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Orsolini L, Longo G, Cicolini A, Volpe U. An expert opinion on the pharmacological interventions for Disruptive Mood Dysregulation Disorder (DMDD). Expert Opin Pharmacother 2024; 25:67-78. [PMID: 38186365 DOI: 10.1080/14656566.2024.2303422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/05/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Disruptive Mood Dysregulation Disorder (DMDD) was officially introduced as a new diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5), under the category of depressive disorders. AREAS COVERED A comprehensive overview and a critical commentary on the currently investigated psychopharmacological approaches for the treatment of DMDD have been here provided. EXPERT OPINION Behavioral and psychosocial interventions should be considered as first-line treatment strategies. When ineffective or partially effective, psychopharmacological strategy is recommended. Overall, pharmacological strategy should be preferred in those individuals with psychiatric comorbidities (e.g. ADHD). Indeed, so far published studies on pharmacological strategies in DMDD are scant and heterogeneous (i.e. age, assessment tools, symptomatology profile, comorbidity, and so forth). Therefore, DMDD psychopharmacological guidelines are needed, particularly to guide clinicians toward the patient's typical symptom profile who could benefit from psychopharmacological strategy.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Giulio Longo
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Angelica Cicolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
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2
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Connors MH. Misconceptions about paediatric bipolar disorder. Acta Neuropsychiatr 2023; 35:374-376. [PMID: 37592840 DOI: 10.1017/neu.2023.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- Michael H Connors
- 1Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, Australia
- 2Department of Psychiatry, University of Melbourne, Melbourne, Australia
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3
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Fekih-Romdhane F, Azzi V, Hallit R, Malaeb D, Dabbous M, Sakr F, Obeid S, Hallit S. Validation of the Arabic version of the brief irritability test (Ar-BITe) in non-clinical adolescents. BMC Psychiatry 2023; 23:701. [PMID: 37752461 PMCID: PMC10521430 DOI: 10.1186/s12888-023-05211-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/22/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Despite the substantial clinical relevance of irritability in the development and maintenance of several mental disorders and its negative effects on functioning, no valid and reliable measures are available yet to identify the presence and consequences of irritability as a distinct construct among the Arabic-speaking populations. To bridge this gap, and help advance this field in the under-researched Arab region, we aimed to validate an Arabic-language version of the Brief Irritability Test (BITe). METHODS Eligible participants were native Arabic-speaking non-clinical adolescents from Lebanon; 527 participants aged 15.73 ± 1.81 years (56% females) completed the survey. RESULTS Utilizing the Confirmatory Factor Analysis approach, we found that the five items of the Arabic BITe loaded into a single factor structure. The scale showed excellent reliability, as both Cronbach's alpha and McDonald's omega coefficient values were of 0.88. Multi-group analyses showed invariance across sex groups in our sample at the configural, metric, and scalar levels. Female adolescents exhibited higher BITe scores than their male counterparts (14.01 vs. 13.25), but this difference did not reach the statistical significance. Good concurrent validity was supported based on positive correlations between irritability scores and measures of aggression, anger and hostility (r Pearson's coefficients ranging from 0.35 to 0.42), as well as positive correlations with insomnia symptoms scores. CONCLUSION The present findings allow us to conclude that the Arabic version of the BITe is a unidimensional, reliable, valid, brief, and economic self-report measure of the irritability construct for both male and female Arabic-speakers. Providing an Arabic validated version of the BITe will hopefully foster the research efforts of the Arab scientific community in this area, and promote the implementation of timely, evidence-informed and culturally-sensitive mental health interventions that appropriately address irritability-related problems and consequences among Arab young populations.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of psychiatry "Ibn Omrane", Razi hospital, Manouba, 2010, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Vanessa Azzi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon
- Department of Infectious Disease, Notre Dame des Secours, University Hospital Center, Byblos, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon.
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Psychology Department, College of Humanities, Effat University, Jeddah, 21478, Saudi Arabia.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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4
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Abstract
OBJECTIVES Paediatric bipolar disorder - bipolar disorder occurring in prepubertal children - is a diagnosis subject to considerable controversy. Whilst historically considered to be very rare, proponents since the 1990s have argued that mania can present differently in children and, as such, is much more common than previously thought. Such proposals raise questions about the validity of proposed phenotypes and potential risks of iatrogenic harm. METHODS I critically examine the construct of paediatric bipolar disorder using Robins and Guze's (1970, American Journal of Psychiatry126, 983-987) influential criteria for the validity of a psychiatric diagnosis. I review, in turn, evidence relating to its clinical description, delimitation from other conditions, follow-up studies, family studies, laboratory studies, and treatment response. RESULTS Across domains, existing research highlights significant challenges establishing the diagnosis. This includes significant heterogeneity in operationalising criteria for children; variable or poor inter-rater reliability; difficulty distinguishing paediatric bipolar disorder from other conditions; large differences in rates of diagnosis between the United States of America and other countries; limited evidence of continuity with adult forms; and a lack of evidence for proposed paediatric phenotypes in children at genetic high-risk of the condition. Laboratory and treatment studies are limited, but also do not provide support for the construct. CONCLUSIONS Evidence for the more widespread existence of paediatric bipolar disorder and its various proposed phenotypes remains weak. The ongoing popularity of the diagnosis, most evident in America, may reflect social pressures and broader limitations in psychiatric nosology. The uncertainty around the diagnosis highlights the need for careful longitudinal assessment of children potentially affected.
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Carlson GA, Singh MK, Amaya-Jackson L, Benton TD, Althoff RR, Bellonci C, Bostic JQ, Chua JD, Findling RL, Galanter CA, Gerson RS, Sorter MT, Stringaris A, Waxmonsky JG, McClellan JM. Narrative Review: Impairing Emotional Outbursts: What They Are and What We Should Do About Them. J Am Acad Child Adolesc Psychiatry 2023; 62:135-150. [PMID: 35358662 DOI: 10.1016/j.jaac.2022.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Impairing emotional outbursts, defined by extreme anger or distress in response to relatively ordinary frustrations and disappointments, impact all mental health care systems, emergency departments, schools, and juvenile justice programs. However, the prevalence, outcome, and impact of outbursts are difficult to quantify because they are transdiagnostic and not explicitly defined by current diagnostic nosology. Research variably addresses outbursts under the rubrics of tantrums, anger, irritability, aggression, rage attacks, or emotional and behavioral dysregulation. Consistent methods for identifying and assessing impairing emotional outbursts across development or systems of care are lacking. METHOD The American Academy of Child and Adolescent Psychiatry Presidential Task Force (2019-2021) conducted a narrative review addressing impairing emotional outbursts within the limitations of the existing literature and independent of diagnosis. RESULTS Extrapolating from the existing literature, best estimates suggest that outbursts occur in 4%-10% of community children (preschoolers through adolescents). Impairing emotional outbursts may respond to successful treatment of the primary disorder, especially for some children with attention-deficit/hyperactivity disorder whose medications have been optimized. However, outbursts are generally multi-determined and often represent maladaptive or deficient coping strategies and responses. CONCLUSION Evidence-based strategies are necessary to address factors that trigger, reinforce, or excuse the behaviors and to enhance problem-solving skills. Currently available interventions yield only modest effect sizes for treatment effect. More specific definitions and measures are needed to track and quantify outbursts and to design and assess the effectiveness of interventions. Better treatments are clearly needed.
