Pediatric-onset Bipolar Disorder Research Articles

Sensation Seeking in Children and Adults with Pediatric-Onset Bipolar Disorder.

Bipolar disorder (BD) is one of the most impairing psychiatric illnesses. Those with pediatric-onset BD tend to have worse outcomes; therefore, accurate conceptualization is important for aspects of care, such as tailored treatment interventions. Sensation seeking behaviors may be a window into the psychopathology of pediatric-onset BD. Participants with BD and healthy controls (HC) ages 7-27 completed self-report assessments, including the Sensation Seeking Scale- V (SSS-V). Among the BD group, there was a significant positive correlation between the Disinhibition subscale and age. Analyses indicated that the BD group scored lower on the Thrill and Adventure Seeking subscale but higher on the Disinhibition scale when compared to the HC group. We found that individuals with pediatric-onset BD are more likely to engage in socially risky behaviors. These results are an important step in understanding sensation seeking characteristics in BD youth and improving treatment, ultimately helping individuals live a more stable life.

Emotional regulation neural circuitry abnormalities in adult bipolar disorder: dissociating effects of long-term depression history from relationships with present symptoms

Bipolar disorder (BD) is common and debilitating and confounding effects of depression history on neural activity in BD are unknown. We aimed to dissociate neural activity reflecting past depression-load vs. present symptom severity using the Course and Outcome of Bipolar Youth (COBY), a prospective longitudinal cohort study of pediatric-onset BD. In n = 54 COBY (18–32 years), we modeled depression scores over time (up to 17.5 years) using a standardized autoregressive moving average (ARMA) model, followed by k-means cluster analysis. N = 36 healthy participants (HC, 20–36 years) were included. Using two factorial analyses, we parsed the impact of ARMA-defined past depression-load on neural activity from the impact of current symptoms on neural activity (p < 0.001, k > 30) and examined relationships with past and present symptoms (ps FDR-corrected). ARMA identified three COBY groups based on past depression-load. ARMA-defined COBY participants with the greatest past depression-load vs. other groups showed greater activity in right temporoparietal junction, thalamus, insula, premotor cortex, left fusiform gyrus, bilateral precuneus and cerebellum. In contrast, BD-COBY participants vs. HC showed greater activity in left hippocampus, dorsolateral prefrontal cortex, and right somatosensory cortex, plus the above thalamus, premotor cortex and cerebellum; activity positively correlated with present symptom severity in most regions. Past depression-load was related to social cognition and salience perception network activity, potentially reflecting heightened attention to socially relevant distracters, while present symptoms were associated with emotion processing and reappraisal network activity, potentially reflecting abnormal emotional experience and regulation. Differentiating aberrant neural activity related to long-term depression vs. present affective symptoms can help target interventions to networks associated with pathophysiological processes, rather than long-term illness effects.

Trajectories of Historical Depressions in Adults With Pediatric Onset Bipolar Disorder Identifies Neural Circuity That Helps to Explain Recurrent Thoughts of Death

Trajectories of Historical Depressions in Adults With Pediatric Onset Bipolar Disorder Identifies Neural Circuity That Helps to Explain Recurrent Thoughts of Death

Longitudinal outcomes in pediatric- and adult-onset bipolar patients compared to healthy and schizophrenia controls.

Comparing outcomes of bipolar disorder (BD) with schizophrenia (SCZ) and psychiatrically healthy controls (PHC), contrasting pediatric-onset with adult-onset disorders. A nationwide cohort study, including patients with an incident diagnosis of BD or SCZ registered in the Danish National Patient Registry and corresponding PHCs. Outcomes were (a) duration of hospitalization, (b) psychiatric admissions, (c) psychiatric outpatient contacts, (d) bone-fracture-related healthcare contacts, (e) self-harm-related healthcare contacts (including suicide and non-suicidal self-injuries), and (f) criminal charges. Incidence rate ratios (IRRs), adjusted for age at first psychiatric contact, substance abuse and parental psychiatric illness, were calculated, comparing pediatric-onset BD (5-17years) and adult-onset BD (18-39years) with age- and sex-matched SCZ patients and PHC. Pediatric-onset BD (n=349) performed better than 1:1-matched pediatric-onset SCZ (n=349) on all six outcomes (IRR=0.30 for self-harm-related contacts (P<0.001) to IRR=0.86 for criminal charges (P=0.05). Similar, but less pronounced results were observed comparing 1:1-matched adult-onset BD (n=5515) with adult-onset SCZ (n=5515) IRR=0.58 for psychiatric outpatient contact (P<0.001) to IRR=0.93 for criminal charges (P<0.001), except for more bone-fracture-related contacts in adult-onset BD (IRR=1.13, P<0.01). Comparing pediatric-onset BD (n=365) to 1:3-matched PHC (n=1095), only self-harm-related contacts differed significantly (IRR=2.80, P<0.001). Conversely, comparing adult-onset BD (n=6005) with 1:3-matched PHC (n=18015), self-harm-related contacts (IRR=16.68, P<0.001), bone fractures (IRR=1.74, P<0.001), and criminal charges (IRR=2.03, P<0.001) were more common in BD. BD was associated with poorer outcomes than PHC, but better outcomes than SCZ. Furthermore, outcomes were more favorable in pediatric-onset BD when indirectly contrasted to adult-onset BD.

