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Perino MT, Harper-Lednicky JC, Vogel AC, Sylvester CM, Barch DM, Luby JL. Social anxiety moderates the association between adolescent irritability and bully perpetration. Dev Psychopathol 2024:1-8. [PMID: 38476047 PMCID: PMC11393177 DOI: 10.1017/s0954579424000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Preliminary work suggests anxiety moderates the relationship between irritability and bullying. As anxiety increases, the link between irritability and perpetration decreases. We hypothesize that any moderation effect of anxiety is driven by social anxiety symptoms. We sought to explicate the moderating effect of anxiety, while clarifying relations to other aggressive behaviors. METHODS A sample of adolescents (n = 169, mean = 12.42 years of age) were assessed using clinician rated assessments of anxiety, parent reports of irritability and bullying behaviors (perpetration, generalized aggression, and victimization). Correlations assessed zero-order relations between variables, and regression-based moderation analyses were used to test interactions. Johnson-Neyman methods were used to represent significant interactions. RESULTS Irritability was significantly related to bullying (r = .403, p < .001). Social, but not generalized, anxiety symptoms significantly moderated the effect of irritability on bully perpetration (t(160) = -2.94, b = -.01, p = .0038, ΔR2 = .0229, F(1, 160) = 8.635). As social anxiety symptoms increase, the link between irritability and perpetration decreases. CONCLUSIONS Understanding how psychopathology interacts with social behaviors is of great importance. Higher social anxiety is linked to reduced relations between irritability and bullying; however, the link between irritability and other aggression remains positive. Comprehensively assessing how treatment of psychopathology impacts social behaviors may improve future intervention.
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Affiliation(s)
- Michael T Perino
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Alecia C Vogel
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Chad M Sylvester
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychology and Brain Sciences, Washington University in St Louis, St. Louis, MO, USA
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Su MH, Liao SC, Chen HC, Lu ML, Chen WY, Hsiao PC, Chen CH, Huang MC, Kuo PH. The association of personality polygenic risk score, psychosocial protective factors and suicide attempt in mood disorder. J Psychiatr Res 2022; 156:422-428. [PMID: 36323145 DOI: 10.1016/j.jpsychires.2022.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/28/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Some personality traits, especially neuroticism, has been found to be associated with suicide attempt (SA) in mood disorder patients. The present study explored the association between personality traits and SA using polygenic risk scores (PRS) for personality among patients with mood disorders. We also investigated the effects of a variety of psychosocial variables on SA. Patients with bipolar disorder (BPD, N = 841) and major depressive disorder (MDD, N = 710) were recruited from hospitals in Taiwan. Lifetime SA and information on psychosocial factors was collected. We calculated the PRS of neuroticism and extraversion. A trend test for SA was performed across quartiles of the PRS for neuroticism and extraversion, and logistic regression analyses were performed to examine the associations between psychosocial factors and SA, accounting for the PRS of personality traits. The prevalence of SA was higher in MDD than in BPD patients. The risk of SA was elevated in MDD patients with a higher quintile of PRS in neuroticism and a lower quintile of PRS in extraversion. The multiple regression analysis results demonstrated that later age of onset, higher family support and resilience, and lower overall social support were protective factors against SA. From the perspective of suicide prevention efforts, strengthening family support and conducting resilience training for patients with mood disorders may be beneficial interventions in clinical settings.
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Affiliation(s)
- Mei-Hsin Su
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Department of Psychiatry, National Taiwan University BioMedical Park Hospital, Zhubei City, Hsinchu County, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsi-Chung Chen
- Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Wen-Yin Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taipei, Taiwan
| | - Po-Chang Hsiao
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Hsin Chen
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taiwan.
