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López-Díaz Á, Palermo-Zeballos FJ, Gutierrez-Rojas L, Alameda L, Gotor-Sánchez-Luengo F, Garrido-Torres N, Métrailler J, Alerci L, Bonnarel V, Cano-Domínguez P, Avanesi-Molina E, Soto-Ontoso M, Torrecilla-Olavarrieta R, Muñoz-Manchado LI, Torres-Hernández P, González-Higueras F, Prados-Ojeda JL, Herrera-Cortés M, Meca-García JM, Gordillo-Urbano RM, Sánchez-Robles C, Delgado-Durán T, Soriano-Peña MF, Golay P, Conus P, Crespo-Facorro B, Ruiz-Veguilla M. Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records. BJPsych Open 2024; 10:e22. [PMID: 38179604 PMCID: PMC10790217 DOI: 10.1192/bjo.2023.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/31/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research. AIMS This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery-Åsberg Depression Rating Scale (MADRS-6). METHOD A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation. RESULTS The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set. CONCLUSIONS The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings.
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Affiliation(s)
- Álvaro López-Díaz
- Mental Health Clinical Management Unit, Virgen Macarena University Hospital, Seville, Spain; Translational Psychiatry Research Group (PsyNal), Seville Biomedical Research Centre (IBiS), Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Seville, Spain; Department of Psychiatry, School of Medicine, University of Seville, Spain; and First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain
| | - Fernanda Jazmín Palermo-Zeballos
- Mental Health Clinical Management Unit, Virgen Macarena University Hospital, Seville, Spain; and First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain
| | - Luis Gutierrez-Rojas
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; Mental Health Clinical Management Unit, San Cecilio University Hospital, Granada, Spain; Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Spain; and Department of Psychiatry, University of Granada, Spain
| | - Luis Alameda
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, Switzerland; and Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Francisco Gotor-Sánchez-Luengo
- Department of Psychiatry, School of Medicine, University of Seville, Spain; First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - Nathalia Garrido-Torres
- Translational Psychiatry Research Group (PsyNal), Seville Biomedical Research Centre (IBiS), Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Seville, Spain; First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - Johann Métrailler
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Livia Alerci
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Vincent Bonnarel
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Pablo Cano-Domínguez
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Elma Avanesi-Molina
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Miguel Soto-Ontoso
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Torrecárdenas University Hospital, Almería, Spain
| | - Rocio Torrecilla-Olavarrieta
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Jerez University Hospital, Cádiz, Spain
| | - Leticia Irene Muñoz-Manchado
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Jerez University Hospital, Cádiz, Spain
| | - Pedro Torres-Hernández
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Jaén University Hospital, Spain
| | - Fermín González-Higueras
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Jaén University Hospital, Spain
| | - Juan Luis Prados-Ojeda
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - Mario Herrera-Cortés
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - José Miguel Meca-García
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Poniente University Hospital, Almería, Spain
| | - Rafael Manuel Gordillo-Urbano
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Infanta Margarita Hospital, Córdoba, Spain
| | - Cristina Sánchez-Robles
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Juan Ramón Jiménez Hospital, Huelva, Spain
| | - Tomás Delgado-Durán
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Juan Ramón Jiménez Hospital, Huelva, Spain
| | - María Felipa Soriano-Peña
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, San Agustín University Hospital, Linares, Spain
| | - Philippe Golay
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Benedicto Crespo-Facorro
- Translational Psychiatry Research Group (PsyNal), Seville Biomedical Research Centre (IBiS), Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Seville, Spain; Department of Psychiatry, School of Medicine, University of Seville, Spain; First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - Miguel Ruiz-Veguilla
- Translational Psychiatry Research Group (PsyNal), Seville Biomedical Research Centre (IBiS), Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Seville, Spain; Department of Psychiatry, School of Medicine, University of Seville, Spain; First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen del Rocío University Hospital, Seville, Spain
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Langfus JA, Chen YL, Janos JA, Youngstrom JK, Findling RL, Youngstrom EA. Psychometric Properties and Clinical Utility of CBCL and P-GBI Sleep Items in Children and Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-18. [PMID: 37972333 PMCID: PMC11096265 DOI: 10.1080/15374416.2023.2272965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Sleep is crucial to overall health, playing a complex role in a wide range of mental health concerns in children and adults. Nevertheless, clinicians may not routinely assess sleep problems due to lack of awareness or limitations such as cost or time. Scoring sleep-related items embedded on broader scales may help clinicians get more out of tools they are already using. The current study explores evidence of reliability, validity, and clinical utility of sleep-related items embedded on two caregiver-report tools: the Child Behavior Checklist (CBCL) and Parent General Behavior Inventory (P-GBI). METHOD Youth aged 5-18 years and their parents were recruited from both an academic medical center (N = 759) and an urban community health center (N = 618). Caregivers completed the CBCL and P-GBI as part of a more comprehensive outpatient evaluation. Exploratory factor analyses, multi-group confirmatory factor analyses, and graded response models evaluated dimensionality, reliability, and invariance across samples. Correlations and receiver operating characteristic curve analyses probed associations with diagnostic and demographic variables. RESULTS Two subscales emerged for each itemset. Across both samples, P-GBI sleep subscales were more reliable and consistent than CBCL sleep subscales, showed greater coverage of sleepiness and insomnia constructs, were better at discriminating individuals within a wider range of sleep complaints, and showed significant correlation with mood disorder diagnoses. CONCLUSIONS The P-GBI sleep items provide a brief, reliable measure for assessing distinct dimensions of sleep complaints and detecting mood symptoms or diagnoses related to the youth's sleep functioning, making them a useful addition to clinical practice.
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Affiliation(s)
- Joshua A. Langfus
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yen-Ling Chen
- Department of Psychology, University of Nevada, Las Vegas, NV
| | - Jessica A. Janos
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer K. Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Robert L. Findling
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA
| | - Eric A. Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Helping Give Away Psychological Science, 501c3
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Gu W, Zhao Q, Yuan C, Yi Z, Zhao M, Wang Z. Impact of adverse childhood experiences on the symptom severity of different mental disorders: a cross-diagnostic study. Gen Psychiatr 2022; 35:e100741. [PMID: 35572774 PMCID: PMC9036421 DOI: 10.1136/gpsych-2021-100741] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/24/2022] [Indexed: 11/27/2022] Open
Abstract
Background Adverse childhood experiences have a significant impact on different mental disorders. Objective To compare differences in adverse childhood experiences among those with different mental disorders and their relationships in a cross-disorder manner. Methods The study included 1513 individuals aged ≥18 years : 339 patients with substance use disorders, 125 patients with schizophrenia, 342 patients with depression, 136 patients with bipolar disorder, 431 patients with obsessive-compulsive disorder (OCD), and 140 healthy controls. The Early Trauma Inventory Self Report-Short Form was used to investigate childhood traumatic experiences, and the Addiction Severity Index, Positive and Negative Syndrome Scale, Hamilton Depression Scale, Young Mania Rating Scale, and Yale-Brown Obsessive-Compulsive Scale were used to assess mental disorder severity. Correlation and multivariate logistic regression were analysed between adverse childhood experiences and clinical features. Results Levels of adverse childhood experiences were significantly different among different mental disorders. Moreover, 25.8% of patients with substance use disorders reported childhood trauma, which was significantly higher than found in the other four psychiatric disorder groups. Emotional abuse scores were positively correlated with disease severity: the higher the total trauma score, the more severe the mental disorder. Conclusions Adverse childhood experiences are a common phenomenon in those with mental disorders, and the level of trauma affects mental disorder severity. Emotional abuse is closely related to many mental disorders. The incidence or severity of mental disorders can be reduced in the future by reducing the incidence of adverse childhood experiences or by timely intervention in childhood trauma.
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Affiliation(s)
- Wenjie Gu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengmei Yuan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenghui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wozniak J, DiSalvo M, Farrell A, Vaudreuil C, Uchida M, Ceranoglu TA, Joshi G, Cook E, Faraone SV, Biederman J. Findings from a pilot open-label trial of N-acetylcysteine for the treatment of pediatric mania and hypomania. BMC Psychiatry 2022; 22:314. [PMID: 35505312 PMCID: PMC9066881 DOI: 10.1186/s12888-022-03943-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 04/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pediatric bipolar disorder is a highly prevalent and morbid disorder and is considered a prevalent public health concern. Currently approved treatments often pose the risk of serious side effects. Therefore, this study assessed the efficacy and tolerability of N-acetylcysteine (NAC), in children and adolescents with bipolar spectrum disorder. METHODS We conducted a 12-week open-label trial of NAC for treatment of mania and hypomania in children and adolescents ages 5-17 with bipolar spectrum disorder including participants with full and subthreshold manic symptoms, accepting those with and without mixed states with co-occurring depression, and Young Mania Rating Scale scores ≥ 20 and < 40. Symptoms of mania and depression were assessed using the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Children's Depression Rating Scale (CDRS), and Clinical Global Impression (CGI) Severity (CGI-S) and Improvement (CGI-I) scales for mania and depression. RESULTS This study had a high drop-out rate with only 53% completing all 12 weeks. There was a significant reduction in YMRS, HDRS, and CDRS mean scores from baseline to endpoint. Of the 24 exposed participants, 54% had an anti-manic response measured by a reduction in YMRS ≥ 30% and 46% had a CGI-I mania score ≤ 2 at endpoint. Additionally, 62% of participants had an anti-depressive response measured by a reduction in HDRS ≥ 30%, 31% had an anti-depressive response measured by a reduction in CDRS ≥ 30%, and 38% had a CGI-I depression score ≤ 2 at endpoint. CONCLUSIONS These pilot open-label findings in a small sample provide preliminary data supporting the tolerability and safety of NAC in a pediatric population. The findings of this pilot scale study indicating improvement in mania and depression are promising, but require replication with a monotherapy randomized placebo controlled clinical trial and larger sample. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02357290 . First Registration 06/02/2015.