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Affiliation(s)
- Gabrielle A Carlson
- Renaissance School of Medicine at Stony Brook University, Putnam Hall, South Campus, Stony Brook, New York.
| | | | | | - Tami D Benton
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Jeff Q Bostic
- MedStar Georgetown University Hospital, Washington, DC
| | - Jaclyn Datar Chua
- Perelman School of Medicine, University of Pennsylvania, Philadelphia; University of Pennsylvania, Philadelphia
| | | | - Cathryn A Galanter
- SUNY Downstate, Brooklyn, New York; Kings County Hospital Center, Brooklyn, New York
| | | | - Michael T Sorter
- Cincinnati Children's Hospital and the University of Cincinnati, Ohio
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6
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Carlson GA. Pediatric bipolar disorder: A recurrent or chronic debate? Bipolar Disord 2022; 24:229-231. [PMID: 34850508 DOI: 10.1111/bdi.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gabrielle A Carlson
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
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7
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Sherwood SN, Carlson GA, Freeman AJ. Decreasing rate of inpatient pediatric bipolar disorder diagnosis in the US between 2004 and 2010. Bipolar Disord 2022; 24:149-160. [PMID: 34664344 DOI: 10.1111/bdi.13145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Diagnosis of bipolar disorder (BD) increased substantially among youth between the mid-1990s and mid-2000s in the United States. This dramatic increase in diagnosis resulted in concern regarding the potential for misdiagnosis of BD among youth. However, the rate of BD diagnosis in the United States had not been evaluated nationally since the mid-2000s. It was unclear whether changes in diagnostic rates continued to occur. Therefore, the present study aimed to assess the pattern of longitudinal trends in the rate of national inpatient BD diagnosis subsequent to 2004. METHODS Data included a nationally representative dataset of inpatient hospitalizations between 1996 and 2010. De-identified data were obtained from the National Hospital Discharge Survey (NHDS) conducted annually by the National Center for Health Statistics. RESULTS The proportion of BD diagnoses relative to all psychiatric diagnoses increased between 1996 and 2004 among children and adolescents. The proportion of BD diagnoses then decreased between 2004 and 2010 among children but continued to increase for adolescents. However, population-adjusted rates of BD diagnosis per 10,000 individuals in the general population initially increased until the mid-2000s and then decreased until 2010 for both children and adolescents. CONCLUSIONS Rates of BD diagnosis substantially decreased for youth between the mid-2000s and 2010. This decline coincided with recommendations for more conservative diagnostic practices due to concerns about overdiagnosis and increasing awareness of the side effects of front-line medications used to treat BD in youth. Findings provide insight into changing trends in inpatient service utilization for BD in the United States.
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Affiliation(s)
| | - Gabrielle A Carlson
- Psychiatry and Pediatrics, State University of New York at Stony Brook, East Setauket, New York, USA
| | - Andrew J Freeman
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA.,Division of Child and Family Services, Nevada Department of Health and Human Services, Las Vegas, Nevada, USA
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8
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Comparelli A, Polidori L, Sarli G, Pistollato A, Pompili M. Differentiation and comorbidity of bipolar disorder and attention deficit and hyperactivity disorder in children, adolescents, and adults: A clinical and nosological perspective. Front Psychiatry 2022; 13:949375. [PMID: 36032257 PMCID: PMC9403243 DOI: 10.3389/fpsyt.2022.949375] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
Bipolar Disorder (BD) and Attention Deficit and Hyperactivity Disorder (ADHD) are mental disorders with high degree of lifetime comorbidity. Both BD and ADHD are disorders with onset in childhood and early adolescence. Both disorders are often undiagnosed, misdiagnosed, and sometimes overdiagnosed, leading to high rates of morbidity and disability. The psychiatric and behavioral symptoms associated with ADHD and BD have significant overlap. Albeit the existence of a large body of literature, it is far from being clear whether comorbidity can be explained by the confounding overlap of operationally defined criteria or whether it reflects a genuine comorbidity of two biologically distinct disorders. The aim of this paper is to recognize and/or differentiate the pattern of ADHD across the course of BD from a nosological point of view, focusing on specific clinical and neurobiological dimensions. We found that some critical issues may help to fulfill the purpose of our perspective. We suggest that the relationship between ADHD and BD, based on clinical, developmental, and epidemiological commonalities, can be better clarified using four different scenarios.
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Affiliation(s)
- Anna Comparelli
- Department of Psychiatry, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Lorenzo Polidori
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Sarli
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Andrea Pistollato
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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9
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Silver J, Carlson GA, Olino TM, Perlman G, Mackin D, Kotov R, Klein DN. Differential outcomes of tonic and phasic irritability in adolescent girls. J Child Psychol Psychiatry 2021; 62:1220-1227. [PMID: 33719059 DOI: 10.1111/jcpp.13402] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Irritable mood is a transdiagnostic clinical feature that is present in multiple psychiatric disorders. Although irritability is frequently examined as a unitary construct, two dimensions of irritability, tonic (i.e., irritable mood) and phasic (i.e., temper outbursts), have been hypothesized. However, few studies have examined whether tonic and phasic irritability are empirically separable and predict different forms of psychopathology. METHODS We utilized data from a longitudinal study of a community sample of 550 girls (age 13.5-15.5 years) followed at 9-month intervals for 3 years. We conducted exploratory factor analysis (EFA) using items from three self-report inventories: the International Personality Item Pool Anger scale, Temperament and Affectivity Inventory Anger scale, and Buss-Perry Aggression Questionnaire Anger scale. RESULTS The EFA identified dimensions that were consistent with tonic and phasic irritability. Tonic irritability at baseline independently predicted the development of depressive disorders and generalized anxiety disorder (GAD) in subsequent waves. Phasic irritability independently predicted a decreased probability of GAD, but an increased probability of oppositional defiant, conduct, and substance use disorder, and greater risky sexual behavior and relational aggression during the follow-up. CONCLUSIONS Tonic and phasic irritability appear to be separable constructs with unique implications for later psychopathology and related behavior among adolescent girls. It is important to consider this distinction in research on the etiology and pathophysiology of irritability and developing effective treatments.
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Affiliation(s)
- Jamilah Silver
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | | | - Thomas M Olino
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Greg Perlman
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Daniel Mackin
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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Klein DN, Dougherty LR, Kessel EM, Silver J, Carlson GA. A Transdiagnostic Perspective on Youth Irritability. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2021; 30:437-443. [PMID: 35046617 PMCID: PMC8765598 DOI: 10.1177/09637214211035101] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Irritability is increasingly recognized as a significant clinical problem in youth. It is a criterion for multiple diagnoses and predicts the development of a wide range of disorders. Research on etiopathogenesis suggests that genetic and family environmental factors play a role, as do abnormalities in reward and cognitive control circuitry. However, many of these effects are age dependent. Threat-responsive self-regulatory systems and the degree to which irritability manifests as tonic or phasic influence whether irritable youth exhibit more internalizing versus externalizing outcomes.
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Affiliation(s)
| | | | - Ellen M. Kessel
- Division of Child and Adolescent Psychiatry, Columbia University and New York State Psychiatric Institute
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Parry P, Allison S, Bastiampillai T. 'Pediatric Bipolar Disorder' rates are still lower than claimed: a re-examination of eight epidemiological surveys used by an updated meta-analysis. Int J Bipolar Disord 2021; 9:21. [PMID: 34170440 PMCID: PMC8233426 DOI: 10.1186/s40345-021-00225-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/15/2021] [Indexed: 01/20/2023] Open
Abstract
Background ‘Pediatric bipolar disorder’ (PBD) is a controversial diagnosis with varying rates of clinical diagnosis. A highly cited meta-analysis (Van Meter et al. 2011) of a dozen epidemiological surveys suggested a global community prevalence of PBD of 1.8%. This was updated to 3.9% with eight additional surveys (Van Meter et al. 2019a). In terms of the Cochrane Handbook for Systematic Reviews of Interventions, the heterogenous community surveys were arguably unsuitable for statistical meta-analysis and warranted a narrative analysis. A narrative analysis (Parry et al. 2018) of the original 12 surveys concluded rates of PBD were substantially lower than 1.8% and led to a nine-article debate on the validity, arguable overdiagnosis and iatrogenic aspects of the PBD diagnosis (e.g. Carlson and Dubicka Child Adolesc Mental Health 21:86–87, 2019). This article extends the narrative analysis to include the eight newer community surveys. Methods A narrative analysis of the methodologies and the prevalence rates reported by the epidemiological surveys. Results Across all twenty surveys there was significant variation in methodologies and reported prevalence rates. Of the eight newer surveys, five (two Brazilian, one English, one Turkish, one United States) provided information of pre-adolescent prevalence rates of bipolar spectrum disorder. These pre-adolescent rates were zero or close to zero. Rates of adolescent hypomania and mania were higher, but follow-up data in two studies suggested hypomania might sometimes achieve prolonged remission or not lead to adult bipolar disorder. Limitations Methods in the original surveys vary and criteria used for various bipolar diagnoses were not always fully described. This limitation applies to a narrative analysis but also to a statistical meta-analysis. Conclusion Bipolar disorder is very rare in childhood and rare in adolescence. PBD as a diagnostic construct fails to correlate with adult bipolar disorder and the term should be abandoned. Hypomanic syndromes in adolescence may not always progress to adult bipolar disorder. Early diagnosis of bipolar disorder is important, but over-diagnosis risks adverse iatrogenic consequences.