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Kelberman C, Biederman J, Green A, Spera V, Maiello M, Uchida M. Differentiating bipolar disorder from unipolar depression in youth: A systematic literature review of neuroimaging research studies. Psychiatry Res Neuroimaging 2021; 307:111201. [PMID: 33046342 PMCID: PMC8021005 DOI: 10.1016/j.pscychresns.2020.111201] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 01/14/2023]
Abstract
Differentiating bipolar disorder from unipolar depression is one of the most difficult clinical questions posed in pediatric psychiatric practices, as misdiagnosis can lead to severe repercussions for the affected child. This study aimed to examine the existing literature that investigates brain differences between bipolar and unipolar mood disorders in children directly, across all neuroimaging modalities. We performed a systematic literature search through PubMed, PsycINFO, Embase, and Medline databases with defined inclusion and exclusion criteria. Nine research studies were included in the systematic qualitative review, including three structural MRI studies, five functional MRI studies, and one MR spectroscopy study. Relevant variables were extracted and brain differences between bipolar and unipolar mood disorders in children as well as healthy controls were qualitatively analyzed. Across the nine studies, our review included 228 subjects diagnosed with bipolar disorder, 268 diagnosed with major depressive disorder, and 299 healthy controls. Six of the reviewed studies differentiated between bipolar and unipolar mood disorders. Differentiation was most commonly found in the anterior cingulate cortex (ACC), insula, and dorsal striatum (putamen and caudate) brain areas. Despite its importance, the current neuroimaging literature on this topic is scarce and presents minimal generalizability.
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Affiliation(s)
- Caroline Kelberman
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Joseph Biederman
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA 02114, United States; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, United States
| | - Allison Green
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Vincenza Spera
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56100, Italy
| | - Marco Maiello
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56100, Italy
| | - Mai Uchida
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA 02114, United States; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, United States.
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4
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Suicidal ideation and attempts in unipolar versus bipolar depression: analysis of 131,740 adolescent inpatients nationwide. Psychiatry Res 2020; 291:113231. [PMID: 32574899 DOI: 10.1016/j.psychres.2020.113231] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 12/16/2022]
Abstract
Objective To evaluate the risk of suicidal ideation and suicidal attempt in adolescents with unipolar depression (UD) versus bipolar depression (BD). Method We included 131,740 adolescents (12-17y), with primary diagnoses of UD (92.6%) and BD (7.4%) from the nationwide inpatient sample. We calculated odds ratio (OR) for suicidal behaviors using logistic regression adjusted for demographic confounders and comorbidities. Results Suicidal ideation and suicidal attempt were seen in 14.5% and 38.6% respectively of total inpatients and both were seen in higher proportion of UD. Females have higher odds for suicidal attempt (OR 1.13, 95%CI 1.09-1.16) compared to males. After adjusting for confounders, UD had a marginally higher odds (OR 1.06, 95%CI 1.02-1.11) of suicidal attempt and 1.2 times higher odds (95%CI 1.11-1.26) of suicidal ideation compared to BD. Among adolescents with suicidal attempt, 93.2% had bipolar depression and 6.8% had unipolar depression.The majority of suicidal attempt in the inpatient setting was seen in females, with bipolar depression (74.6% vs. 67.3% in unipolar). Conclusion Our finding is clinically relevant and accentuates the need for early identification of BD, accurate differentiation of UD versus BD for targeted and adequate treatment to minimize suicidal behaviors, treat and manage them per treatment guidelines, and evolving research.
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Abstract
Preschoolers are presenting in increasing numbers to primary care providers and mental health clinics with emotional and behavioural impairment. Preschoolers in the US have the highest rates of school expulsion of all age groups. Because young children are limited in their capacity to convey distress and internal states, impairment is most often expressed behaviourally. Disruptive behaviour, frequently in the form of aggression or dysregulation, is a final common pathway for many disorders in this age group. Tools and training to diagnose pre-school disorders are limited, and while some effective non-medication interventions exist, the evidence base for medication use in this age group is extremely limited. This article reviews approaches to assessing common pre-school disorders including attention deficit hyperactivity disorder (ADHD), disruptive behaviour disorders, anxiety and mood disorders, perceptual disturbances and psychosis, and trauma related disorders. The evidence base for both therapeutic and psychopharmacologic interventions for these disorders is discussed.