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Affiliation(s)
- Janet Wozniak
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit St., Warren 705, Boston, MA, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Maura DiSalvo
- grid.32224.350000 0004 0386 9924Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit St., Warren 705, Boston, MA USA
| | - Abigail Farrell
- grid.32224.350000 0004 0386 9924Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit St., Warren 705, Boston, MA USA
| | - Carrie Vaudreuil
- grid.32224.350000 0004 0386 9924Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit St., Warren 705, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Mai Uchida
- grid.32224.350000 0004 0386 9924Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit St., Warren 705, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - T. Atilla Ceranoglu
- grid.32224.350000 0004 0386 9924Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit St., Warren 705, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Gagan Joshi
- grid.32224.350000 0004 0386 9924Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit St., Warren 705, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Emmaline Cook
- grid.32224.350000 0004 0386 9924Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit St., Warren 705, Boston, MA USA
| | - Stephen V. Faraone
- grid.411023.50000 0000 9159 4457Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY USA
| | - Joseph Biederman
- grid.32224.350000 0004 0386 9924Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit St., Warren 705, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
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Wozniak J, DiSalvo M, Farrell A, Yule A, Joshi G, Cook E, Faraone SV, Biederman J. Can pediatric bipolar disorder be successfully treated when comorbid with conduct disorder? A secondary analysis of clinical trials of risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole. J Psychopharmacol 2022; 36:637-644. [PMID: 35510655 DOI: 10.1177/02698811221087673] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pediatric bipolar disorder (BP) is frequently comorbid with conduct disorder (CD) and its presence adds to the morbidity of BP. While there are no known pharmacological treatments for CD, pediatric BP is responsive to treatment with medications initially indicated for the treatment of psychosis, several of which have Food and Drug Administration (FDA) approval for the treatment of pediatric mania. AIMS The main aim of this secondary analysis was to examine whether pediatric BP comorbid with CD responds similarly to treatment with such selected medications. Considering the well-documented morbidity of CD, this finding could have important clinical and public health significance. METHODS We conducted a secondary analysis of six prospective 8-week open-label trials of selected medications (risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole) using identical methodology in youth with BP with and without comorbid CD. Results: Of 165 youths with BP, 54% (N = 89) met criteria for comorbid CD. The antimanic effects observed did not significantly differ between BP youths with and without comorbid CD, as measured either by a reduction in Young Mania Rating Scale (YMRS) ⩾ 30% or Clinical Global Impression (CGI)-Improvement ⩽ 2 (p = 0.23), or by the more stringent definition of a reduction in YMRS ⩾ 50% (p = 0.61). CONCLUSION Pediatric BP can be effectively treated with the abovementioned medications in the context of comorbid CD. Based on previous research showing that remission of BP is associated with remission of CD, if confirmed, these findings raise the possibility that antimanic treatment of youth with BP comorbid with CD could have secondary benefits in mitigating the morbidity associated with CD. This is a pilot scale finding, the results of which are promising and should be confirmed by larger and long-term follow-up studies.
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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
| | - Amy Yule
- 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
| | - 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
| | - Emmaline Cook
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen V Faraone
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, 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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Zhang N, Niu Y, Sun J, An W, Li D, Wei J, Yan T, Xiang J, Wang B. Altered Complexity of Spontaneous Brain Activity in Schizophrenia and Bipolar Disorder Patients. J Magn Reson Imaging 2021; 54:586-595. [PMID: 33576137 DOI: 10.1002/jmri.27541] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Schizophrenia (SC) and bipolar disorder (BP) share elements of symptoms and the underlying neural mechanisms for both remain unclear. Recently, the complexity of spontaneous functional MRI (fMRI) signals in brain activity has been investigated in SC and BP using multiscale sample entropy (MSE) with inconsistent results. PURPOSE To perform MSE analysis across five time scales to assess differences in resting-state fMRI signal complexity in SC, BP, and normal controls (NC). STUDY TYPE Retrospective. POPULATION Fifty SC, 49 BP, and 49 NC. FIELD STRENGTH/SEQUENCE A 3 T, T2* weighted echo planar imaging (EPI) sequence. ASSESSMENT The mean MSEs of all gray matter (GM) and of 12 regions of interest (ROIs) were extracted using masks across the five scales. The regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) in these ROIs were also determined and the relationship between the three measures was investigated. The correlations between cognitive assessment scores and MSE values were also explored. STATISTICAL TESTS Bonferroni correction, One-way ANOVA, Spearman rank correlation coefficient (r), Gaussian random field (GRF) correction. RESULTS There were decreased GM MSE values in the patient groups (F = 9.629, P < 0.05). SC and BP patients demonstrated lower complexity than NCs in the calcarine fissure, precuneus, inferior occipital gyrus, lingual gyrus and cerebellum, and higher complexity in the median cingulate, thalamus, hippocampus, middle temporal gyrus and middle frontal gyrus. There were significant differences between SC and BP patients in the precuneus (F = 4.890, P < 0.05) and inferior occipital gyrus (F = 5.820, P < 0.05). Calcarine fissure, cingulate, temporal gyrus, occipital gyrus, hippocampus, precuneus, frontal gyrus, and lingual gyrus MSE values were significantly correlated with both ReHo (r > 0.282, P < 0.05) and ALFF (r > 0.278, P < 0.05). Furthermore, median temporal MSE (r = -0.321, P < 0.05) on scale 3 and (r = -0.307, P < 0.05) on scale 4 and median cingulate MSE (r = -0.337, P < 0.05) on scale 5 was significantly negatively correlated with cognitive assessment scores. DATA CONCLUSION These data highlight different patterns of brain signal intensity complexity in SC and BP. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Nan Zhang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Yan Niu
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Jie Sun
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Weichao An
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Dandan Li
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Jing Wei
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Ting Yan
- Translational Medicine Research Center, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jie Xiang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Bin Wang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, Shanxi, China
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Jeffrey J, Klomhaus A, Enenbach M, Lester P, Krishna R. Self-Report Rating Scales to Guide Measurement-Based Care in Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am 2020; 29:601-629. [PMID: 32891365 DOI: 10.1016/j.chc.2020.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Measurement-based care involves the practice of systematically administrating rating scales to patients in order to use the collected information to enhance clinical evaluation, monitor treatment progress, and directly inform decisions relating to each patient's treatment. Rating scales must be psychometrically validated and efficiently administered within the practice setting. Brief rating scales that are available within the public domain may help to optimize workflows and prevent response fatigue. Clinicians should also have a sufficient understanding of the underlying psychometric properties of rating scales to accurately interpret changes in scores over time and use these results to appropriately direct care.
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Affiliation(s)
- Jessica Jeffrey
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, Nathanson Family Resilience Center, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, A8-153, Los Angeles, CA 90095, USA.
| | - Alexandra Klomhaus
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, Nathanson Family Resilience Center, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, A8-153, Los Angeles, CA 90095, USA; Department of Biostatistics, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, Los Angeles, CA 90095, USA
| | - Michael Enenbach
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, Nathanson Family Resilience Center, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, A8-153, Los Angeles, CA 90095, USA; Department of Psychiatry & Biobehavioral Sciences, Division of Child and Adolescent Psychiatry, Jane and Terry Semel Institute of Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, 48-270, Los Angeles, CA 90095, USA
| | - Patricia Lester
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, Nathanson Family Resilience Center, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, A8-153, Los Angeles, CA 90095, USA
| | - Rajeev Krishna
- Psychiatry and Behavioral Health, Nationwide Children's Hospital, Psychiatry T5, 700 Children's Drive, Columbus, OH 43205, USA
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Muratori F, Santocchi E, Calderoni S. Psychiatric assessment. HANDBOOK OF CLINICAL NEUROLOGY 2020; 174:217-238. [PMID: 32977880 DOI: 10.1016/b978-0-444-64148-9.00016-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies have consistently reported an increased prevalence of psychiatric comorbidity (PC) in individuals with neurodevelopmental disorders (NDDs) compared with typically developing controls, with high rates of anxiety disorders in autism spectrum disorders and challenging behaviors in children and adolescent with intellectual disability. Psychiatric assessment in this population should include multiple sources of information, derived from multiple contexts and using multiple methods, with accurate detection of contributing and trigger factors. It is important to focus on detecting change from the child's baseline functioning and to use, when possible, ad hoc instruments for assessing PC in the NDD population. Modifications in the setting and assessment procedures should be scheduled based on the child's age, developmental level, and sensory sensitivities. Simultaneously, validated screening instruments, which dimensionally assess the symptomatology of several NDDs and psychiatric disorders, are warranted to not only assist in the identification of PCs in NDDs but also discriminate among different NDDs. Changes from DSM-IV-TR to DSM-5 have had an impact on the diagnosis of several disorders in children and adolescents and, subsequently, on the current diagnostic tools, requiring appropriate and prompt modifications of the available instruments.
