Early symptoms of mania and the role of parental risk

Findling, Robert L.; Youngstrom, Eric A.; McNamara, Nora; Stansbrey, Robert J.; Demeter, Christine; Bedoya, Denise; Kahana, Shoshana Y.; Calabrese, Joseph R.

doi:10.1111/j.1399-5618.2005.00260.x

Cited by 92 publications

(121 citation statements)

References 29 publications

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“…All subjects were required by study protocol to meet diagnostic criteria for bipolar I disorder (manic or mixed) according to the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR) criteria (American Psychiatric Association 2000) and confirmed by the K-SADS (Kaufman et al 1997). Subjects were eligible if their current symptoms had been present for at least 7 days prior to the screening visit and they had a Young Mania Rating Scale (YMRS) total score ‡17 at the screening and baseline visits (Young et al 1978;Fristad et al 1995).…”

Section: Study Participantsmentioning

confidence: 99%

“…The primary efficacy endpoint was the change from baseline to week 4 in the YMRS total score (Young 1978;Fristad 1995). At screening, baseline, and after weeks 1, 2, 3, and 4 of double-blind treatment, YMRS was assessed by an appropriately qualified and experienced individual trained through the Pfizer rater training program.…”

Section: Outcome Assessmentsmentioning

confidence: 99%

“…(DSM-IV) (American Psychiatric Association 1994) criteria supported by structured diagnostic interview (e.g., Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children [K-SADS]) in research settings. However, symptoms such as grandiosity and abnormally elevated mood are features that more readily differentiate bipolarity from other conditions (Geller et al 1998(Geller et al , 2002aFindling et al 2005).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy, Long-Term Safety, and Tolerability of Ziprasidone in Children and Adolescents with Bipolar Disorder

Findling

Çavuş

Pappadopulos

et al. 2013

Journal of Child and Adolescent Psychopharmacology

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Objective: The purpose of this study was to evaluate the short-and long-term efficacy and safety of ziprasidone in children and adolescents with bipolar I disorder. Methods: Subjects 10-17 years of age with a manic or mixed episode associated with bipolar I disorder participated in a 4 week, randomized, double-blind, placebo-controlled multicenter trial (RCT) followed by a 26 week open-label extension study (OLE). Subjects were randomized 2:1 to initially receive flexible-dose ziprasidone (40-160 mg/day, based on weight) or placebo. Primary outcome was the change in Young Mania Rating Scale (YMRS) scores from baseline. Safety assessments included weight and body mass index (BMI), adverse events (AEs), vital signs, laboratory measures, electrocardiograms, and movement disorder ratings. Results: In the RCT, 237 subjects were treated with ziprasidone (n = 149; mean age, 13.6 years) or placebo (n = 88; mean age, 13.7 years). The estimated least squares mean changes in YMRS total (intent-to-treat population) were -13.83 (ziprasidone) and -8.61 (placebo; p = 0.0005) at RCT endpoint. The most common AEs in the ziprasidone group were sedation (32.9%), somnolence (24.8%), headache (22.1%), fatigue (15.4%), and nausea (14.1%). In the OLE, 162 subjects were enrolled, and the median duration of treatment was 98 days. The mean change in YMRS score from the end of the RCT to the end of the OLE (last observation carried forward) was -3.3 (95% confidence interval, -5.0 to -1.6). The most common AEs were sedation (26.5%), somnolence (23.5%), headache (22.2%), and insomnia (13.6%). For both the RCT and the OLE, no clinically significant mean changes in movement disorder scales, BMI z-scores, liver enzymes, or fasting lipids and glucose were observed. One subject on ziprasidone in the RCT and none during the OLE had Fridericia-corrected QT interval (QTcF) ‡460 ms.Conclusion: These results demonstrate that ziprasidone is efficacious for treating children and adolescents with bipolar disorder. Ziprasidone was generally well tolerated with a neutral metabolic profile.Clinical Trials Registry: NCT00257166 and NCT00265330 at ClinicalTrials.gov.

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Section: Study Participantsmentioning

confidence: 99%

Section: Outcome Assessmentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy, Long-Term Safety, and Tolerability of Ziprasidone in Children and Adolescents with Bipolar Disorder

Findling

Çavuş

Pappadopulos

et al. 2013

Journal of Child and Adolescent Psychopharmacology

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“…Positive correlations between family history of affective disorders and mood swings in this study are consistent with previous reports of a familial basis between cyclothymia or mood swings and bipolar I disorder [15,16] . Thus, it could be speculated that a cyclothymic temperament occurring with familial risk increases the likelihood of bipolar disorder; some authors used the term 'cyclotaxia' to refer to early symptoms of mania and parental risk according to the definition of 'schizotaxia' in terms of high-risk individuals with early symptoms of schizophrenia and genetic risk [17] .…”

