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Danielyan A, Patino LR, Benanzer T, Blom TJ, Welge JA, Chang KD, Adler CM, DelBello MP. Cognitive, Family, and Quality-of-Life Characteristics of Youth with Depression Associated with Bipolar Disorder. J Child Adolesc Psychopharmacol 2023; 33:225-231. [PMID: 37590017 PMCID: PMC10458366 DOI: 10.1089/cap.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background: Depression associated with bipolar disorder (BD) is more common compared to mania. Cognitive, family, and quality-of-life (QOL) factors associated with pediatric bipolar depression are understudied. The goal of this study was to evaluate cognitive, family environmental, and QOL characteristics of youth with bipolar depression. Methods: Thirty-two youth (12-18 years of age) with BD type I currently depressed were recruited from inpatient and outpatient setting. Subjects were assessed using the Behavior Rating Inventory of Executive Function (BRIEF), the Family Environment Scale (FES), and the Child Health Questionnaire-Parental-Form 50 (CHQ-PF50). Results were compared with population norms and the relationship between these domains was calculated. Results: Youth with depression associated with BD did not show significant impairment in executive functions. They displayed impaired family environment in the domains of cohesion, independence, achievement orientation, and organization. Youth also displayed impairments in the psychosocial health domains compared with the population normative data. The CHQ-Psychosocial health significantly negatively correlated with the BRIEF-Global Executive Control score (r = -0.76, p < 0.0001). Conclusion: Depression in youth with BD is associated with impairments in family functioning and QOL. Impairments in psychosocial QOL are associated with cognitive functioning. Further intervention studies examining executive functioning and family environment as treatment targets are needed. ClinicalTrials.gov identifier:NCT00232414.
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Affiliation(s)
- Arman Danielyan
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Luis R. Patino
- Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Tessa Benanzer
- Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Thomas J. Blom
- Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Jeffrey A. Welge
- Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Kiki D. Chang
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Caleb M. Adler
- Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Melissa P. DelBello
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
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Southammakosane C, Danielyan A, Welge J, Blom T, Adler C, Chang K, Howe M, DelBello M. Characteristics of the child behavior checklist in adolescents with depression associated with bipolar disorder. J Affect Disord 2013; 145:405-8. [PMID: 22884238 PMCID: PMC3626494 DOI: 10.1016/j.jad.2012.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 06/13/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND The child behavior checklist-Juvenile bipolar disorder phenotype (CBCL-JBD) has been proposed as a distinct profile specific to children and adolescents who have been diagnosed with bipolar disorder. The objective of this study was to examine whether bipolar disorder youth with depression exhibit the "CBCL-Juvenile bipolar disorder phenotype." METHODS Thirty-two adolescents, ages 12-18 years, with a depressive episode associated with bipolar I disorder were recruited, and their primary caregivers completed the CBCL. RESULTS Only the internalizing subscale (mean=70.2, SD=9.7) and total score (mean=71.5, SD=8.9) reached clinical significance (>70). Moreover, the CBCL-JBD profile scores of our subjects (204.6, SD=27.5) did not reach clinical significance (>210). LIMITATIONS Our subjects differed demographically from those in studies that have confirmed the CBCL-Juvenile bipolar disorder phenotype with regards to sex, age and ADHD comorbidity, thus limiting the interpretability of our comparisons with other studies. Furthermore, our investigation involved a small sample size and did not include a control group, which should be addressed in future studies. CONCLUSIONS The results of our study suggest that the CBCL-JBD profile is not characteristic of depressed youth with bipolar disorder. Better assessment tools for making an accurate and efficient diagnosis of bipolar disorder are needed so that appropriate treatment can be implemented and significant morbidity and mortality are minimized.
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Affiliation(s)
| | - A. Danielyan
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J.A. Welge
- Department of Psychiatry & Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - T.J. Blom
- Department of Psychiatry & Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - C.M. Adler
- Department of Psychiatry & Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - K.D. Chang
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - M. Howe
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - M.P DelBello
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA, Department of Psychiatry & Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, OH, USA, Corresponding Author at.: Melissa DelBello MD, Department of Psychiatry & Behavioral Neurosciences, University of Cincinnati School of Medicine, 260 Stetson Street, Suite 3200/M.L. 559, Cincinnati, OH 45219, USA. (M. DelBello)
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Abstract
Schizophrenia (SZ) is a complex, heterogeneous, and disabling psychiatric disorder that impairs multiple aspects of human cognitive, perceptual, emotional, and behavioral functioning. SZ is relatively frequent (prevalence around 1%), with onset usually during adolescence or early adulthood, and has a deteriorating course. The rapidly growing area of neuroimaging research has has found clear evidence of many cortical and subcortical abnormalities in individuals with SZ. In this article the most recent findings from multiple studies on neurological disorders in SZ are reviewed, and the authors make a strong argument for a neurological basis of the schizophrenic process.