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Affiliation(s)
- Filippo Muratori
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisa Santocchi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Calderoni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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9
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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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10
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Findling RL. Update on the treatment of bipolar disorder in children and adolescents. Eur Psychiatry 2020; 20:87-91. [PMID: 15797690 DOI: 10.1016/j.eurpsy.2004.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Accepted: 12/30/2004] [Indexed: 10/25/2022] Open
Abstract
AbstractAs the phenomenology of pediatric bipolar disorder has become better delineated, clinicians are now able to more accurately assess and treat young people suffering from this condition. For pediatric patients with bipolar I disorder and symptoms of mania, medication monotherapy has been shown to lead to symptom amelioration. However, this treatment modality oftentimes does not lead to full symptom remission. In an attempt to address this observation, combination treatment strategies have recently been investigated. Recently, a maintenance study has shown that in youths who achieved remission on a combination of lithium and divalproate therapy, either of these agents alone was equally effective as a treatment strategy. In youths identified as being at genetic high risk for bipolarity who also had problematic affective symptomatology, treatment with divalproate was not found to be superior to placebo; however, those with the greatest degree of genetic risk for familial psychopathology remained in the trial longer than those with more modest amounts of familial psychopathology. These data suggest that intervention in youths with only one affected parent may not be a rational prevention strategy for pharmacological intervention in bipolar disorder, and that cohorts more genetically at risk may be a more appropriate group for preventative pharmacotherapy.
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Affiliation(s)
- Robert L Findling
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106-5080, USA.
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11
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Lower estimated intelligence quotient is associated with suicide attempts in pediatric bipolar disorder. J Affect Disord 2020; 261:103-109. [PMID: 31610309 DOI: 10.1016/j.jad.2019.09.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/28/2019] [Accepted: 09/30/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Approximately 20% of individual with pediatric bipolar disorder (PBD) have a lifetime history of suicide attempt. Some cognitive measures were associated with a suicide attempt, but no study has assessed the association of this event with the estimated intelligence quotient (IQ) in PBI. In adult Bipolar Disorder no association between IQ and suicidality was found, with different correlations between cognitive measures. There are studies in general population showing a negative correlation and others did not find any association. In Schizophrenia, IQ had a positive correlation with suicide attempt. So, the correlation between IQ and suicidality still controversial. METHODS We recruited 63 children and adolescents younger than 18 years of age with PBD based on DSM-IV criteria from an outpatient clinic in Brazil. Manic and depressive symptoms were assessed with the YMRS and CDRS, respectively. Estimated IQ was assessed with the WISC-III. The presence or absense of suicidal attempt, clinical and demographic variables were assessed with the K-SADS-PL-W. RESULTS Patients who attempted suicide had lower estimated IQ compared to patients who did not attempt suicide (82.72 ± 18.70 vs. 101.0 ± 14.36; p = 0.009). This finding remained after correction for depressive symptoms and family income (OR = 0.94; 95% CI = 0.89 - 0.99; p = 0.029). LIMITATIONS Small sample, reverse causality could not be discarded, we only used two subscales of the WISC-III to estimate intelligence. CONCLUSION Estimated IQ and suicide attempts were negative correlated in PBD. Future longitudinal and larger studies may confirm our findings.
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12
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Black SR, Blampied N, Arnold LE, Fristad MA. Is evidence‐based treatment helping my patient? Utilizing modified Brinley plots to measure clinical change. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2019; 26. [DOI: 10.1111/cpsp.12272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Reinertsen E, Clifford GD. A review of physiological and behavioral monitoring with digital sensors for neuropsychiatric illnesses. Physiol Meas 2018; 39:05TR01. [PMID: 29671754 PMCID: PMC5995114 DOI: 10.1088/1361-6579/aabf64] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Physiological, behavioral, and psychological changes associated with neuropsychiatric illness are reflected in several related signals, including actigraphy, location, word sentiment, voice tone, social activity, heart rate, and responses to standardized questionnaires. These signals can be passively monitored using sensors in smartphones, wearable accelerometers, Holter monitors, and multimodal sensing approaches that fuse multiple data types. Connection of these devices to the internet has made large scale studies feasible and is enabling a revolution in neuropsychiatric monitoring. Currently, evaluation and diagnosis of neuropsychiatric disorders relies on clinical visits, which are infrequent and out of the context of a patient's home environment. Moreover, the demand for clinical care far exceeds the supply of providers. The growing prevalence of context-aware and physiologically relevant digital sensors in consumer technology could help address these challenges, enable objective indexing of patient severity, and inform rapid adjustment of treatment in real-time. Here we review recent studies utilizing such sensors in the context of neuropsychiatric illnesses including stress and depression, bipolar disorder, schizophrenia, post traumatic stress disorder, Alzheimer's disease, and Parkinson's disease.
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Affiliation(s)
- Erik Reinertsen
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America
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14
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Sapmaz D, Baykal S, Akbaş S. The Clinical Features of Comorbid Pediatric Bipolar Disorder in Children with Autism Spectrum Disorder. J Autism Dev Disord 2018; 48:2800-2808. [DOI: 10.1007/s10803-018-3541-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Pediatric Bipolar Disorder: A Case Presentation and Discussion. J Pediatr Health Care 2018; 32:201-206. [PMID: 29126592 DOI: 10.1016/j.pedhc.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/03/2017] [Accepted: 09/07/2017] [Indexed: 11/21/2022]
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16
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An Examination of Fluoxetine for the Treatment of Selective Mutism Using a Nonconcurrent Multiple-Baseline Single-Case Design Across 5 Cases. J Psychiatr Pract 2018; 24:2-14. [PMID: 29320378 DOI: 10.1097/pra.0000000000000284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined the utility of fluoxetine in the treatment of 5 children, aged 5 to 14 years, diagnosed with selective mutism who also demonstrated symptoms of social anxiety. A nonconcurrent, randomized, multiple-baseline, single-case design with a single-blind placebo-controlled procedure was used. Parents and the study psychiatrist completed multiple methods of assessment including Direct Behavior Ratings and questionnaires. Treatment outcomes were evaluated by calculating effect sizes for each participant as an individual and for the participants as a group. Information regarding adverse effects with an emphasis on behavioral disinhibition and ratings of parental acceptance of the intervention was gathered. All 5 children experienced improvement in social anxiety, responsive speech, and spontaneous speech with medium to large effect sizes; however, children still met criteria for selective mutism at the end of the study. Adverse events were minimal, with only 2 children experiencing brief occurrences of minor behavioral disinhibition. Parents found the treatment highly acceptable.
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17
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Lippard ETC, Mazure CM, Johnston JAY, Spencer L, Weathers J, Pittman B, Wang F, Blumberg HP. Brain circuitry associated with the development of substance use in bipolar disorder and preliminary evidence for sexual dimorphism in adolescents. J Neurosci Res 2017; 95:777-791. [PMID: 27870392 DOI: 10.1002/jnr.23901] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/29/2016] [Accepted: 08/05/2016] [Indexed: 02/06/2023]
Abstract
Substance use disorders and mood disorders are highly comorbid and confer a high risk for adverse outcomes. However, data are limited on the neurodevelopmental basis of this comorbidity. Substance use initiation typically occurs during adolescence, and sex-specific developmental mechanisms are implicated. In this preliminary study, we review the literature and investigate regional gray matter volume (GMV) associated with subsequent substance use problems in adolescents with bipolar disorder (BD) and explore these associations for females and males. Thirty adolescents with DSM-IV-diagnosed BD and minimal alcohol/substance exposure completed baseline structural magnetic resonance imaging scans. At follow-up (on average 6 years post baseline), subjects were administered the CRAFFT interview and categorized into those scoring at high ( ≥ 2: CRAFFTHIGH ) vs. low ( < 2: CRAFFTLOW ) risk for alcohol/substance problems. Lower GMV in prefrontal, insular, and temporopolar cortices were observed at baseline among adolescents with BD reporting subsequent alcohol and cannabis use compared to adolescents with BD who did not (P < 0.005, clusters ≥ 20 voxels). Lower dorsolateral prefrontal GMV was associated with future substance use in both females and males. In females, lower orbitofrontal and insula GMV was associated with future substance use, while in males, lower rostral prefrontal GMV was associated with future use. Lower orbitofrontal, insular, and temporopolar GMV was observed in those who transitioned to smoking tobacco. Findings indicate that GMV development is associated with risk for future substance use problems in adolescents with BD, with results implicating GMV development in regions subserving emotional regulation in females and regions subserving executive processes and attention in males. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Elizabeth T C Lippard
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Carolyn M Mazure
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Women's Health Research at Yale, Yale School of Medicine, New Haven, Connecticut
| | | | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Judah Weathers
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Fei Wang
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.,Women's Health Research at Yale, Yale School of Medicine, New Haven, Connecticut.,Child Study Center, Yale School of Medicine, New Haven, Connecticut
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18
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Stevanovic D, Jafari P, Knez R, Franic T, Atilola O, Davidovic N, Bagheri Z, Lakic A. Can we really use available scales for child and adolescent psychopathology across cultures? A systematic review of cross-cultural measurement invariance data. Transcult Psychiatry 2017; 54:125-152. [PMID: 28157447 DOI: 10.1177/1363461516689215] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In this systematic review, we assessed available evidence for cross-cultural measurement invariance of assessment scales for child and adolescent psychopathology as an indicator of cross-cultural validity. A literature search was conducted using the Medline, PsychInfo, Scopus, Web of Science, and Google Scholar databases. Cross-cultural measurement invariance data was available for 26 scales. Based on the aggregation of the evidence from the studies under review, none of the evaluated scales have strong evidence for cross-cultural validity and suitability for cross-cultural comparison. A few of the studies showed a moderate level of measurement invariance for some scales (such as the Fear Survey Schedule for Children-Revised, Multidimensional Anxiety Scale for Children, Revised Child Anxiety and Depression Scale, Revised Children's Manifest Anxiety Scale, Mood and Feelings Questionnaire, and Disruptive Behavior Rating Scale), which may make them suitable in cross-cultural comparative studies. The remainder of the scales either showed weak or outright lack of measurement invariance. This review showed only limited testing for measurement invariance across cultural groups of scales for pediatric psychopathology, with evidence of cross-cultural validity for only a few scales. This study also revealed a need to improve practices of statistical analysis reporting in testing measurement invariance. Implications for future research are discussed.
