Bipolar Disorder In Children Research Articles

Risk of Pediatric Bipolar Disorder After General Anesthesia in Infants and Toddlers: A Propensity Score-Matched Population-Based Cohort Study.

The potential role of anesthesia as an independent risk factor for childhood bipolar disorder (BD) remains unclear. To address this, we conducted a population-based cohort study employing propensity score matching to compare BD incidence between pediatric patients undergoing surgery with and without general anesthesia. Our study included patients aged 0-3 years who received at least 1 episode of general anesthesia and were hospitalized for over 1 day in Taiwan between January 2004 and December 2014. They were matched 1:1 with a population not receiving general anesthesia to assess pediatric BD incidence. The study cohort comprised 15 070 patients, equally distributed between the general anesthesia and nongeneral anesthesia groups (7535 each). Multivariate Cox regression analysis revealed adjusted hazard ratios (aHRs; 95% CIs) for pediatric BD in the general anesthesia group as 1.26 (1.04-1.54; P = .021) compared to the nongeneral anesthesia group. Moreover, the incidence rate ratio (95% CI) for the general anesthesia group was 1.26 (1.03-1.53) compared to the nongeneral anesthesia group. Early childhood exposure to general anesthesia is significantly associated with an increased risk of pediatric BD. This expands understanding of pediatric BD's complex development, informing preventive strategies, and enhancing mental health outcomes for vulnerable young patients and global pediatric healthcare.

122. BISS and YMRS as Measures to Assess Bipolar Disorder in Children and Adolescents

122. BISS and YMRS as Measures to Assess Bipolar Disorder in Children and Adolescents

Advancing clinical practice and discovery research through revised taxonomy: Case in point bipolar disorder diagnosis: Commentary on "The diagnosis of bipolar disorder in children and adolescents: Past, present and future".

Advancing clinical practice and discovery research through revised taxonomy: Case in point bipolar disorder diagnosis: Commentary on "The diagnosis of bipolar disorder in children and adolescents: Past, present and future".

The Child Behavior Check List Usefulness in Screening for Severe Psychopathology in Youth: A Narrative Literature Review

Objective: This article will review the use of the CBCL to diagnose youth with psychopathological disorders focusing on: ADHD, Mood Disorders, Autism Spectrum disorders, and Disruptive Disorders. Method: Using a narrative review approach, we investigate the usefulness of the CBCL as a screening tool to detect childhood onset psychopathology across different diagnostic syndromes. Results: The available literature supports the use of the CBCL for ADHD screening and as a measure of ADHD severity. While some studies support a specific profile linked with childhood bipolar disorder, replication studies for this profile found mixed results. The CBCL was also found to be useful in screening for patients presenting with Autism Spectrum Disorders, Conduct Disorder, and Childhood Bipolar Disorder all of which presents with more severely impaired scores. Conclusion: The CBCL holds promise as a screening tool for childhood psychopathology.

Differentiation between depression and bipolar disorder in child and adolescents by voice features

ObjectiveMajor depressive disorder (MDD) and bipolar disorder (BD) are serious chronic disabling mental and emotional disorders, with symptoms that often manifest atypically in children and adolescents, making diagnosis difficult without objective physiological indicators. Therefore, we aimed to objectively identify MDD and BD in children and adolescents by exploring their voiceprint features.MethodsThis study included a total of 150 participants, with 50 MDD patients, 50 BD patients, and 50 healthy controls aged between 6 and 16 years. After collecting voiceprint data, chi-square test was used to screen and extract voiceprint features specific to emotional disorders in children and adolescents. Then, selected characteristic voiceprint features were used to establish training and testing datasets with the ratio of 7:3. The performances of various machine learning and deep learning algorithms were compared using the training dataset, and the optimal algorithm was selected to classify the testing dataset and calculate the sensitivity, specificity, accuracy, and ROC curve.ResultsThe three groups showed differences in clustering centers for various voice features such as root mean square energy, power spectral slope, low-frequency percentile energy level, high-frequency spectral slope, spectral harmonic gain, and audio signal energy level. The model of linear SVM showed the best performance in the training dataset, achieving a total accuracy of 95.6% in classifying the three groups in the testing dataset, with sensitivity of 93.3% for MDD, 100% for BD, specificity of 93.3%, AUC of 1 for BD, and AUC of 0.967 for MDD.ConclusionBy exploring the characteristics of voice features in children and adolescents, machine learning can effectively differentiate between MDD and BD in a population, and voice features hold promise as an objective physiological indicator for the auxiliary diagnosis of mood disorder in clinical practice.