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Affiliation(s)
- Peter Parry
- College of Medicine and Public Health, Flinders University, Adelaide, Australia. .,Children's Health Queensland Clinical Unit, School of Clinical Medicine, University of Queensland, Brisbane, Australia.
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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Abstract
Outbursts (severe temper loss) in children are a common reason for treatment referral. However, the diagnostic system has not classified them in a way that expands knowledge. Outbursts are nested in the concept of irritability, which consists of a feeling and a behavioral dimension. Both need to be identified but kept separate. This review summarizes the phenomenology of outbursts normatively and clinically. Severe temper loss needs a consistent label, an operationalized way of classification and measurement, and an assessment approach independent of diagnosis until other data are gathered to more accurately determine what condition provides the most accurate diagnostic home.
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Affiliation(s)
- Lauren Spring
- Psychiatry Residency Training; Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Health, HSC T-10, 101 Nicolls Road, Stony Brook, NY 11794, USA.
| | - Gabrielle A Carlson
- Renaissance School of Medicine, Stony Brook University, Putnam Hall-South Campus, 101 Nicolls Road, Stony Brook, NY 11794-8790, USA
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Sherwood SN, Greenway J, Freeman AJ. Decreasing rate of inpatient pediatric bipolar disorder diagnosis between 2005 and 2015. J Affect Disord 2020; 274:859-863. [PMID: 32664026 DOI: 10.1016/j.jad.2020.05.029] [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: 09/03/2019] [Revised: 04/22/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The rate of bipolar disorder (BD) diagnosis in youth increased between the mid-1990s and mid-2000s in the U.S. and remained low in other countries. The discrepancy resulted in concerns regarding misdiagnosis of BD. However, the longitudinal trajectory of BD diagnosis subsequent to the mid-2000s was unclear. Therefore, the current study assessed longitudinal changes in the rate of inpatient BD diagnosis in the state of Nevada between 2005 and 2015. METHODS Data included Medicaid administrative billing claims (n = 48,108 unique admissions) for youth 5-17 hospitalized at one of five psychiatric inpatient hospitals in Nevada. Regressions assessed changes in the rate of diagnosis over time for BD and compared to depressive disorders (DD). RESULTS The rate of BD diagnosis declined between 2005 and 2015. The rate of DD diagnosis remained stable for boys and increased substantially for girls during the same time period. LIMITATIONS Some individuals may have been repeatedly hospitalized throughout the study period and contribute more than one unique admission. Findings from this study were limited to a sample of Medicaid-insured youth in a single state. CONCLUSIONS The rate of mood disorder diagnosis in inpatient units is changing. The use of BD as a diagnosis is decreasing in Nevada which may reflect US trends nationally, though still high by international comparison. In contrast, DD increased for girls but not boys. Awareness of the current diagnostic trends for BD may assist inpatient administrators and clinicians in preparing for anticipated service utilization and planning allocation of resources.
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Affiliation(s)
- Samantha N Sherwood
- Department of Psychology, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, Nevada, USA
| | - Joseph Greenway
- Center for Health Information Analysis at the University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, Nevada, USA
| | - Andrew J Freeman
- Department of Psychology, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, Nevada, USA.
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14
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Duffy A, Carlson G, Dubicka B, Hillegers MHJ. Pre-pubertal bipolar disorder: origins and current status of the controversy. Int J Bipolar Disord 2020; 8:18. [PMID: 32307651 PMCID: PMC7167382 DOI: 10.1186/s40345-020-00185-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/17/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Evidence from epidemiological, clinical and high-risk studies has established that the peak period of risk for onset of bipolar disorder spans late adolescence and early adulthood. However, the proposal of the existence of a pre-pubertal form of bipolar disorder manifesting in early childhood created substantial debate. In this narrative review, the literature and contributing factors pertaining to the controversy surrounding the proposed pre-pubertal bipolar disorder subtype are discussed. The resolution of the debate and lessons learned are highlighted. MAIN BODY In the mid 1990s US researchers proposed that chronic irritability and explosive temper in pre-pubertal children with pre-existing ADHD and/or other learning and developmental disorders might represent a variant of mania. A number of factors contributed to this proposal including severely ill children with no diagnostic home given changes in the ADHD DSM diagnostic criteria and over-reliance on symptoms and structured interviews rather than on a clinical assessment incorporating developmental history, social context and clinical course. Prospective studies of children at high familial risk did not support the proposed pre-pubertal bipolar phenotype; but rather provided convergent evidence that bipolar disorder onset in adolescence and early adulthood not uncommonly preceded by sleep and internalizing symptoms and most often debuting as depression in adolescence (after puberty). Epidemiological studies of population and hospital discharge data provided evidence that the pre-pubertal bipolar phenotype was largely a US driven phenomenon. CONCLUSIONS Psychiatric diagnosis is particularly challenging given the current lack of objective biomarkers. However, validity and utility of clinical diagnoses can be strengthened if all available predictive information is used to formulate a diagnosis. As in other areas of medicine, critical information required to make a valid diagnosis includes developmental history, clinical course, family history and treatment response-weighed against the known trajectories of classical disorders. Moreover, given that psychiatric disorders are in evolution over childhood and adolescence and symptoms, in of themselves, are often non-specific, a thorough clinical assessment incorporating collateral history and psychosocial context is paramount. Such an approach might have avoided or at least brought a more timely resolution to the debate on pre-pubertal mania.
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Affiliation(s)
- A. Duffy
- Queen’s University, Kingston, Canada
- Department of Psychiatry, University Oxford, Oxford, UK
| | - G. Carlson
- Renaissance School of Medicine, Stonybrook University, Stony Brook, NY USA
| | - B. Dubicka
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M. H. J. Hillegers
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
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Carlson GA, Klein DN. Editorial: Antidepressants to the Rescue in Severe Mood Dysregulation and Disruptive Mood Dysregulation Disorder? J Am Acad Child Adolesc Psychiatry 2020; 59:339-341. [PMID: 31128267 DOI: 10.1016/j.jaac.2019.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/17/2019] [Indexed: 01/12/2023]
Abstract
Children with irritability and outbursts pose a serous therapeutic problem. Many of them have attention-deficit/hyperactivity disorder (ADHD) with emotion dysregulation, which is sometimes captured in the diagnosis of disruptive mood dysregulation disorder (DMDD). Some follow-up data find a connection between DMDD and depression and anxiety in adults. This prompted Towbin and colleagues1 to launch a trial where children (ages 7-17) with DMDD were treated first with methylphenidate (MPH) and then randomized to citalopram (CTP) or placebo over 8 weeks. The response to CTP was complicated by lack of specific measures of both irritable mood and severity of outbursts. Future studies should include standardized and normed parent and teacher measures of both externalizing and internalizing behavior as well as irritability specific measures rating how the child feels. Studies also need better measures of the actual outbursts-not just their frequency but how agitated or aggressive the child gets during an outburst (ie, what the child does) and how long the outbursts last. Measuring DMDD on inpatient units is especially complicated because of the therapeutic nature of the setting. Further work is needed with much larger samples to identify who improves with the treatment, exactly which domains of psychopathology improve and by how much. Finally, It is also critical to conduct longer-term trials to determine the stability of the response beyond 8 weeks.
