and a lack of stringent criteria for a manic/hypomanic episode. This review summarizes current knowledge of the relationship between ADHD and bipolar disorder, the rates with which ADHD and bipolar disorder coexist in youth of differing ages, their presence in community, clinical, and high risk samples, and their longitudinal course. Treatment studies are reviewed, highlighting findings in comorbid cases, which support the efficacy of stimulants and other agents for ADHD without worsening mood symptoms, and efficacy of second generation antipsychotics for bipolar disorder. In conclusion, a lack of clarity regarding the diagnostic boundaries between childhood ADHD and bipolar disorder remains, however, treatments targeting symptoms of each disorder when comorbid, provide some efficacy.
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Affiliation(s)
- Caroly Pataki
- Keck School of Medicine of the University of Southern California, 546 16th Street, Santa Monica, CA 90402, USA.
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23
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Demeter CA, Youngstrom EA, Carlson GA, Frazier TW, Rowles BM, Lingler J, McNamara NK, Difrancesco KE, Calabrese JR, Findling RL. Age differences in the phenomenology of pediatric bipolar disorder. J Affect Disord 2013; 147:295-303. [PMID: 23219057 DOI: 10.1016/j.jad.2012.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 11/05/2012] [Accepted: 11/06/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The primary purpose of this study was to explore whether age differences in the phenomenology of bipolar disorders from 4 to 17 years of age exist. METHODS Outcome measures included questionnaires pertaining to mood symptoms, psychosocial functioning, and family history of psychiatric illness. Phenomenology was examined in two diagnostic groups: syndromal bipolar disorder (bipolar I or II) and subsyndromal bipolar disorder (bipolar disorder not otherwise specified or cyclothymia) and across six age cohorts: 4-6, 7-8, 9-10, 11-13, and 14-17 years. Analyses examined linear and non-linear age effects on clinician-rated measures of mood and psychosocial functioning. RESULTS Participants were 535 outpatients (339 males) ages 4-17 years. The proportion diagnosed with comorbid ADHD was significantly lower in the oldest age group. Age groups showed significant moderate decreases in motor activity, aggression, and irritability with age. Many symptoms of depression showed significant increases with age. BP I cases showed much higher manic symptoms, and BP I and BP II cases indicated slightly to moderately higher depressive symptoms, compared to subsyndromal cases. These patterns held after adjusting for comorbid ADHD, and age did not interact with syndrome status. There were also age differences in total scores for measures of mood symptoms and psychosocial functioning. LIMITATIONS Mood ratings were completed based on the same interview that informed the research diagnoses. Also, mood episode at time of interview was not captured. CONCLUSIONS These findings affirm the existence of bipolar disorder from pre-school children through adolescence, with a similar clinical presentation across a wide developmental age span.
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Affiliation(s)
- Christine A Demeter
- Department of Psychiatry, Case Western Reserve University, University Hospitals of Cleveland, OH, United States.
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24
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Retz W, Stieglitz RD, Corbisiero S, Retz-Junginger P, Rösler M. Emotional dysregulation in adult ADHD: What is the empirical evidence? Expert Rev Neurother 2013; 12:1241-51. [PMID: 23082740 DOI: 10.1586/ern.12.109] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder characterized by symptoms of inattention, hyperactivity and impulsivity. There is an ongoing discussion whether symptoms of emotional dysregulation should be added to the conceptualization of ADHD in order to describe the psychopathology of ADHD more precisely, at least in adult patients. Symptoms of emotional dysregulation are well defined and seem to be distinct factors of the psychopathology of adult ADHD. Assessment of this psychopathological dimension has shown sufficient reliability and validity. Empirical studies have confirmed a high prevalence of this psychopathological feature in adults with ADHD that compares to the frequency of the ADHD core symptoms, inattention, hyperactivity and impulsivity. Evidence is given that emotional dysregulation has an independent effect on social problems associated with ADHD in adult life. Moreover, pharmacological and psychotherapeutic interventions help to ameliorate emotional dysregulation together with symptoms of inattention and hyperactivity/impulsivity. Thus, there is growing evidence that emotional dysregulation might be recognized as a core feature of ADHD.
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Affiliation(s)
- Wolfgang Retz
- Saarland University Hospital, Homburg/Saar, Germany.
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25
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Hypomania spectrum disorders from adolescence to adulthood: a 15-year follow-up of a community sample. J Affect Disord 2013; 145:190-9. [PMID: 22884232 DOI: 10.1016/j.jad.2012.07.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 07/20/2012] [Accepted: 07/21/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is a lack of scientific knowledge about the broader spectrum of hypomania in adolescence and the course over time. To investigate this, we used longitudinal data spanning from adolescence to age 31 years. METHOD A community sample of adolescents (N=2300) was screened for depressive symptoms. Adolescents (16-17 years) with a positive screening and matched controls were interviewed with a structured diagnostic interview. A blinded follow-up assessment was conducted 15 years later, with a structured diagnostic interview covering the age span 19-31 years. Questions about treatment and family history were included. RESULTS Ninety adolescents (16-17 years) with a lifetime hypomania spectrum episode (3.9% of the total sample) were identified: 40 with fullsyndromal, 18 with brief-episode (<4 day), and 32 with subsyndromal (1-2 main symptoms and 1-2 additional symptoms) hypomania. The hypomania symptoms reported by the fullsyndromal and the brief-episode groups were similar, whereas the subsyndromal group per definition reported fewer symptoms. Of the 90 adolescents with a hypomania spectrum episode, 64 (71%) participated in the follow-up interview. Mania in adulthood was reported by 2 (3%), hypomania by an additional 4 (6%), and major depression by 38 (59%). Incidence of mood episodes in adulthood did not differ between the subgroups of hypomania spectrum. LIMITATIONS 29% of the participants with hypomania spectrum were lost to follow-up. CONCLUSION The results indicate that only a small proportion of adolescents with hypomania spectrum episodes continue to have (hypo)mania in adulthood. Thus, maintenance or prophylactic treatment does not seem warranted for this group.
