Early-onset Bipolar Disorder Research Articles

Understanding and treating psychopathology in schools: Introduction to the special issue

AbstractInvestigating psychopathology in school‐aged children is a topical discussion given the recent increased focus of the U.S. government and professional psychology on this issue. In the last 5 years, the Surgeon General of the United States (Satcher, 2000) and the President's New Freedom Commission on Mental Health (2003) both addressed the need for schools to actively participate in the treatment of children's mental health disorders. Further, psychologists were charged with transforming mental health care for children and families by promoting collaboration between schools, families, and communities; identifying empirically supported interventions; and enhancing culturally competent care for children and teens (P. Tolan & K. Dodge, 2005). To achieve these goals, mental health professionals in the schools need to be able to understand and effectively treat psychopathology in the school setting. School‐based treatment of psychopathology should be based on effective collaboration and grounded within the cultural context of the student population. A comprehensive understanding takes into account the biological basis of these disorders and factors influencing risk and resiliency. Treatment needs for these students often combine traditional therapies and psychopharmacology. Within a comprehensive system of care, specific disorders such as Reactive Attachment Disorder, Early Onset Bipolar Spectrum Disorder, Posttraumatic Stress Disorder, depression, and anxiety can and should be treated in schools. © 2006 Wiley Periodicals, Inc. Psychol Schs 43: 413–417, 2006.

Mood disorders in teenage girls

This article reviews our current understanding of depressive and bipolar disorders in teenage girls. It highlights issues related to causality, assessment and treatment. Early onset depression arises as a consequence of inter-related predisposing and precipitating factors which together lead to alterations to biological and psychological functioning and result in depression. Assessment needs to be carefully and thoroughly undertaken by a clinician with experience in child and adolescent mental health problems. Following a brief psychoeducational intervention, further treatment should be initially with psychotherapeutic approaches. Cognitive and interpersonal therapies are supported by the best evidence. Pharmacological treatments may be associated with increased suicidal ideation and behaviour and should only be initiated by those with specialist training and experience in child and adolescent mental health problems. Early onset bipolar disorder remains a controversial area of practice, with uncertainty over the application of diagnostic criteria, validity of the disorder and its relationship with other disorders such as ADHD. For those adolescents and, rarely, children with true bipolar disorder, the longer-term outcome for early-onset bipolar disorder appears to be similar to that for adults, although younger sufferers are more likely to have a more rapidly cycling clinical picture than adults. There is very little research evidence investigating response to medication although there is some evidence for the efficacy of lithium, valproic acid and carbamazepine in the treatment of early-onset mania.

N‐acetylaspartate levels in bipolar offspring with and at high‐risk for bipolar disorder

Studies have reported decreased N-acetylaspartate (NAA) in dorsolateral prefrontal cortex (DLPFC) of adults and children with bipolar disorder (BD), suggesting decreased neuronal density in this area. However, it is unclear if this finding represents neurodegeneration after or a trait marker present before BD onset. To address this question, we used proton magnetic resonance spectroscopy ((1)H-MRS) to compare DLPFC levels of NAA among bipolar offspring with early-onset BD, bipolar offspring with subsyndromal symptoms of BD and healthy children. Participants were 9-18 years old, and included 60 offspring of parents with bipolar I or II disorder (32 with BD and 28 with subsyndromal symptoms of BD), and 26 healthy controls. (1)H-MRS at 3 T was used to study 8-cm(3) voxels placed in left and right DLPFC. There were no significant group differences in mean right or left DLPFC NAA/Cr ratios. Exploratory analyses of additional metabolites (myoinositol, choline) also yielded no significant group differences. NAA/Cr ratios were not correlated with age, duration of illness, or exposure to lithium or valproate. Our findings suggest that DLPFC NAA/Cr ratios cannot be used as a trait marker for BD. Although we did not find decreased DLPFC NAA/Cr ratios in children and adolescents with BD, it is still possible that such levels begin to decrease after longer durations of illness into adulthood. Longitudinal neuroimaging studies of patients with BD accounting for developmental and treatment factors are needed to further clarify the neurodegenerative aspects of BD.