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Affiliation(s)
| | | | | | | | | | | | | | - Aneta Lakic
- Clinic for Neurology and Psychiatry for Children and Youth
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19
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Abstract
A reproducible characteristic of early-onset bipolar disorder (BPD) is its atypicality when compared to the adult form. Research and practice consistently confirms early-onset BPD to be chronic rather than acute and continuous rather than episodic, with mixed manic states rather than biphasic and multifarious patterns of comorbidity. Research into successful psychotropic treatments for early-onset BPD is on-going and diverse. Similarly, psychosocial interventions are in the prototype phase. This school-based case study follows an 18-month course of treatment for a 16-year-old female with early-onset BPD comorbid with attentiondeficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder, and situationally predisposed panic attacks. The first 6 months of treatment involved no medications. During this time, intensive psychosocial and cognitive-behavioral interventions including affect-regulation training, behavior modification, self-monitoring, contingency management, educational accommodations, emergency classroom protocols, and intensive psychotherapy were successfully implemented. In the second phase of treatment, after numerous unsuccessful psychotropic trials, the client's mood was stabilized with gabapentin (Neurontin), with methylphenidate (Ritalin) being added to treat her ADHD with astounding results.
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20
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Storch EA, Bussing R, Jacob ML, Nadeau JM, Crawford E, Mutch PJ, Mason D, Lewin AB, Murphy TK. Frequency and correlates of suicidal ideation in pediatric obsessive-compulsive disorder. Child Psychiatry Hum Dev 2015; 46:75-83. [PMID: 24682580 PMCID: PMC4179999 DOI: 10.1007/s10578-014-0453-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study examined the frequency and sociodemographic and clinical correlates of suicidal ideation in a sample of children and adolescents with obsessive-compulsive disorder (OCD). Fifty-four youth with OCD and their parent(s) were administered the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime, Children's Yale-Brown Obsessive Compulsive Scale, and Children's Depression Rating Scale-Revised. Children completed the Suicidal Ideation Questionnaire-Junior (SIQ-JR), Child Obsessive Compulsive Impact Scale-Child, and Multidimensional Anxiety Scale for Children; parents completed the Child Obsessive Compulsive Impact Scale-Parent, Swanson, Nolan, and Pelham-IV Parent Scale, and Young Mania Rating Scale-Parent Version. Seven youth endorsed clinically significant levels of suicidal ideation on the SIQ-JR. Suicidal ideation was significantly related to clinician-rated depressive symptoms, age, child-rated impairment and anxiety symptoms, and symmetry, sexuality/religiosity and miscellaneous symptom dimensions. There was no significant association between suicidal ideation and obsessive-compulsive symptom severity, comorbidity patterns, or several parent-rated indices (e.g., impairment, impulsivity). These results provide initial information regarding the frequency and correlates of suicidal ideation in treatment-seeking youth with OCD. Clinical implications are discussed, as well as directions for future research.
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Affiliation(s)
| | | | | | | | | | - P. Jane Mutch
- Department of Pediatrics, University of South Florida
| | - Dana Mason
- Department of Psychiatry, University of Florida
| | - Adam B. Lewin
- Department of Pediatrics, University of South Florida
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21
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Beidas RS, Stewart RE, Walsh L, Lucas S, Downey MM, Jackson K, Fernandez T, Mandell DS. Free, brief, and validated: Standardized instruments for low-resource mental health settings. COGNITIVE AND BEHAVIORAL PRACTICE 2015; 22:5-19. [PMID: 25642130 PMCID: PMC4310476 DOI: 10.1016/j.cbpra.2014.02.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Evidence-based assessment has received little attention despite its critical importance to the evidence-based practice movement. Given the limited resources in the public sector, it is necessary for evidence-based assessment to utilize tools with established reliability and validity metrics that are free, easily accessible, and brief. We review tools that meet these criteria for youth and adult mental health for the most prevalent mental health disorders to provide a clinical guide and reference for the selection of assessment tools for public sector settings. We also discuss recommendations for how to move forward the evidence-based assessment agenda.
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Affiliation(s)
- Rinad S. Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA
| | - Rebecca E. Stewart
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA
| | - Lucia Walsh
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA
| | - Steven Lucas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA
- Graduate School of Education, University of Pennsylvania, Philadelphia, PA
| | - Margaret Mary Downey
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA
| | - Kamilah Jackson
- Department of Behavioral Health and Intellectual DisAbility Services, Philadelphia, PA
| | - Tara Fernandez
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA
| | - David S. Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA
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22
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Renk K, White R, Lauer BA, McSwiggan M, Puff J, Lowell A. Bipolar disorder in children. PSYCHIATRY JOURNAL 2014; 2014:928685. [PMID: 24800202 PMCID: PMC3994906 DOI: 10.1155/2014/928685] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 12/21/2013] [Indexed: 12/31/2022]
Abstract
Although bipolar disorder historically was thought to only occur rarely in children and adolescents, there has been a significant increase in children and adolescents who are receiving this diagnosis more recently (Carlson, 2005). Nonetheless, the applicability of the current bipolar disorder diagnostic criteria for children, particularly preschool children, remains unclear, even though much work has been focused on this area. As a result, more work needs to be done to further the understanding of bipolar symptoms in children. It is hoped that this paper can assist psychologists and other health service providers in gleaning a snapshot of the literature in this area so that they can gain an understanding of the diagnostic criteria and other behaviors that may be relevant and be informed about potential approaches for assessment and treatment with children who meet bipolar disorder criteria. First, the history of bipolar symptoms and current diagnostic criteria will be discussed. Next, assessment strategies that may prove helpful for identifying bipolar disorder will be discussed. Then, treatments that may have relevance to children and their families will be discussed. Finally, conclusions regarding work with children who may have a bipolar disorder diagnosis will be offered.
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Affiliation(s)
- Kimberly Renk
- University of Central Florida, P.O. Box 161390, Orlando, FL 32816, USA
| | - Rachel White
- University of Central Florida, P.O. Box 161390, Orlando, FL 32816, USA
| | - Brea-Anne Lauer
- University of Central Florida, P.O. Box 161390, Orlando, FL 32816, USA
| | - Meagan McSwiggan
- University of Central Florida, P.O. Box 161390, Orlando, FL 32816, USA
| | - Jayme Puff
- University of Central Florida, P.O. Box 161390, Orlando, FL 32816, USA
| | - Amanda Lowell
- University of Central Florida, P.O. Box 161390, Orlando, FL 32816, USA
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23
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Mazzone L, Postorino V, De Peppo L, Fatta L, Lucarelli V, Reale L, Giovagnoli G, Vicari S. Mood symptoms in children and adolescents with autism spectrum disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3699-3708. [PMID: 24029798 DOI: 10.1016/j.ridd.2013.07.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/30/2013] [Accepted: 07/30/2013] [Indexed: 05/28/2023]
Abstract
Asperger Syndrome (AS) and High Functioning Autism (HFA) are psychiatric conditions belonging to the Autistic Spectrum Disorders (ASDs), characterized by social dysfunction and focused interest, in the absence of mental retardation. Previous reports suggest that AS/HFA may be associated with important psychiatric comorbidities. Among the psychiatric internalizing disorders, depression and anxiety are probably the most common disorders. The aim of this study is to evaluate the prevalence of mood disorders and identifying peculiar clinical features in subjects suffering from AS and HFA. 30 male patients with AS/HFA, 30 male patients affected by Major Depression (MD) and 35 male Typically Developing (TD) comparison were assessed with the CDI and the CDRS-R. Participants' parents were invited to complete the CBCL and the P-YMRS. Moreover, the CGAS was rated by the clinicians. The evaluation of depressive symptoms showed that AS/HFA group reported higher depressive symptoms, as showed by CDI total, CBCL internalizing and CDRS-R total, compared to the TD group. No significant difference of depressive symptoms was found between the AS/HFA and the MD group, with the exception of CDRS-R total score. Moreover, linear regression analysis in the AS/HFA group between CGAS and depressive symptoms revealed that a higher level of depressive symptoms increased the risk of poorer global functioning. These results suggest that the depressive symptoms in AS/HFA patients may be associated with poorer global functioning, with a consequent impairment in their psychological profile and social adjustment, and should alert clinicians to the importance of assessing mood disorders in order to choose the appropriate treatment.
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Affiliation(s)
- Luigi Mazzone
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children's Hospital Bambino Gesù, Rome, Italy.