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Affiliation(s)
- Nadia Zaim
- Division of Child and Adolescent Psychiatry, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joyce Harrison
- Division of Child and Adolescent Psychiatry, The Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Psychiatry, Kennedy Krieger Institute, Baltimore, MD, USA
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Whalen DJ, Gilbert KE, Kelly D, Hajcak G, Kappenman ES, Luby JL, Barch DM. Preschool-Onset Major Depressive Disorder is Characterized by Electrocortical Deficits in Processing Pleasant Emotional Pictures. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:91-108. [PMID: 31515716 PMCID: PMC7286427 DOI: 10.1007/s10802-019-00585-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Reductions in positive affect are a salient feature of preschool-onset major depressive disorder. Yet, little is known about the psychophysiological correlates of this blunted positive affect and whether reduced physiological responding to pleasant stimuli may differentiate depressed and healthy young children. 120 four-to-seven year old children with current depression and 63 psychiatrically healthy 4-to-7 year old children completed a simple picture-viewing task of pleasant and neutral pictures while event-related potentials (ERPs) were recorded. The early-childhood version of the Kiddie Schedule for Affective Disorders and Depression was used to establish psychiatric diagnoses. A one-way ANCOVA was used to test for group differences in response to pleasant and neutral pictures. Young children with depression showed a reduced response to pleasant vs. neutral pictures (LPP), after controlling for children's age (F(1,180) = 4.15, p = 0.04, η2 = 0.02). The LPP for the children with preschool-onset depression (M = 0.99, SE = 0.65) was significantly smaller than the LPP in the healthy group of young children (M = 3.27, SE = 0.90). This difference did not vary as a function of depression or anhedonia severity within the group with depression or the healthy children. Similar to older children and adolescents with depression, young children with depression display reductions in responsivity to pleasant stimuli as indexed by the LPP. These findings extend prior findings indicating a blunted response to pleasant stimuli in preschool- onset depression. Given the greater neuroplasticity of emotional response and regulation, these findings suggest clinical attention to emotional response to pleasure is an important target in preschool-onset depression. Clinical trial registration information: A Randomized Control Trial of PCIT-ED for Preschool Depression; http://clinicaltrials.gov/;NCT02076425.
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Affiliation(s)
- Diana J Whalen
- Department of Psychiatry, Washington University School of Medicine in St. Louis, 4444 Forest Park, Suite 2100, St. Louis, MO, 63108, USA.
| | - Kirsten E Gilbert
- Department of Psychiatry, Washington University School of Medicine in St. Louis, 4444 Forest Park, Suite 2100, St. Louis, MO, 63108, USA
| | - Danielle Kelly
- Department of Psychiatry, Washington University School of Medicine in St. Louis, 4444 Forest Park, Suite 2100, St. Louis, MO, 63108, USA
| | - Greg Hajcak
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Emily S Kappenman
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine in St. Louis, 4444 Forest Park, Suite 2100, St. Louis, MO, 63108, USA
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine in St. Louis, 4444 Forest Park, Suite 2100, St. Louis, MO, 63108, USA
- The Program in Neuroscience, Washington University in St. Louis, St. Louis, MO, USA
- Department of Psychology, Washington University in St. Louis, St. Louis, MO, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
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Suicide Attempts in Juvenile Bipolar Versus Major Depressive Disorders: Systematic Review and Meta-Analysis. J Am Acad Child Adolesc Psychiatry 2017; 56:825-831.e3. [PMID: 28942804 DOI: 10.1016/j.jaac.2017.07.783] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/06/2017] [Accepted: 07/27/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Suicide attempts are prevalent in association with major mood disorders, and risk is greater with bipolar disorder (BD) than major depressive disorder (MDD) in adults. There may be similar relationships in juvenile mood disorders, but the evidence has not been compiled systematically and quantitatively. METHOD We searched for reports of studies comparing rates of suicide attempts in children or adolescents diagnosed with BD or MDD, and applied random-effects meta-analysis. RESULTS In 6 reports from 1995 to 2017, with 2,303 participants diagnosed with mood disorder from the United States and South Korea, aged 3 to 18 years, rates of suicide attempts differed significantly by diagnosis: BD (31.5%) > MDD (20.5%) > hypomania or mania-only (8.49%). Risk of suicide attempts differed (BD > MDD) highly significantly by meta-analysis (odds ratio [OR] = 1.71, CI = 1.33-2.20, p < .0001), and was very similar if a study with attempts and suicidal ideation was excluded (OR = 1.64, CI = 1.26-2.15, p < .0001). CONCLUSION Risk of suicide attempts in juvenile mood disorder patients ranked: BD > MDD >> hypomania or mania-only >> juvenile general population.