Closer Examination of Bipolar Disorder in School-Age Children

Children who present with severe behavioral concerns may be diagnosed as having other commonly diagnosed childhood disorders, such as attention deficit hyperactivity disorder, oppositional defiant disorder, and/or conduct disorder, among others, when they may be suffering from early-onset bipolar disorder. Awareness of the symptoms of early-onset bipolar disorder may lead to appropriate referrals for assessment and treatment, as well as collaborative program planning for children with bipolar disorder. Implications and recommendations for school counselors are discussed.

A Closer Examination of Bipolar Disorder in School-Age Children

Children who present with severe behavioral concerns may be diagnosed as having other commonly diagnosed childhood disorders, such as attention deficit hyperactivity disorder, oppositional defiant disorder, and/or conduct disorder, among others, when they may be suffering from early-onset bipolar disorder. Awareness of the symptoms of early-onset bipolar disorder may lead to appropriate referrals for assessment and treatment, as well as collaborative program planning for children with bipolar disorder. Implications and recommendations for school counselors are discussed.

Suicide and Attempted Suicide in Bipolar Disorder

To determine the main risk factors for suicide and nonfatal suicidal behavior in patients with bipolar disorder through a systematic review of the international literature. Studies were identified through electronic searches of MEDLINE (1966-December 2003), EMBASE (1980-December 2003), PsycINFO (1872-November 2003), and Biological Abstracts (1985-December 2003) using index and free-text search terms for bipolar disorder, bipolar depression, manic depression, mania, and affective disorders; combined with terms for self-harm, self-injury, suicide, attempted suicide, automutilation, self-mutilation, self-poisoning, and self-cutting; and combined with terms for risk, case control, cohort, comparative, longitudinal, and follow-up studies. No language restrictions were applied to the search. Included studies were cohort, case-control, and cross-sectional investigations of patients with bipolar disorder in which suicide (13 studies) or attempted suicide (23 studies) was reported as an outcome. The selected studies also used diagnostic tools including the DSM, International Classification of Diseases, and Research Diagnostic Criteria. Meta-analysis of factors reported in more than 1 study identified the main risk factors for suicide as a previous suicide attempt and hopelessness. The main risk factors for nonfatal suicidal behavior included family history of suicide, early onset of bipolar disorder, extent of depressive symptoms, increasing severity of affective episodes, the presence of mixed affective states, rapid cycling, comorbid Axis I disorders, and abuse of alcohol or drugs. Prevention of suicidal behavior in patients with bipolar disorder should include attention to these risk factors in assessment and treatment, including when deciding whether to initiate treatment aimed specifically at reducing suicide risk.

Reduced Amygdalar Gray Matter Volume in Familial Pediatric Bipolar Disorder

Subcortical limbic structures have been proposed to be involved in the pathophysiology of adult and pediatric bipolar disorder (BD). We sought to study morphometric characteristics of these structures in pediatric subjects with familial BD compared with healthy controls. Twenty children and adolescents with BD I (mean age = 14.6 years, four females) and 20 healthy age, gender, and IQ-matched controls underwent high-resolution magnetic resonance imaging at 3 T. Patients were mostly euthymic and most were taking medications. Amygdala, hippocampus, thalamus, and caudate volumes were determined by manual tracings from researchers blinded to diagnosis. Analyses of covariance were performed, with total brain volume, age, and gender as covariates. No differences were found in the volumes of hippocampus, caudate, and thalamus between subjects with BD and controls. Subjects with BD had smaller volumes in the left and right amygdala, driven by reductions in gray matter volume. Exploratory analyses revealed that subjects with BD with past lithium or valproate exposure tended to have greater amygdalar gray matter volume than subjects with BD without such exposure. Children and adolescents with early-onset BD may have reduced amygdalar volumes, consistent with other studies in this population. Prolonged medication exposure to lithium or valproate may account for findings in adults with BD of increased amygdalar volume relative to controls.