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24
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Adelson S, Bell R, Graff A, Goldenberg D, Haase E, Downey JI, Friedman RC. Is increased sexual behavior a symptom of bipolar disorder in children and adolescents? Psychodyn Psychiatry 2013; 41:419-35. [PMID: 24001164 DOI: 10.1521/pdps.2013.41.3.419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
While there is consensus that bipolar disorder exists in children and adolescents, its diagnostic criteria are debated. Excessive sexual behavior has been reported in youth who may have juvenile bipolar disorder (JBD), and has been termed "hypersexuality." Although there is no universal definition of this term, this observation has led to a hypothesis that increased sexual behavior characterizes the bipolar syndrome in children and adolescents, and differentiates it from attention deficit hyperactivity disorder. Although this hypothesis is plausible, evidence for it is incomplete, because testing it definitively would require both establishing a standard definition of hypersexuality in children and adolescents, and also reaching consensus about the other nonsexual criteria for pediatric bipolar disorder. In addition, studies to test it would need to control factors other than JBD that are known to increase sexual behavior in children and adolescents. These include sexual abuse and related posttraumatic stress disorder, excessive exposure to sexual stimuli, psychiatric illness in general, and social variables such as family chaos and social stress. Some of these factors might increase sexual behavior in youth with bipolar disorder through psychodynamic mechanisms rather than as a result of the illness itself. Therefore, further research is needed to determine whether increased sexual behavior can serve as a diagnostically valuable criterion for bipolar disorder in children and adolescents, and whether it differentiates the disorder from other conditions known to be associated with increased sexual behavior in youth.
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Affiliation(s)
- Stewart Adelson
- Divisions of Child and Adolescent Psychiatry and of Gender, Sexuality and Health, Columbia University College of Physicians and Surgeons, USA.
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25
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Papachristou E, Ormel J, Oldehinkel AJ, Kyriakopoulos M, Reinares M, Reichenberg A, Frangou S. Child Behavior Checklist-Mania Scale (CBCL-MS): development and evaluation of a population-based screening scale for bipolar disorder. PLoS One 2013; 8:e69459. [PMID: 23967059 PMCID: PMC3743889 DOI: 10.1371/journal.pone.0069459] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 06/10/2013] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Early identification of Bipolar Disorder (BD) remains poor despite the high levels of disability associated with the disorder. OBJECTIVE We developed and evaluated a new DSM orientated scale for the identification of young people at risk for BD based on the Child Behavior Checklist (CBCL) and compared its performance against the CBCL-Pediatric Bipolar Disorder (CBCL-PBD) and the CBCL-Externalizing Scale, the two most widely used scales. METHODS The new scale, CBCL-Mania Scale (CBCL-MS), comprises 19 CBCL items that directly correspond to operational criteria for mania. We tested the reliability, longitudinal stability and diagnostic accuracy of the CBCL-MS on data from the TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective epidemiological cohort study of 2230 Dutch youths assessed with the CBCL at ages 11, 13 and 16. At age 19 lifetime psychiatric diagnoses were ascertained with the Composite International Diagnostic Interview. We compared the predictive ability of the CBCL-MS against the CBCL-Externalising Scale and the CBCL-PBD in the TRAILS sample. RESULTS The CBCL-MS had high internal consistency and satisfactory accuracy (area under the curve = 0.64) in this general population sample. Principal Component Analyses, followed by parallel analyses and confirmatory factor analyses, identified four factors corresponding to distractibility/disinhibition, psychosis, increased libido and disrupted sleep. This factor structure remained stable across all assessment ages. Logistic regression analyses showed that the CBCL-MS had significantly higher predictive ability than both the other scales. CONCLUSIONS Our data demonstrate that the CBCL-MS is a promising screening instrument for BD. The factor structure of the CBCL-MS showed remarkable temporal stability between late childhood and early adulthood suggesting that it maps on to meaningful developmental dimensions of liability to BD.
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Affiliation(s)
- Efstathios Papachristou
- Child Psychiatry Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Johan Ormel
- Interdisciplinary Center of Psychpathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Albertine J. Oldehinkel
- Interdisciplinary Center of Psychpathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marinos Kyriakopoulos
- Child Psychiatry Department, Institute of Psychiatry, King's College London, London, United Kingdom
- Child and Adolescent Mental Health Services, Maudsley Hospital, London, United Kingdom
| | - María Reinares
- Child Psychiatry Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Abraham Reichenberg
- Ichan School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Sophia Frangou
- Ichan School of Medicine at Mount Sinai, New York City, New York, United States of America
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Pearson GS. Use of polypharmacy with children and adolescents. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2013; 26:158-9. [PMID: 23607828 DOI: 10.1111/jcap.12034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Serrano E, Ezpeleta L, Castro-Fornieles J. Comorbidity and phenomenology of bipolar disorder in children with ADHD. J Atten Disord 2013; 17:330-8. [PMID: 22290694 DOI: 10.1177/1087054711427553] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the comorbidity of bipolar disorder (BPD) in children with ADHD and to study the psychopathological profile of ADHD children with and without mania. METHOD A total of 100 children with ADHD were assessed with a semistructured diagnostic interview and questionnaires of mania, ADHD, and general psychopathology. RESULTS 8% of children met criteria for BPD and 6% for BPD-not specified. ADHD children with bipolar spectrum disorder had greater comorbidity with disruptive behavior disorders and scored higher on the Young Mania Rating Scales and on the Child Behavior Checklist (CBCL) Scales of rule-breaking behavior, externalizing problems, and total problems; however, significance on the CBCL Scales was lost when controlling for disruptive behavior disorders. CONCLUSION BPD is frequently associated with ADHD; it has important implications for prognosis and choice of treatment. Differences on the CBCL Scales could be explained by the comorbidity with disruptive behavior disorders rather than by a specific manic profile.
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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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Subramaniam M, Abdin E, Vaingankar JA, Chong SA. Prevalence, correlates, comorbidity and severity of bipolar disorder: results from the Singapore Mental Health Study. J Affect Disord 2013; 146:189-96. [PMID: 23017543 DOI: 10.1016/j.jad.2012.09.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 09/03/2012] [Accepted: 09/03/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Bipolar disorder (BPD) is a serious mental disorder and a leading cause of premature mortality worldwide. Prevalence and risk factors of BPD have not been well studied in multi-ethnic Asian populations. The study aimed to establish the prevalence of BPD and examine the associated socio-demographic correlates, comorbidity, severity, impairment and treatment contact in the Singapore resident population. METHODS The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample of the resident (citizens and permanent residents) population in Singapore. The diagnoses were established using the World Mental Health Composite International Diagnostic Interview version 3.0 (CIDI 3.0) diagnostic modules for lifetime and 12-month prevalence of select mental illnesses including BPD. RESULTS The lifetime and 12-month prevalence estimates for BPD were 1.2% and 0.6%, respectively. More than two-thirds (69.4%) of respondents with lifetime BPD had other lifetime mental disorders, and approximately half (52.6%) of respondents with lifetime BPD also had at least one chronic physical condition; chronic pain was the most prevalent comorbid condition. LIMITATIONS The data was based on respondents' self-report and there could be an element of recall bias and under-reporting. We also did not obtain information on mixed episodes and rapid cycling disorders. CONCLUSIONS The high comorbidity, clinical severity, and role impairment associated with BPD exert a heavy toll at an individual and societal level.
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Affiliation(s)
- Mythily Subramaniam
- Research Division, Institute of Mental Health, 10, Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore.
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Bussing R, Murphy TK, Storch EA, McNamara JP, Reid AM, Garvan CW, Goodman WK. Psychometric properties of the Treatment-Emergent Activation and Suicidality Assessment Profile (TEASAP) in youth with OCD. Psychiatry Res 2013; 205:253-61. [PMID: 23031804 PMCID: PMC3540123 DOI: 10.1016/j.psychres.2012.09.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 09/12/2012] [Accepted: 09/14/2012] [Indexed: 11/25/2022]
Abstract
This study evaluated the psychometric properties of the treatment-emergent activation and suicidality assessment profile (TEASAP) in a clinical sample of 56 youth aged 7-17 with obsessive-compulsive disorder (OCD) who participated in a double-blind randomized controlled trial. The 38-item TEASAP demonstrated good internal consistency for its total score (α=0.93) and adequate to good performance for its five subscale scores (α=0.65-0.92). One-week test-retest stability (N=18) was adequate (Intraclass correlation coefficient [ICC]=0.68-0.80) except for Self-Injury (ICC=0.46). Construct validity was supported by total and subscale TEASAP score relationships with related constructs, including irritability, hyperactivity, externalizing behaviors, manic symptoms, and suicidal ideation, and the absence of relationships with unrelated constructs. Predictive validity was established for the Disinhibition subscale through significant associations with subsequent activation events. Furthermore, TEASAP sensitivity to change in activation scores over time was supported by longitudinal associations of TEASAP scores with clinician ratings of activation over the course of treatment. Findings indicate that the TEASAP has acceptable psychometric properties in a clinical sample of youth with OCD and merits further study in larger samples for additional refinement of its measurement approaches.
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Affiliation(s)
- Regina Bussing
- Department of Psychiatry, Pediatrics and Clinical & Health Psychology, University of Florida, Box 100234, UFHSC, Gainesville, FL 32610-0234, USA.
| | - Tanya K. Murphy
- Departments of Pediatrics and Psychiatry & Behavioral Neurosciences, University of South Florida, St. Petersburg, FL
| | - Eric A. Storch
- Departments of Pediatrics and Psychiatry & Behavioral Neurosciences, University of South Florida, St. Petersburg, FL
| | | | - Adam M. Reid
- Department of Psychiatry, University of Florida, Gainesville, Fl
| | - Cynthia W. Garvan
- School of Human Development and Organizational Studies in Education, University of Florida, Gainesville, Fl
| | - Wayne K. Goodman
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
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Abstract
Youth who have mental health issues are more likely than their peers to seek primary care services. The primary care setting is an appropriate venue for screening and identifying pediatric depression. Additionally, nurse practitioners can provide initial management or referral to psychiatric mental health professionals for evidence-based treatments.
