Pediatric Psychiatric Disorders Research Articles

Expression alteration of Neuroligin family gene in attention deficit and hyperactivity disorder and autism spectrum disorder

BackgroundAutism spectrum disorder (ASD) is a complex neurodevelopment disorder with social and communicational deficiency, language impairment, and ritualistic behaviors. Attention deficit hyperactivity disorder (ADHD) is a pediatric psychiatric disorder with symptoms, including attention deficit, hyperactivity, and impulsiveness. ADHD is a childhood-onset disorder that can persist into adult life. Neuroligins are post-synaptic cell-adhesion molecules that connect neurons and have an essential role in the mediation of trans-synaptic signaling and shaping the synapse and circuits and neural network functioning. AimsPresent study aimed to shed light on the role of the Neuroligin gene family in ASD and ADHD. Methods and proceduresmRNA levels of the Neuroligin gene family (NLGN1, NLGN2, NLGN3, and NLGN4X) were studied in the peripheral blood of 450 unrelated ASD patients, 450 unrelated ADHD patients, and the normal group included 490 unrelated non-psychiatric children by quantitative PCR. Also, clinical situations were considered. Outcomes and resultsResults showed that mRNA levels of NLGN1, NLGN2, and NLGN3 were significantly down-regulated in the ASD group vs. control subjects. In ADHD, a significant reduction of NLGN2 and NLGN3 was detected in comparison with normal children. A comparison of ASD and ADHD subjects revealed that NLGN2 was significantly down-regulated in ASD subjects. ConclusionsThe Neuroligin family gene may play an essential role in the etiology of ASD and ADHD and thus be a source for a better understanding of neurodevelopment disorders. ImplicationsSimilar patterns of deficiency of Neuroligin family genes in ASDs and ADHDs may indicate the role of these genes in functions that have been affected in both disorders.

The DIAMOND-KID: Psychometric Properties of a Structured Diagnostic Interview for DSM-5 Anxiety, Mood, and Obsessive-Compulsive and Related Disorders in Children and Adolescents.

The objective of the present study was to examine the reliability and validity of a new semi-structured interview for pediatric psychiatric disorders, which is needed as existing interviews do not cover the full range of anxiety, mood, and obsessive-compulsive disorder (OCD)-related disorders. Three hundred eleven child patients (aged 10-17) were administered the Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders-Child and Adolescent Version (DIAMOND-KID). Of these, 65 provided interrater reliability data and 59 provided test-retest reliability data. Participants also completed self-report measures that assessed symptoms of anxiety, mood, and OCD and related disorders. Although parents/guardians could participate in the interview at the clinician's discretion, most of the initial interviews and all of the reliability interviews were based on the child's self-report. Test-retest reliability ranged from very good to excellent. Interrater reliability was more variable, with estimates for generalized anxiety disorder and major depressive disorder in the questionable range; the other interrater reliability estimates ranged from good to very good. Convergent validity was established by significant between-group comparisons on applicable self-report measures for all diagnoses. The results of the present study indicate that the DIAMOND-KID is a promising semi-structured diagnostic interview for 5th edition of the Diagnostic and Statistical Manual of Mental Disorders in pediatric populations.

Pediatric emergency care admissions for somatic symptom disorders during the COVID-19 pandemic.