Magnetic Resonance Imaging Studies in Early-Onset Bipolar Disorder: A Critical Review

Neuroimaging studies of early-onset bipolar disorder (BD) are important in order to establish a fuller understanding of the underlying pathophysiology of the illness. The advantages of studying BD in children and adolescents include the relative absence of some confounds present in adult-onset research, such as lengthy duration of illness and exposure to treatments, greater number of mood episodes, and the presence of substance abuse or dependence. Finally, studying youths with the disorder may enhance our knowledge about the neural mechanisms of affective dysregulation and may specifically elucidate whether there are abnormalities that are unique to the early-onset form of the illness. PubMed was used to identify peer-reviewed publications from the past 15 years (January 1990 to January 2005) that used brain-imaging techniques (anatomic, functional, and biochemical) to research early-onset BD. Eleven studies using anatomic magnetic resonance imaging (MRI), seven using magnetic resonance spectroscopy (MRS), and two using functional MRI (fMRI) were identified. Structural abnormalities were reported in total cerebral, white matter, superior temporal gyrus, putamen, thalamus, amygdala, and hippocampal volumes. Deficits in cortical gray matter were also reported. Using MRS, abnormalities were reported in the dorsolateral prefrontal cortex, anterior cingulate, and basal ganglia. One fMRI study found increased activation in the putamen and thalamus of BD youths compared to controls, and a second found abnormal prefrontal-subcortical activation in familial pediatric BD. Published MRI studies of early-onset BD are few. Nonetheless, extant data implicate abnormalities in brain regions thought to regulate mood and cognition. Synthesis of the findings into an overall model of anatomic and functional disruption is difficult due to the methodological variations among studies and the limitations of individual studies, such as the use of small sample sizes, the heterogeneity of sample characteristics, and the wide range of brain structures selected for analysis. Recommendations are offered to guide future research. It will be important for future studies to reproduce prior findings and determine which findings are unique to early-onset BD, relative to adult-onset illness. In addition, studies will need to establish the extent to which early-onset BD may overlap with comorbid disruptive, mood, anxiety, or psychotic disorders.

Early Onset Bipolar Disorder: Clinical and Research Considerations

This article examined some of the reasons for confusion and controversy surrounding the frequency of diagnosis of bipolar disorder, especially in prepubertal children. Four case vignettes are used to articulate questions surrounding manifestations of euphoria and grandiosity, informant variance, diagnostic implications of medication-induced behavioral toxicity, and treatment implications of family history. Although extant literature cited addresses some of the issues, specific research is needed for definitive answers.

Vulnerability to Mental Illnesses: Gender Makes a Difference, and So Does Providing Good Psychiatric Care

Vulnerability to Mental Illnesses: Gender Makes a Difference, and So Does Providing Good Psychiatric Care

Gender Differences in Incidence and Age at Onset of Mania and Bipolar Disorder Over a 35-Year Period in Camberwell, England

Despite clear gender differences in the symptoms and course of bipolar affective disorder, studies investigating age at onset by gender have yielded inconsistent results. The authors investigated gender differences in age at onset and incidence of first-episode mania and bipolar disorder in an epidemiological catchment area in southeast London over a 35-year period. All adult cases of first-episode psychosis, mania, or hypomania presenting to services in Camberwell, southeast London (1965-1999), were identified. Computerized diagnoses for these cases were generated by using the Operational Checklist for Psychotic Disorders program. Incidence rates and rate ratios of DSM-IV bipolar I disorder, first manic episode, by gender and age (10-year age-at-onset categories) were calculated. Differences in age at onset of first-episode mania and bipolar disorder by gender were examined by using univariate and multivariate analyses. Men had a significantly earlier onset of first-episode mania and bipolar disorder, with childhood antisocial behavior also being significantly associated, after multivariate analysis. Women had higher incidence rates of bipolar I disorder throughout adult life, except for early life (ages 16-25 years), although gender differences in individual age bands did not reach statistical significance. Men appear to have an earlier onset of mania and bipolar disorder than women. The association of male gender and childhood antisocial behavior with early-onset bipolar disorder raised the possibility of the existence of an early-onset subgroup.