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Fidan T, Kirpinar I, Oral M, Koçak K. Is there a relationship between attention deficit/hyperactivity disorder and manic symptoms among children with mental retardation of unknown etiology? Compr Psychiatry 2011; 52:644-9. [PMID: 21310401 DOI: 10.1016/j.comppsych.2010.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 11/12/2010] [Accepted: 11/29/2010] [Indexed: 11/25/2022] Open
Abstract
Mental retardation (MR) is common and lifelong. In children and adolescents with MR, the rate of attention deficit/hyperactivity disorder (ADHD) and bipolar disorder is higher than that in the general population. However, there are no previous sufficient data that exist in establishing a relationship between ADHD and manic symptoms. The aim of the present study was to examine the relationship between manic symptoms and ADHD as well as oppositional-defiant disorder (ODD) and conduct disorder (CD) in children with MR of unknown etiology (MR-UE). A total of 167 children with MR-UE attending a rehabilitation and training school in Erzurum, Turkey, were included in the study. We administered the Child Disruptive Behavior Screening and Rating Scale related to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the Young Mania Rating Scale-Parent Version (P-YMRS) to parents. The age range of children and adolescents with MR-UE was between 5 and 21 years, with a mean age of 11.13 ± 3.75 years. In total, 5.8% of children and adolescents with MR-UE showed a border intelligence quotient (IQ), with 58.4% having a mild IQ, 29.2% having a moderate IQ, and 6.6% having severe IQ. According to the Child Disruptive Behavior Screening and Rating Scale related to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 40.1% of children and adolescents with MR-UE had inattention, 19.9% had hyperactivity, 28.7% had ODD, and 13.3% had CD. A total of 7.2% of the children and adolescents with MR-UE had probable mania, and 1.8% had mania according to Young Mania Rating Scale-Parent Version. A positive correlation existed between the mean scores of Young Mania Rating Scale-Parent Version and the mean scores of inattention, hyperactivity, ODD, and CD (P = .000). Hyperactivity and ODD were predictors of being manic/probably manic. Diagnosing psychiatric disorders in children and adolescents with MR-UE is difficult but essential for better functioning. Manic symptoms and disruptive behaviors as well as ADHD symptoms were prevalent among children and adolescents with MR-UE and hyperactivity, and oppositional-defiant symptoms were predictors of manic symptoms in these patients.
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Affiliation(s)
- Tülin Fidan
- Faculty of Medicine, Department of Child Psychiatry, Ataturk University, 25240 Erzurum, Turkey.
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Mullin BC, Harvey AG, Hinshaw SP. A preliminary study of sleep in adolescents with bipolar disorder, ADHD, and non-patient controls. Bipolar Disord 2011; 13:425-32. [PMID: 21843282 PMCID: PMC3158129 DOI: 10.1111/j.1399-5618.2011.00933.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the sleep of adolescents with bipolar disorder (BD) to groups of adolescents with attention-deficit hyperactivity disorder-combined type (ADHD-C) and those without psychopathology. METHODS A sample of 13 adolescents diagnosed with BD who were not in the midst of a mood episode, 14 adolescents with ADHD-C, and 21 healthy controls, all between the ages of 11 and 17 years served as participants. They were psychiatrically evaluated using a structured diagnostic interview and completed four nights of in-home sleep monitoring using actigraphy and sleep diaries. RESULTS Sleep diary estimates of sleep indicated that participants with BD experienced more awakenings than their peers with ADHD, whereas actigraphic estimates revealed that participants with BD slept longer and with less wakefulness than their peers. CONCLUSIONS In between mood episodes, adolescents with BD experience their sleep as more fragmented than that of their peers but do not exhibit more disturbed sleep as estimated by actigraphy. The possible influence of psychotropic medication is an important consideration when assessing sleep in the context of BD.
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Affiliation(s)
- Benjamin C Mullin
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
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Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA, Viana MC, Andrade LH, Hu C, Karam EG, Ladea M, Medina-Mora ME, Ono Y, Posada-Villa J, Sagar R, Wells JE, Zarkov Z. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. ARCHIVES OF GENERAL PSYCHIATRY 2011; 68:241-51. [PMID: 21383262 PMCID: PMC3486639 DOI: 10.1001/archgenpsychiatry.2011.12] [Citation(s) in RCA: 1595] [Impact Index Per Article: 122.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methods. OBJECTIVES To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder (BPS) in the World Health Organization World Mental Health Survey Initiative. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, face-to-face, household surveys of 61,392 community adults in 11 countries in the Americas, Europe, and Asia assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, a fully structured, lay-administered psychiatric diagnostic interview. MAIN OUTCOME MEASURES Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) disorders, severity, and treatment. RESULTS The aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I), 0.4% for BP-II, 1.4% for subthreshold BP, and 2.4% for BPS. Twelve-month prevalences were 0.4% for BP-I, 0.3% for BP-II, 0.8% for subthreshold BP, and 1.5% for BPS. Severity of both manic and depressive symptoms as well as suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across BP subtypes. Symptom severity was greater for depressive episodes than manic episodes, with approximately 74.0% of respondents with depression and 50.9% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least 1 other disorder, with anxiety disorders (particularly panic attacks) being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries, where only 25.2% reported contact with the mental health system. CONCLUSIONS Despite cross-site variation in the prevalence rates of BPS, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior, and comorbidity across each diagnostic category provide evidence for the validity of the concept of BPS. Treatment needs for BPS are often unmet, particularly in low-income countries.
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West AE, Celio CI, Henry DB, Pavuluri MN. Child Mania Rating Scale-Parent Version: a valid measure of symptom change due to pharmacotherapy. J Affect Disord 2011; 128:112-9. [PMID: 20858565 PMCID: PMC2994944 DOI: 10.1016/j.jad.2010.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 05/04/2010] [Accepted: 06/03/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND The development of valid parent-report measures of symptom change in pediatric bipolar disorder (PBD) is imperative to evaluate the effectiveness of different treatment approaches; yet, few studies have tested the sensitivity of symptom measures. The current study evaluated the sensitivity of the Child Mania Rating Scale (CMRS-P) to detect symptom change over time in a treatment study for PBD. METHODS Data on symptom change were drawn from a prospective six-week, double-blind, placebo-controlled, randomized outpatient medication treatment trial of risperidone versus divalproex. The sample included 66 children with Bipolar type I disorder. Measures were administered every week for six weeks of treatment. RESULTS The CMRS-P demonstrated statistically (p ≤ .05) and clinically significant change in symptom report from pre to post-test. Growth curve modeling indicated that the CMRS-P demonstrated overall similarity to the YMRS in the magnitude and trajectory of change over time. Finally, results indicate that the CMRS-P is able to detect response rates with moderate levels of agreement with other measures. LIMITATIONS Limitations of this study include a relatively small sample size and uncertain generalizability beyond treatment trials. CONCLUSIONS The CMRS-P is short, easy to administer, and represents parent's report of symptoms, all strengths which make it a compelling treatment outcome tool. This preliminary evidence of its validity as a treatment outcome measure makes it applicable in other research settings and suggests its potential use in clinical settings.
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Affiliation(s)
- Amy E West
- University of Illinois at Chicago, Chicago, IL 60608, United States.
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Serrano E, Ezpeleta L, Alda JA, Matalí JL, San L. Psychometric properties of the Young Mania Rating Scale for the identification of mania symptoms in Spanish children and adolescents with attention deficit/hyperactivity disorder. Psychopathology 2011; 44:125-32. [PMID: 21228617 DOI: 10.1159/000320893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 09/02/2010] [Indexed: 01/21/2023]
Abstract
BACKGROUND Diagnosing mania in children is difficult, due to the high comorbidity and symptom overlap with attention deficit/hyperactivity disorder (ADHD). The detection of manic symptoms in ADHD has important implications for prognosis and choice of treatment. Our objective was to study the utility of the Young Mania Rating Scale (YMRS) for discriminating mania in Spanish children with ADHD. METHOD One hundred children and adolescents with ADHD between 8 and 17 years of age were evaluated with a structured diagnostic interview (Diagnostic Interview for Children and Adolescents-IV), the YMRS, the Parent-Young Mania Rating Scale (P-YMRS), the Child Mania Rating Scale-Parent Version (CMRS-P) and the Children's Global Assessment Scale. RESULTS The YMRS showed a 1-dimensional structure with good internal consistency and test-retest reliability. The YMRS was associated with the P-YMRS and the CMRS-P. The scores obtained with the YMRS differentiated between ADHD with and without mania. The receiver operating characteristic curve analysis showed good diagnostic efficiency in differentiating mania in ADHD (area under the curve of 0.90). CONCLUSIONS The Spanish version of the YMRS is a valid and reliable instrument for detecting and quantifying the symptoms of mania in children and adolescents with ADHD. The results provide further knowledge about the frequent association between ADHD and manic symptoms in children.
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Affiliation(s)
- Eduardo Serrano
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Sant Joan de Déu, Barcelona, Spain.
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Joshi G, Biederman J, Wozniak J, Doyle R, Hammerness P, Galdo M, Sullivan N, Williams C, Brethel K, Woodworth KY, Mick E. Response to second generation antipsychotics in youth with comorbid bipolar disorder and autism spectrum disorder. CNS Neurosci Ther 2010; 18:28-33. [PMID: 21114638 DOI: 10.1111/j.1755-5949.2010.00219.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the impact of comorbid autism spectrum disorders (ASD) on the response to second-generation antipsychotics (SGA) in pediatric bipolar disorder (BPD). METHODS Secondary analysis of identically designed 8-week open-label trials of SGA monotherapy (risperidone, olanzapine, quetiapine, ziprasidone, or aripiprazole) in youth with BPD. RESULTS Of the 151 BPD subjects 15% (n= 23) met criteria for comorbid ASD. There were no differences in the rate of antimanic response (YMRS change ≥30% or CGI-Improvement ≤2: 65% vs. 69%; P= 0.7) in the presence of comorbid ASD. CONCLUSION No difference observed in the rate of antimanic response or tolerability to SGA monotherapy in the presence of ASD comorbidity.