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Hutchison AK, Kelsay K, Talmi A, Noonan K, Ross RG. Thought Disorder in Preschool Children with Attention Deficit/Hyperactivity Disorder (ADHD). Child Psychiatry Hum Dev 2016; 47:618-26. [PMID: 26429569 PMCID: PMC4818201 DOI: 10.1007/s10578-015-0594-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Preschool identification of and intervention for psychiatric symptoms has the potential for lifelong benefits. However, preschool identification of thought disorder, a symptom associated with long term risk for social and cognitive dysfunction, has received little attention with previous work limited to examining preschoolers with severe emotional and behavioral dysregulation. Using story-stem methodology, 12 children with ADHD and 12 children without ADHD, ages 4.0-6.0 years were evaluated for thought disorder. Thought disorder was reliably assessed (Cronbach's alpha = .958). Children with ADHD were significantly more likely than children without ADHD to exhibit thought disorder (75 vs 25 %; Fischer's Exact Test = .0391). Thought disorder can be reliably assessed in preschool children and is present in preschool children with psychiatric illness including preschool children with ADHD. Thought disorder may be identifiable in preschool years across a broad range of psychiatric illnesses and thus may be an appropriate target of intervention.
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Affiliation(s)
- Amanda K. Hutchison
- University of Colorado Denver School of Medicine, Department of Psychiatry, Aurora, Colorado
| | - Kimberly Kelsay
- University of Colorado Denver School of Medicine, Department of Psychiatry, Aurora, Colorado,Children’s Hospital Colorado Pediatric Mental Health Institute, Aurora, Colorado
| | - Ayelet Talmi
- University of Colorado Denver School of Medicine, Department of Psychiatry, Aurora, Colorado,Children’s Hospital Colorado Pediatric Mental Health Institute, Aurora, Colorado
| | - Kate Noonan
- University of Colorado Denver School of Medicine, Department of Psychiatry, Aurora, Colorado
| | - Randal G. Ross
- University of Colorado Denver School of Medicine, Department of Psychiatry, Aurora, Colorado
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Whalen DJ, Dixon-Gordon K, Belden AC, Barch D, Luby JL. Correlates and Consequences of Suicidal Cognitions and Behaviors in Children Ages 3 to 7 Years. J Am Acad Child Adolesc Psychiatry 2015; 54:926-37.e2. [PMID: 26506583 PMCID: PMC4677777 DOI: 10.1016/j.jaac.2015.08.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/17/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Despite research documenting the existence of depression and other psychiatric disorders in early childhood, little is known about the nature and consequences of suicidal cognitions and behaviors (SI) in young children ages 3 to 7 years. The identification of trajectories of SI across childhood is a critical step toward preventing childhood suicide. METHOD Participants were 306 children enrolled in a prospective longitudinal investigation of young children and their families. Children and their families completed a baseline assessment between ages 3 and 7 years, and at least 1 follow-up assessment (ages 7-12 years). Child psychopathology, suicidal thoughts, plans, and behaviors were assessed via parent and trained interviewer report before age 9, and also with self-report after age 9. Data on maternal history of psychopathology, as well as maternal and family history of suicide attempts, were also obtained through parent report. RESULTS Controlling for a range of clinical and demographic variables, early-childhood SI (as defined as suicidal thoughts, behavior, or any expression of plans/attempts occurring before age 7) and suicidal themes in play were concurrently associated with childhood attention-deficit/hyperactivity (ADHD) and oppositional defiant/conduct disorders (ODD/CD). Early-childhood SI also predicted school-age depression and ODD/CD; however, these findings were no longer significant after controlling for the same diagnoses at the childhood baseline. Longitudinal analysis indicated that early-childhood SI was a robust predictor of school-age SI, even after accounting for psychiatric disorders at both time points. CONCLUSION Extending current research, these findings demonstrate that early-childhood SI confers significant risk for continuation into school-age SI and is concurrently associated with ADHD and ODD/CD. Although the meaning of early-childhood SI remains unclear, results suggest that it is a clinically important phenomenon that should be carefully assessed and taken seriously as a marker of risk for ongoing suicidal ideation/behavior. These findings suggest that early screening for SI in childhood is indicated in clinical settings, particularly in children less than 7 years of age with depression and externalizing disorders.