Table of Contents

The Brown University Child & Adolescent Psychopharmacology UpdateVolume 7, Issue 3 p. 1-12 Table of Contents First published: 18 August 2005 https://doi.org/10.1002/cpu.19900703AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract Exploring the Controversy, the Diagnosis and the Treatment New Treatment Guidelines Available for Children and Adolescents with Bipolar Disorder Experts Discuss Comorbid Conditions in Children with Bipolar Disorder Atypical Antipsychotics May Offer Some Hope for Bipolar Mania: More Testing on Safety Is Needed Bipolar Disorder in Preschoolers Combination Treatment for Pediatric Mania Family-Based Therapy for Teens with BPD Early-Onset Bipolar Disorder Health Canada Suspends Adderall Expanded Recall of Methylin Chewable Tablets Errors in Zyprexa and Zyrtec Prescribing/Dispensing Bolded Warning for Off-Label Gabitril use Volume7, Issue3March 2005Pages 1-12 RelatedInformation

Transtorno bipolar de início tardio: uma variedade orgânica do transtorno de humor?

Bipolar disorder (BD) is commonly associated with late adolescence or early adulthood, although a substantial proportion of patients develops the condition in later life. The results of early clinical investigations suggested that cases of bipolar disorder with onset in later life were more often associated with 'organic causes', and could potentially justify the distinction between early and late onset bipolar disorder. This paper reviews currently available evidence in support of the organic hypothesis for late onset bipolar disorder. It concludes that the split of bipolar disorder according to age at onset is artificial, and lacks clinical significance and epidemiological support.

Psychosocial interventions for children with early-onset bipolar spectrum disorder.

Once considered virtually nonexistent, bipolar disorder in children has recently received a great deal of attention from mental health professionals and the general public. This paper provides a current review of literature pertaining to the psychosocial treatment of children with early-onset bipolar spectrum disorder (EOBPSD). Commencing with evidence of the emerging interest in this topic, we then focus on terminology, the rationale for studying EOBPSD in children, current research and clinical progress, possible explanations for the recent increase in recognition, and essential issues that form the foundation of effective psychosocial treatment. Next we explore areas of research with direct implications for psychosocial treatment. These include biological and psychosocial risk factors associated with bipolar disorder; and the psychosocial treatment of adult-onset bipolar disorder, childhood-onset unipolar disorder, and anger management in children. Following this, we discuss treatments being developed and tested for children with EOBPSD. Finally, we conclude with recommendations for future studies needed to move the field forward.

Long-Term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD)

Background Early onset of mood symptoms in bipolar disorder has been associated with poor outcome in many studies; however, the factors that might contribute to poor outcome have not been adequately investigated. Methods The first consecutive 1000 adult bipolar patients enrolled in the National Institute of Mental Health's Systematic Treatment Enhancement Program for Bipolar Disorder were assessed at study entry to determine details of their age of onset of mood symptoms. Clinical course, comorbidity, and functional status and quality of life were compared for groups with very early (age < 13 years), early (age 13–18 years), and adult (age > 18 years) onset of mood symptoms. Results Of 983 subjects in whom age of onset could be determined, 272 (27.7%) experienced very early onset, and 370 (37.6%) experienced early onset. Earlier onset was associated with greater rates of comorbid anxiety disorders and substance abuse, more recurrences, shorter periods of euthymia, greater likelihood of suicide attempts and violence, and greater likelihood of being in a mood episode at study entry. Conclusions Very early or early onset of bipolar disorder might herald a more severe disease course in terms of chronicity and comorbidity. Whether early intervention might modify this risk merits further investigation.

A systematic chart review of the naturalistic course and treatment of early-onset bipolar disorder in a child and adolescent psychiatry center