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Beauchaine TP, Tackett JL. Irritability as a Transdiagnostic Vulnerability Trait:Current Issues and Future Directions. Behav Ther 2020; 51:350-364. [PMID: 32138943 DOI: 10.1016/j.beth.2019.10.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022]
Abstract
In recent years, irritability has received increasing attention among mental health professionals given its transdiagnostic associations with diverse forms of psychopathology. In contrast to other emotional states and traits, however, literature addressing associations between irritability and related temperament and personality constructs is limited. In addition, those who study irritability have diverse perspectives on its neurobiological substrates. In this comment, we situate irritability in the literatures on child temperament and adult personality, and describe a model in which irritability derives from low tonic dopamine (DA) levels and low phasic DA reactivity in subcortical neural structures implicated in appetitive responding. We note that different findings often emerge in neuroimaging studies when irritability is assessed in circumscribed diagnostic groups versus representative samples. We conclude with directions for future research, and propose that more authors use hierarchical Bayesian modeling, which captures functional dependencies between irritability and other dispositional traits (e.g., trait anxiety) that standard regression models are insensitive too. Treatment implications are also considered.
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Parry P, Allison S, Bastiampillai T. The geography of a controversial diagnosis: A bibliographic analysis of published academic perspectives on 'paediatric bipolar disorder'. Clin Child Psychol Psychiatry 2019; 24:529-545. [PMID: 30905170 DOI: 10.1177/1359104519836700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The hypothesis that bipolar disorder presents before puberty with atypical mania has proved to be controversial. Published academic perspectives on the validity of Paediatric Bipolar Disorder (PBD) appear to vary between the United States and the rest of the world. METHODS We examined the perspectives of articles citing four seminal articles. The citing articles were grouped as either supportive or non-supportive of the PBD hypothesis, and the perspectives of the articles by US authors were compared with those by non-US authors. RESULTS There were 787 citing articles commenting on PBD, mostly published in US-based journals. Most authors were affiliated with several US institutions. Among the 624 articles with US authorship, the majority (83%) supported PBD. Of the 163 articles by non-US authors, most (60%) supported the traditional view that bipolar disorders are rare before mid-adolescence. Published academic perspectives in favour of the PBD hypothesis are mostly concentrated in several US institutions. CONCLUSION There is majority support for PBD among citing articles from the United States, whereas the traditional perspective predominates in articles from most other countries.
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Affiliation(s)
- Peter Parry
- 1 School of Clinical Medicine - Children's Health Queensland Clinical Unit, University of Queensland, Australia.,2 College of Medicine and Public Health, Flinders University, Australia
| | - Stephen Allison
- 2 College of Medicine and Public Health, Flinders University, Australia
| | - Tarun Bastiampillai
- 2 College of Medicine and Public Health, Flinders University, Australia.,3 Mind and Brain Theme, South Australian Health and Medical Research Institute, Australia
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Comorbid disorders as moderators of response to family interventions among adolescents with bipolar disorder. J Affect Disord 2019; 246:754-762. [PMID: 30623821 PMCID: PMC6363856 DOI: 10.1016/j.jad.2018.12.125] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/15/2018] [Accepted: 12/24/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND While family interventions have shown efficacy in improving mood symptoms and family functioning in pediatric bipolar disorder, few studies have examined the effects of comorbid psychiatric conditions on patients' symptomatic or functional responses to treatment. METHODS 145 adolescents with bipolar I or II disorder were randomly assigned to family-focused therapy (FFT-A) or a brief psychoeducational therapy (enhanced care; EC) and followed over 2 years. Participants received pharmacotherapy for the study's duration. We examined whether comorbid anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorders (DBDs; i.e., oppositional defiant and conduct disorder) predicted the proportion of weeks that participants experienced mood symptoms during follow-up, and whether comorbid disorders moderated the effects of treatment assignment on mood symptoms and family conflict. RESULTS Comorbid anxiety was associated with a greater proportion of weeks with depressive symptoms, more severe (hypo)manic symptoms during follow-up, and greater family conflict over the 2-year study. Comorbid ADHD was associated with a greater proportion of weeks with (hypo)manic symptoms, more severe (hypo)manic symptoms, and greater family conflict. Additionally, youth with comorbid ADHD who received FFT-A had more favorable trajectories of (hypo)manic symptoms and family functioning than youth with comorbid ADHD who received EC. Comorbid DBDs were consistently associated with more severe depressive symptoms and greater family conflict throughout the study. LIMITATIONS Randomization to treatments was not stratified on comorbid disorders. The longitudinal trajectories of anxiety, attentional, and disruptive behavior symptoms were not examined. CONCLUSIONS The course of bipolar disorder in adolescents is strongly affected by comorbid disorders. Future research should examine whether adolescents with more complex presentations of bipolar disorder should be treated with different or more intensive psychosocial protocols than adolescents without these presentations.
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Duffy A, Heffer N, Goodday SM, Weir A, Patten S, Malhi GS, Cipriani A. Efficacy and tolerability of lithium for the treatment of acute mania in children with bipolar disorder: A systematic review: A report from the ISBD-IGSLi joint task force on lithium treatment. Bipolar Disord 2018; 20:583-593. [PMID: 30221434 DOI: 10.1111/bdi.12690] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess the efficacy and tolerability of lithium for the treatment of acute mania in children and adolescent diagnosed with bipolar disorder. METHODS A systematic literature search up to August 2017 was conducted for clinical trials that included lithium in males and females up to 18 years of age with a diagnosis of bipolar disorder and experiencing a manic or mixed episode according to standardized diagnostic criteria. The protocol was registered in PROSPERO (CRD42017055675). RESULTS Four independent studies described in seven manuscripts met the inclusion criteria. Overall, 176 patients were treated with lithium either as a monotherapy or adjunct to risperidone. Efficacy results suggest that lithium may be superior to placebo (standardized mean difference [SMD] -0.42, 95% confidence interval [CI] -0.88 to 0.04), comparable to sodium divalproex (SMD -0.07, 95% CI: -0.31 to 0.18), but significantly less effective than risperidone for treating protracted manic/mixed episodes and comorbid attention-deficit hyperactivity disorder (ADHD) in prepubertal children (SMD 0.85, 95% CI: 0.54 to 1.15). Lithium was not associated with serious adverse events, and was generally well tolerated with common side effects similar to those reported in adults. CONCLUSIONS Limited data suggests that lithium may be an effective and tolerable treatment for some forms of paediatric mania. However, lithium is clearly inferior in efficacy to risperidone in prepubertal patients diagnosed with protracted manic/mixed episodes and comorbid ADHD. There is a lack of data concerning the efficacy and tolerability of lithium as an acute treatment for classical mania in adolescents and important clinical issues remain unaddressed.