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Affiliation(s)
| | | | | | - Deanna Barch
- Washington University School of Medicine, St. Louis, MO. Also with Washington University
| | - Joan L. Luby
- Washington University School of Medicine, St. Louis, MO
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Kowatch RA, Scheffer RE, Monroe E, Delgado S, Altaye M, Lagory D. Placebo-controlled trial of valproic Acid versus risperidone in children 3-7 years of age with bipolar I disorder. J Child Adolesc Psychopharmacol 2015; 25:306-13. [PMID: 25978742 PMCID: PMC4442574 DOI: 10.1089/cap.2014.0166] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The objective of this study was to determine the efficacy and safety of valproic acid versus risperidone in children, 3-7 years of age, with bipolar I disorder (BPD), during a mixed or manic episode. METHODS Forty-six children with Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text Revision (DSM-IV-TR) diagnosis of bipolar disorder, manic, hypomanic, or mixed episode, were recruited over a 6 year period from two academic outpatient programs for a double-blinded, placebo-controlled trial in which subjects were randomized in a 2:2:1 ratio to risperidone solution, valproic acid, or placebo. RESULTS After 6 weeks of treatment, the least-mean Young Mania Rating Scale (YMRS) total scores change, adjusted for baseline YMRS scores, from baseline by treatment group was: Valproic acid 10.0±2.46 (p=0.50); risperidone 18.82±1.55 (p=0.008); and placebo 4.29±3.56 (F=3.93, p=0.02). The mixed models for repeated measure (MMRM) analysis found a significant difference for risperidone-treated subjects versus placebo treated subjects (p=0.008) but not for valproic acid-treated subjects versus placebo-treated subjects (p=0.50). Treatment with risperidone over 6 weeks led to increased prolactin levels, liver functions, metabolic measures, and weight/body mass index (BMI). Treatment with valproic acid led to increases in weight/BMI and decreases in total red blood cells (RBC), hemoglobin, and hematocrit. CONCLUSIONS In this small sample of preschool children with BPD, risperidone demonstrated clear efficacy versus placebo, whereas valproic acid did not. The laboratory and weight findings suggest that younger children with BPD are more sensitive to the effects of both of these psychotropics, and that, therefore, frequent laboratory and weight monitoring are warranted.
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Affiliation(s)
- Robert A. Kowatch
- The Ohio State University Wexner Medical Center/Nationwide Children's Hospital, Columbus, Ohio
| | - Russell E. Scheffer
- Department of Psychiatry and Behavioral Sciences and Pediatrics, University of Kansas School of Medicine, Wichita, Texas
| | - Erin Monroe
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Psychiatry and Behavioral Sciences and Pediatrics, University of Kansas School of Medicine, Wichita, Texas
| | - Sergio Delgado
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mekibib Altaye
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Denise Lagory
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Can unipolar and bipolar pediatric major depression be differentiated from each other? A systematic review of cross-sectional studies examining differences in unipolar and bipolar depression. J Affect Disord 2015; 176:1-7. [PMID: 25682377 DOI: 10.1016/j.jad.2015.01.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/15/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION While pediatric mania and depression can be distinguished from each other, differentiating between unipolar major depressive disorder (unipolar MDD) and bipolar major depression (bipolar MDD) poses unique clinical and therapeutic challenges. Our aim was to examine the current body of knowledge on whether unipolar MDD and bipolar MDD in youth could be distinguished from one another in terms of clinical features and correlates. METHODS A systematic literature search was conducted on studies assessing the clinical characteristics and correlates of unipolar MDD and bipolar MDD in youth. RESULTS Four scientific papers that met our priori inclusion and exclusion criteria were identified. These papers reported that bipolar MDD is distinct from unipolar MDD in its higher levels of depression severity, associated impairment, psychiatric co-morbidity with oppositional defiant disorder, conduct disorder and anxiety disorders, and family history of mood and disruptive behavior disorders in first-degree relatives. LIMITATIONS Though we examined a sizeable and diverse sample, we were only able to identify four cross sectional informative studies in our review. Therefore, our conclusions should be viewed as preliminary. CONCLUSIONS These findings can aid clinicians in differentiating the two forms of MDD in youth.