Studies on the naturalistic course of early-onset bipolar disorder are few and studies evaluating the efficacy of pharmacotherapy consist largely of open trials of thymoleptics and neuroleptics on small samples. The current study was undertaken to map the course of the disorder and the prevailing prescribing practice in early-onset bipolar disorder at a child and adolescent psychiatry center in India. A chart review of 139 children and adolescents (<16 years) with a DSM-IV diagnosis of bipolar disorder—mania was performed and the baseline demographic and clinical characteristics, episode characteristics, and treatment and follow-up details were collected and the data analyzed. The index episode remitted in all 133 (96%) subjects for whom the information was available. One hundred twenty-five (90%) subjects received thymoleptics for the index episode, of which lithium was used in 85%. Valproate was the next most commonly used thymoleptic (18%). Eighteen (13%) subjects received combination thymoleptics. Sixty-eight percent received neuroleptics either alone or as adjuncts in the acute phase. During the follow-up period, which ranged from 3 to 56 months (mean ± SD, 15 ± 14), 35% of subjects relapsed, 89% within the first 2 years. Twenty-eight percent of subjects relapsed despite being on apparently adequate doses of lithium. The limitations of the study are that it is retrospective in nature, and that structured diagnostic tools and rating scales were not used. We conclude that lithium is the most commonly used thymoleptic in early-onset bipolar disorder. Lithium alone or in combination with neuroleptics appears to have good efficacy in the acute phase of the disorder. The majority of relapses occurred in the first 2 years and the efficacy of currently used thymoleptics in prophylaxis is uncertain.

Defining and identifying early onset bipolar spectrum disorder.

Early onset bipolar spectrum disorder (EOBPSD) is difficult to diagnose because of symptom overlap with other disorders and nearly ubiquitous comorbidity. A thorough assessment of EOBPSD should include the following: 1) a timeline of the child's development, from birth to present, showing the episodic nature of EOBPSD; 2) a structured clinical interview determining comorbidity and differential diagnosis; 3) a family history genogram to ascertain familial loading and environmental stressors, which informs case conceptualization; 4) depression and mania rating scales to assess symptom severity and track treatment outcome; 5) global rating scales to obtain cross-informant data and inform broad-based treatments; and 6) a current mood log to document baseline functioning and track treatment outcome. Examples of a timeline, family history genogram, and current mood log are presented. This comprehensive approach to assessing EOBPSD, a severe and possibly lifelong disorder, is strongly advocated. No scale, instrument, or technique alone is adequate to diagnose EOBPSD.

The Hand-to-Hand Family Education Program: A Means of Reducing Parental Stress and Increasing Support in Families of Children with Brain Disorders

Free AccessThe Hand-to-Hand Family Education Program: A Means of Reducing Parental Stress and Increasing Support in Families of Children with Brain DisordersKristen H. Davidson and Mary A. FristadKristen H. DavidsonSearch for more papers by this author and Mary A. FristadSearch for more papers by this authorPublished Online:June 2005https://doi.org/10.1521/capn.9.2.7.33305PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutSuggested ReadingsSisson , D. P., & Fristad, M. A., (2001). A survey of stress and support for parents of children with early-onset bipolar disorder. Bipolar Disorders, 3(2), 58. Crossref, Google Scholar Previous article Next article FiguresReferencesRelatedDetails Cited byCited by1. Creating Partnerships Between Consumer Groups and Professional Psychologists.Online publication date: 1 October 2004. Go to citation Crossref Google Scholar Volume 9Issue 2Mar 2004 Information© The Guilford PressPDF download

Earlier onset of bipolar disorder in children by antidepressants or stimulants? An hypothesis

Among adults and adolescents, bipolar disorder (BD) has a similar prevalence in the US and in the Netherlands. However, among pre-pubertal children, BD is frequently diagnosed in the US and seldomly in the Netherlands. This suggests that, among children, the prevalence of BD is lower in the Netherlands than in the US, indicating an earlier onset of BD in the US than in the Netherlands. It is hypothesized that this may be related to the greater use of antidepressants and stimulants for depression or attention deficit disorder with hyperactivity by US children. In those children who are genetically at risk to develop BD, these drugs may lead to a switch into mania.

Bipolar disorder in youth: An update

The authors highlight some of the important findings regarding juvenile-onset bipolar disorder that have been published in recent years. Topics covered include the impact of definition on understanding epidemiologic studies of early-onset bipolar disorder, comorbidity, developmental risk factors, switching and medication response, family studies, and treatment. Some of the controversy surrounding bipolar disorder in youth diminishes if bipolar disorder is viewed as a spectrum, and children may fit along the spectrum without meeting full criteria for classic bipolar I disorder.