Negative expressed emotion best discriminates families with bipolar disorder children

Nader, Edmir G.; Kleinman, Ana; Gomes, Bernardo Carramão; Bruscagin, Claudia; Santos, Bernardo dos; Nicoletti, Mark; Soares, Jair C.; Lafer, Beny; Caetano, Sheila C.

doi:10.1016/j.jad.2012.11.017

Cited by 22 publications

(26 citation statements)

References 33 publications

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“…For example, Brazilian families with PBD also show lower positive regard and higher negative expressed emotion (EE) compared to control families. 47 There are, however, examples of non-replication. In contrast to US data, a recent Brazilian imaging study did not find white matter microstructure differences between PBD youth, healthy bipolar offspring and healthy controls, 48 and parent report of youth mood symptoms showed much lower discriminative validity than parent report in other countries.…”

Section: | International Findingsmentioning

confidence: 99%

The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research

et al. 2017

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Objectives Over the past two decades, there has been tremendous growth in research regarding bipolar disorder (BD) among children and adolescents (ie, pediatric BD [PBD]). The primary purpose of this article is to distill the extant literature, dispel myths or exaggerated assertions in the field, and disseminate clinically relevant findings. Methods An international group of experts completed a selective review of the literature, emphasizing areas of consensus, identifying limitations and gaps in the literature, and highlighting future directions to mitigate these gaps. Results Substantial, and increasingly international, research has accumulated regarding the phenomenology, differential diagnosis, course, treatment, and neurobiology of PBD. Prior division around the role of irritability and of screening tools in diagnosis has largely abated. Gold-standard pharmacologic trials inform treatment of manic/mixed episodes, whereas fewer data address bipolar depression and maintenance/continuation treatment. Adjunctive psychosocial treatment provides a forum for psychoeducation and targets primarily depressive symptoms. Numerous neurocognitive and neuroimaging studies, and increasing peripheral biomarker studies, largely converge with prior findings from adults with BD. Conclusions As data have accumulated and controversy has dissipated, the field has moved past existential questions about PBD toward defining and pursuing pressing clinical and scientific priorities that remain. The overall body of evidence supports the position that perceptions about marked international (US vs elsewhere) and developmental (pediatric vs adult) differences have been overstated, although additional research on these topics is warranted. Traction toward improved outcomes will be supported by continued emphasis on pathophysiology and novel therapeutics.

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Section: | International Findingsmentioning

confidence: 99%

The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research

et al. 2017

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“…Families of children at risk and who actually have BPSD show dysfunctional interactions, including high levels of: conflict (Barron et al, 2014; Belardinelli et al, 2008; Chang, Blasey, Ketter, & Steiner, 2001; Ferreira et al, 2013; Nader et al, 2013); control (Ferreira et al, 2013; Nader et al, 2013); aggression (Keenan-Miller et al, 2012); quarreling (Schenkel, West, Harral, Patel, & Pavuluri, 2008); forceful punishment (Schenkel et al, 2008); parental tension (Nader et al, 2013); and negative expressed emotion (Nader et al, 2013). These families also demonstrate low levels of: warmth, affection, and intimacy (Schenkel et al, 2008); cohesion (Belardinelli et al, 2008; Chang et al, 2001; Ferreira et al, 2013; Nader et al, 2013); expressiveness (Barron et al, 2014; Belardinelli et al, 2008); organization (Barron et al, 2014; Belardinelli et al, 2008; Chang et al, 2001; Ferreira et al, 2013; Nader et al, 2013); intellectual-cultural orientation (Barron et al, 2014; Belardinelli et al, 2008; Ferreira et al, 2013); active-recreational orientation (Barron et al, 2014; Belardinelli et al, 2008; Ferreira et al, 2013); moral-religious emphasis (Ferreira et al, 2013); and positive expressed emotion (Nader et al, 2013). In addition, worse longitudinal course of BPSD is predicted by impaired family characteristics, such as: low maternal warmth (Geller et al, 2008); chronic stress in family, romantic, and peer relationships (Kim, Miklowitz, Biuckians, & Mullen, 2007; Siegel et al, 2015); frequency and severity of independent family stressful life events (Kim et al, 2007); low levels of cohesion and adaptability (Sullivan, Judd, Axelson, & Miklowitz, 2012); and high levels of conflict (Sullivan et al, 2012).…”