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26
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Ambrosini PJ, Bennett DS, Elia J. Attention deficit hyperactivity disorder characteristics: II. Clinical correlates of irritable mood. J Affect Disord 2013; 145:70-6. [PMID: 22868057 PMCID: PMC3496809 DOI: 10.1016/j.jad.2012.07.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/03/2012] [Accepted: 07/17/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study describes the relationship of irritable mood (IRR) with affective disorders in youths with attention deficit hyperactivity disorder (ADHD). METHODS Five hundred ADHD subjects were assessed with the childhood version of the Schedule for Affective Disorder & Schizophrenia. Subjects were in a genetic ADHD protocol and limited to those of Caucasian/European descent. RESULTS The most prevalent concurrent diagnoses were oppositional defiant disorder (ODD) (43.6%), minor depression/dysthymic disorder (MDDD) (18.8%), and generalized anxiety (13.2%)/overanxious disorder (12.4%). IRR subjects (21.0%) compared to the non-IRR (NIRR) group had higher rates of all affective disorders (76.2% vs. 9.6%) and ODD (83.8% vs. 32.9%) but lower rates of hyperactive ADHD (1.9% vs. 8.9%). Among those without comorbidities, 98.3% were NIRR. Logistic regression found IRR mood significantly associated with major depressive disorder (odds ratio [OR]: 33.4), MDDD (OR: 11.2), ODD (OR: 11.6), and combined ADHD (OR: 1.7) but not with anxiety disorders. Among symptoms, it associated IRR mood with a pattern of dysthymic and ODD symptoms but with fewer separation anxiety symptoms. Diagnostic and symptomatic parameters were unaffected by demographic variables. LIMITATIONS Potential confounders influencing these results include patient recruitment from only one clinical service; a cohort specific sample effect because some presumed affective disorders and non-Caucasians were excluded; and the young mean age (10.2 years) limiting comorbid patterns. CONCLUSIONS The prominence of an MDDD pattern suggests this IRR group is appropriate in the DSM V's proposed chronic depressive disorder, possibly with or without temper dysregulation. A new diagnosis of disruptive mood dysregulation disorder may be unwarranted.
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Affiliation(s)
- Paul J. Ambrosini
- Division of Child & Adolescent Psychiatry, Drexel University College of Medicine, Philadelphia, PA,Corresponding author: Paul J. Ambrosini, MD Drexel University College of Medicine Division of Child & Adolescent Psychiatry PO Box 45358, Philadelphia, PA 19124 Tel: 215-831-6962 Fax: 215-831-7830 (fax)
| | - David S. Bennett
- Division of Child & Adolescent Psychiatry, Drexel University College of Medicine, Philadelphia, PA
| | - Josephine Elia
- Department of Child & Adolescent Psychiatry, The Children's Hospital of Philadelphia and Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA
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27
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Arnold LE, Mount K, Frazier T, Demeter C, Youngstrom EA, Fristad MA, Birmaher B, Horwitz S, Findling RL, Kowatch R, Axelson D. Pediatric bipolar disorder and ADHD: family history comparison in the LAMS clinical sample. J Affect Disord 2012; 141:382-9. [PMID: 22464937 PMCID: PMC3574899 DOI: 10.1016/j.jad.2012.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 03/06/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transgenerational association of bipolar spectrum disorder (BPSD) and attention deficit/hyperactivity disorder (ADHD) has been reported, but inconclusively. METHOD Children ages 6-12 were systematically recruited at first outpatient visit at 9 clinics at four universities and reliably diagnosed; 621 had elevated symptoms of mania (>12 on the Parent General Behavior Inventory 10-Item Mania Scale); 86 had scores below 12. We analyzed baseline data to test a familial association hypothesis: compared to children with neither BPSD nor ADHD, those with either BPSD or ADHD would have parents with higher rates of both bipolar and ADHD symptoms, and parents of comorbid children would have even higher rates of both. RESULTS Of 707 children, 421 had ADHD without BPSD, 45 BPSD without ADHD, 117 comorbid ADHD+BPSD, and 124 neither. The rate of parental manic symptoms was similar for the comorbid and BPSD-alone groups, significantly greater than for ADHD alone and "neither" groups, which had similar rates. ADHD symptoms in parents of children with BPSD alone were significantly less frequent than in parents of children with ADHD (alone or comorbid), and no greater than for children with neither diagnosis. Family history of manic symptoms, but not ADHD symptoms, was associated with parent-rated child manic-symptom severity over and above child diagnosis. LIMITATIONS The sample was not epidemiologic, parent symptoms were based on family history questions, and alpha was 0.05 despite multiple tests. CONCLUSIONS These results do not support familial linkage of BPSD and ADHD; they are compatible with heritability of each disorder separately with coincidental overlap.
