Youths with BP spectrum disorders showed a continuum of BP symptom severity from subsyndromal to full syndromal with frequent mood fluctuations. Results of this study provide preliminary validation for BP-NOS.

Objective-Alterations in reward-related brain function and phenomenological aspects of positive affect are increasingly examined in the development of major depressive disorder. The authors tested differences in reward-related brain function in healthy and depressed adolescents, and the authors examined direct links between reward-related brain function and positive mood that occurred in realworld contexts.Method-Fifteen adolescents with major depressive disorder and 28 adolescents with no history of psychiatric disorder, ages 8-17 years, completed a functional magnetic resonance imaging guessing task involving monetary reward. Participants also reported their subjective positive affect in natural environments during a 4-day cell-phone-based ecological momentary assessment.Results-Adolescents with major depressive disorder exhibited less striatal response than healthy comparison adolescents during reward anticipation and reward outcome, but more response in dorsolateral and medial prefrontal cortex. Diminished activation in a caudate region associated with this depression group difference was correlated with lower subjective positive affect in natural environments, particularly within the depressed group.Conclusions-Results support models of altered reward processing and related positive affect in young people with major depressive disorder and indicate that depressed adolescents' brain response to monetary reward is related to their affective experience in natural environments. Additionally, these results suggest that reward-processing paradigms capture brain function relevant to real-world positive affect.Depression that begins in childhood or adolescence disrupts functioning in academic, family, peer, and affective contexts (1). A central issue in the pathophysiology of depression is how affective brain systems are disrupted in ways associated with mood correlates of the disorder. From a developmental affective neuroscience perspective, it is important to consider not only neural systems underpinning negative affect but also positive affect systems, because diminished pleasant mood, decreased motivation for rewarding experiences, and unusual dopamine system function may represent core aspects of depression, particularly early in its course (2,3). Understanding early developmental changes in neural reward systems in depression could provide insights relevant to treatments while brain development is underway (4) because treatments provided early in development could have the potential for more Address correspondence and reprint requests to Dr. Forbes, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara St., Loeffler 319, Pittsburgh, PA 15213; E-mail: forbese@upmc.edu (e-mail). Dr. Birmaher has participated in forums sponsored by companies such as Solvay and Abcomm and has lectured at a Solvay-sponsored meeting and participated in the following forums: Jazz Pharmaceuticals, Solvay Pharmaceuticals, and Abcomm. All remaining authors report no competing interes...

Children and adolescents with BP-II and BP-NOS have a phenotype that is on a continuum with that of youth with BP-I. Elevated mood is a common feature of youth with BP-spectrum illness.

Objective-To assess the longitudinal course of youth with bipolar spectrum disorders.Methods-413 youth (7-17 years) with bipolar-I (n=244), bipolar-II (n=28), and bipolar NotOtherwise-Specified (NOS) (n=141) were recruited mainly from outpatient clinics at the University of Pittsburgh, Brown, and UCLA. Symptoms were ascertained retrospectively on average every 9.4 months for 4 years using the Longitudinal Interval Follow-up Evaluation. Rates and time to recovery and recurrence and week-by-week symptomatic status were analyzed.Results-Approximately 2.5 years after onset of their index episode, 81.5% of subjects fully recovered, but 1.5 years later 62.5% had a syndromal recurrence, particularly depression. One-third of the subjects had one syndromal recurrence and 30% ≥ 2 syndromal recurrences. The polarity of the index episode predicted the polarity of subsequent episodes. Subjects were symptomatic during 60% of follow-up time, particularly with subsyndromal symptoms of depression and mixed-polarity, with numerous changes in mood polarity. Manic symptomatology, especially syndromal, was less frequent and bipolar-II was mainly manifested by depressive symptoms. Forty-percent of subjects had syndromal and/or subsyndromal symptoms during 75% of follow-up period. During 17% of follow-up time subjects, especially those with bipolar-I, experienced psychosis. Twenty-five percent of bipolar-II subjects converted into bipolar-I and 38% of bipolar-NOS converted into bipolar -I/II. Early-onset, bipolar-NOS, long duration, low socio-economic status, and family history of mood disorders were associated with poorer outcomes.Conclusions-Bipolar spectrum disorder in youth is an episodic disorder characterized by subsyndromal and, less frequently, syndromal episodes with mainly depressive and mixed symptoms and rapid mood changes.

Our results suggest that amygdala function is affected in both anxiety and depression during childhood and adolescence. Moreover, this disruption appears to be specific to the child's own rating of everyday anxiety.