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Affiliation(s)
- Anne Duffy
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | | | - Sarah M Goodday
- Department of Epidemiology, University of Toronto, Toronto, Ontario, Canada
| | - Arielle Weir
- Mood Disorders Centre of Ottawa, Ottawa, Ontario, Canada
| | - Scott Patten
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Gin S Malhi
- The University of Sydney School of Medicine, Sydney, Australia
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20
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Parsing cyclothymic disorder and other specified bipolar spectrum disorders in youth. J Affect Disord 2018; 238:375-382. [PMID: 29909300 PMCID: PMC6322201 DOI: 10.1016/j.jad.2018.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Most studies of pediatric bipolar disorder (BP) combine youth who have manic symptoms, but do not meet criteria for BP I/II, into one "not otherwise specified" (NOS) group. Consequently, little is known about how youth with cyclothymic disorder (CycD) differ from youth with BP NOS. The objective of this study was to determine whether youth with a research diagnosis of CycD (RDCyc) differ from youth with operationalized BP NOS. METHOD Participants from the Course and Outcome of Bipolar Youth study were evaluated to determine whether they met RDCyc criteria. Characteristics of RDCyc youth and BP NOS youth were compared at baseline, and over eight-years follow-up. RESULTS Of 154 youth (average age 11.96 (3.3), 42% female), 29 met RDCyc criteria. RDCyc youth were younger (p = .04) at baseline. Over follow-up, RDCyc youth were more likely to have a disruptive behavior disorder (p = .01), and were more likely to experience irritability (p = .03), mood reactivity (p = .02), and rejection sensitivity (p = .03). BP NOS youth were more likely to develop hypomania (p = .02), or depression (p = .02), and tended to have mood episodes earlier in the eight-year follow-up period. LIMITATIONS RDCyc diagnoses were made retrospectively and followed stringent criteria, which may highlight differences that, under typical clinical conditions and more vague criteria, would not be evident. CONCLUSION There were few differences between RDCyc and BP NOS youth. However, the ways in which the groups diverged could have implications; chronic subsyndromal mood symptoms may portend a severe, but ultimately non-bipolar, course. Longer follow-up is necessary to determine the trajectory and outcomes of CycD symptoms.
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21
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Carlson GA, Klein DN. Commentary: Frying pan to fire? Commentary on Stringaris et al. (2018). J Child Psychol Psychiatry 2018; 59:740-743. [PMID: 29924397 PMCID: PMC6093282 DOI: 10.1111/jcpp.12873] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2018] [Indexed: 01/28/2023]
Abstract
The bipolar disorder diagnosis in prepubertal children became popular because it answered a clinical need to treat the explosive behavior component of irritability and the hope that antimanic strategies would be helpful. Poor definition of episodes resulted in mixing chronic and episodic irritability in samples of children with bipolar disorder. The subsequent dramatic increase in neuroleptic use is a testimony to the importance of the problem of irritability and our need to better understand it. Insofar as our use of the term irritability conflates proneness to anger with the subsequent aggressive response, it will again not be clear who is being studied. We need to uncouple the mood and behavior aspects of irritability for further study or we will have traded the imprecision of "bipolar" for the imprecision of irritability.
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Affiliation(s)
- Gabrielle A. Carlson
- Professor of Psychiatry and Pediatrics, Stony Brook University School of Medicine
| | - Daniel N. Klein
- Distinguished Professor of Psychology, Stony Brook University
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Carlson GA. Commentary: Bipolar disorder in youth - what is it and where is it? - a commentary on Parry et al. (2018). Child Adolesc Ment Health 2018; 23:23-25. [PMID: 32677371 DOI: 10.1111/camh.12243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 11/28/2022]
Abstract
Parry and colleagues reexamine the 12 articles that comprise a widely cited, 2011 meta-analysis of community studies of pediatric bipolar that stated no differences exist between rates in the United States and other countries. This reexamination concludes not only are there in fact considerable differences in rates of bipolar disorder (both bipolar I disorder and bipolar spectrum disorder) but also the rates overall are lower than the meta-analysis stated. This editorial explains some of the reasons behind the overly enthusiastic reports of bipolar disorder rates in youth including definitional (what is pediatric and what is bipolar) and assessment ambiguities and the bona fide effort to explain the psychopathology underpinning explosive children. Although the questions of what prepubertal bipolar disorder is have themselves been polarizing, common ground is being increasingly found.
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Affiliation(s)
- Gabrielle A Carlson
- New York State University, Department of Psychiatry and Behavioural Science, Putnam Hall State University of New York, Stony Brook, NY, 11794-8790, USA
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23
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Parry P, Allison S, Bastiampillai T. 'Paediatric bipolar disorder' rates are lower than claimed - a reexamination of the epidemiological surveys used by a meta-analysis. Child Adolesc Ment Health 2018; 23:14-22. [PMID: 32677365 DOI: 10.1111/camh.12231] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND 'Paediatric bipolar disorder' (PBD) is a controversial diagnosis where often prepubertal children as well as adolescents, who may have a range of psychiatric disorders or symptoms, are diagnosed with a severe mental illness requiring lifelong medication. Clinically, it has often been applied in the United States but rarely in most other countries. A meta-analysis (Van Meter et al., Journal of Clinical Psychiatry, , 72, 1250) claimed that the prevalence of PBD was similar to adults at 1.8% with no difference between the United States and other countries. This conclusion has been highly cited. METHODS The heterogeneous nature of the original 12 epidemiological surveys warrants a qualitative analysis, rather than statistical meta-analysis as performed by Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250). Thus, the meta-analysis and each of the 12 studies (six from the United States; six from other countries) were reexamined. RESULTS Most of the 12 surveys predated the emergence of the PBD hypothesis. The 12 surveys were mainly of adolescents and at times young adults with few prepubertal children. Prevalence rates in the 12 studies suggest a lower rate of bipolar disorder, especially in non-US samples. For example, the Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250) meta-analysis chose a rate of 2.8% by summation of adolescent and parent responses in a Dutch survey, however the rate fell to 0% if requiring concordance of adolescent and parent responses. Indeed, it could be argued that four of the non-US studies show 0% rates of PBD. CONCLUSIONS Rates of PBD were generally substantially lower than 1.8%, particularly in non-US surveys, and if both parent and adolescent reports were required to meet the diagnostic threshold they fell to close to zero. The reanalysis suggests that bipolar disorder is rare before the expected age of onset in later adolescence.
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Affiliation(s)
- Peter Parry
- Department of Psychiatry, Royal Brisbane & Women's Hospital, University of Queensland, Herston, Brisbane, QLD, 4006, Australia.,School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Stephen Allison
- School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- School of Medicine, Flinders University, Adelaide, SA, Australia.,Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Ryles F, Meyer TD, Adan-Manes J, MacMillan I, Scott J. A systematic review of the frequency and severity of manic symptoms reported in studies that compare phenomenology across children, adolescents and adults with bipolar disorders. Int J Bipolar Disord 2017; 5:4. [PMID: 28155204 PMCID: PMC5289931 DOI: 10.1186/s40345-017-0071-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/04/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In the last two decades, there has been a significant increase in the diagnosis of Bipolar Disorder (BD) in children. The notion of prepubertal onsets of BD is not without controversy, with researchers debating whether paediatric cases have a distinct symptom profile or follow a different illness trajectory from other forms of BD. The latter issue is difficult to address without long-term prospective follow-up studies. However, in the interim, it is useful to consider the phenomenology observed in groups of cases with different ages of onset and particularly to compare manic symptoms in children diagnosed with BD compared to cases presenting with BD in adolescence and adulthood. This review systematically explores the phenomenology of manic or hypomanic episodes in groups defined by age at onset of BD (children, adolescents and adults; or combined age groups e.g. children and adolescents versus adults). METHODS Literature reviews of PubMed and Scopus were conducted to identify publications which directly compared the frequency or severity of manic symptoms in individuals with BD presenting with a first episode of mania in childhood, adolescence or adulthood. RESULTS Of 304 studies identified, 55 texts warranted detailed review, but only nine studies met eligibility criteria for inclusion. Comparison of manic symptoms across age groups suggested that irritability is a key feature of BD with an onset in childhood, activity is the most prominent in adolescent-onset BD and pressure of speech is more characteristic of adult-onset BD. However, none of the eligible studies made a direct comparison of phenomenology in children versus adults. Assessment procedures varied in quality and undermined the reliability of cross-study comparisons. Other limitations were: the scarcity of comparative studies, the geographic bias (most studies originated in the USA), the failure to fully consider the impact of psychiatric comorbidities on recorded symptoms and methodological heterogeneity. CONCLUSIONS Despite frequent discussion of similarities and differences in phenomenology of mania presenting in different age groups, systematic research is lacking and studies are still required to reliably establish whether the frequency and severity of manic symptoms varies. Such information has implications for clinical practice and the classification of mental disorders.