During the COVID-19 pandemic, children and adolescents with psychiatric disorders experienced an exacerbation of their symptoms with more access to the emergency department (ED). However, little is known about the experience of somatic symptom disorders (SSDs) during the COVID-19 pandemic in children. Therefore, we aimed to compare the rates of pediatric ED admissions for SSDs before and during the COVID-19 pandemic and to understand whether the relative risk of ED admissions for SSDs changed between the two periods. We retrospectively enrolled all children between 4 and 14years admitted for SSDs in the pediatric ED of Santobono-Pausilipon Hospital, Naples, Italy, from March 11th, 2020, to March 11th, 2021 (pandemic period), and in the same time period of the previous year (pre-pandemic period). We identified 205/95,743 (0,21%) children with SSDs presenting in ED in the pre-pandemic year and 160/40,165 (0,39%) in the pandemic year (p < 0.05). Considering the accesses for age, we observed a relative decrease of the accesses for SSDs over 12years old (IRR 0,59; CI 0,39-0,88), while we found no differences under 12years old (IRR 0,87; CI 0,68-1,10). Conclusion:In this study, we found that despite the massive decrease in pediatric admissions due to the COVID-19 pandemic, somatic symptom disorders' admissions to the pediatric ED increased, suggesting an impact of the pandemic also on pediatric psychiatric disorders. What is Known: • During the COVID -19 pandemic, children and adolescents with a psychiatric disorder experienced exacerbation of their symptoms with more accesses in Emergency Department. What is New: • We found that despite the massive decrease of the pediatric admissions due to the COVID-19 pandemic, somatic symptom disorders admissions in healthy children to the pediatric Emergency Department increased ,suggesting an impact of the pandemic also on the pediatric psychiatric disorders.

The Development of Somatic Symptom Disorder in Children: Psychological Characteristics and Psychiatric Comorbidity

Somatic symptom disorder (SSD) is one of the most common pediatric psychiatric disorders in adolescents, and several biological, psychological, and social factors have been considered to contribute to its development. The aim of the present study was to elucidate the link between psychological functioning (depression and anxiety), psychological characteristics (perfectionism and alexithymia), negative life events, and parental accommodation in children diagnosed with SSD. Fifty patients (age range 7-18 years) were diagnosed with SSD in an outpatient clinic and completed multiple self-report questionnaires on SSD symptoms, negative life events, and psychological factors. Linear regression models were used to indicate predictors of SSD symptoms. Cluster analysis was performed to identify gastrointestinal and abdominal complaints and their associations. Association with SSD symptoms was strongest for state anxiety (standardized β= 0.85, 95% confidence interval [CI]=0.44, 1.27, P= 0.0006), depression (β= 0.72, 95% CI=0.38, 1.06, P= 0.0006), trait anxiety (β= 0.60, 95% CI=0.22, 0.98, P= 0.0005), and family accommodation (β= 0. 49, 95% CI=0.23, 0.75, P= 0.001). These factors were associated with gastrointestinal but not with neurological complaints. Family accommodation was associated with somatic complaints among children younger than 12 years (r= 0.57, P= 0.007), while state anxiety (r= 0.69, P= 0.007) and depression (r= 0.65, P= 0.007) were significantly associated among older children. Several psychological factors may result in a somatic response. The phenotypic expression of these factors may vary among different ages. Somatic complaints were related to parental accommodation among young children, while it was strongly associated with anxiety and depression among adolescents.

Treating pediatric psychiatric disorders reduces later SUDs

Treating pediatric psychiatric disorders reduces later SUDs

Study: Treating pediatric psychiatric disorders reduces later SUDs

The earlier the treatment and the longer it lasts for pediatric psychiatric problems, especially for attention deficit‐hyperactivity disorder (ADHD), the less likely substance use disorders (SUDs) will arise later in life, according to a study by researchers who have delved into this issue for years. The study, “The Impact of Pharmacotherapy of Childhood‐Onset Psychiatric Disorders on the Development of Substance Use Disorders,” published in the current issue of the Journal of Child and Adolescent Psychopharmacology, should put to rest many of the concerns about treating young people with psychotropic medications.

The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders.