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Uchida M, Serra G, Zayas L, Kenworthy T, Hughes B, Koster A, Faraone SV, Biederman J. Can manic switches be predicted in pediatric major depression? A systematic literature review. J Affect Disord 2015; 172:300-6. [PMID: 25451429 DOI: 10.1016/j.jad.2014.09.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 09/30/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The rate of switching from major depression to bipolar disorder is high in children. Predicting who is at risk for switching poses unique challenges and is of high clinical relevance. Our aim was to examine the existing scientific literature elucidating if certain clinical correlates predict ultimate bipolar switches in children initially presenting with a depressive episode. METHODS We conducted a systematic literature search of studies assessing the risk factors for bipolar switching in youth. In all, seven studies fit our a priori criteria and were thus included in our qualitative review. RESULTS Together, these papers found that manic switches in pediatric depression can be predicted by several risk factors, including positive family history of mood disorders, emotional and behavioral dysregulation, subthreshold mania, and psychosis. LIMITATIONS We identified only seven prospective informative studies for our review. The majority of subjects included in these studies were referred and Caucasian. Thus, the results may not generalize to other community samples and other ethnicities. CONCLUSIONS These findings can help alert clinicians of the risk of manic switches.
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Affiliation(s)
- Mai Uchida
- Massachusetts General Hospital, Department of Pediatric Psychopharmacology, Boston, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA.
| | - Giulia Serra
- Sant'Andrea Hospital, Sapienza University, NESMOS Department, Rome, Italy; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Lazaro Zayas
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Tara Kenworthy
- Massachusetts General Hospital, Department of Pediatric Psychopharmacology, Boston, MA, USA
| | - Brittany Hughes
- Massachusetts General Hospital, Department of Pediatric Psychopharmacology, Boston, MA, USA
| | - Ariana Koster
- Massachusetts General Hospital, Department of Pediatric Psychopharmacology, Boston, MA, USA
| | - Stephen V Faraone
- SUNY Upstate Medical University, Departments of Psychiatry and of Neuroscience and Physiology, Syracuse, NY, USA
| | - Joseph Biederman
- Massachusetts General Hospital, Department of Pediatric Psychopharmacology, Boston, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
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Dervic K, Garcia-Amador M, Sudol K, Freed P, Brent DA, Mann JJ, Harkavy-Friedman JM, Oquendo MA. Bipolar I and II versus unipolar depression: clinical differences and impulsivity/aggression traits. Eur Psychiatry 2014; 30:106-13. [PMID: 25280430 DOI: 10.1016/j.eurpsy.2014.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 06/12/2014] [Accepted: 06/29/2014] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate distinguishing features between bipolar I, II and unipolar depression, and impulsivity/aggression traits in particular. METHODS Six hundred and eighty-five (n=685) patients in a major depressive episode with lifetime Unipolar (UP) depression (n=455), Bipolar I (BP-I) disorder (n=151), and Bipolar II (BP-II) (n=79) disorder were compared in terms of their socio-demographic and clinical characteristics. RESULTS Compared to unipolar patients, BP-I and BP-II depressed patients were significantly younger at onset of their first depressive episode, and were more likely to experience their first depressive episode before/at age of 15. They also had more previous affective episodes, more first- and second-degree relatives with history of mania, more current psychotic and subsyndromal manic symptoms, and received psychopharmacological and psychotherapy treatment at an earlier age. Furthermore, BP-I and BP-II depressed patients had higher lifetime impulsivity, aggression, and hostility scores. With regard to bipolar subtypes, BP-I patients had more trait-impulsivity and lifetime aggression than BP-II patients whereas the latter had more hostility than BP-I patients. As for co-morbid disorders, Cluster A and B Personality Disorders, alcohol and substance abuse/dependence and anxiety disorders were more prevalent in BP-I and BP-II than in unipolar patients. Whereas the three groups did not differ on other socio-demographic variables, BP-I patients were significantly more often unemployed that UP patients. CONCLUSION Our findings comport with major previous findings on differences between bipolar and unipolar depression. As for trait characteristics, bipolar I and II depressed patients had more life-time impulsivity and aggression/hostility than unipolar patients. In addition, bipolar I and II patients also differed on these trait characteristics.