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Affiliation(s)
- Faye Ryles
- Early Intervention in Psychiatry Hub, NTW NHS Trust, Newcastle upon Tyne, UK
| | - Thomas D. Meyer
- Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, TX USA
| | | | - Iain MacMillan
- Early Intervention in Psychiatry Hub, NTW NHS Trust, Newcastle upon Tyne, UK
| | - Jan Scott
- Academic Psychiatry, Wolfson Unit, Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
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Goldstein BI, Birmaher B, Carlson GA, DelBello MP, Findling RL, Fristad M, Kowatch RA, Miklowitz DJ, Nery FG, Perez‐Algorta G, Van Meter A, Zeni CP, Correll CU, Kim H, Wozniak J, Chang KD, Hillegers M, Youngstrom EA. The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research. Bipolar Disord 2017; 19:524-543. [PMID: 28944987 PMCID: PMC5716873 DOI: 10.1111/bdi.12556] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/14/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Over the past two decades, there has been tremendous growth in research regarding bipolar disorder (BD) among children and adolescents (ie, pediatric BD [PBD]). The primary purpose of this article is to distill the extant literature, dispel myths or exaggerated assertions in the field, and disseminate clinically relevant findings. METHODS An international group of experts completed a selective review of the literature, emphasizing areas of consensus, identifying limitations and gaps in the literature, and highlighting future directions to mitigate these gaps. RESULTS Substantial, and increasingly international, research has accumulated regarding the phenomenology, differential diagnosis, course, treatment, and neurobiology of PBD. Prior division around the role of irritability and of screening tools in diagnosis has largely abated. Gold-standard pharmacologic trials inform treatment of manic/mixed episodes, whereas fewer data address bipolar depression and maintenance/continuation treatment. Adjunctive psychosocial treatment provides a forum for psychoeducation and targets primarily depressive symptoms. Numerous neurocognitive and neuroimaging studies, and increasing peripheral biomarker studies, largely converge with prior findings from adults with BD. CONCLUSIONS As data have accumulated and controversy has dissipated, the field has moved past existential questions about PBD toward defining and pursuing pressing clinical and scientific priorities that remain. The overall body of evidence supports the position that perceptions about marked international (US vs elsewhere) and developmental (pediatric vs adult) differences have been overstated, although additional research on these topics is warranted. Traction toward improved outcomes will be supported by continued emphasis on pathophysiology and novel therapeutics.
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Affiliation(s)
- Benjamin I Goldstein
- Centre for Youth Bipolar DisorderSunnybrook Health Sciences CentreTorontoCanada,Departments of Psychiatry and PharmacologyUniversity of TorontoTorontoCanada
| | - Boris Birmaher
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Gabrielle A Carlson
- Department of PsychiatryStony Brook University School of MedicineStony BrookNYUSA
| | - Melissa P DelBello
- Department of Psychiatry & Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOHUSA
| | - Robert L Findling
- Department of Psychiatry & Behavioral SciencesThe Johns Hopkins UniversityBaltimoreMDUSA
| | - Mary Fristad
- Ohio State University Wexner Medical Center/Nationwide Children's HospitalColumbusOHUSA
| | - Robert A Kowatch
- Ohio State University Wexner Medical Center/Nationwide Children's HospitalColumbusOHUSA
| | | | - Fabiano G Nery
- Department of Psychiatry & Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOHUSA
| | | | - Anna Van Meter
- Ferkauf Graduate School of PsychologyYeshiva UniversityBronxNYUSA
| | | | - Christoph U Correll
- The Zucker Hillside HospitalDepartment of PsychiatryNorthwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineHofstra Northwell School of MedicineHempsteadNYUSA
| | - Hyo‐Won Kim
- Department of PsychiatryUniversity of Ulsan College of MedicineAsan Medical CenterSeoulKorea
| | - Janet Wozniak
- Clinical and Research Program in Pediatric PsychopharmacologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Kiki D Chang
- Department of PsychiatryStanford UniversityPalo AltoCAUSA
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry and PsychologyErasmus Medical Center‐SophiaRotterdamThe Netherlands
| | - Eric A Youngstrom
- Department of Psychology and NeuroscienceUniversity of North CarolinaChapel HillNCUSA
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Ong ML, Youngstrom EA, Chua JJX, Halverson TF, Horwitz SM, Storfer-Isser A, Frazier TW, Fristad MA, Arnold LE, Phillips ML, Birmaher B, Kowatch RA, Findling RL. Comparing the CASI-4R and the PGBI-10 M for Differentiating Bipolar Spectrum Disorders from Other Outpatient Diagnoses in Youth. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:611-623. [PMID: 27364346 PMCID: PMC5685560 DOI: 10.1007/s10802-016-0182-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We compared 2 rating scales with different manic symptom items on diagnostic accuracy for detecting pediatric bipolar spectrum disorder (BPSDs) in outpatient mental health clinics. Participants were 681 parents/guardians of eligible children (465 male, mean age = 9.34) who completed the Parent General Behavior Inventory-10-item Mania (PGBI-10 M) and mania subscale of the Child and Adolescent Symptom Inventory-Revised (CASI-4R). Diagnoses were based on KSADS interviews with parent and youth. Receiver operating characteristic (ROC) analyses and diagnostic likelihood ratios (DLRs) determined discriminative validity and provided clinical utility, respectively. Logistic regressions tested for incremental validity in the CASI-4R mania subscale and PGBI-10 M in predicting youth BPSD status above and beyond demographic and common diagnostic comorbidities. Both CASI-4R and PGBI-10 M scales significantly distinguished BPSD (N = 160) from other disorders (CASI-4R: Area under curve (AUC) = .80, p < 0.0005; PGBI-10 M: AUC = 0.79, p < 0.0005) even though scale items differed. Both scales performed equally well in differentiating BPSDs (Venkatraman test p > 0.05). Diagnostic likelihood ratios indicated low scores on either scale (CASI: 0-5; PGBI-10 M: 0-6) cut BPSD odds to 1/5 of those with high scores (CASI DLR- = 0.17; PGBI-10 M DLR- = 0.18). High scores on either scale (CASI: 14+; PGBI-10 M: 20+) increased BPSD odds about fourfold (CASI DLR+ = 4.53; PGBI-10 M DLR+ = 3.97). Logistic regressions indicated the CASI-4R mania subscale and PGBI-10 M each provided incremental validity in predicting youth BPSD status. The CASI-4R is at least as valid as the PGBI-10 M to help identify BPSDs, and can be considered as part of an assessment battery to screen for pediatric BPSDs.