Background and Objective: Child- and adolescent-onset psychopathology is known to increase the risk for developing substance use and substance use disorders (SUDs). While pharmacotherapy is effective in treating pediatric psychiatric disorders, the impact of medication on the ultimate risk to develop SUDs in these youth remains unclear. Methods: We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review of peer-reviewed literature published on PubMed through November 2021, examining pharmacological treatments of psychiatric disorders in adolescents and young adults and their effect on substance use, misuse, and use disorder development. Results: Our search terms yielded 21 studies examining the impact of pharmacotherapy and later SUD in attention-deficit/hyperactivity disorder (ADHD), two studies on Major Depressive Disorder, and three studies on psychotic disorders. The majority of these studies reported reductions in SUD (N = 14 sides) followed by no effects (N = 10) and enhanced rates of SUD (N = 2). Studies in ADHD also reported that earlier-onset and longer-duration treatment was associated with the largest risk reduction for later SUD. Conclusions: Overall, pharmacological treatments for psychiatric disorders appear to mitigate the development of SUD, especially when treatment is initiated early and for longer durations. More studies on the development of SUD linked to the effects of psychotherapy alone and in combination with medication, medication initiation and duration, adequacy of treatment, non-ADHD disorders, and psychiatric comorbidity are necessary.

Meta-analytical transdiagnostic neural correlates in common pediatric psychiatric disorders

In the last decades, neuroimaging studies have attempted to unveil the neurobiological markers underlying pediatric psychiatric disorders. Yet, the vast majority of neuroimaging studies still focus on a single nosological category, which limit our understanding of the shared/specific neural correlates between these disorders. Therefore, we aimed to investigate the transdiagnostic neural correlates through a novel and data-driven meta-analytical method. A data-driven meta-analysis was carried out which grouped similar experiments’ topographic map together, irrespectively of nosological categories and task-characteristics. Then, activation likelihood estimation meta-analysis was performed on each group of experiments to extract spatially convergent brain regions. One hundred forty-seven experiments were retrieved (3124 cases compared to 3100 controls): 79 attention-deficit/hyperactivity disorder, 32 conduct/oppositional defiant disorder, 14 anxiety disorders, 22 major depressive disorders. Four significant groups of experiments were observed. Functional characterization suggested that these groups of aberrant brain regions may be implicated internally/externally directed processes, attentional control of affect, somato-motor and visual processes. Furthermore, despite that some differences in rates of studies involving major depressive disorders were noticed, nosological categories were evenly distributed between these four sets of regions. Our results may reflect transdiagnostic neural correlates of pediatric psychiatric disorders, but also underscore the importance of studying pediatric psychiatric disorders simultaneously rather than independently to examine differences between disorders.

ANXIETY AND DEPRESSION AMONG SIBLINGS OF CHILDREN WITH CEREBRAL PALSY ATTENDING NEUROLOGY CLINIC AT ALEXANDRIA UNIVERSITY CHILDREN'S HOSPITAL Elham Elsayed Elsakka, Shimaa Anwar Mohamed, Mohamed Abdelhady Ali Abdelhady Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt

: CP is a group of permanent disorders of motor function, which are due to a non-progressive lesion, or abnormality of the developing/immature brain. Motor function disorders are often accompanied by other dysfunctions, such as: sensation, perceptual, cognitive, communication and behavioral disorders, epilepsy, and secondary musculoskeletal disorders. (1) It is the most common cause of motor disability in childhood. (2)The worldwide prevalence of CP ranges from 1 to 4 per 1,000 live births. In Egypt, the prevalence is about 2.6-4.6 per 1,000 live births.Having a child with CP in the family not only affects parents’ lives including physical and psychological well-being, financial stability and support of services , but also affects normal siblings, who are considered as “population at risk to experience psychological difficulties” .(5, 6) According to the American Psychiatric Association, behavioral disorders , anxiety disorders, and depression are the most common pediatric psychiatric disorders.(7)Anxiety disorders are among the most common childhood emotional problems, with lifetime prevalence ranging from 8.3% to 27%.(8)Depression: is a mental state or chronic mental disorder characterized by feelings of sadness, loneliness, despair, low self-esteem, signs of psychomotor retardation ,or less frequently, agitation, withdrawal from social contact ,change of appetite and insomnia.(10)The overall prevalence of pediatric depressive disorders is 12.3% with 14.1% for females and 8.6% for males.(11)

Neural mechanisms of reward processing in adolescent irritability.