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Affiliation(s)
- L. Eugene Arnold
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Ohio State University, Columbus, OH, United States
- Corresponding author. Tel.: +1 614 292 9780, +1 614 561 1429 (Cell).
| | - Katherine Mount
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Ohio State University, Columbus, OH, United States
- Corresponding author. Tel.: +1 614 293 9197; fax: +1 614 293 4949.
| | - Thomas Frazier
- Center for Pediatric Behavioral Health and Center for Autism, Cleveland Clinic, Cleveland, OH, United States
| | - Christine Demeter
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Case Western Reserve University, Cleveland, OH, United States
| | - Eric A. Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mary A. Fristad
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Ohio State University, Columbus, OH, United States
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Sarah Horwitz
- Department of Pediatrics and Stanford Health Policy, Stanford University School of Medicine, Stanford, CA, United States
| | - Robert L. Findling
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Case Western Reserve University, Cleveland, OH, United States
| | - Robert Kowatch
- Child and Adolescent Psychiatry, Ohio State University, and Nationwide Children’s Hospital, Columbus, OH, United States
| | - David Axelson
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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28
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Skirrow C, Hosang GM, Farmer AE, Asherson P. An update on the debated association between ADHD and bipolar disorder across the lifespan. J Affect Disord 2012; 141:143-59. [PMID: 22633181 DOI: 10.1016/j.jad.2012.04.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 04/05/2012] [Accepted: 04/05/2012] [Indexed: 12/12/2022]
Abstract
Diagnostic formulations for attention deficit hyperactivity disorder (ADHD) and bipolar disorder (BD) both include symptoms of distractibility, psychomotor agitation and talkativeness, alongside associated emotional features (irritability and emotional lability). Treatment studies suggest the importance of accurate delineation of ADHD and BD. However, boundaries between the two disorders are blurred by the introduction of broader conceptualisations of BD. This review attempts to elucidate whether associations between ADHD and BD are likely to be driven by superficial symptomatological similarities or by a more meaningful etiological relationship between the disorders. This is achieved by outlining findings on comorbidity, temporal progression of the disorders, familial co-variation, and neurobiology in ADHD and BD across the lifespan. Longitudinal studies fail to consistently show developmental trajectories between ADHD and BD. Comparative research investigating neurobiology is in its infancy, and although some similarities are seen between ADHD and BD, studies also emphasise differences between the two disorders. However, comorbidity and family studies appear to show that the two disorders occur together and aggregate in families at higher than expected rates. Furthermore close inspection of results from population studies reveals heightened co-occurrence of ADHD and BD even in the context of high comorbidity commonly noted in psychopathology. These results point towards a meaningful association between ADHD and BD, going beyond symptomatic similarities. However, future research needs to account for heterogeneity of BD, making clear distinctions between classical episodic forms of BD, and broader conceptualisations of the disorder characterised by irritability and emotional lability, when evaluating the relationship with ADHD.
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Affiliation(s)
- Caroline Skirrow
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, United Kingdom.
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29
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Abstract
Issues complicating the differential diagnosis of bipolar disorder in young people are discussed. They include: a) the subtype of bipolar disorder being considered; b) the person's age and stage of development; c) whether one views bipolar disorder more conservatively, requiring clear episodes that mark a distinct change from premorbid levels of function, or more liberally, focusing for instance on severe irritability/explosive outbursts as the mood change; d) who is reporting manic symptoms, and whether symptoms are past and must be recalled or current and more likely to be observed; e) impact of family history. The diagnosis of mania/bipolar I disorder may not become clear for a number of years. This is an impairing disorder, but so are the conditions from which it must be distinguished. Family history may increase the odds that certain symptoms/behaviors are manifestations of bipolar disorder but it does not make the diagnosis. Until there are biomarkers that can confirm the diagnosis, and treatments unique to the condition, it is wise to make a diagnosis of bipolar disorder in children and adolescents provisionally and keep an open mind to the likelihood that revisions may be necessary.
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Affiliation(s)
- GABRIELLE A. CARLSON
- Department of Psychiatry and Behavioral Sciences,
Stony Brook University School of Medicine, Putnam Hall-South Campus, Stony
Brook, NY 11794-8790, USA
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30
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Wu YP, Aylward BS, Roberts MC, Evans SC. Searching the scientific literature: implications for quantitative and qualitative reviews. Clin Psychol Rev 2012; 32:553-7. [PMID: 22819996 DOI: 10.1016/j.cpr.2012.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 06/14/2012] [Accepted: 06/26/2012] [Indexed: 10/28/2022]
Abstract
Literature reviews are an essential step in the research process and are included in all empirical and review articles. Electronic databases are commonly used to gather this literature. However, several factors can affect the extent to which relevant articles are retrieved, influencing future research and conclusions drawn. The current project examined articles obtained by comparable search strategies in two electronic archives using an exemplar search to illustrate factors that authors should consider when designing their own search strategies. Specifically, literature searches were conducted in PsycINFO and PubMed targeting review articles on two exemplar disorders (bipolar disorder and attention deficit/hyperactivity disorder) and issues of classification and/or differential diagnosis. Articles were coded for relevance and characteristics of article content. The two search engines yielded significantly different proportions of relevant articles overall and by disorder. Keywords differed across search engines for the relevant articles identified. Based on these results, it is recommended that when gathering literature for review papers, multiple search engines should be used, and search syntax and strategies be tailored to the unique capabilities of particular engines. For meta-analyses and systematic reviews, authors may consider reporting the extent to which different archives or sources yielded relevant articles for their particular review.