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Affiliation(s)
- Arman Danielyan
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45244, USA
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March J, Silva S, Curry J, Wells K, Fairbank J, Burns B, Domino M, Vitiello B, Severe J, Riedal K, Goldman M, Feeny N, Findling R, Stull S, Baab S, Weller EB, Robbins M, Weller RA, Jessani N, Waslick B, Sweeney M, Dublin R, Walkup J, Ginsburg G, Kastelic E, Koo H, Kratochvil C, May D, LaGrone R, Vaughan B, Albano AM, Hirsch GS, Podniesinki E, Chu A, Reincecke M, Leventhal B, Rogers G, Jacobs R, Pathak S, Wells J, Lavanier SA, Danielyan A, Rohde P, Simons A, Grimm J, Frank S, Emslie G, Kennard B, Hughes C, Mayes TL, Rosenberg D, Benazon N, Butkus M, Bartoi M. The Treatment for Adolescents With Depression Study (TADS): outcomes over 1 year of naturalistic follow-up. Am J Psychiatry 2009; 166:1141-9. [PMID: 19723787 DOI: 10.1176/appi.ajp.2009.08111620] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Treatment for Adolescents With Depression Study (TADS) evaluates the effectiveness of fluoxetine, cognitive-behavioral therapy (CBT), and their combination in adolescents with major depressive disorder. The authors report effectiveness outcomes across a 1-year naturalistic follow-up period. METHOD The randomized, controlled trial was conducted in 13 academic and community sites in the United States. Stages I, II, and III consisted of 12, 6, and 18 weeks of acute, consolidation, and continuation treatment, respectively. Following discontinuation of TADS treatments at the end of stage III, stage IV consisted of 1 year of naturalistic follow-up. The participants were 327 subjects between the ages of 12 and 17 with a primary DSM-IV diagnosis of major depressive disorder. No TADS treatment was provided during the follow-up period; treatment was available in the community. The primary dependent measures, rated by an independent evaluator blind to treatment status, were the total score on the Children's Depression Rating Scale-Revised and the rate of response, defined as a rating of much or very much improved on the Clinical Global Impressions improvement measure. RESULTS Sixty-six percent of the eligible subjects participated in at least one stage IV assessment. The benefits seen at the end of active treatment (week 36) persisted during follow-up on all measures of depression and suicidality. CONCLUSIONS In contrast to earlier reports on short-term treatments, in which worsening after treatment is the rule, the longer treatment in the TADS was associated with persistent benefits over 1 year of naturalistic follow-up.
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Affiliation(s)
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- Department of Psychiatry and Behavioral Sciences and the Duke Clinical Research Institute at Duke University Medical Center, Durham, NC 27705, USA.
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Danielyan A, Pathak S, Kowatch RA, Arszman SP, Johns ES. Clinical characteristics of bipolar disorder in very young children. J Affect Disord 2007; 97:51-9. [PMID: 16822549 DOI: 10.1016/j.jad.2006.05.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 05/17/2006] [Accepted: 05/25/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND Clinical information about bipolar disorder (BPD) in preschool-age (3-7 years old) children is extremely limited. This study examined clinical presentations, applicability of the DSM-IV diagnostic criteria, comorbidity, recovery and relapse rates, as well as some treatment strategies used in the management of BPD in preschoolers. METHODS The charts of 26 outpatient children, ages 3-7, refereed to a child psychiatry outpatient clinic with mood and behavioral symptoms, were retrospectively reviewed. RESULTS The majority of the patients were referred with the tentative diagnosis of ADHD but the most common diagnoses made by child and adolescent psychiatrists at the time of initial evaluation were BPD NOS (61.5%), followed by BPD I (26.9%), and mood disorder NOS (23.1%). Thirty-eight percent of the patients had one or more comorbid diagnoses. The most common presenting symptoms were irritability (84.6%) and aggression (88.5%). The most widely prescribed class of medications after diagnosis in the clinic was atypical antipsychotics and mood stabilizers. Twenty-six percent of the patients were treated with a combination of atypical antipsychotics and mood stabilizers. LIMITATIONS Retrospective design; small sample size; lack of a comparison group. CONCLUSIONS The course of BPD with onset in preschool years is complicated with high recovery and relapse rates. The questions of development of age-appropriate diagnostic criteria, long-term prognosis and treatment strategies used in this population require further intensive investigation.