Irritability is impairing and prevalent across pediatric psychiatric disorders and typical development, yet its neural mechanisms are largely unknown. This study evaluated the relation between adolescent irritability and reward-related brain function as a candidate neural mechanism. Adolescents from intervention-seeking families in the community (N=52; mean age=13.80, SD=1.94) completed a monetary incentive delay task to assess reward anticipation and feedback (reward receipt and omission) during fMRI acquisition. Whole-brain analyses, controlling for age, examined brain activation and striatal and amygdala connectivity in relation to irritability. Irritability was measured using the parent- and youth-reported Affective Reactivity Index. Irritability was associated with altered reward processing-related activation and connectivity in multiple networks during reward anticipation and feedback, including increased striatal activation and altered ventral striatum connectivity with prefrontal areas. Our findings suggest that irritability is associated with altered neural patterns during reward processing and that aberrant prefrontal cortex-mediated top-down control may be related to irritability. These findings inform our understanding of the etiology of youth irritability and the development of mechanism-based interventions.

Effects of Early-Life Aripiprazole and Risperidone on Locomotor Activity in Adult Rats

The use of antipsychotic drugs for pediatric psychiatric disorders has risen significantly over the last three decades, despite an absence of data documenting their long-term effects on brain development. We have used rats as a model system to show that early-life risperidone administration increases locomotor activity and locomotor responses to dopaminergic drugs during adulthood. The present study compared the effects of early-life risperidone to early-life aripiprazole administration on locomotor activity and locomotor responses to NMDA receptor blockade during adulthood.

Risk of seizures associated with antipsychotic treatment in pediatrics with psychiatric disorders: a nested case-control study in Korea.

Antipsychotic drugs raise seizure risk in adults, and antipsychotic drug use is increasing among pediatric psychiatric disorder patients. However, few studies have examined seizure risk in this younger patient population. To evaluate seizure risk in pediatric patients on antipsychotics, we conducted a nested case-control study using a nationwide database. Patient information was retrieved from the Korean Health Insurance Review and Assessment (HIRA) database from 2008-2018. Antipsychotic use among newly diagnosed psychiatric patients was gathered starting 1 year before the index date and categorized as recent, past, consistent, or none. Seizure cases among these patients were defined based on (1) prescription of antiepileptic drugs or (2) an electroencephalography (EEG) examination among patients with seizure diagnostic code. A conditional logistic regression model was constructed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for seizure risk due to antipsychotic use. In total, 1523 seizure cases and 6092 seizure-free controls aged 8-19years with newly diagnosed psychiatric disorders were included for analysis. Logistic regression revealed a significant association between antipsychotic use and seizure development (recent users OR = 4.03, 95% CI 3.4-4.79; consistent users: OR = 2.84, 95% CI 2.44-3.3). Seizure risk enhanced further with an increase in the number of antipsychotic drugs used. Risperidone, aripiprazole, quetiapine, olanzapine, paliperidone, and blonanserin were independently associated with greater seizure risk. Pediatric patients receiving antipsychotics, especially new or multiple antipsychotic users, should be carefully monitored for seizure development.

Enhanced Nitric Oxide (NO) and Decreased ADMA Synthesis in Pediatric ADHD and Selective Potentiation of NO Synthesis by Methylphenidate.