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Affiliation(s)
- K Dervic
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY 10032, New York, USA; Department of Psychiatry and Behavioral Science, College of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| | - M Garcia-Amador
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - K Sudol
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY 10032, New York, USA
| | - P Freed
- 286, Madison Ave, New York, NY 10016, USA
| | - D A Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - J J Mann
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY 10032, New York, USA
| | | | - M A Oquendo
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY 10032, New York, USA.
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Luby JL, Gaffrey MS, Tillman R, April LM, Belden AC. Trajectories of preschool disorders to full DSM depression at school age and early adolescence: continuity of preschool depression. Am J Psychiatry 2014; 171:768-76. [PMID: 24700355 PMCID: PMC4103647 DOI: 10.1176/appi.ajp.2014.13091198] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Preschool-onset depression, a developmentally adapted form of depression arising between ages 3 and 6, has demonstrated numerous validated features, including characteristic alterations in stress reactivity and brain function. This syndrome is characterized by subthreshold DSM criteria for major depressive disorder, raising questions about its clinical significance. To clarify the utility and public health significance of the preschool-onset depression construct, the authors investigated diagnostic outcomes of preschool children at school age and in adolescence. METHOD In a longitudinal prospective study of preschool children, the authors assessed the likelihood of meeting full criteria for major depressive disorder at age 6 or later as a function of preschool depression, other preschool axis I disorders, maternal history of depression, nonsupportive parenting, and traumatic life events. RESULTS Preschool-onset depression emerged as a robust predictor of major depressive disorder in later childhood even after accounting for the effect of maternal history of depression and other risk factors. Preschool-onset conduct disorder also predicted major depression in later childhood, but this association was partially mediated by nonsupportive parenting, reducing by 21% the effect of preschool conduct disorder in predicting major depression. CONCLUSIONS Study findings provide evidence that this preschool depressive syndrome is a robust risk factor for developing full criteria for major depression in later childhood, over and above other established risk factors. The results suggest that attention to preschool depression and conduct disorder in addition to maternal history of depression and exposure to trauma may be important in identifying young children at highest risk for later major depression and applying early interventions.
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Affiliation(s)
- Joan L. Luby
- Joan Luby, Early Emotional Development Program, Department of Psychiatry, Washington University School of Medicine at Washington University Medical Center, Campus Box 8134, 660 South Euclid Ave., St. Louis, MO 63110-1093, USA; Tel: +1 314 286 2730;
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15
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Memarzia J, Tracy D, Giaroli G. The use of antipsychotics in preschoolers: a veto or a sensible last option? J Psychopharmacol 2014; 28:303-19. [PMID: 24451556 DOI: 10.1177/0269881113519506] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Recent reports have illustrated a dramatic rise in the use of antipsychotics in preschool children, medications originally designed and licensed for the treatment of adult psychotic disorders. Within this context, the current usage and the associated diagnoses are reviewed and compared with official guidelines and licensing for such use, highlighting a controversial challenge for clinicians. A review of the evidence base of the relative efficacy of such medications for a range of disorders is given. Associated safety and side effects are discussed, with compelling evidence for increased adverse events associated with use of antipsychotics in preschoolers, and neurodevelopmental hypotheses are used to guide predictions of long-term risk. An apparent gap in the literature and evidence base supporting such use and elucidating the risks and benefits leaves a challenge for clinicians and researchers and hinders the development of appropriate guidelines. Pragmatism in clinical practice, mindful of the limited evidence base that does exist and the propensity for harm, is necessary; far more research is required in this important area.