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Affiliation(s)
- Yelena P Wu
- Clinical Child Psychology Program, University of Kansas, 2010 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS 66045, USA
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31
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Memory in Early Onset Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder: Similarities and Differences. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2012; 40:1179-92. [DOI: 10.1007/s10802-012-9631-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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32
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Abstract
OBJECTIVE Pediatric bipolar disorder (PBD) reflects shifts in conceptualizing bipolar disorder among children and adolescents since the mid-1990s. Since then, PBD diagnoses, predominantly in the United States, have increased dramatically, and the diagnosis has attracted significant controversy. During the same period, psychiatric theory and practice has become increasingly biological. The aim of this paper is to examine the rise of PBD in terms of wider systemic influences. METHOD In the context of literature referring to paradigm shifts in psychiatry, we reviewed the psychiatric literature, media cases, and information made available by investigative committees and journalists. RESULTS Social historians and prominent psychiatrists describe a paradigm shift in psychiatry over recent decades: from an era of "brainless psychiatry," when an emphasis on psychodynamic and family factors predominated to the exclusion of biological factors, to a current era of "mindless psychiatry" that emphasizes neurobiological explanations for emotional and behavioral problems with limited regard for contextual meaning. Associated with this has been a tendency within psychiatry and society to neglect trauma and attachment insecurity as etiological factors; the "atheoretical" (but by default biomedical) premise of the Diagnostic and Statistical Manual of Mental Disorders (3rd and 4th eds.); the influence of the pharmaceutical industry in research, continuing medical education, and direct-to-consumer advertising; and inequality in the U.S. health system that favors "diagnostic upcoding." Harm from overmedicating children is now a cause of public concern. CONCLUSION It can be argued that PBD as a widespread diagnosis, particularly in the United States, reflects multiple factors associated with a paradigm shift within psychiatry rather than recognition of a previously overlooked common disorder.
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Affiliation(s)
- Peter I Parry
- Department of Psychiatry, Flinders University, Adelaide, Australia.
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33
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Heiler S, Legenbauer T, Bogen T, Jensch T, Holtmann M. Severe mood dysregulation: in the "light" of circadian functioning. Med Hypotheses 2011; 77:692-5. [PMID: 21831530 DOI: 10.1016/j.mehy.2011.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 06/29/2011] [Accepted: 07/07/2011] [Indexed: 10/17/2022]
Abstract
Severe affective and behavioral dysregulation, labeled as severe mood dysregulation (SMD), is a widely spread phenomenon among adolescent psychiatric patients. This phenotype constitutes severe impairment across multiple settings, including various symptoms, such as non-episodic anger, mood instability, and hyperarousal. Moreover, SMD patients often show depression and reduced need for sleep. Despite a lifetime prevalence of 3.3%, systematic research is still scarce, and treatments that have been established do not account for the range of symptoms present in SMD. Considering the circadian dysfunctions, two hormones, melatonin and cortisol, are essential. When these hormones are dysregulated, the circadian rhythm gets out of synchrony. Since evidence is emerging showing that the worse the sleep-wake cycle is entrained, the worse the psychiatric symptoms are depicted, the importance of proper circadian functioning becomes clear. Chronotherapy as the controlled exposure to environmental stimuli (e.g. light) acting on biological rhythms has shown therapeutic effects. In both seasonal and major depression chronotherapy has been implemented, decreasing depressive symptoms and stabilizing circadian rhythms. Preliminary evidence from SMD related disorders, namely attention-deficit/hyperactivity disorder and pediatric bipolar depression, indicates that morning light therapy elicits positive influences on other symptoms as well. Hence, light therapy might not only be effective for depressive symptoms and circadian rhythms, but might also be beneficial for symptoms including inattention and irritability. We hypothesize that light therapy might be a helpful adjunctive treatment enhancing affective and circadian functioning, and eliciting positive influences on behavior. Physiologically, changes of both cortisol levels and melatonin production are expected.
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Affiliation(s)
- Sarah Heiler
- Ruhr-University Bochum, LWL-University Hospital Hamm for Child and Adolescent Psychiatry, Heithofer Allee 64, D-59071 Hamm, Germany.
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Chan J, Stringaris A, Ford T. Bipolar Disorder in Children and Adolescents Recognised in the UK: A Clinic-Based Study. Child Adolesc Ment Health 2011; 16:71-78. [PMID: 32847219 DOI: 10.1111/j.1475-3588.2010.00566.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diagnoses of paediatric bipolar disorder have increased over the last two decades in the United States, where high levels of comorbidity with ADHD have also been reported. AIMS To explore how British clinicians apply these diagnoses. METHOD We compared 378 young people under the age of 18 who received a diagnosis of bipolar disorder and/or ADHD from a large NHS mental health trust between 1992 and 2007. RESULTS Children with bipolar disorder were rare in this sample (n = 35, 1.0%), particularly under the age of 13 (n = 9, 0.3%). Children with bipolar disorder presented more often with affective and psychotic symptoms than children with ADHD. Irritability was common in both disorders. Core ADHD symptoms were prevalent in both conditions but occurred in a greater proportion of children with ADHD. CONCLUSION Our findings suggest that psychiatrists in England use the traditional adult criteria of bipolar disorder rather than the broader criteria being adopted by some practitioners in the US.
