Cognitive Flexibility in Phenotypes of Pediatric Bipolar Disorder

Dickstein, Daniel P.; Nelson, Eric E.; McClure, Erin B.; Grimley, Mary E.; Knopf, Lisa; Brotman, Melissa A.; Rich, Brendan A.; Pine, Daniel S.; Leibenluft, Ellen

doi:10.1097/chi.0b013e31802d0b3d

Cited by 141 publications

(118 citation statements)

References 65 publications

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“…Moreover, our findings do not exclude the possibility that BD and SMD have common pathophysiologic features. Indeed, previous studies suggest that the two share behavioral deficits in emotion labeling processing 14,22 and cognitive flexibility, 23 although the neural mechanisms mediating these deficits may differ between the two patient groups. 24 In sum, to the extent that the question, "Is SMD a developmental presentation of BD?"…”

Section: Discussionmentioning

confidence: 99%

Pediatric Bipolar Disorder Versus Severe Mood Dysregulation: Risk for Manic Episodes on Follow-Up

Stringaris

Baroni

Haimm

et al. 2010

Journal of the American Academy of Child & Adolescent Psych

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Objective-An important question in pediatric bipolar research is whether marked nonepisodic irritability is a manifestation of bipolar disorder in youth. This study tests the hypothesis that youth with severe mood dysregulation (SMD), a category created for the purpose of studying children presenting with severe nonepisodic irritability, will be significantly less likely to develop (hypo-)manic or mixed episodes over time than will youth with bipolar disorder (BD). Method-Patients with SMD (N = 84) and narrowly defined BD (N = 93) at baseline were followed up in 6-monthly intervals using the relevant K-SADS modules to ascertain (hypo-)manic or mixed episodes.Results-Only one of 84 SMD subjects (1/84 [1.2%]; 95% confidence interval CI = 0.0003 to 0.064) experienced a (hypo-)manic or mixed episode during the study (median follow-up = 28.7 months). The frequency of such episodes was more than 50 times higher in those with narrowly defined BD (58/93 [62.4%]; 95% CI 0.52 to 0.72).Conclusions-These data suggest that, over an approximately 2-year follow-up period, youth with SMD are unlikely to develop (hypo-)manic or mixed episodes. Keywords bipolar disorder; pediatric; severe mood dysregulation; irritability; ADHD In American psychiatric clinics and inpatient settings, dramatic increases in the rates of diagnosis of pediatric bipolar disorder (BD) have been documented over the past decade, 1,2 with a concomitant increase in prescription rates for antipsychotic medication. 3 This rapid increase in the diagnosis of pediatric BD has coincided with the contention that the clinical presentation of BD differs between children and adults. 4,5 The debate regarding the pediatric presentation of BD is complex. One important aspect of it has been the suggestion that marked irritability, even when it does not constitute an episodic change from baseline, is a manifestation of BD in youth. 4,6,7 To provide a framework for research on whether irritable children without distinct manic episodes have a developmental presentation of BD, we operationalized 8 a clinical syndrome, severe mood dysregulation (SMD), designed to capture chronically irritable children whose diagnostic status is in doubt. This paper uses a longitudinal sample to investigate the extent to which subjects with SMD develop episodes of (hypo-)mania, compared to youth with narrowly defined BD.The criteria for SMD require a persistent, nonepisodic clinical presentation of negatively valenced mood with frequent and impairing anger outbursts, combined with at least three of the "B" criteria of mania (pressured speech, agitation, insomnia, and flight of ideas/racing thoughts) and one (distractibility) that is also common to ADHD. 8 A community-based follow-up study suggests that SMD is common, with a lifetime prevalence of 3.3% in youth 9 to 19 years of age. 9 Furthermore, in that sample SMD predicted depressive disorder at 7-year follow-up in youths who were 9 to 19 years old at baseline. 9 Consistent with this finding, another community-based study of nonepisod...

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Section: Discussionmentioning

confidence: 99%

Pediatric Bipolar Disorder Versus Severe Mood Dysregulation: Risk for Manic Episodes on Follow-Up

Stringaris

Baroni

Haimm

et al. 2010

Journal of the American Academy of Child & Adolescent Psych

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“…Data indicate that both BD and SMD phenotypes exhibit impairment in their ability to adapt to changing reward contingencies (Dickstein et al 2004;Gorrindo et al 2005;Dickstein et al 2007). However, the specific pattern of this cognitive flexibility impairment differs between the two groups (Dickstein et al 2007). Moreover, from a clinical perspective, SMD subjects resemble not only those with BD, but also individuals with psychopathy.…”

Section: Introductionmentioning

confidence: 99%

Processing of Differentially Valued Rewards and Punishments in Youths with Bipolar Disorder or Severe Mood Dysregulation

Rau

Blair

Berghorst

et al. 2008

Journal of Child and Adolescent Psychopharmacology

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Background-Youths with chronic irritability and hyperarousal (i.e., severe mood dysregulation, SMD) have reward-and punishment-processing deficits distinct from those exhibited by children with episodic symptoms of mania (i.e., narrow-phenotype bipolar disorder, BD). Additionally, youths with SMD, like those with psychopathy, have prominent reactive aggression. Therefore, we hypothesized that SMD, but not BD, youths would be impaired on a decision-making task that has identified reward-and punishment-processing deficits in individuals with psychopathy.

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“…Recent work using standardized behavioral paradigms to assess emotional processing has identified several deficits in euthymic bipolar youths (3)(4)(5)(6)(7)(8), including difficulty identifying facial emotions (5,7,9,10). Indeed, the brain regions that mediate facial emotion processing overlap with the ventrolateral prefrontal cortex-striatumamygdala circuit implicated in the pathophysiology of both pediatric and adult bipolar disorder (9,11).…”

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confidence: 99%

Facial Emotion Labeling Deficits in Children and Adolescents at Risk for Bipolar Disorder

Brotman¹,

Guyer²,

Lawson³

et al. 2008

AJP

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Cognitive Flexibility in Phenotypes of Pediatric Bipolar Disorder

Cited by 141 publications

References 65 publications

Pediatric Bipolar Disorder Versus Severe Mood Dysregulation: Risk for Manic Episodes on Follow-Up

Pediatric Bipolar Disorder Versus Severe Mood Dysregulation: Risk for Manic Episodes on Follow-Up

Processing of Differentially Valued Rewards and Punishments in Youths with Bipolar Disorder or Severe Mood Dysregulation

Facial Emotion Labeling Deficits in Children and Adolescents at Risk for Bipolar Disorder

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