Section: Discussionmentioning

confidence: 99%

Early Mood Swings as Symptoms of the Bipolar Prodrome: Preliminary Results of a Retrospective Analysis

et al. 2009

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Background/Aims: Temperament and mood swings are promising indicators for the characterization of mood spectrum vulnerability. The aim of this study was to investigate the relationship between affective temperament and mood swings in bipolar disorder. We explored these clinical features retrospectively. Methods: Patients who met the criteria for bipolar I disorder were enrolled in the study. Exclusion criteria were partial remittance and a full affective or psychotic episode. Data concerning illness and family history, mood swings (semistructured interview for mood swings) and depression (Beck, Depression Inventory) were obtained. We examined premorbid temperament with the validated German version Temps-M of the original version Temps-A. Patients with and without mood swings were compared with respect to the dominant temperament. Results: Out of 20 bipolar patients, 6 subjects reported mood swings prior to the onset of affective disorder. Subjects with mood swings prior to the onset of bipolar disorder significantly correlated with a positive family history of affective disorders. Concerning cyclothymic and irritable temperament, bipolar affective patients with mood swings had higher scores. No differences were found between males and females. Conclusion: Our findings go in line with previous results that mood swings, as represented by the cyclothymic temperament, are present prior to the first onset of bipolar disorder in a subset of patients. These traits may represent vulnerability markers and could presumably be used to identify individuals at high risk for developing bipolar disorder in order to prevent this illness. Further studies are indicated to clarify the correlation with genetic risk factors.

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“…They do find that a large number of parents meet criteria for bipolar disorder as well as meeting criteria for major depression, anxiety disorders, substance abuse and early onset of diverse symptomatology. Unfortunately, the studies do not specify whether the parents meet criteria for bipolar I or bipolar II; whether they exhibit any of the classic symptoms of bipolar I (spending sprees, grandiosity, hallucinations); or whether the parents' symptomatology ever became a focus of attention for others (Borchardt, Bernstein, & Crosby, 1995;Endrass et al, 2007;Faraone, Biederman, Mennin, Wozniak, & Spencer, 1997;Findling et al, 2005;Geller et al, 2006;Wozniak, Biederman, Mundy, Mennin, & Faraone, 1995). We can conclude from these studies that children share many behaviors with their parents.…”

Section: Pediatric Bipolarmentioning

confidence: 99%

Can a Diagnosis Be Epidemic, With Therapeutic Efforts the Catastrophe?

Littrell

2012

Ethical Hum Psychol Psychiatry

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The diagnosis of Bipolar Spectrum Disorders (BSD) given for office visits has risen 40 fold for children and has risen dramatically for adults as well. Some of the growth may have been fueled by re-categorization of individuals who would previously have received diagnoses of major depression along with the widening of diagnostic criteria for BSD. Concomitant with the rise in BSD diagnoses, the number of adults and children receiving atypical antipsychotics has increased dramatically. Recent evidence finds that atypical antipsychotics cause considerable reduction in brain volume. It is thus imperative to ensure that those with diagnoses comprising BSD-Bipolar I, Bipolar II, and Bipolar Not Otherwise specified (NOS)-actually share a common etiology and are being appropriately treated. This paper reviews the history, evidentiary support, and implications associated with the expansion of the Bipolar Spectrum. Can a Diagnosis Be Epidemic, with Therapeutic Efforts the Catastrophe?In the years from 1999 to 2003, the diagnosis of bipolar given in office visits has increased 40 fold for children. Bipolar Disorder diagnoses have increased during the same time period for adults as well rising from 4.77% of office visits to 6.28% of office visits (Moreno et al., 2007).Allen Frances (2009), the Chairperson of the DSM-IV, has suggested that the sharp rise in bipolar diagnoses is attributable to the manner in which criteria for the disorders were written-that it was an issue of taxonomy rather than epidemiology. Obviously, diagnostic criteria have profound implications for who is diagnosed, at what age, and whether they are treated with psychotropic medications. Because psychotropic medications carry substantial risks-if not guarantees-of side effects, those decisions must be judicious, and ever cognizant of Hippocrates' admonishment: First, do no harm. This review constitutes an audit of psychiatry's books, asking if they balance when the substantial risk of harm from such diagnoses and the regimen of medication they entail is taken fully into account. Creation of the Bipolar SpectrumOver the years, those behaviors categorized under the bipolar label have expanded greatly. In the DSM-II (Association, 1968), manic-depression, listed under the heading "affective psychoses", was the only bipolar type diagnosis. With subsequent editions of the DSM, new categories of affect perturbations were included in manuals. The DSM-III (Association, 1980) provided descriptions of the behaviors required to meet criteria for mixed and manic episodes. The DSM-III-R (Association, 1987) added criteria for hypomania (specified in the next paragraph). The literature recognized that some persons who had experienced an episode of depression did have periods when they were enthusiastic, energetic, and animated to the extent that they met criteria for hypomania. Kupfer, Carpenter, and Frank (1988) had argued that such individuals, who were labeled Bipolar II, should be viewed as experiencing a variant of major depression. Dunner (1993) disagr...

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Early symptoms of mania and the role of parental risk

Cited by 92 publications

References 29 publications

Efficacy, Long-Term Safety, and Tolerability of Ziprasidone in Children and Adolescents with Bipolar Disorder

Efficacy, Long-Term Safety, and Tolerability of Ziprasidone in Children and Adolescents with Bipolar Disorder

Early Mood Swings as Symptoms of the Bipolar Prodrome: Preliminary Results of a Retrospective Analysis

Can a Diagnosis Be Epidemic, With Therapeutic Efforts the Catastrophe?

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