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Affiliation(s)
- Judy Chan
- The Cottage, St. Marks Hospital, Maidenhead SL6 6DU, UK. E-mail:
| | - Argyris Stringaris
- Institute of Psychiatry, King's College London, Denmark Hill, London SE5 8AF, UK
| | - Tamsin Ford
- Tamsin Ford, Peninsula College of Medicine and Dentistry, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
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Torralva T, Gleichgerrcht E, Torrente F, Roca M, Strejilevich SA, Cetkovich M, Lischinsky A, Manes F. Neuropsychological functioning in adult bipolar disorder and ADHD patients: a comparative study. Psychiatry Res 2011; 186:261-6. [PMID: 20832868 DOI: 10.1016/j.psychres.2010.08.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 08/05/2010] [Accepted: 08/12/2010] [Indexed: 12/21/2022]
Abstract
Bipolar disorder (BD) and adult attention deficit hyperactivity disorder (ADHD) usually manifest with shared clinical symptoms, proving quite challenging to thoroughly differentiate one from another. Previous research has characterized these two disorders independently, but no study compared both pathologies from a neuropsychological perspective. The aim of this study was to compare the neuropsychological profile of adult ADHD and BD with each other and against a control group, in order to understand the way in which comprehensive cognitive assessment can contribute to their discrimination as distinct clinical entities as well as their differential diagnosis. All groups were successfully matched for age, sex, years of education, and premorbid IQ. Participants were assessed with an extensive neuropsychological battery evaluating multiple domains. Compared to controls, BD patients had a poorer performance on immediate verbal memory tasks. Both clinical groups exhibited significantly lower scores than controls on the recognition phase of verbal and non-verbal memory tasks, as well as on a task of executive functioning with high working memory demand. Noticeably, however, ADHD had significantly better performance than BD on the recognition phase of both the Rey list memory task and the Rey Figure. The better performance of ADHD patients over BD may reflect the crucial role of the executive component on their memory deficits and gives empirical support to further differentiate the neuropsychological profile of BD and adult ADHD patients in clinical practice.
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Holtmann M, Buchmann AF, Esser G, Schmidt MH, Banaschewski T, Laucht M. The Child Behavior Checklist-Dysregulation Profile predicts substance use, suicidality, and functional impairment: a longitudinal analysis. J Child Psychol Psychiatry 2011; 52:139-47. [PMID: 20854363 DOI: 10.1111/j.1469-7610.2010.02309.x] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent studies have identified a Child Behavior Checklist profile that characterizes children with severe affective and behavioral dysregulation (CBCL-dysregulation profile, CBCL-DP). In two recent longitudinal studies the CBCL-DP in childhood was associated with heightened rates of comorbid psychiatric disorders, among them bipolar disorder, an increased risk for suicidality, and marked psychosocial impairment at young-adult follow-up. This is the first study outside the US that examines the longitudinal course of the CBCL-DP. METHODS We studied the diagnostic and functional trajectories and the predictive utility of the CBCL-DP in the Mannheim Study of Children at Risk, an epidemiological cohort study on the outcome of early risk factors from birth into adulthood. A total of 325 young adults (151 males, 174 females) participated in the 19-year assessment. RESULTS Young adults with a higher CBCL-DP score in childhood were at increased risk for substance use disorders, suicidality and poorer overall functioning at age 19, even after adjustment for parental education, family income, impairment and psychiatric disorders at baseline. Childhood dysregulation was not related to bipolar disorder in young adulthood. The CBCL-DP was neither a precursor of a specific pattern of comorbidity nor of comorbidity in general. CONCLUSIONS Children with high CBCL-DP values are at risk for later severe, psychiatric symptomatology. The different developmental trajectories suggest that the CBCL-DP is not simply an early manifestation of a single disease process but might rather be an early developmental risk marker of a persisting deficit of self-regulation of affect and behavior.
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Affiliation(s)
- Martin Holtmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
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McNamara RK, Nandagopal JJ, Strakowski SM, DelBello MP. Preventative strategies for early-onset bipolar disorder: towards a clinical staging model. CNS Drugs 2010; 24:983-96. [PMID: 21090835 DOI: 10.2165/11539700-000000000-00000] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Bipolar disorder is a chronic and typically recurring illness with significant psychosocial morbidity. Although the aetiological factors that contribute to the onset of mania, and by definition bipolar I disorder, are poorly understood, it most commonly occurs during the adolescent period. Putative risk factors for developing bipolar disorder include having a first-degree relative with a mood disorder, physical/sexual abuse and other psychosocial stressors, substance use disorders, psychostimulant and antidepressant medication exposure and omega-3 fatty acid deficiency. Prominent prodromal clinical features include episodic symptoms of depression, anxiety, hypomania, anger/irritability and disturbances in sleep and attention. Because prodromal mood symptoms precede the onset of mania by an average of 10 years, and there is low specificity of risk factors and prodromal features for mania, interventions initiated prior to onset of the disorder (primary prevention) or early in the course of the disorder (early or secondary prevention) must be safe and well tolerated upon long-term exposure. Indeed, antidepressant and psychostimulant medications may precipitate the onset of mania. Although mood stabilizers and atypical antipsychotic medications exhibit efficacy in youth with bipolar I disorder, their efficacy for the treatment of prodromal mood symptoms is largely unknown. Moreover, mood stabilizers and atypical antipsychotics are associated with prohibitive treatment-emergent adverse effects. In contrast, omega-3 fatty acids have neurotrophic and neuroprotective properties and have been found to be efficacious, safe and well tolerated in the treatment of manic and depressive symptoms in children and adolescents. Together, extant evidence endorses a clinical staging model in which subjects at elevated risk for developing mania are treated with safer interventions (i.e. omega-3 fatty acids, family-focused therapy) in the prodromal phase, followed by pharmacological agents with potential adverse effects for nonresponsive cases and secondary prevention. This approach warrants evaluation in prospective longitudinal trials in youth determined to be at ultra-high risk for bipolar I disorder.
