AACAP 2006 Research Forum—Advancing Research in Early-Onset Bipolar Disorder: Barriers and Suggestions

Abstract

Objective: The 2006 Research Forum addressed the goal of formulating a research agenda for early-onset bipolar disorder (EOBP) and improving outcome by understanding the risk and protective factors that contribute to its severity and chronicity. Method: Five work groups outlined barriers and research gaps in EOBP genetics, neuroimaging, prodromes, psychosocial factors, and pharmacotherapy. Results: There was agreement that the lack of consensus on the definition and diagnosis of EOBP is the primary barrier to advancing research in BP in children and adolescents. Related issues included: the difficulties in managing co-morbidity both statistically and clinically; acquiring adequate sample sizes to study the genetics, biology, and treatment; understanding the EOBP's developmental aspects; and identifying environmental mediators and moderators of risk and protection. Similarly, both psychosocial and medication treatment strategies for children with BP are hamstrung by diagnostic issues. To advance the research in EOBP, both training and funding mechanisms need to be developed with these issues in mind. Conclusions: EOBP constitutes a significant public health concern. Barriers are significant but identifiable and thus are not insurmountable. To advance the understanding of EOBP, the field must be committed to resolving diagnostic and assessment issues. Once achieved, with adequate personnel and funding resources, research into the field of EOBP will doubtless be advanced at a rapid pace.

Early Intervention for Symptomatic Youth at Risk for Bipolar Disorder: A Randomized Trial of Family-Focused Therapy

“…Of the 40 participants, 30 (75.0%) received ongoing medication sessions from study psychiatrists (mean 6.27 ± 3.34 visits, range [2][3][4][5][6][7][8][9][10][11][12][13][14]. Patients in FFT-HR and EC did not differ at randomization on use of mood stabilizers, atypical antipsychotics, psychostimulants, or antidepressants (all ps > .10) and were equally likely to receive followup medication management from a study psychiatrist (χ 2 [1] = 0.03, p = .86).…”

“…3 Significant controversies exist about the diagnostic boundaries of early-onset BD, but agreement is substantial that BD and its subthreshold antecedents have a considerable impact on general functioning and quality of life. 4 Youth who meet a stringent operational definition of BD Not Otherwise Specified (BD-NOS)-characterized by brief, recurrent subthreshold (hypo)manic and depressive periods with a clear change in functioning-have cumulative affective morbidity, impairment, suicidal ideation, and comorbidity comparable to or exceeding that of youth with BD I. 2,5 When combined with a family history of mania in first-or second-degree relatives, more than 50% of youth with BD-NOS progress to fully syndromal BD I or II over 5 years.…”

Paediatric Bipolar Disorder – Are Attachment and Trauma Factors Considered?

“…An American Academy of Child and Adolescent Psychiatry (AACAP) research forum on early-onset bipolar disorder (Carlson et al, 2009) contained a passage on contextual issues, maltreatment and family dysfunction. The article mentioned "insecure attachment" as a "risk factor for emotional dysregulation and externalizing disorders" among offspring of parents with bipolar disorder.…”

“…The term "maltreatment" is not mentioned. The AACAP 2006 Research Forum (Carlson et al, 2009) had co-authors from the MGH/Harvard group and as above did mention maltreatment and abuse by name.…”

“…In 2006, although still labelling the phenomenology as BD, the AACAP 2006 research forum (Carlson et al, 2009) did list a range of contextual environmental adversity factors as implicated in the aetiology of PBD. In 2007 an official AACAP "practice parameter" publication (AACAP, 2007) included authors who have published articles sceptical about PBD.…”