Third Argentine Consensus statement on management Bipolar Disorders. Section3: Bipolar Disorder in the context of special situations

This document constitutes the third and last part of the Third Argentine Consensus on the Management of Bipolar Disorders carried out by the Argentine Association of Biological Psychiatry (AAPB). Continuing with the initial objective, this section of the Consensus on the Management of Bipolar Disorders is focused on the management of bipolar disorders in special populations. This section constitutes a comprehensive review and expert consideration of the scientific evidence on: a) the management of bipolar disorders in treatment-resistant patients; b) the management of bipolar disorder in childhood and adolescence; c) the management of bipolar disorders in women during their perinatal period and, d) the management of bipolar disorders in older adults.

Altered white matter integrity in euthymic children with bipolar disorder: A tract-based spatial statistical analysis of diffusion tensor imaging

Pediatric Bipolar Disorder (BD) is a serious mental illness that affects children and adolescents, characterized by episodes of mania, depression, and mixed episodes. Recent studies have suggested that abnormalities in the white matter (WM) may be a contributing factor. The neuropathogenesis of BD in children is not well-described, and research in this area is limited. Euthymic phase is a period in which clinical symptoms are present but not severe enough to significantly impact mood and daily behavior. In order to better understand the WM changes associated with BD in children, this study utilized Diffusion Tensor Imaging (DTI), to investigate alterations in WM microstructure. 20 confirmed euthymic BD children (aged 7–16) and 20 typically developing children were included in the study. DTI scans were obtained using a 3 T Magnetom Skyra and were analyzed using tract-based spatial statistics (TBSS) to examine changes in fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD). Results showed that compared to the healthy control group, the euthymic BD group exhibited increased FA, AD, RD, and MD values in several brain regions, including the thalamus, precentral corticospinal tract, and superior longitudinal fasciculus. Conversely, decreased values were observed in the body of the corpus callosum and inferior fronto-occipital fasciculus. These findings suggest that alterations in WM microstructure are a hallmark of pediatric bipolar disorder. These findings provide important insights into the brain changes associated with pediatric bipolar disorder and open the door for new avenues of research.

The diagnosis of bipolar disorder in children and adolescents: Past, present and future.

This article examines the ongoing debate concerning the diagnosis of bipolar disorder in children and adolescents. This contentious issue has generated robust discussion over the past two decades without consensus, and as such the true prevalence of so-called paediatric bipolar disorder (PBD) remains unknown. In this article we offer a solution to break this deadlock. Recent meta-analyses and additional literature concerning the definition and prevalence of PBD was critically reviewed with a view to understanding the perspectives of those developing the taxonomy of PBD, and those engaged in research and clinical practice. A key finding is the lack of iteration and meaningful communication between the various groups interested in PBD that stems from deep-seated problems within our classificatory systems. This undermines our research efforts and complicates clinical practice. These problems make the already difficult diagnosis of bipolar disorder in adults even more challenging to transpose to younger populations, and additional complexities arise when parsing clinical phenomenology from normative developmental changes in youth. Therefore, in those manifesting bipolar symptoms post-puberty, we argue for the use of adolescent bipolar disorder to describe bipolar symptoms whereas in pre-pubertal children, we propose a reconceptualisation that allows symptomatic treatment to be advanced whilst requiring critical review of these symptoms over time. Significant changes in our current taxonomy are necessary and to be clinically meaningful, these revisions to our diagnoses need to be developmentally-informed.

3.101 Does Lithium With Antipsychotics Make Children and Adolescents With Bipolar Disorder Gain Weight?

Bipolar disorder in children and adolescents is a serious illness with a chronic course and a high recurrence rate. Drug compliance issues are very important to maintain therapy. Most antipsychotics and mood stabilizers cause weight gain and lead to poor drug compliance. Mood stabilizers and antipsychotics are usually used for treating bipolar disorder. However, weight gain is an adverse effect of these drugs. In this study, we tried to investigate whether lithium with antipsychotics causes more weight gain than lithium monotherapy and to determine which mood stabilizer causes more weight gain.