Attention deficit hyperactivity disorder (ADHD) is a common pediatric psychiatric disorder, frequently treated with methylphenidate (MPH). Recently, MPH’s cardiovascular safety has been questioned by observational studies describing an increased cardiovascular risk in adults and blood pressure alterations in children. We considered members of the L-arginine (Arg)/nitric oxide (NO) pathway as possible early cardiovascular risk factors in pediatric ADHD children. They include the NO metabolites, nitrite and nitrate, the NO precursor Arg, and asymmetric dimethylarginine (ADMA), an endogenous NO synthase (NOS) inhibitor and a cardiovascular risk factor in adults. We conducted a prospective clinical trial with 42 ADHD children (aged 6–16 years) with (n = 19) and without (n = 23) MPH treatment. Age-matched children without ADHD (n = 43) served as controls. All plasma and urine metabolites were determined by gas chromatography-mass spectrometry. We observed higher plasma nitrite and lower plasma ADMA concentrations in the ADHD children. MPH-treated ADHD children had higher plasma nitrite concentrations than MPH-untreated ADHD children. As NOS activity is basally inhibited by ADMA, MPH treatment seems to have decreased the inhibitory potency of ADMA. Percentiles of systolic blood pressure were higher in MPH-treated ADHD children. The underlying mechanisms and their implications in the MPH therapy of pediatric ADHD with MPH remain to be elucidated in larger cohorts.

Trends in psychiatric disorders prevalence and prescription patterns of children in Alberta, Canada.

To describe the trends in the prevalence and incidence of children with psychiatric disorders, the types of medication prescribed, and the type of physician providing the prescriptions. This retrospective study linked six population-based administrative databases (2008-2015) in Alberta, Canada. The prevalence of paediatric psychiatric disorders increased from 12.6 per 100 population in 2008 to 15.0 per 100 population in 2015, while the incidence rate increased from 2.0 per 100 population to 2.2 per 100 population in the same period. The proportion of patients dispensed any psychiatric medication increased from 21.4% in 2008 to 28.2% in 2015. Over the same period, dispensations for antidepressants increased from 7.0% to 11.2% and stimulants to treat ADHD, from 11.9% to 15.9%. For antidepressants, general practitioners (GPs) wrote the highest proportion of prescriptions (44.3% in 2011-48.1% in 2015), while paediatricians wrote the lowest proportion (8.7% in 2011-11.0% in 2015) and the proportion by psychiatrists decreased from 33.4% in 2011 to 27.2% in 2015. For stimulants to treat ADHD, paediatricians were the most frequent prescribers (36.9% in 2011-39.3% in 2015) followed by GPs as the second most frequent (33.1% in 2011-33.5% in 2015), while psychiatrists were the least likely to prescribe stimulants for ADHD. The increasing trend of psychiatric diagnoses and medication prescriptions in the paediatric population is evident using population-based administrative databases. The lack of safety and adverse consequences of medication use in this cohort warrants additional monitoring data.

The 5-Year Course of Medication Treatment in Childhood Anxiety Disorders.

For pediatric psychiatric disorders, given the marked increase in use of medications without an understanding of the typical treatment course, the primary goal of the current study was to examine the course of pharmacotherapy over 5 years in children with newly diagnosed anxiety disorders. We reviewed provider billing and prescription ordering records of a tertiary medical center from 2008 through 2015 to identify children (aged 7-17 years) newly diagnosed with an anxiety disorder and to determine the psychopharmacologic treatment that they received from 2010 through 2015. The frequency at which patients received prescriptions from 9 classes of psychotropic medications at any point during the study period was determined. We used χ² analyses and independent sample t tests to examine the relationship between receiving a psychotropic prescription and various patient characteristics. The study cohort included 108 patients (mean [SD] age = 12.8 [3.3] years). In this group, 73.1% received pharmacotherapy on at least 1 occasion over the 5-year period, and 41.7% received medications from more than 1 class. Of those who received a prescription, 50% (27/54) of patients remained on medication for 5 years. This estimate rose to 71% (5/7) within the subset of patients who were medication-naive at the beginning of the observation period and were still in high school during year 5. Guidelines implying discontinuation of medication after symptom remission and a limited period of stability do not accurately reflect clinical practice.