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Affiliation(s)
- Jessica Memarzia
- 1Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
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16
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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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Barch DM, Gaffrey MS, Botteron KN, Belden AC, Luby JL. Functional brain activation to emotionally valenced faces in school-aged children with a history of preschool-onset major depression. Biol Psychiatry 2012; 72:1035-42. [PMID: 22770650 PMCID: PMC3498571 DOI: 10.1016/j.biopsych.2012.06.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 04/23/2012] [Accepted: 06/01/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent research has demonstrated that clinical depression can emerge as early as the preschool period. Here, we examine brain function in children with a history of preschool-onset depression (PO-MDD) in comparison with healthy children. METHODS Participants were medication naïve school-aged children (ages 7-11) with PO-MDD (n = 22) or no psychiatric history (n = 16) followed longitudinally as part of the Preschool Depression Study. We used functional magnetic resonance imaging measures of blood oxygen level-dependent signal to examine functional brain activity in response to emotionally valenced faces (sad, fearful, angry, happy, neutral) following a negative mood induction provided to all children. RESULTS In categorical group comparisons, children with PO-MDD demonstrated increased activity in parietal cortex in response to sad faces but no differences in brain activity in a priori regions of interest (e.g., amygdala). However, in dimensional analyses, the severity of depression symptoms at the baseline preschool assessment predicted increased responses to sad faces in amygdala, hippocampal, parietal, and orbital frontal regions. CONCLUSIONS School-aged children with a history of PO-MDD showed patterns of functional brain responses to emotionally evocative stimuli similar to patterns found in adults and adolescents with major depression. These patterns were most strongly related to the severity of depression during the preschool period, suggesting that the magnitude of early symptoms may be particularly important for understanding altered brain function. These findings suggest that an early episode of depression before age 6 may be associated with enduring brain change or may represent a biomarker that was present even before the preschool episode.
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Affiliation(s)
- Deanna M. Barch
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, United States,Department of Psychology, Washington University in St. Louis, Saint Louis, MO, United States,The Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Michael S. Gaffrey
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, United States
| | - Kelly N. Botteron
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, United States,The Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Andrew C. Belden
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, United States
| | - Joan L. Luby
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, United States
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Abstract
There is rising interest in identifying precursors to bipolar disorder symptoms, including thought disorder. Thought disorder is identified in adults through self-report and in school-aged children through parent report and child story-telling. This study is an exploration to determine if preschoolers with mood dysregulation have evidence of disordered thoughts using a story-stem completion method. Participants included two groups of 3.5-6 year-old children: 20 with mood dysregulation including manic symptoms and 11 typically developing comparison children. Children were administered story completion narratives including one story where the child character accidentally cuts him/herself while pretending to cook. The children were asked to complete the stories and their responses were analyzed for atypical themes consistent with disordered thoughts such as violence or bizarreness outside of the story or props coming to life. Thirty-five percentage of symptomatic preschoolers versus 0% of typically developing preschoolers ascribed independent actions to inanimate props (p = 0.03). Eighty percentage of symptomatic preschoolers versus 9% of typically developing preschoolers utilized props in a violent or bizarre manner outside the central story (p < 0.001). Preschool children with symptoms of dysregulated mood express themes related to the unusual use of story props which may indicate disordered thoughts. This preschool expression of dysregulated mood appears similar to and possibly continuous with school-age and adult versions of bipolar disorder.
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Hegadoren K, Norris C, Lasiuk G, Silva DGVD, Chivers-Wilson K. The many faces of depression in primary care. TEXTO & CONTEXTO ENFERMAGEM 2009. [DOI: 10.1590/s0104-07072009000100019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Depression is a serious global health problem. It creates a huge economic burden on society and on families and has serious and pervasive health impacts on the individual and their families. Specialized psychiatric services are often scarce and thus the bulk of care delivery for depression has fallen to primary care providers, including advanced practice nurses and experienced nurses who work in under-serviced regions. These health professionals require advanced knowledge about the many faces that depression can display. This article reviews some of the faces of depression seen by primary care providers in their practices. Considering depression as a heterogeneous spectrum disorder requires attention to both the details of the clinical presentation, as well as contextual factors. Recommendations around engagement and potential interventions will also be discussed, in terms of the client population as well as for the practitioner who may be isolated by geography or discipline.
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