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Affiliation(s)
- Gagan Joshi
- Pediatric Psychopharmacology Research Department, Massachusetts General Hospital, USA.
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Nierenberg AA, Akiskal HS, Angst J, Hirschfeld RM, Merikangas KR, Petukhova M, Kessler RC. Bipolar disorder with frequent mood episodes in the national comorbidity survey replication (NCS-R). Mol Psychiatry 2010; 15:1075-87. [PMID: 19564874 PMCID: PMC2891194 DOI: 10.1038/mp.2009.61] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Virtually nothing is known about the epidemiology of rapid cycling bipolar disorder (BPD) in community samples. Nationally representative data are reported here for the prevalence and correlates of a surrogate measure of DSM-IV rapid cycling BPD from the National Comorbidity survey Replication (NCS-R), a national survey of the US household population. DSM-IV disorders were assessed in the NCS-R with the WHO Composite International Diagnostic Interview (CIDI). Although the CIDI did not assess rapid cycling, it did assess the broader category of 12-month BPD with frequent mood episodes (FMEs), having at least four episodes of mania/hypomania or major depression in the 12 months before interview. Roughly one-third of NCS-R respondents with lifetime DSM-IV BPD and half with 12-month BPD met criteria for FME. FME was associated with younger age-of-onset (of BP-I, but not BP-II) and higher annual persistence (73% of the years since first onset of illness with an episode) than non-FME BPD. No substantial associations of FME vs non-FME BPD were found with socio-demographics, childhood risk factors (parental mental disorders, other childhood adversities) or comorbid DSM-IV disorders. However, FME manic episodes had greater clinical severity than non-FME episodes (assessed with a fully structured version of the Young Mania Rating Scale) and FME hypomanic episodes had greater role impairment than non-FME episodes (assessed with the Sheehan Disability Scales). Whether these indicators of severity merely reflect attenuated effects of rapid cycling or independent effects of sub-threshold rapid cycling warrants further study given the high proportion of lifetime cases who met criteria for FME.
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Affiliation(s)
- Andrew A. Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston MA 02114 USA
| | - Hagop S. Akiskal
- The International Mood Center, University of California San Diego and VA Psychiatry Service, 3350 La Jolla Village Drive (116A), San Diego, CA USA
| | - Jules Angst
- Zurich University Psychiatric Hospital, Zurich, Switzerland
| | - Robert M. Hirschfeld
- The Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555-0188 USA
| | - Kathleen R. Merikangas
- The Intramural Research Program, Section on Developmental Genetic Epidemiology, National Institute of Mental Health, 15 K North Drive, MSC #2670, Bethesda, MD 20892-2670 USA
| | - Maria Petukhova
- The Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115 USA
| | - Ronald C. Kessler
- The Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115 USA
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Angst J, Cui L, Swendsen JJ, Rothen S, Cravchik A, Kessler R, Merikangas K. Major depressive disorder with subthreshold bipolarity in the National Comorbidity Survey Replication. Am J Psychiatry 2010; 167:1194-201. [PMID: 20713498 PMCID: PMC3145248 DOI: 10.1176/appi.ajp.2010.09071011] [Citation(s) in RCA: 223] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE There is growing clinical and epidemiologic evidence that major mood disorders form a spectrum from major depressive disorder to pure mania. The authors examined the prevalence and clinical correlates of major depressive disorder with subthreshold bipolarity compared with pure major depressive disorder in the National Comorbidity Survey Replication (NCS-R). METHOD The NCS-R is a nationally representative face-to-face household survey of the U.S. population conducted between February 2001, and April 2003. Lifetime history of mood disorders, symptoms, and clinical indicators of severity were collected using version 3.0 of the World Health Organization's Composite International Diagnostic Interview. RESULTS Nearly 40% of study participants with a history of major depressive disorder had a history of subthreshold hypo-mania. This subgroup had a younger age at onset, more episodes of depression, and higher rates of comorbidity than those without a history of hypomania and lower levels of clinical severity than those with bipolar II disorder. CONCLUSIONS These findings demonstrate heterogeneity in major depressive disorder and support the validity of inclusion of subthreshold mania in the diagnostic classification. The broadening of criteria for bipolar disorder would have important implications for research and clinical practice.
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Affiliation(s)
- Jules Angst
- Department of Psychiatry, Zurich University Psychiatric Hospital, Zurich, Switzerland
| | - Lihong Cui
- Intramural Research Program, Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD
| | - J. Joel Swendsen
- National Scientific Research Center (CNRS 5231), Bordeaux, France
| | - S. Rothen
- Intramural Research Program, Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD,Department of Psychiatry, University Hospital Center and University of Lausanne, Switzerland,Department of Psychiatry, University Hospital of Geneva, Switzerland
| | - Anibal Cravchik
- Intramural Research Program, Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD
| | - Ronald Kessler
- The Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Kathleen Merikangas
- Intramural Research Program, Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD
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40
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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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Abstract
OBJECTIVE The literature on bipolar in children and adolescents was reviewed to provide an update for clinicians. REVIEW PROCESS Literature of particular relevance to evidence-based practice was selected for critical review. OUTCOMES An up-to-date overview of clinical features, epidemiology, prognosis, aetiology, assessment and intervention was provided. CONCLUSIONS Bipolar disorder in children and adolescence is a relatively common, multifactorially determined and recurring problem which persists into adulthood. Psychometrically robust screening questionnaires and structured interviews facilitate reliable assessment. Multimodal chronic care programmes involving medication (notably lithium) and family-oriented psychotherapy are currently the treatment of choice.
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Affiliation(s)
- Alan Carr
- University College Dublin, Belfield, Ireland.
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42
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Krüger S, Quilty L, Bagby M, Lippold T, Bermpohl F, Bräunig P. The Observer-Rated Scale for Mania (ORSM): development, psychometric properties and utility. J Affect Disord 2010; 122:179-83. [PMID: 19716180 DOI: 10.1016/j.jad.2009.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 07/22/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The diagnosis of mania largely depends on the quality of information the physician is provided with. Often, the patient cannot give an accurate account of the symptom development and thus information from relatives and friends is required. No systematic rating instrument is available, however, to facilitate this. OBJECTIVE In this study, the psychometric properties of the 49-item Observer-Rated Scale for Mania (ORSM) are reported. METHODS The scale was used in 113 inpatients and the following psychometric aspects were assessed: reliability, test-retest reliability, construct validity (factor analysis, discriminant analysis, comparison of means), extreme-group validity, prognostic validity, sensitivity, specificity, positive and negative predictive values. RESULTS The ORSM proved highly valid and reliable. Factor analysis revealed three factors which were labelled euphoric mania, instable mania and psychotic mania. CONCLUSION The ORSM is a useful instrument to help non-professionals who are in regular contact with the patient diagnosed a manic/mixed episode. It thus complements existing rating scales for mania, which are either designed for professionals or are self-rating instruments.
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Affiliation(s)
- Stephanie Krüger
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Charité Campus Mitte, Universitätsmedizin Berlin, 10117 Berlin, Germany.
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43
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Lus G, Mukaddes NM. Co-morbidity of bipolar disorder in children and adolescents with attention deficit/hyperactivity disorder (ADHD) in an outpatient Turkish sample. World J Biol Psychiatry 2010; 10:488-94. [PMID: 19401947 DOI: 10.1080/15622970902929876] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aimed to assess the prevalence of bipolar disorder (BPD) in children and adolescents with attention deficit hyperactivity disorder (ADHD), and to compare the clinical characteristics of a group with ADHD with a group with co-morbidity of ADHD and BPD. The study includes 121 individuals, aged 6-16 years, with a diagnosis of ADHD. Co-morbidity of BPD was evaluated using the Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime version (K-SADS-PL) and the Parent-Young Mania Rating Scale (P-YMRS). The Child Behavior Checklist (CBCL) was used to assess psychopathology in two groups. Ten children (8.3%) in the ADHD sample received the additional diagnosis of BPD. The ADHD + BPD group had significantly higher scores than the ADHD group on withdrawn, anxiety/depression, social problems, thought problems, attention problems, aggression, externalization, total score items of CBCL, and on the P-YMRS. It could be concluded that BPD is not a rare co-morbid condition in children with diagnosis of ADHD and subjects with this co-morbidity show more severe psychopathology than subjects with pure ADHD. Differential diagnosis of BPD disorder in subjects with ADHD seems crucial in establishing an effective treatment program, and therefore improving mental health outcomes.