The effects of amphetamine on working memory and locomotor activity in adult rats administered risperidone early in life

Antipsychotic drugs are used to manage symptoms of pediatric psychiatric disorders despite the relative absence of research regarding the long-term effects of these drugs on brain development. Using rats as a model, research has demonstrated that administration of the antipsychotic drug, risperidone, during early postnatal development elevates locomotor activity and sensitivity to the locomotor effects of amphetamine during adulthood. Because risperidone targets neurotransmitter receptors and forebrain regions associated with working memory, the present study determined whether early-life risperidone altered working memory during adulthood and its sensitivity to amphetamine-induced impairment. Female and male rats received subcutaneous (sc) injections of risperidone daily on postnatal days 14-42. Early-life risperidone increased spontaneous locomotor activity and amphetamine-induced hyperactivity during adulthood, although the effects were significantly greater in females. Working memory was tested in an operant-based, delayed non-matching-to-sample task. Early-life risperidone did not affect the percentage of correct choices observed during sessions with 0–8 second delays but impaired performance during sessions with 0–24 second delays. In a subsequent set of tests using 0–24 second delays, amphetamine (0.75 and 1.25 mg/kg, sc) significantly reduced the percentage of correct choices at most delays, but risperidone did not exacerbate this effect. These data suggest that early-life risperidone leads to modest deficits in working memory during adulthood, but does not alter the perturbation of working memory by amphetamine.

6.5 The Good Behavior Game: How It Works and What It Does for Psychiatric Disorders

Pediatric psychiatric disorders are increasing every 2 years. Can a fun, well-tested classroom game invented in 1969 reduce these disorders? The answer is “yes.” In this session, participants will learn the following: 1) how the game works; 2) the breadth of longitudinal outcomes; and 3) how to scale up the game. The game is played during regular school instruction. Teachers divide children into 2 to 5 teams per classroom, balancing teams with high-achieving, shy, and disruptive students. The teams work to increase PAX (“peace, productivity, health, and happiness”). If the teacher counts 3 or fewer “spleems” (disruptive behaviors that reduce PAX) per team, the team wins. Rewards vary from written notes praising an individual child to permission for the team to engage in activities not usually allowed during class (eg, tapping a pencil on a desk or throwing paper balls). These activities use peer reinforcement to socialize children. The entire intervention uses positive and playful language. Notes praising a child are called“tootles,” and the rewards for good behavior (pencil tapping, ball throwing) are called “Granny’s wacky prizes.” PAX language directed at teachers and parents is positive and aspirational. PAX materials refer to 4 of the following miracles that happen when children go to school: 1) learning to read; 2) learning to write; 3) learning mathematics; and 4) “acquiring the mental ability to sustain attention, self-regulate or self-manage, and cooperate with others intentionally.” The breadth of longitudinal outcomes was based on multiple RCTs by colleagues at Johns Hopkins and real-world implementations. Population-level implementation of the game shows that it is possible for public or private entities to cost-effectively prevent or treat DSM-5-classified multiple disorders.

Using machine learning and surface reconstruction to accurately differentiate different trajectories of mood and energy dysregulation in youth.