A retrospective cohort study of the change in inflammatory parameters in childhood schizophrenia and bipolar disorder from childhood to adulthood

Background/Aim: The etiologies of childhood schizophrenia and bipolar disorder have not yet been clarified. In cases in which the symptoms of mood are not dominant and psychotic symptoms are more dominant, it may be difficult to distinguish between childhood schizophrenia and bipolar disorder diagnoses. Follow-up studies concerning this subject have indicated that approximately half of the adolescents diagnosed with bipolar disorder were first (and incorrectly) diagnosed with schizophrenia. Therefore, strong markers are still needed to be used in the differential diagnosis at the time of the first application. An increase in the number of studies on the neuroinflammatory process in pediatric schizophrenia and bipolar illness have started to appear in the literature. The neutrophil–lymphocyte, thrombocyte–lymphocyte, and thrombocyte–neutrophil ratio (NLR, TLR, and TNR, respectively) levels in patients with childhood schizophrenia and childhood bipolar disorder at the time of admission and five years later were evaluated to determine whether inflammatory markers changed over time.
 Methods: Twelve patients diagnosed with childhood schizophrenia and 14 patients diagnosed with childhood bipolar disorder were included in the study. Active infections, medical, neurological, endocrine, and metabolic illnesses, mental retardation, further concomitant psychiatric diagnoses, and intoxication were all exclusion factors. Hemograms from the same patients who satisfied the inclusion criteria when they originally applied and again at the fifth year follow-up were evaluated. Age, gender, neutrophil, lymphocyte, leukocyte, and thrombocyte values were recorded. NLR was calculated by dividing the neutrophil count by lymphocyte count. TLR value was calculated by dividing the thrombocyte count by lymphocyte count. TNR value was calculated by dividing the thrombocyte count by neutrophil count. Bipolar disorder and schizophrenia status were compared using NLR, TLR, and TNR parameters both at the time of initial diagnosis and at the fifth year of follow-up.
 Results: When the initial admission hemograms of patients with childhood schizophrenia or childhood bipolar disorder were examined, no statistically significant differences between the two groups in terms of NLR (P = 0.150) and TLR (P = 0.440) were found. TNR was significantly higher in childhood bipolar disorder patients than in childhood schizophrenia (P = 0.015). At the fifth year follow-up, the hemograms of individuals diagnosed with either childhood schizophrenia or childhood bipolar disorder were compared, and no statistically significant differences between the two groups in NLR, (P = 0.572),TLR (P = 0.758), and TNR (P = 0.328) were found.
 Conclusion: It was concluded that NLR and TLR levels did not change significantly over time in either disease and could not be used for the differential diagnosis of either disease. TNR may be considered for differential diagnoses in childhood schizophrenia and bipolar disease, particularly at the time of the first episode after confirmation of this study's findings with future studies.

Diagnosis of disruptive mood dysregulation disorder in offsprings of bipolar parents

BackgroundDisruptive mood dysregulation disorder (DMDD) was introduced in (DSM-5) as a new diagnostic category to get control on the exaggerated diagnosis of bipolar disorder in children and adolescents which was elevated more than 40 times in the last decade. Few studies were done recently to explore the role of family history of bipolar disorder in the occurrence of DMDD in children and adolescents. Unfortunately, there is limited number of studies about the familial transmission of DMDD.The aim of this study is to examine the presence of a relation between DMDD and the presence of a family history of bipolar disorder through comparing the diagnosis of DMDD in offspring of parents with (a) bipolar disorder and (b) a control group.ResultsThe distribution of psychiatric disorders among the studied groups highlighted that DMDD and depressive disorder are significantly present in the offsprings of bipolar parents more than in the offsprings of control parents. DMDD is significantly present among offsprings of bipolar parents aged ≤ 11 years old (p = 0.008*). Also, DMDD is significantly (p = 0.02) present among male offsprings of bipolar parents. Also, depressive disorder is significantly (p = 0.002) present among female offsprings of control parents. While significant comorbidity between DMDD and depressive disorders (p = 0.018*) was detected.ConclusionsThis study revealed that DMDD and depressive disorders are significantly present in the offsprings of bipolar parents higher than in the offsprings of control parents. DMDD is significantly present among the offsprings of bipolar parents aged ≤ 11 years old.The relation between sex and affective disorders among the offsprings was also assessed revealing that DMDD is significantly present among male offsprings of bipolar parents. Also, depressive disorders are significantly present among female offsprings of control parents.Potential implicationsThis study has several clinical implications. This study draws attention to the importance of the careful assessment of the offsprings of bipolar patients to check the presence of different childhood psychiatric disorders such as DMDD. Also, symptoms of temper outbursts and persistent irritability in childhood require the necessary of psychiatric evaluation not only for the patients but also for their families. In addition, this study highlights the need for accurate updated diagnostic instruments to differentiate between these overlapping symptoms.As regards implications for future research, following-up of children diagnosed with DMDD to recognize the prognostic outcome of this new diagnostic category is necessary.