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Affiliation(s)
- Robert K McNamara
- Department of Psychiatry, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Horwitz SM, Demeter CA, Pagano ME, Youngstrom EA, Fristad MA, Arnold LE, Birmaher B, Gill MK, Axelson D, Kowatch RA, Frazier TW, Findling RL. Longitudinal Assessment of Manic Symptoms (LAMS) study: background, design, and initial screening results. J Clin Psychiatry 2010; 71:1511-7. [PMID: 21034684 PMCID: PMC3051351 DOI: 10.4088/jcp.09m05835yel] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe the design of a longitudinal study of youth with elevated symptoms of mania (ESM), as well as the prevalence and correlates of manic symptoms. Bipolar disorder in youth is serious and is surrounded by controversy about its phenomenology, course, and treatment. Yet, there are no longitudinal studies of youth selected only for ESM, the phenomenological hallmark. The study's objective is to document the rate and sociodemographic correlates of ESM in children attending outpatient psychiatric clinics. METHOD Parents of 3,329 children aged 6-12 years visiting 10 outpatient clinics were asked to complete the Parent General Behavior Inventory 10-Item Mania Scale (PGBI-10M). Children with PGBI-10M scores ≥ 12 (ESM positive-screen [ESM+]) and a matched sample of ESM screen-negative (ESM-) children were invited to enroll in the longitudinal study. The sample was accrued from November 14, 2005, to November 28, 2008. RESULTS Most of the children whose parents filled out the PGBI-10M (N = 2,622, 78.8%) participated in the study. Nonparticipants were slightly younger (mean age = 9.1 years [SD = 2.0 years] versus 9.4 years [SD = 2.0 years] for participants; t3327 = 4.42, P < .001). Nearly half of the participants (43%) were ESM+; these were more likely to be Latino (4.2% versus 2.5% for ESM-; χ(2)1 = 5.45, P = .02), younger (mean age = 9.3 years [SD = 2.0 years] versus 9.6 years [SD = 1.9 years] for ESM-; t2620 = 3.8, P < .001), and insured by Medicaid (48.4% versus 35.4% for ESM-; χ(2)1 = 45.00, P < .001). There were no sociodemographic differences between those who did versus did not agree to enroll in the longitudinal portion (yes to enrollment: n = 621, 55.2%; no to enrollment: n = 503, 44.8%). Four items best discriminated ESM+ children from ESM- children. Three of the 4 items were not the most commonly endorsed items, but all were indicative of behavioral extremes. CONCLUSIONS Data suggest that ESM+ is not rare in 6- to 12-year-olds. Children who are ESM+ show behavioral extremes, including rapid mood shifts, compared to ESM- children.
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Affiliation(s)
- Sarah McCue Horwitz
- Department of Pediatrics and Stanford Health Policy, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA 94305-6019, USA.
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Dejong M. Some reflections on the use of psychiatric diagnosis in the looked after or "in care" child population. Clin Child Psychol Psychiatry 2010; 15:589-99. [PMID: 20923905 DOI: 10.1177/1359104510377705] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The current classification system, DSM-IV, inadequately captures the range and type of psychopathology seen in the "in care" population of children. A combination of pre-natal influences, early interpersonal trauma involving the primary caregiving relationship, disturbed and disrupted attachment relationships and other significant losses and adverse environmental effects produce a complex constellation of symptoms and a pervasive impact on development that is difficult to categorize. The challenges facing DSM-V are illustrated, highlighting unresolved topics such as quasi-autism, reactive attachment disorder and complex trauma.
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Affiliation(s)
- Margaret Dejong
- Great Ormond Street Hospital, London, and the Institute of Child Health, UK.
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Dickstein DP, Finger EC, Brotman MA, Rich BA, Pine DS, Blair JR, Leibenluft E. Impaired probabilistic reversal learning in youths with mood and anxiety disorders. Psychol Med 2010; 40:1089-1100. [PMID: 19818204 PMCID: PMC3000432 DOI: 10.1017/s0033291709991462] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND From an affective neuroscience perspective, our understanding of psychiatric illness may be advanced by neuropsychological test paradigms probing emotional processes. Reversal learning is one such process, whereby subjects must first acquire stimulus/reward and stimulus/punishment associations through trial and error and then reverse them. We sought to determine the specificity of previously demonstrated reversal learning impairments in youths with bipolar disorder (BD) by now comparing BD youths to those with severe mood dysregulation (SMD), major depressive disorder (MDD), anxiety (ANX), and healthy controls. METHOD We administered the probabilistic response reversal (PRR) task to 165 pediatric participants aged 7-17 years with BD (n=35), SMD (n=35), ANX (n=42), MDD (n=18) and normal controls (NC; n=35). Our primary analysis compared PRR performance across all five groups matched for age, sex and IQ. RESULTS Compared to typically developing controls, probabilistic reversal learning was impaired in BD youths, with a trend in those with MDD (p=0.07). CONCLUSIONS Our results suggest that reversal learning deficits are present in youths with BD and possibly those with MDD. Further work is necessary to elucidate the specificity of neural mechanisms underlying such behavioral deficits.
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Affiliation(s)
- D P Dickstein
- National Institute of Mental Health (NIMH) Mood and Anxiety Disorders Program.
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Grimmer Y, Hohmann S, Banaschewski T, Holtmann M. Früh beginnende bipolare Störungen, ADHS oder Störung der Affektregulation? KINDHEIT UND ENTWICKLUNG 2010. [DOI: 10.1026/0942-5403/a000025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Die Arbeit gibt einen Überblick über die Hintergründe der Kontroverse und leitet daraus konkrete Schlussfolgerungen für die klinische Praxis ab. Bei der Diagnostik früher bipolarer Störungen ist vorrangig auf das Auftreten von abgrenzbaren Episoden mit eindeutigen Stimmungsänderungen und Veränderungen von Verhalten und Kognition zu achten. Das Mischbild aus ADHS und begleitender affektiver Dysregulation sollte nicht im Sinne einer beginnenden bipolaren Störung interpretiert werden, bedarf aber stärkerer Beachtung, insbesondere bei der Entwicklung geeigneter psycho- und pharmakotherapeutischer Ansätze. Erläutert werden zudem Gemeinsamkeiten und Unterschiede von bipolaren Störungen mit Schizophrenie, Depression, ADHS, Borderline-Persönlichkeitsstörung und Substanzmissbrauch.