Receiver Operating Characteristic Curve Analysis of Screening Tools for Bipolar Disorder Comorbid With ADHD in Schoolchildren

Objective: We compared Child Behavior Checklist (CBCL)-AAA (Attention Problems, Aggressive Behavior, and Anxious/Depressed) and Parent–Young Mania Rating Scale (P-YMRS) profiles in Brazilian children with ADHD, pediatric-onset bipolar disorder (PBD), and PBD + ADHD. Method: Following analyses of variance or Kruskal–Wallis tests with multiple-comparison Least Significant Difference (LSD) or Dunn’s Tests, thresholds were determined by Mann–Whitney U Tests and receiver operating characteristic (ROC) plots. Results: Relative to ADHD, PBD and PBD + ADHD groups scored higher on the Anxious/Depressed, Thought Problems, Rule-Breaking, and Aggressive Behavior subscales and Conduct/Delinquency Diagnostic Scale of the CBCL; all three had similar attention problems. The PBD and PBD + ADHD groups scored higher than the ADHD and healthy control (HC) groups on all CBCL problem scales. The AAA-profile ROC had good diagnostic prediction of PBD + ADHD. PBD and PBD-ADHD were associated with (similarly) elevated P-YMRS scores. Conclusion: The CBCL-PBD and P-YMRS can be used to screen for manic behavior and assist in differential diagnosis.

Distinguishing bipolar disorder from other psychiatric disorders in children.

Pediatric onset bipolar disorder (BD) is a challenging diagnosis with potentially debilitating outcomes. This review aims to critically evaluate recently published literature relevant to the diagnosis of BD in youth, emphasizing interesting and important new findings characterizing pediatric BD and reporting updates in the diagnostic and statistical manual relevant to this disorder in youth. Challenges regarding the diagnosis of BD will be discussed, in addition to important distinctions with other childhood disorders, including other bipolar spectrum disorders; major depressive disorder; dysthymia; disruptive mood dysregulation disorder (DMDD); attention-deficit/hyperactivity disorder (ADHD) and other disruptive behavioral disorders; anxiety disorders, including post-traumatic stress disorder (PTSD); psychotic disorders; autism spectrum disorders; substance use disorders; and borderline personality disorder. The review concludes with a comment on past research limitations and future directions in the field.

Further evidence that pediatric-onset bipolar disorder comorbid with ADHD represents a distinct subtype: Results from a large controlled family study

We used familial risk analysis to clarify the diagnostic comorbidity between pediatric BP-I disorder and ADHD, testing the hypothesis that pediatric-BP-I disorder comorbid with ADHD represents a distinct subtype. Structured diagnostic interviews were used to obtain DSM-IV psychiatric diagnoses on first-degree relatives (n = 726) of referred children and adolescents satisfying diagnostic criteria for BP-I disorder (n = 239). For comparison, diagnostic information on the first-degree relatives (N = 511) of non-bipolar ADHD children (N = 162) and the first degree relatives (N = 411) of control children (N = 136) with neither ADHD nor BP-I disorder were examined. BP-I disorder and ADHD in probands bred true irrespective of the comorbidity with the other disorder. We also found that the comorbid condition of BP-I disorder plus ADHD also bred true in families, and the two disorders co-segregated among relatives. This large familial risk analysis provides compelling evidence that pediatric BP-I disorder comorbid with ADHD represents a distinct familial subtype.

Dulcan's Textbook of Child and Adolescent Psychiatryedited by DulcanMina K., M.D. Washington, DC, American Psychiatric Publishing, 2010, 1104 pp., $252.00.

Dulcan's Textbook of Child and Adolescent Psychiatryedited by DulcanMina K., M.D. Washington, DC, American Psychiatric Publishing, 2010, 1104 pp., $252.00.