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Affiliation(s)
- Arman Danielyan
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, D-3014, Cincinnati, OH 45229, United States.
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Abstract
During recent years there has been a dramatic increase in the use of psychotropic medication for the treatment of bipolar disorder (BPD) in children. There is an emerging set of data to support this use.Mood stabilizers, including lithium and valproic acid (valproate sodium), have generally formed the mainstay of treatment in children and adolescents with BPD. However, the atypical antipsychotics, such as risperidone, aripiprazole, and quetiapine may be more effective as first-line treatment options and in some ways easier to use than the traditional mood stabilizers. As in adults, mood stabilization is often difficult to achieve in pediatric patients with BPD, and combined treatment with mood stabilizers and atypical antipscyhotics is commonly used. Data from controlled trials of psychotropic medications in children and adolescents with BPD are very limited, and hence, in the majority of cases physicians base their treatment decisions on data from case reports, case series, or open trials. More controlled studies of both monotherapy and polypharmacotherapy for BPD in children and adolescents are needed.
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Affiliation(s)
- Arman Danielyan
- Cincinnati Children's Hospital Medical Center, OH 45267, USA
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Abstract
OBJECTIVE Using predetermined criteria for study quality and methods, a literature review and meta-analysis of seven reports about pediatric bipolar disorder (BPD) was conducted to determine if there is a consistent picture of the phenomenology and clinical characteristics of BPD in children and adolescents. METHODS Searches were conducted in MedLine and PsycINFO using the terms mania, BPD, children and adolescents, and was limited to published articles in peer-reviewed journals. Seven reports were selected that met the following criteria: a systematic method for the elicitation and reporting of symptoms and clinical characteristics of subjects; subjects were interviewed by a trained researcher or clinician; ages 5-18 years; use of a diagnostic system, either DSM or RDC for categorization; a consensus method for the establishment of the diagnosis of BPD. RESULTS Most DSM-IV symptoms of mania were common in the children and adolescents with BPD with the most common symptoms being increased energy, distractibility, and pressured speech. On average, four of five bipolar cases also showed threshold levels of irritable mood and grandiosity, and more than 70% of all cases showed elated/euphoric mood, decreased need for sleep, or racing thoughts. Roughly 69% of cases also showed poor judgment, whereas only half of bipolar cases demonstrated flight of ideas, and slightly more than one-third showed hypersexuality or psychotic features. CONCLUSIONS The clinical picture that emerges is that of children or adolescents with periods of increased energy (mania or hypomania), accompanied by distractibility, pressured speech, irritability, grandiosity, racing thoughts, decreased need for sleep and euphoria/elation.
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Affiliation(s)
- Robert A Kowatch
- Department of Psychiatry, Cincinnati Children's Hospital Medical Center/University of Cincinnati Medical Center, Cincinnati, OH 45267, USA.
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Di Fiorino M, Danielyan A, Gemignani A. Guidelines for behavioral emergencies. Psychiatr Serv 2005; 56:1159-60. [PMID: 16148340 DOI: 10.1176/appi.ps.56.9.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pathak S, Arszman SP, Danielyan A, Johns ES, Smirnov A, Kowatch RA. Psychotropic utilization and psychiatric presentation of hospitalized very young children. J Child Adolesc Psychopharmacol 2005; 14:433-42. [PMID: 15650500 DOI: 10.1089/cap.2004.14.433] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sanjeev Pathak
- Division of Child and Adolescent Psychiatry, Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Panossian A, Danielyan A, Mamikonyan G, Wikman G. Methods of phytochemical standardisation of rhizoma Cimicifugae racemosae. Phytochem Anal 2004; 15:100-108. [PMID: 15116940 DOI: 10.1002/pca.742] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The methanolic extract of roots of Cimicifuga racemosa and its methanolysis products have been analysed by GC-MS. 2-Hexylcyclopropaneoctanoic acid (9,10-methylenehexadecanoic acid) was found to be the marker most specific for the identification for this herb. For the phytochemical standardisation of Rhizoma Cimicifugae racemosae, validated methods for the quantitative analysis of formononetin (by TLC-fluorometry), of isoferulic acid (by GC-MS of the methyl ester), and of total triterpene glycosides (transformed to coloured complexes and measured photometrically) in roots of C. racemosa have been developed. The contents of formononetin, isoferulic acid and total triterpene glycosides (measured as actein) in the herb ranged from 0.0031 to 0.0035, from 1.22 to 1.35 and from 20.09 to 22.06 mg/g dry weight, respectively.
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Affiliation(s)
- A Panossian
- ExLab Expert Analytical Laboratory of Armenian Drug Agency, 49/4 Komitas Str., Yerevan, 375051 Armenia.
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