Section: Families Of Children With Bpsdmentioning

confidence: 99%

Parenting Stress Among Caregivers of Children With Bipolar Spectrum Disorders

Algorta

MacPherson

Youngstrom

et al. 2017

Journal of Clinical Child & Adolescent Psychology

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Objective Caregivers of psychiatrically impaired children experience considerable parenting stress. However, no research has evaluated parenting stress within the context of pediatric bipolar spectrum disorders (BPSD). Thus, the aim of this investigation was to identify predictors and moderators of stress among caregivers in the Longitudinal Assessment of Manic Symptoms (LAMS) study. Method Participants included 640 children and their caregivers in the LAMS cohort. Children had a mean age of 9.4±1.9 years (68% male, 23% BPSD); parents had a mean age of 36.5±8.3 years (84% mothers). Results Children with BPSD had more service utilization, psychiatric diagnoses, mood and anxiety symptoms, and functional impairment, but fewer disruptive behavior disorders. Caregivers of children with BPSD were more likely than caregivers of children without BPSD to have a partner, elevated depressive symptoms, antisocial tendencies, and parenting stress (Cohen’s d=.49). For the whole sample, higher child IQ, mania, anxiety, disruptive behavior, and caregiver depression predicted increased parenting stress; maternal conduct disorder predicted lower stress. Child anxiety and disruptive behavior were associated with elevated caregiver stress only for non-BPSD children. Conclusions Caregivers of children with BPSD experience significant burden and thus require specialized, family-focused interventions. As stress was also elevated, to a lesser degree, among depressed caregivers of children with higher IQ, mania, anxiety, and disruptive behavior, these families may need additional supports as well. Though parents with conduct/antisocial problems evidenced lower stress, these difficulties should be monitored. Thus, parenting stress should be evaluated and addressed in the treatment of childhood mental health problems, especially BPSD.

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“…Compared to adults with bipolar disorder, children and adolescents with PBD spend more time symptomatic with mixed presentations, rapid mood fluctuations, and subthreshold symptoms (Birmaher et al, 2009; Geller, Tillman, Bolhofner, & Zimerman, 2008), and have greater impairment in functioning and quality of life (Perlis et al, 2009). In addition, youth with PBD often present with: psychotic features and psychiatric comorbidity, especially with attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (Birmaher et al, 2009; Geller et al, 2008; Van Meter et al, 2016); poor psychosocial and family functioning (Keenan-Miller, Peris, Axelson, Kowatch, & Miklowitz, 2012; Kim, Miklowitz, Biuckians, & Mullen, 2007; Nader et al, 2013); and suicidality (Hauser, Galling, & Correll, 2013). …”

Section: Introductionmentioning

confidence: 99%

“…Thus, MF-PEP helped parents become better mental health consumers and advocates, and access to higher-quality services resulted in children’s decreased symptom severity (Fristad et al, 2009). Although not yet studied, it is also expected that improvements in parenting skills and coping, family functioning, and the home environment would facilitate children’s symptom improvement, as these deficits are associated with PBD in cross-sectional studies (Keenan-Miller et al, 2012; Nader et al, 2013; Schenkel, West, Harral, Patel, & Pavuluri, 2008), predictive of worse course in longitudinal analyses (Geller et al, 2008; Kim et al, 2007; Sullivan, Judd, Axelson, & Miklowitz, 2012), and thus directly targeted in Evidence-Based Treatments (EBTs) for PBD (Fristad & MacPherson, 2014; Weinstein et al, 2013). …”

Section: Introductionmentioning

confidence: 99%

“…mixed mood states, rapid mood fluctuations, psychosis, and comorbidity; Birmaher et al, 2009; Geller et al, 2008); affective circuitry brain dysfunction (e.g. poor problem-solving during affective stimulation via hypoactivation of the dorsolateral and ventrolateral prefrontal cortices, hyperactivation of the amygdala, and deficits in the superior temporal and visual cortices: Garrett et al, 2012; Passarotti & Pavuluri, 2011); and impairment in psychosocial and family functioning (Keenan-Miller et al, 2012; Kim et al, 2007; Nader et al, 2013; Schenkel et al, 2008). …”

Section: Introductionmentioning

confidence: 99%

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Mediators in the randomized trial of Child- and Family-Focused Cognitive-Behavioral Therapy for pediatric bipolar disorder

MacPherson

Weinstein

Henry

et al. 2016

Behaviour Research and Therapy

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Mediation analyses can identify mechanisms of change in Cognitive-Behavioral Therapy (CBT). However, few studies have analyzed mediators of CBT for youth internalizing disorders; only one trial evaluated treatment mechanisms for youth with mixed mood diagnoses. This study evaluated mediators in the randomized trial of Child- and Family-Focused CBT (CFF-CBT) versus Treatment As Usual (TAU) for pediatric bipolar disorder (PBD), adjunctive to pharmacotherapy. Sixty-nine children ages 7-13 with PBD were randomly assigned to CFF-CBT or TAU. Primary outcomes (child mood, functioning) and candidate mediators (family functioning, parent/child coping) were assessed at baseline and 4-, 8-, 12- (post-treatment), and 39-weeks (follow-up). Compared with TAU, children receiving CFF-CBT exhibited greater improvement in mania, depression, and global functioning. Several parent and family factors significantly improved in response to CFF-CBT versus TAU, and were associated with the CFF-CBT treatment effect. Specifically, parenting skills and coping, family flexibility, and family positive reframing showed promise as mediators of child mood symptoms and global functioning. Main or mediating effects for youth coping were not significant. CFF-CBT may impact children’s mood and functioning by improving parenting skills and coping, family flexibility, and family positive reframing. Findings highlight the importance of parent coping and family functioning in the treatment of PBD.

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Negative expressed emotion best discriminates families with bipolar disorder children

Cited by 22 publications

References 33 publications

The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research

The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research

Parenting Stress Among Caregivers of Children With Bipolar Spectrum Disorders

Mediators in the randomized trial of Child- and Family-Focused Cognitive-Behavioral Therapy for pediatric bipolar disorder

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