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Affiliation(s)
- Yvonne Grimmer
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters am Zentralinstitut für Seelische Gesundheit Mannheim
| | - Sarah Hohmann
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters am Zentralinstitut für Seelische Gesundheit Mannheim
| | - Tobias Banaschewski
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters am Zentralinstitut für Seelische Gesundheit Mannheim
| | - Martin Holtmann
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters am Zentralinstitut für Seelische Gesundheit Mannheim
- Klinik für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik der LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum
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Birmaher B, Axelson D, Goldstein B, Monk K, Kalas C, Obreja M, Hickey MB, Iyengar S, Brent D, Shamseddeen W, Diler R, Kupfer D. Psychiatric disorders in preschool offspring of parents with bipolar disorder: the Pittsburgh Bipolar Offspring Study (BIOS). Am J Psychiatry 2010; 167:321-30. [PMID: 20080982 PMCID: PMC2868596 DOI: 10.1176/appi.ajp.2009.09070977] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors evaluated lifetime prevalence and specificity of DSM-IV psychiatric disorders and severity of depressive and manic symptoms at intake in preschool offspring of parents with bipolar I and II disorders. METHOD A total of 121 offspring ages 2-5 years from 83 parents with bipolar disorder and 102 offspring of 65 demographically matched comparison parents (29 with non-bipolar psychiatric disorders and 36 without any lifetime psychopathology) were recruited for the study. Parents with bipolar disorder were recruited through advertisements and adult outpatient clinics, and comparison parents were ascertained at random from the community. Participants were evaluated with standardized instruments. All staff were blind to parental diagnoses. RESULTS After adjustment for within-family correlations and both biological parents' non-bipolar psychopathology, offspring of parents with bipolar disorder, particularly those older than age 4, showed an eightfold greater lifetime prevalence of attention deficit hyperactivity disorder (ADHD) and significantly higher rates of having two or more psychiatric disorders compared to the offspring of the comparison parents. While only three offspring of parents with bipolar disorder had mood disorders, offspring of parents with bipolar disorder, especially those with ADHD and oppositional defiant disorder, had significantly more severe current manic and depressive symptoms than comparison offspring. CONCLUSIONS Preschool offspring of parents with bipolar disorder have an elevated risk for ADHD and have greater levels of subthreshold manic and depressive symptoms than children of comparison parents. Longitudinal follow-up is warranted to evaluate whether these children are at high risk for developing mood and other psychiatric disorders.
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Affiliation(s)
- Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
| | - David Axelson
- Department of Psychiatry, Western Psychiatric Institute and Clinic; University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Benjamin Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic; University of Pittsburgh Medical Center, Pittsburgh, PA, Department of Psychiatry, Sunnybrook Health Sciences Centre; Toronto, Canada
| | - Kelly Monk
- Department of Psychiatry, Western Psychiatric Institute and Clinic; University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Catherine Kalas
- Department of Psychiatry, Western Psychiatric Institute and Clinic; University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mihaela Obreja
- Department of Psychiatry, Western Psychiatric Institute and Clinic; University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mary Beth Hickey
- Department of Psychiatry, Western Psychiatric Institute and Clinic; University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Satish Iyengar
- Department of Psychiatry, Western Psychiatric Institute and Clinic; University of Pittsburgh Medical Center, Pittsburgh, PA, Department of Statistics, University of Pittsburgh, Pittsburgh, PA
| | - David Brent
- Department of Psychiatry, Western Psychiatric Institute and Clinic; University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Wael Shamseddeen
- Department of Psychiatry, Western Psychiatric Institute and Clinic; University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Rasim Diler
- Department of Psychiatry, Western Psychiatric Institute and Clinic; University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David Kupfer
- Department of Psychiatry, Western Psychiatric Institute and Clinic; University of Pittsburgh Medical Center, Pittsburgh, PA
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Walshaw PD, Alloy LB, Sabb FW. Executive function in pediatric bipolar disorder and attention-deficit hyperactivity disorder: in search of distinct phenotypic profiles. Neuropsychol Rev 2010; 20:103-20. [PMID: 20165924 PMCID: PMC2834768 DOI: 10.1007/s11065-009-9126-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 12/21/2009] [Indexed: 01/18/2023]
Abstract
Often, there is diagnostic confusion between bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD) in youth due to similar behavioral presentations. Both disorders have been implicated as having abnormal functioning in the prefrontal cortex; however, there may be subtle differences in the manner in which the prefrontal cortex functions in each disorder that could assist in their differentiation. Executive function is a construct thought to be a behavioral analogy to prefrontal cortex functioning. We provide a qualitative review of the literature on performance on executive function tasks for BD and ADHD in order to determine differences in task performance and neurocognitive profile. Our review found primary differences in executive function in the areas of interference control, working memory, planning, cognitive flexibility, and fluency. These differences may begin to establish a pediatric BD profile that provides a more objective means of differential diagnosis between BD and ADHD when they are not reliably distinguished by clinical diagnostic methods.
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Affiliation(s)
- Patricia D Walshaw
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, CA, USA.