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Affiliation(s)
- Mian-Li Ong
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC, 27599-3270, USA
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC, 27599-3270, USA.
| | - Jesselyn Jia-Xin Chua
- Department of Psychology, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore
| | - Tate F Halverson
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC, 27599-3270, USA
| | - Sarah M Horwitz
- Department of Child and Adolescent Psychiatry, New York University, New York, NY, USA
| | | | - Thomas W Frazier
- Cleveland Clinic Foundation, 2049 E 100th St, Cleveland, OH, 44195, USA
| | - Mary A Fristad
- Department of Psychology, Ohio State University, Columbus, OH, 43210, USA
| | - L Eugene Arnold
- Research Unit on Pediatric Psychopharmacology, Ohio State University, Columbus, OH, 43210, USA
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Robert A Kowatch
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Robert L Findling
- Department of Psychiatry, Kennedy Krieger Institute, John Hopkins University, Baltimore, MD, 21218, USA
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Purper-Ouakil D, Porfirio MC, Le Strat Y, Falissard B, Gorwood P, Masi G. What do childhood attention deficit/hyperactivity symptoms in depressed adults tell us about the bipolar spectrum? Psychiatry Res 2017; 249:244-251. [PMID: 28126580 DOI: 10.1016/j.psychres.2016.12.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 06/15/2016] [Accepted: 12/31/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aims to establish if adult patients with major depressive disorder (MDD) and childhood Attention Deficit/Hyperactivity disorder (ADHD) symptoms would be more frequently within the bipolar spectrum than depressed patients without childhood ADHD. METHODS This study was carried out in outpatients recruited by psychiatrists in private practice, with 3963 participants being included in the final sample. Clinicians filled out questionnaires about current depressive symptoms in their patients, lifetime bipolar symptoms, global assessment of functioning and parental history of both major depression and bipolar disorder. Patients assessed current level of anxiety and depressive symptoms and antecedents of childhood ADHD symptoms. RESULTS Depressed adults with significant childhood ADHD symptoms had a specific pattern of their major depressive episode compared to depressed patients without such symptoms. Subjects with childhood ADHD symptoms were more likely to report lifetime symptoms of mania/hypomania and to have a parent with type I or II bipolar disorder. The developmental trajectories of familial risk for lifetime bipolar symptoms showed that parental bipolar disorder influenced lifetime bipolar symptoms both through a direct pathway and an indirect pathway involving childhood ADHD symptoms. Childhood ADHD and number of depressive symptoms both made direct contributions to lifetime bipolar symptoms.
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Affiliation(s)
- D Purper-Ouakil
- Unit of Child and Adolescent Psychiatry (MPEA1), CHU Montpellier-Saint Eloi Hospital, Montpellier, France.
| | - M C Porfirio
- Unit of Child Neurology and Psychiatry of "Tor Vergata", University of Rome, Italy
| | - Y Le Strat
- AP-HP Hôpital Louis Mourier, 178 Rue des Renouillers, 92700 Colombes, France; INSERM U894 Centre Psychiatrie et Neurosciences, Paris, France
| | - B Falissard
- INSERM U1178, Maison de Solenn, Paris, France
| | - P Gorwood
- INSERM U894 Centre Psychiatrie et Neurosciences, Paris, France; CMME Saint Anne Hospital, Hôpital Sainte-Anne (Paris-Descartes University), France
| | - G Masi
- Stella Maris Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
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Abstract
The age at onset of bipolar disorder ranging from childhood to adolescent to adult has significant implications for frequency, severity and duration of mood episodes, comorbid psychopathology, heritability, response to treatment, and opportunity for early intervention. There is increasing evidence that recognition of prodromal symptoms in at-risk populations and mood type at onset are important variables in understanding the course of this illness in youth. Very early childhood onset of symptoms including anxiety/depression, mood lability, and subthreshold manic symptoms, along with family history of a parent with early onset bipolar disorder, appears to predict the highest risk of early onset disorder with the most severe course.
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Affiliation(s)
- Gabrielle A Carlson
- Stony Brook University School of Medicine, Putnam Hall-South Campus, Stony Brook, NY, 11794-8790, USA.
| | - Caroly Pataki
- Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
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Categorical and dimensional psychopathology in Dutch and US offspring of parents with bipolar disorder: A preliminary cross-national comparison. J Affect Disord 2016; 205:95-102. [PMID: 27423424 PMCID: PMC5373647 DOI: 10.1016/j.jad.2016.06.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 05/30/2016] [Accepted: 06/03/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Accumulating evidence suggests cross-national differences in adults with bipolar disorder (BD), but also in the susceptibility of their offspring (bipolar offspring). This study aims to explore and clarify cross-national variation in the prevalence of categorical and dimensional psychopathology between bipolar offspring in the US and The Netherlands. METHODS We compared levels of psychopathology in offspring of the Pittsburgh Bipolar Offspring Study (n=224) and the Dutch Bipolar Offspring Study (n=136) (age 10-18). Categorical psychopathology was ascertained through interviews using the Schedule for Affective Disorders and Schizophrenia for School Age Children (K-SADS-PL), dimensional psychopathology by parental reports using the Child Behavior Checklist (CBCL). RESULTS Higher rates of categorical psychopathology were observed in the US versus the Dutch samples (66% versus 44%). We found no differences in the overall prevalence of mood disorders, including BD-I or -II, but more comorbidity in mood disorders in US versus Dutch offspring (80% versus 34%). The strongest predictors of categorical psychopathology were maternal BD (OR: 1.72, p<.05), older age of the offspring (OR: 1.19, p<.05), and country of origin (US; OR: 2.17, p<.001). Regarding comorbidity, only country of origin (OR: 7.84, p<.001) was a significant predictor. In general, we found no differences in dimensional psychopathology based on CBCL reports. LIMITATIONS Preliminary measure of inter-site reliability. CONCLUSIONS We found cross-national differences in prevalence of categorical diagnoses of non-mood disorders in bipolar offspring, but not in mood disorder diagnoses nor in parent-reported dimensional psychopathology. Cross-national variation was only partially explained by between-sample differences. Cultural and methodological explanations for these findings warrant further study.
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Evaluation of Bipolar Disorder in Children and Adolescents Referred to a Mood Service: Diagnostic Pathways and Manic Dimensions. J Psychiatr Pract 2016; 22:429-441. [PMID: 27824775 DOI: 10.1097/pra.0000000000000187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Few studies have examined pediatric mental health services for early-onset bipolar disorder (BD). The goal of this study was to describe diagnostic pathways and manic dimensions in BD among referred children and adolescents. METHODS Data were obtained from a review of the charts of 814 subjects, 2 to 17 years of age, with a complaint of mood disturbances who were referred between 2003 and 2012 to a university-based child and adolescent clinic that specializes in mood disorders. After screening, eligible participants (N=494) were systematically assessed and followed to determine diagnoses on the basis of criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision in accordance with the best-estimate approach. Manic symptoms were subjected to principal component analysis to investigate the dimensional bipolar profile of the sample. RESULTS Among the total help-seeking sample, approximately one third of the participants dropped out at intake and, after an average follow-up of 1.7 years, one third had been determined to meet criteria for BD and one third did not fulfill operational criteria for BD. The diagnostic status was changed in 35% of patients: approximately 10% were false positive (going from any bipolar diagnosis to a nonbipolar diagnosis) and approximately 25% were false negative (going from a nonbipolar diagnosis to any bipolar diagnosis). Most patients who converted to a bipolar diagnosis were initially labeled with major depressive disorder or attention-deficit/hyperactivity disorder and had a longer follow-up period. Relevant manic dimensions were elation, grandiosity, and disruption, which explained 41.4% of total variance. CONCLUSIONS Regular reappraisal and follow-up of children and adolescents with mood disturbances provides a window for detection of BD (eg, of core manic dimensions). A coordinated and hierarchical connection among pediatric mental health services with different degrees of specialization is recommended.