Difficulty regulating positive mood and energy is a feature that cuts across different pediatric psychiatric disorders. Yet, little is known regarding the neural mechanisms underlying different developmental trajectories of positive mood and energy regulation in youth. Recent studies indicate that machine learning techniques can help elucidate the role of neuroimaging measures in classifying individual subjects by specific symptom trajectory. Cortical thickness measures were extracted in sixty-eight anatomical regions covering the entire brain in 115 participants from the Longitudinal Assessment of Manic Symptoms (LAMS) study and 31 healthy comparison youth (12.5 y/o;-Male/Female = 15/16;-IQ = 104;-Right/Left handedness = 24/5). Using a combination of trajectories analyses, surface reconstruction, and machine learning techniques, the present study aims to identify the extent to which measures of cortical thickness can accurately distinguish youth with higher (n = 18) from those with lower (n = 34) trajectories of manic-like behaviors in a large sample of LAMS youth (n = 115; 13.6 y/o; M/F = 68/47, IQ = 100.1, R/L = 108/7). Machine learning analyses revealed that widespread cortical thickening in portions of the left dorsolateral prefrontal cortex, right inferior and middle temporal gyrus, bilateral precuneus, and bilateral paracentral gyri and cortical thinning in portions of the right dorsolateral prefrontal cortex, left ventrolateral prefrontal cortex, and right parahippocampal gyrus accurately differentiate (Area Under Curve = 0.89;p = 0.03) youth with different (higher vs lower) trajectories of positive mood and energy dysregulation over a period up to 5years, as measured by the Parent General Behavior Inventory-10 Item Mania Scale. Our findings suggest that specific patterns of cortical thickness may reflect transdiagnostic neural mechanisms associated with different temporal trajectories of positive mood and energy dysregulation in youth. This approach has potential to identify patterns of neural markers of future clinical course.

Clinical and social outcome of children and adolescents presenting in the emergency room for disruptive behavior in Lyon and the Rhône-Alpes region: A multidisciplinary approach

Over the last decade, the frequency of emergency room (ER) visits for pediatric psychiatric disorders has increased in the most western countries. Although data available in France is scarce, a similar trend was observed concerning violent or runaway youth. There is no medical consensus on the status and care management of disruptive behavior (DB) in children and adolescents in ER. Seclusion and physical restraint are often requested to treat violence. With a blur lawful framework for minors, such coercive measures raise ethical issues while contradicting the idea of the patients’ autonomy and well-being. Moreover, consulting in the ER for such situations could lead to an inappropriate use of the healthcare system, a poor assessment of associated psychiatric disorders or comorbidities and an underestimation of suicide risk. Thus, the ER visit for a disruptive child or adolescent is characterized by its uncertainty. It represents a situation of heterogeneity in care management as well as a stake of social exclusion and of dangerous behavior.The study aims to:.– analyze these uncertainties by presenting a multidisciplinary and integrative research methodology through combining clinical evidence and social sciences comprehension;– to implement a cohort to describe children and adolescents admitted to the ER for DB (aggressiveness, violence, fugue or theft), their care management and their social and clinical outcome;– to pool these clinical data with an ethnographic fieldwork focused on DB as a “trouble” experienced by various professionals in the ER.We will focus our presentation on these methodological considerations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Pediatric Mania: The Controversy between Euphoria and Irritability.

: Pediatric Bipolar Disorder (BD) is a highly morbid pediatric psychiatric disease, consistently associated with family psychiatric history of mood disorders and associated with high levels of morbidity and disability and with a great risk of suicide. While there is a general consensus on the symptomatology of depression in childhood, the phenomenology of pediatric mania is still highly debated and the course and long-term outcome of pediatric BD still need to be clarified. We reviewed the available studies on the phenomenology of pediatric mania with the aim of summarizing the prevalence, demographics, clinical correlates and course of these two types of pediatric mania. Eighteen studies reported the number of subjects presenting with either irritable or elated mood during mania. Irritability has been reported to be the most frequent clinical feature of pediatric mania reaching a sensitivity of 95–100% in several samples. Only half the studies reviewed reported on number of episodes or cycling patterns and the described course was mostly chronic and ultra-rapid whereas the classical episodic presentation was less common.Few long-term outcome studies have reported a diagnostic stability of mania from childhood to young adult age. Future research should focus on the heterogeneity of irritability aiming at differentiating distinct subtypes of pediatric psychiatric disorders with distinct phenomenology, course, outcome and biomarkers. Longitudinal studies of samples attending to mood presentation, irritable versus elated, and course, chronic versus episodic, may help clarify whether these are meaningful distinctions in the course, treatment and outcome of pediatric onset bipolar disorder.