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Affiliation(s)
- Gozde Lus
- Child Psychiatry Department, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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44
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Joshi G, Mick E, Wozniak J, Geller D, Park J, Strauss S, Biederman J. Impact of obsessive-compulsive disorder on the antimanic response to olanzapine therapy in youth with bipolar disorder. Bipolar Disord 2010; 12:196-204. [PMID: 20402712 DOI: 10.1111/j.1399-5618.2010.00789.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare antimanic response to olanzapine therapy in youth with bipolar disorder (BPD) based on the status of comorbidity with obsessive-compulsive disorder (OCD). METHODS Secondary analysis of identically designed 8-week open-label trials of olanzapine therapy in youth with BPD. Severity of mania assessed with the Young Mania Rating Scale (YMRS) and Clinical Global Impression (CGI) scales. RESULTS Of the 52 BPD subjects (mean age 8.4 +/- 3.1 years) enrolled in the olanzapine trials (mean dose 8.5 +/- 4.3 mg/day), 39% (n = 20) met criteria for comorbid OCD. Antimanic response in BPD subjects was significantly worse in the presence of comorbid OCD (YMRS mean reduction: -5.9 +/- 13.1 versus -13.7 +/- 18.8, p = 0.04; > or = 30% reduction: 25% versus 63%, p = 0.008; CGI-Improvement score < or = 2: 25% versus 68%, p = 0.003). There was no difference in the rate of dropouts (50% versus 29%, p = 0.2) or adverse effects in BPD subjects with or without comorbid OCD. CONCLUSIONS Less than expected antimanic response to olanzapine therapy in the presence of comorbidity with OCD suggests that OCD is an important functionally impairing psychiatric comorbidity that may impact the efficacy of antimanic agents in youth with BPD. This study is limited by its design of secondary analysis of data from trials of an uncontrolled nature. Further prospective controlled trials are warranted.
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Affiliation(s)
- Gagan Joshi
- Pediatric Psychopharmacology Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
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45
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Reid JM, Storch EA, Murphy TK, Bodzin D, Mutch PJ, Lehmkuhl H, Aman M, Goodman WK. Development and Psychometric Evaluation of the Treatment-Emergent Activation and Suicidality Assessment Profile. CHILD & YOUTH CARE FORUM 2010; 39:113-124. [PMID: 20473344 DOI: 10.1007/s10566-010-9095-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although effective in treating a range of childhood psychiatric conditions, selective serotonin reuptake inhibitors (SSRI) have been implicated in the induction of an "activation syndrome" (characterized by symptoms of irritability, restlessness, emotional labiality, etc.) that may represent an intermediary state change that fosters suicidality. SSRI-induced activation syndrome is well-accepted by many clinicians and thought to be relatively common, particularly in children and teens. However, gaps exist in empirical data on phenomenology and tools for early detection. With this in mind, we report on a recently funded National Institutes of Health grant to develop a measure of behavioral activation to be completed in a clinical setting. We discuss the development of this measure-the Treatment-Emergent Activation and Suicidality Assessment Profile (TE-ASAP)-as well as psychometric results from a sample of youth with internalizing disorders who were at varying stages of SSRI treatment. Overall, psychometric data were quite promising, with the TE-ASAP demonstrating excellent reliability (i.e., internal consistency, inter-rater, short-term test-retest stability) and strong validity properties. Through further evaluation of the TE-ASAP in the context of a controlled multimodal trial in youth with obsessive-compulsive disorder, we hope to augment understanding of activation syndrome and, in turn, mitigate risks through early detection of this potentially lifethreatening adverse effect.
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Affiliation(s)
- Jeannette M Reid
- Department of Pediatrics, University of South Florida, 800 6th Street South 4th Floor, St. Petersburg, FL 33701, USA
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Wozniak J, Mick E, Waxmonsky J, Kotarski M, Hantsoo L, Biederman J. Comparison of open-label, 8-week trials of olanzapine monotherapy and topiramate augmentation of olanzapine for the treatment of pediatric bipolar disorder. J Child Adolesc Psychopharmacol 2009; 19:539-45. [PMID: 19877978 DOI: 10.1089/cap.2009.0042] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to test the efficacy and safety of olanzapine + topiramate versus olanzapine monotherapy in the treatment of bipolar disorder (BPD) and treatment-attendant weight gain in children and adolescents. METHOD Subjects (N = 40) were outpatients of both sexes, 6-17 years of age, with a Diagnostic and Statistical Manual of Mental Disorders, 4(th) edition (DSM-IV) diagnosis of BPD (manic, hypomanic, or mixed) and Young Mania Rating Scale (YMRS) total score of >15 treated over 8-week periods in two partially concurrent open-label trials with olanzapine (n = 17) or olanzapine + topiramate (n = 23). RESULTS Subjects in both groups experienced a statistically significant reduction in YMRS scores after 8-week, open-label treatment with olanzapine (baseline YMRS = 26.7 +/- 9.5; end-point YMRS = 18.2 +/- 12.5, p = 0.04) and olanzapine +topiramate (baseline YMRS = 31.3 +/- 7.9; end-point YMRS = 20.4 +/- 11.4, p = 0.04). There was no difference in response between the two groups based on YMRS or Clinical Global Impressions-Improvement (CGI-I) scores. Adverse events were few and mild and similar between the two groups, with the exception of weight gain. The weight gain in the olanzapine group was 5.3 +/- 2.1 kg and the weight gain in the olanzapine + topiramate group was statistically significantly lower, 2.6 +/- 3.6 kg. CONCLUSIONS Augmentation of olanzapine with topiramate resulted in a reduced weight gain over the course of an 8-week, open-label trial when compared with olanzapine treatment alone, but did not lead to greater reduction in symptoms of mania.
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Affiliation(s)
- Janet Wozniak
- Pediatric Psychopharmacology Research Department, Massachusetts General Hospital , Department of Psychiatry at Harvard Medical School, Boston, Massachusetts, USA.
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47
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Danner S, Fristad MA, Arnold LE, Youngstrom EA, Birmaher B, Horwitz SM, Demeter C, Findling RL, Kowatch RA. Early-onset bipolar spectrum disorders: diagnostic issues. Clin Child Fam Psychol Rev 2009; 12:271-93. [PMID: 19466543 PMCID: PMC3575107 DOI: 10.1007/s10567-009-0055-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Since the mid 1990s, early-onset bipolar spectrum disorders (BPSDs) have received increased attention in both the popular press and scholarly press. Rates of diagnosis of BPSD in children and adolescents have increased in inpatient, outpatient, and primary care settings. BPSDs remain difficult to diagnose, particularly in youth. The current diagnostic system makes few modifications to accommodate children and adolescents. Researchers in this area have developed specific BPSD definitions that affect the generalizability of their findings to all youth with BPSD. Despite knowledge gains from the research, BPSDs are still difficult to diagnose because clinicians must: (1) consider the impact of the child's developmental level on symptom presentation (e.g., normative behavior prevalence, environmental limitations on youth behavior, pubertal status, irritability, symptom duration); (2) weigh associated impairment and course of illness (e.g., neurocognitive functioning, failing to meet full DSM criteria, future impairment); and (3) make decisions about appropriate assessment (differentiating BPSD from medical illnesses, medications, drug use, or other psychiatric diagnoses that might better account for symptoms; comorbid disorders; informant characteristics and assessment measures to use). Research findings concerning these challenges and relevant recommendations are offered. Areas for further research to guide clinicians' assessment of children with early-onset BPSD are highlighted.
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49
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Youngstrom EA, Freeman AJ, Jenkins MM. The assessment of children and adolescents with bipolar disorder. Child Adolesc Psychiatr Clin N Am 2009; 18:353-90, viii-ix. [PMID: 19264268 PMCID: PMC2915577 DOI: 10.1016/j.chc.2008.12.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The overarching goal of this article is to examine the current best evidence for assessing bipolar disorder (BPD) in children and adolescents and provide a comprehensive, evidence-based approach to diagnosis. Evidence- based assessment strategies are organized around the "3 Ps" of clinical assessment: Predict important criteria or developmental trajectories, Prescribe a change in treatment choice, and inform Process of treating the youth and his/her family. The review characterizes BPD in youths-specifically addressing bipolar diagnoses and clinical subtypes; it then provides an actuarial approach to assessment using prevalence of disorder, risk factors, and questionnaires; discusses treatment thresholds; and identifies practical measures of process and outcomes. The clinical tools and risk factors selected for inclusion in this review represent the best empirical evidence in the literature. By the end of the article, clinicians will have a framework and set of clinically useful tools with which to effectively make evidence-based decisions regarding the diagnosis of BPD in children and adolescents.
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Affiliation(s)
- Eric A Youngstrom
- Department of Psychology, University of North Carolina, Chapel Hill, NC 27599-3270, USA.
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50
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McDougall T. Nursing children and adolescents with bipolar disorder: assessment, diagnosis, treatment, and management. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2009; 22:33-9. [PMID: 19200290 DOI: 10.1111/j.1744-6171.2008.00167.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
TOPIC The role of the mental health nurse in the assessment, diagnosis, treatment, and management of children and adolescents with bipolar disorder in community and hospital settings. PURPOSE In many areas of clinical practice, mental health nurses have more contact with service users than any other professional group. They are therefore well placed to support children and adolescents with bipolar disorder during first contact with primary care services, through engagement with specialist mental health services, and in accessing early intervention and crisis services. This paper summarizes the contribution that child and adolescent mental health nurses make to the care of children and adolescents with bipolar disorder. SOURCES This paper is based on evidence from systematic reviews; meta-analyses and best practice evidence from CINAHL; EMBASE; MEDLINE, PsychINFO; Cochrane Collaboration; National Institute for Health and Clinical Excellence; National Collaborating Centre for Mental Health; NHS Centre for Reviews and Dissemination; Oxford Centre for Evidence Based Medicine; United States Agency for Healthcare Research and Quality. CONCLUSIONS Child and adolescent mental health nurses work with children and adolescents who have bipolar disorder in a range of settings. These include community mental health services, hospitals, and schools. Due to the multidisciplinary nature of the treatment and management of bipolar disorder during childhood and adolescence, nurses have a major role to play in providing frontline assessment services, monitoring treatment, and delivering psychosocial interventions.
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Affiliation(s)
- Tim McDougall
- Cheshire & Wirral Foundation NHS Trust, Cheshire, UK.
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