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Carlson GA. Disruptive Mood Dysregulation Disorder: Where Did It Come from and Where Is It Going. J Child Adolesc Psychopharmacol 2016; 26:90-3. [PMID: 27007451 DOI: 10.1089/cap.2016.29102.gca] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Gabrielle A Carlson
- Division of Child and Adolescent Psychiatry, Stony Brook University School of Medicine , Stony Brook, New York
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Van Meter A, Youngstrom E, Freeman A, Feeny N, Youngstrom JK, Findling RL. Impact of Irritability and Impulsive Aggressive Behavior on Impairment and Social Functioning in Youth with Cyclothymic Disorder. J Child Adolesc Psychopharmacol 2016; 26:26-37. [PMID: 26835744 PMCID: PMC4779275 DOI: 10.1089/cap.2015.0111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Research on adults with cyclothymic disorder (CycD) suggests that irritability and impulsive aggression (IA) are highly prevalent among this population. Less is known about whether these behaviors might also distinguish youth with CycD from youth without CycD. Additionally, little is known about how irritability and IA relate to one another, and whether they are associated with different outcomes. This study aimed to compare irritability and IA across diagnostic subtypes to determine whether CycD is uniquely associated with these behaviors, and to assess how irritability and IA relate to youth social and general functioning. METHODS Participants (n = 459), 11-18 years of age, were recruited from an urban community mental health center and an academic outpatient clinic; 25 had a diagnosis of CycD. Youth and caregivers completed measures of IA and irritability. Youth and caregivers also completed an assessment of youth friendship quality. Clinical interviewers assessed youth social, family, and school functioning. RESULTS Youth with CycD had higher scores on measures of irritability and IA than youth with nonbipolar disorders, but scores were not different from other youth with bipolar spectrum disorders. Measures of irritability and IA were correlated, but represented distinct constructs. Regression analyses indicated that irritability was related to friendship quality (p < 0.005). Both IA and irritability were related to social impairment (ps < 0.05-0.0005) and Child Global Assessment Scale (C-GAS) scores (ps = 0.05-0.005). CycD diagnosis was associated with poorer caregiver-rated friendship quality and social functioning (ps < 0.05). CONCLUSIONS We found that irritability and aggression were more severe among youth with CycD than among youth with nonbipolar diagnoses, but did not differ across bipolar disorder subtypes. Among youth seeking treatment for mental illness, irritability and IA are prevalent and nonspecific. Irritability and IA were uniquely related to our outcomes of social and general functioning, suggesting that it is worthwhile to assess each separately, in order to broaden our understanding of the characteristics and correlates of each.
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Affiliation(s)
- Anna Van Meter
- Ferkauf Graduate School, Yeshiva University, Bronx, New York
| | - Eric Youngstrom
- Department of Psychology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrew Freeman
- Department of Psychology,The University of Nevada at Las Vegas, Las Vegas, Nevada
| | - Norah Feeny
- Department of Psychology, Case Western Reserve University, Cleveland, Ohio
| | - Jennifer Kogos Youngstrom
- Department of Psychology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Carlson GA, Pataki C. Bipolar Disorder Among Children and Adolescents. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2016; 14:15-19. [PMID: 31975789 DOI: 10.1176/appi.focus.20150038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Although for years it was felt to be almost nonexistent, very-early-onset bipolar disorder (before age 12) has become an important member of the mood disorder spectrum of youths. Whether there is a separate subtype characterized by severe irritability or whether the problem of emotionally explosive children is better explained by other conditions is still being resolved. The diagnosis of bipolar I disorder requires an episode of mania, and understanding those manic symptoms is the source of differences in interpretation.
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Affiliation(s)
- Gabrielle A Carlson
- Dr. Carlson is professor of Psychiatry and Pediatrics and director emerita in the Division of Child and Adolescent Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York (e-mail: ). Dr. Pataki is clinical professor of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles
| | - Caroly Pataki
- Dr. Carlson is professor of Psychiatry and Pediatrics and director emerita in the Division of Child and Adolescent Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York (e-mail: ). Dr. Pataki is clinical professor of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles
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Carlson GA, Pataki C. Disruptive Mood Dysregulation Disorder Among Children and Adolescents. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2016; 14:20-25. [PMID: 31975790 DOI: 10.1176/appi.focus.20150039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Disruptive mood dysregulation disorder (DMDD) was introduced in the mood disorders section of DSM-5. Its primary symptoms are "severe, recurrent temper outbursts" (manifested verbally and/or physically) superimposed on and associated with chronic irritability. DMDD is a condition with an early age of onset (i.e., symptoms apparent by age 10, although the diagnosis cannot be made before age 6); however, nothing is known about the condition among adults in part because questions about temper outbursts (versus "often losing temper") are not consistently asked after 6 years of age. Other qualifiers are present so that better-known conditions are not overlooked. For instance, manic symptoms that are present for more than 1 day, symptoms that are not exclusively occurring during major depressive disorder, or symptoms that are better explained by autism, posttraumatic stress disorder, separation anxiety, and dysthymia are exclusionary. Although DMDD can co-occur with attention-deficit hyperactivity disorder (ADHD), conduct disorder, and substance use disorder, it preempts diagnoses of both oppositional defiant disorder and intermittent explosive disorder.
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Affiliation(s)
- Gabrielle A Carlson
- Dr. Carlson is professor of Psychiatry and Pediatrics and director emerita in the Division of Child and Adolescent Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York (e-mail: ). Dr. Pataki is clinical professor of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles
| | - Caroly Pataki
- Dr. Carlson is professor of Psychiatry and Pediatrics and director emerita in the Division of Child and Adolescent Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York (e-mail: ). Dr. Pataki is clinical professor of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles
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Vedel Kessing L, Vradi E, Kragh Andersen P. Diagnostic stability in pediatric bipolar disorder. J Affect Disord 2015; 172:417-21. [PMID: 25451446 DOI: 10.1016/j.jad.2014.10.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 10/20/2014] [Accepted: 10/20/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The diagnostic stability of pediatric bipolar disorder has not been investigated previously. The aim was to investigate the diagnostic stability of the ICD-10 diagnosis of pediatric mania/bipolar disorder. METHODS All patients below 19 years of age who got a diagnosis of mania/bipolar disorder at least once in a period from 1994 to 2012 at psychiatric inpatient or outpatient contact in Denmark were identified in a nationwide register. RESULTS Totally, 354 children and adolescents got a diagnosis of mania/bipolar disorder at least once; a minority, 144 patients (40.7%) got the diagnosis at the first contact whereas the remaining patients (210; 59.3%) got the diagnosis at later contacts before age 19. For the latter patients, the median time elapsed from first treatment contact with the psychiatric service system to the first diagnosis with a manic episode/bipolar disorder was nearly 1 year and for 25% of those patients it took more than 2½ years before the diagnosis was made. The most prevalent other diagnoses than bipolar disorder at first contact were depressive disorder (21.4%), acute and transient psychotic disorders or other non-organic psychosis (19.2%), reaction to stress or adjustment disorder (14.8%) and behavioral and emotional disorders with onset during childhood or adolescents (10.9%). Prevalence rates of schizophrenia, personality disorders, anxiety disorder or hyperkinetic disorders (ADHD) were low. LIMITATIONS Data concern patients who get contact to hospital psychiatry only. CONCLUSIONS Clinicians should be more observant on manic symptoms in children and adolescents who at first glance present with transient psychosis, reaction to stress/adjustment disorder or with behavioral and emotional disorders with onset during childhood or adolescents (F90-98) and follow these patients more closely over time identifying putable hypomanic and manic symptoms as early as possible.
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Affiliation(s)
- Lars Vedel Kessing
- Psychiatric Center Copenhagen, Department O, 6233 Blegdamsvej 9, 2100 Copenhagen, Denmark and University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark.
| | - Eleni Vradi
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Per Kragh Andersen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
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Parry PI, Richards LME. Stark discrepancy in pediatric bipolar diagnoses between the US and UK/Australia. J Am Acad Child Adolesc Psychiatry 2014; 53:1234-5. [PMID: 25440313 DOI: 10.1016/j.jaac.2014.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/16/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Peter I Parry
- School of Medicine, Royal Brisbane Clinical School, University of Queensland, Brisbane, QLD, Australia.
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