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Abstract
BACKGROUND Mood lability is a concept widely used. However, data on its prevalence and morbid associations are scarce. We sought to establish the occurrence and importance of mood lability in a large community sample of children and adolescents by testing a priori hypotheses. METHOD Cross-sectional data were taken from a national mental health survey including 5326 subjects aged 8-19 years in the UK. The outcomes were prevalence and characteristics of mood lability and its associations with psychopathology and overall impairment. RESULTS Mood lability occurred in more than 5% of the population of children and adolescents, both by parent and self-report. Mood lability was strongly associated with a wide range of psychopathology and was linked to significant impairment even in the absence of psychiatric disorders. Mood lability was particularly strongly associated with co-morbidity between internalizing and externalizing disorders, even when adjusting for the association with individual disorders. The pattern of results did not change after excluding youth with bipolar disorder or with episodes of elated mood. CONCLUSIONS Clinically significant mood lability is relatively common in the community. Our findings indicate that mood lability is not a mere consequence of other psychopathology in that it is associated with significant impairment even in the absence of psychiatric diagnoses. Moreover, the pattern of association of mood lability with co-morbidity suggests that it could be a risk factor shared by both internalizing and externalizing disorders. Our data point to the need for greater awareness of mood lability and its implications for treatment.
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Affiliation(s)
- A Stringaris
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry at King's College London, 16 De Crespigny Park, Denmark Hill, London, UK.
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Luckenbaugh DA, Findling RL, Leverich GS, Pizzarello SM, Post RM. Earliest symptoms discriminating juvenile-onset bipolar illness from ADHD. Bipolar Disord 2009; 11:441-51. [PMID: 19500097 DOI: 10.1111/j.1399-5618.2009.00684.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Controversy surrounds the diagnosis and earliest symptoms of childhood-onset bipolar illness, emphasizing the importance of prospective longitudinal studies. To acquire a preliminary, more immediate view of symptom evolution, we examined the course of individual symptoms over the first 10 years of life in juvenile-onset bipolar illness (JO-BP) compared with attention-deficit hyperactivity disorder (ADHD). METHODS Parents of formally diagnosed children retrospectively rated 37 symptoms in each year of the child's life based on the degree of dysfunction in their child's usual family, social, or educational roles. A subset of children with onset of bipolar disorder prior to age 9 (JO-BP) compared with those with ADHD was the focus of this analysis. RESULTS Brief and extended periods of mood elevation and decreased sleep were strong early differentiators of JO-BP and ADHD children. Depressive and somatic symptoms were later differentiators. Irritability and poor frustration tolerance differentiated the two groups only in their greater incidence and severity in JO-BP compared with a moderate occurrence in ADHD. In contrast, hyperactivity, impulsivity, and decreased attention showed highly similar trajectories in the two groups. CONCLUSIONS Elevated mood and decreased sleep discriminated JO-BP and ADHD as early as age 3, while classic ADHD symptoms were parallel in the groups. These retrospective results provide preliminary insights into symptom differences and their temporal evolution between bipolar disorder and ADHD in the first 10 years of life.
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Affiliation(s)
- David A Luckenbaugh
- Mood and Anxiety Disorders Program, NIMH, NIH, Department of Health and Human Services, Bethesda, MD, USA
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Garber J, Frankel SA, Street BM. Construct validity of childhood bipolar disorder: A developmental perspective. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1468-2850.2009.01157.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Baroni A, Lunsford JR, Luckenbaugh DA, Towbin KE, Leibenluft E. Practitioner review: the assessment of bipolar disorder in children and adolescents. J Child Psychol Psychiatry 2009; 50:203-15. [PMID: 19309325 PMCID: PMC2786990 DOI: 10.1111/j.1469-7610.2008.01953.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND An increasing number of youth are being diagnosed with, and treated for, bipolar disorder (BD). Controversy exists about whether youth with non-episodic irritability and symptoms of attention deficit hyperactivity disorder (ADHD) should be considered to have a developmental presentation of mania. METHOD A selective review of the literature related to this question, along with recommendations to guide clinical assessment. RESULTS Data indicate differences between youth with episodic mania and those with non-episodic irritability in longitudinal diagnostic associations, family history, and pathophysiology. In youth with episodic mania, elation and irritability are both common during manic episodes. CONCLUSIONS In diagnosing mania in youth, clinicians should focus on the presence of episodes that consist of a distinct change in mood accompanied by concurrent changes in cognition and behavior. BD should not be diagnosed in the absence of such episodes. In youth with ADHD, symptoms such as distractibility and agitation should be counted as manic symptoms only if they are markedly increased over the youth's baseline symptoms at the same time that there is a distinct change in mood and the occurrence of other associated symptoms of mania. Although different techniques for diagnosing comorbid illnesses have not been compared systematically, it appears most rational to diagnose co-occurring illnesses such as ADHD only if the symptoms of the co-occurring illness are present when the youth is euthymic.
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Affiliation(s)
- Argelinda Baroni
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Jessica R. Lunsford
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - David A. Luckenbaugh
- Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Kenneth E. Towbin
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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Assessment and diagnostic issues in pediatric bipolar disorder. Arch Psychiatr Nurs 2008; 22:344-55. [PMID: 19026923 DOI: 10.1016/j.apnu.2007.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 08/23/2007] [Accepted: 08/25/2007] [Indexed: 11/23/2022]
Abstract
The purpose of this article is to provide clinicians with detailed information on pediatric bipolar disorder (PBD) in children and adolescents to aid in the accurate assessment and diagnosis of the disorder. PBD is a complex condition that presents with a wide array of features, making it a difficult disorder to diagnose and treat. The debilitating nature of PBD makes it necessary for clinicians to address the disorder as early as possible to help ensure positive outcomes. The assessment and diagnostic process is an integral step toward determining appropriate treatment interventions. This article presents an overview of the assessment and diagnostic process, including diagnostic criteria, epidemiology, comorbidities, differential diagnoses, and risk factors. The distinctive childhood features of PBD and the diagnostic controversies are also addressed.
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Affiliation(s)
- Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD 20892, USA.
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