Psychosocial Treatments for Bipolar Disorder in Children and Adolescents.

Evidence suggests that adjunctive psychosocial intervention for the treatment of pediatric bipolar spectrum disorders (BPSDs) is effective, feasible, and highly accepted as both an acute and maintenance treatment for youth with BPSD diagnoses as well as a preventive treatment for high-risk youth who are either asymptomatic or exhibit subsyndromal mood symptoms. Here, we provide a comprehensive review of all known evidence-based interventions, including detailed descriptions of treatment targets and core components, results of clinical trials, and updated research on mediators and moderators of treatment efficacy. Treatments are presented systematically according to level of empirical support (i.e., well established, probably efficacious, possibly efficacious, experimental, or questionable); upcoming and ongoing trials are included when possible. In line with a staging approach, preventive interventions are presented separately. Recommendations for best practices based on age, stage, and additional evidence-based child and family factors shown to affect treatment outcomes are provided.

Why it is so Important to Diagnose Bipolar Disorder in Children and Adolescents?

The diagnosis of bipolar disorder in children and adolescents has not progressed among child psychiatrists despite increasingly solid data. It is unipolar depression, anxiety disorders including panic attacks and of course hyperkinesia with attention deficit disorder that are at the top of the bill. This is how adult psychiatrists inherit bipolar patients whose diagnosis was ignored in childhood or adolescence, often dormant for years. The diagnostic guidelines, although not perfect, quickly lead to the diagnosis of bipolar disorder, especially as when parents are questioned, there are arguments leading to family disease. If mood stabilizers are little or no effective before the age of 12, they can be used successfully after that age. Behavioral therapies can take over or methylphenidate in the case of obvious school problems.

The relationship between sleep and depression and bipolar disorder in children and young people.

Sleep difficulties are often reported in practice, and are part of the diagnostic criteria for depression and bipolar disorder. To inform the understanding of the relationship between sleep and both depression and bipolar disorder. We conducted a narrative literature review of affective disorders and sleep difficulties in children and young people. Specific sleep disorders, such as parasomnias, narcolepsy and sleep-related movement disorders, are associated with depression, whereas insomnia, obstructive sleep apnoea and circadian rhythm disorders are associated with both depression and bipolar disorder in children and young people. Conversely, children and young people with depression can present with a number of sleep difficulties, and these are associated with higher depression severity and greater fatigue, suicidal ideation, physical complaints, pain and decreased concentration. Sleep disturbances among adolescents with bipolar disorder can affect the severity of depressive and manic symptoms, are a poor prognostic indicator and have been associated with social and academic impairment. Antidepressants and antipsychotics can directly affect sleep architecture, which clinicians need to be aware of. Non-pharmacological interventions for sleep problems could prevent and/or minimise the risk of relapse in affective disorders. Sleep difficulties can occur before, during and after an episode of depression or bipolar disorder, and have a higher prevalence in affective disorders compared with the general population. A multi-modal approach would include the treatment of both the affective and specific sleep disorder. Further research is needed in this field to understand the impact of combined interventions on clinical outcomes.

A commentary on youth onset bipolar disorder.

Given ongoing disagreement about the diagnosis of pediatric bipolar disorder, we sought to illuminate key empirical findings regarding the condition in children and adolescents. We conducted a review of extant studies of the diagnosis, course, and treatment of bipolar disorder in children and adolescents. Bipolar disorder is a lifelong, familial condition with frequent onset in childhood or adolescence. Secular trends indicate that globally, the onset of puberty is occurring earlier, which may contribute to increased identification of mood disorders in younger populations. Despite opinions to the contrary, bipolar disorder has been observed in youth around the world, not just in the U.S. Discrete and episodic manic symptoms occur on a continuum/spectrum of severity and duration. Clinicians may be just as likely to miss mania (false negatives) as overcall it (false positives). As is true in adults, periodicity and heterogeneity are defining features of early onset bipolar disorder. Youth who are misdiagnosed and undiagnosed tend to do poorly over the long term. Youth with and at risk for bipolar disorder are frequently exposed to maltreatment, abuse, and bullying. Fortunately, there are now many evidence-based interventions that have been studied in thousands of youth with or at high risk for bipolar disorder, demonstrating large effect sizes for evaluated treatments versus comparative treatments. Identifying optimal methods for the evaluation and treatment of bipolar disorder in children and adolescents represents important advances in the field. Recognizing the occurrence of mania symptoms in youth is pivotal for improving outcomes in patients living with bipolar disorder.