Affective prosody labeling in youths with bipolar disorder or severe mood dysregulation

Accurate identification of nonverbal emotional cues is essential to successful social interactions, yet most research is limited to emotional face expression labeling. Little research focuses on the processing of emotional prosody, or tone of verbal speech, in clinical populations. Using the Diagnostic Analysis of Nonverbal Accuracy, the current study examined whether youths with pediatric-onset bipolar disorder (BD) and/or those with chronic and severe irritability (i.e. the severe mood dysregulation phenotype) are impaired in their ability to identify the emotional prosody of a spoken sentence with neutral content. Youths with severe mood dysregulation (n = 67) performed more poorly than healthy comparison children (n = 57), even when the sample was limited to unmedicated patients. Medicated BD youths (n = 52) exhibited impairment relative to healthy comparison children. No interactions between group and emotion were observed, suggesting that emotional prosody labeling problems may represent a general deficit in chronically irritable youths and in medicated youths with BD. In concert with previously documented facial emotion labeling deficits, difficulties ascertaining the correct emotional tone of a spoken sentence may contribute to emotion dysregulation in chronically irritable children, and possibly also in youths with BD.

Diagnosing Bipolar Disorder in Children and Adolescents

Pediatric-onset bipolar disorder is common but often difficult to diagnose in younger patients. Clinicians should be sure to establish the presence of a full manic episode to make the diagnosis of bipolar I disorder. Because adult criteria are used for children and adolescents, clinicians also should be aware of developmental norms that can help to make an accurate diagnosis. Bipolar disorder NOS and other disorders in children and adolescents may be prodromal states for bipolar disorder, especially in the presence of a positive family history.

Survey of Expert Treatment Approaches for Children with Bipolar Disorder-Not Otherwise Specified and Bipolar-I Presentations

The intrinsic difficulties in studying and treating children younger than 10 years who have bipolar affective disorders were highlighted in the article by Post (see page 879). Currently, there are virtually no Food and Drug Administration (FDA)-approved medications for children with pediatric onset bipolar disorder (PBD) who are younger than 10 years. This is in contrast to the nearly 20 FDA-approved medications for the treatment of attention-deficit/hyperactivity disorder (ADHD), an illness with onset before 7 years. Existing guidelines for PBD suggest that mood stabilization with lithium, anticonvulsants, or second-generation antipsychotics (SGA) in PBD is the first step in treating mania prior to the use of adjuvant stimulant medications to treat comorbid ADHD.

A Tribute to Robert Post’s Bipolar ‘Perfect Storm’

This issue of &lt;em&gt;Psychiatric Annals,&lt;/em&gt; guest edited by Robert Post, MD, featuring two articles written by him, is mainly focused on the issue of pediatric-onset bipolar disorder. For years, Dr. Post has been trying to draw our attention to the early onset of bipolar disorder and its consequences, articulating the need for more treatment-focused research in bipolar disorder, but particularly child-onset bipolar disorder.

Will neuroimaging ever be used to diagnose pediatric bipolar disorder?

There is a great need for discovery of biological markers that could be used diagnostically for pediatric onset disorders, particularly those with potentially confusing phenomenology such as pediatric-onset bipolar disorder (BD). Obtaining these markers would help overcome current subjective diagnostic techniques of relying on parent and child interview and symptomatic history. Brain imaging may be the most logical choice for a diagnostic tool, and certain neurobiological abnormalities have already been found in pediatric BD. However, much work remains to be done before neuroimaging can be used reliably to diagnose this disorder, and because of the nature of BD and the limitations of imaging technology and technique, neuroimaging will likely at most be only a diagnostic aide in the near future. In this paper we discuss the characteristics of pediatric BD that complicate the use of biological markers as diagnostic tools, how neuroimaging techniques have been used to study pediatric BD so far, and the limitations and potential of such techniques for future diagnostic use.

Six‐year‐old Thomas Diagnosed with Pediatric Onset Bipolar Disorder: A Case Study

<i>Six‐year‐old Thomas Diagnosed with Pediatric Onset Bipolar Disorder: A Case Study</i>

Pediatric-onset bipolar disorder: a neglected clinical and public health problem.

Bipolar disorder (BPD), probably the most prevalent psychotic disorder in adults, has been relatively neglected or controversial in children and adolescents over the past century. We reviewed the literature on early-onset BPD. Estimates of prevalence, particularly before puberty, are limited by historical biases against pediatric mood disorders and by formidable diagnostic complexity and comorbidity. Although clinical features of pediatric and adult BPD have similarities, pediatric cases probably cannot be defined solely by features characteristic of adult cases. Onset was before age 20 years in at least 25% of reported BPD cases, with some increase in this incidence over the past century. Pediatric BPD is familial more often than is adult-onset BPD, may be associated with a premorbid cyclothymic or hyperthymic temperament, and can be precipitated by antidepressant treatment. Pediatric BPD episodes frequently include irritability, dysphoria, or psychotic symptoms; they are commonly chronic and carry high risks of substance abuse and suicide. BPD is often recognized in adolescents, but the syndrome or its antecedents are almost certainly underrecognized and undertreated in children. Controlled studies of short- and long-term treatment, course, and outcome in this disorder remain strikingly limited, and the syndrome urgently requires increased clinical and scientific interest.