Clinical presentation, differential diagnosis and management of bipolar disorder in children and adolescents: a review

Bipolar disorder is a mental illness that causes serious disabilities in both social and work function. The occurrence of this disorder in children and adolescent age group has gained the attention of research workers since the 20th century. The varied clinical presentation of this disorder in comparison to the adult population, as well as the management approaches have been a matter of debate for ages. The aim of the study was to put forward the diagnostic and treatment approaches of bipolar disorder in children and adolescent.

Bipolar Type I Disorder in Children

Bipolar disorder in children and adolescents is a clinical disorder that causes publicmental health problems that need attention. In the last decade, bipolar disorder inchildren and adolescents has become a trendy field, both in the clinical area and inresearch, especially in terms of diagnosis, which is still controversial. The controversythat remains is whether it is possible to diagnose bipolar disorder in prepubertalchildren. Based on the DSM-IV-TR diagnostic criteria, the prevalence of the bipolardisorder in children scarce rare. Epidemiological studies report the lifetimeprevalence of bipolar I and II disorders in late adolescence is about 1 per cent. Variousstudies in a large population have shown a prevalence rate of 0.1% -2%. The onsetof bipolar disorder in children and adolescents is often accompanied by a more severedisease course, compared to bipolar disorder with onset in adulthood. This casereport presents a case of bipolar 1 in children accompanied by comprehensivemanagement.

12.4 CAN MACHINE LEARNING HELP IDENTIFY CHILDHOOD RISK INDICATORS OF FUTURE DEVELOPMENT OF BIPOLAR DISORDER? RESULTS FROM A 10-YEAR LONGITUDINAL FOLLOW-UP STUDY

The main aim of the present study was to assess whether machine learning can empirically identify early predictors of future bipolar disorder outcomes based on presenting childhood characteristics and identifying the important factors for that prediction. We used the extra trees algorithm with repeated sampling cross-validation to ascertain generalizability of the model (sensitivity and specificity) to unseen data and to ascertain a distribution of model performance. We also identified important features in the classification. The final sample consisted of 492 children, 52% male, ranging in age—at their first evaluation—from 6 to 19 years (μ = 11). The sensitivity of our model—the rate at which it correctly predicted that a subject would develop bipolar disorder—was 70%. Its specificity was found to be 68%. We also determined that childhood features were particularly good at differentiating between patients who developed bipolar disorder and patients who did not, including the School Adjustment Inventory for Children and Adolescents (SAICA) school behavior problems, CBCL rule-breaking t score, CBCL attention problems t score, socioeconomic status (SES), and CBCL externalizing t score. We applied machine learning prediction models to longitudinal data and successfully predicted the development of bipolar disorder in children observed at baseline and followed up to 10 years to their late adolescence and young adulthood. The finding that childhood school and social behavior problems were predictive of the future development of bipolar disorder are consistent with the literature.

A comment on an important question in psychiatry (QuiP): Whether paediatric bipolar disorder a valid diagnosis?

The question of the validity of the diagnosis of paediatric bipolar disorder centres on the controversy surrounding a proposed pre-pubertal subtype. As pointed out by Malhi & Bell1 , the validity of classical bipolar disorder in adolescence, diagnosed on the basis of expert clinical assessment, is not in question. Nor is there debate around whether or not children with the proposed prepubertal phenotype have serious mental health concerns. Further, longitudinal prospective studies have provided indisputable evidence that antecedent subthreshold mood symptoms and non-mood disorders (i.e. sleep, anxiety) predict bipolar disorder in children at confirmed familial risk2 . Rather, the controversy centres on the speculation raised by Wozniak et al3 that a presentation in very young children (median age 5, mostly male sex) characterized by explosive temper, chronic irritability, comorbid ADHD and other neurodevelopmental disorders, represents an early developmental variant of bipolar disorder - so called prepubertal bipolar disorder or prepubertal mania.

Navigating the diagnostic challenges of bipolar disorder in youth.

Bipolar disorder in youth is difficult to diagnose and treat, but early detection is important to mitigate risks and improve patient outcomes. This article evaluates the unique challenges of diagnosing and treating bipolar disorder in children and adolescents. Bipolar disorder is associated with a significant personal and societal health burden and frequently is misdiagnosed and incorrectly treated. More research is needed to understand the pathophysiology of bipolar disorder and which treatment options are best throughout the lifespan.