Patterns of Comorbidity and Dysfunction in Clinically Referred Preschool and School-Age Children with Bipolar Disorder

Wilens, Timothy E.; Biederman, Joseph; Forkner, Peter; Ditterline, Jeff; Morris, Matthew C.; Moore, Hadley; Galdo, Maribel; Spencer, Thomas; Wozniak, Janet

doi:10.1089/104454603322724887

Cited by 72 publications

(58 citation statements)

References 58 publications

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“…IN CHILDREN AND ADOLESCENTS, bipolar disorder (BD) is one of the most debilitating psychiatric illnesses, often resulting in academic and social difficulties, hospitalization, and/ or suicidality (Wilens et al 2003;Dickstein et al 2005). However, questions remain regarding the diagnosis of pediatric BD, because it has been suggested that mania in youths may present with chronic irritability rather than an episodic mood disturbance (Carlson et al 1998;Leibenluft et al 2003).…”

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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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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“…For example, studies of children with ODD demonstrate an association between irritability and negative affect, which encompasses temper outbursts, and risk for later depressive or anxiety disorders (Stringaris and Goodman 2009a,b;Burke et al 2010;Rowe et al 2010). Conversely, some investigators argue that severe outbursts are the primary manifestation of mania in children, thus justifying the diagnosis of bipolar disorder, even in very young children (Wozniak et al 1995;Wilens et al 2003). This diagnostic practice has likely contributed to the 40-fold increase in bipolar diagnoses in children since the late 1990s (Moreno et al 2007;Carlson and Glovinsky 2009).…”

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confidence: 99%

Clinical Features of Young Children Referred for Impairing Temper Outbursts

Roy

Klein

Angelosante

et al. 2013

Journal of Child and Adolescent Psychopharmacology

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Objective: In light of the current controversy about whether severe temper outbursts are diagnostic of mania in young children, we conducted a study to characterize such children, focusing on mania and other mood disorders, emotion regulation, and parental psychiatric history. Methods: Study participants included 51 5-9-year-old children with frequent, impairing outbursts (probands) and 24 nonreferred controls without outbursts. Parents completed a lifetime clinical interview about their child, and rated their child's current mood and behavior. Teachers completed a behavior rating scale. To assess emotion regulation, children were administered the Balloons Game, which assesses emotion expressivity in response to frustration, under demands of high and low regulation. Parental lifetime diagnoses were ascertained in blind clinical interviews. Results: No child had bipolar disorder, bipolar disorder not otherwise specified (NOS), or major depression (MDD). The most prevalent disorder was oppositional defiant disorder (88.2%), followed by attention-deficit/hyperactivity disorder (74.5%), anxiety disorders (49.0%), and non-MDD depressive disorders (33.3%). Eleven probands (21.6%) met criteria for severe mood dysregulation. During the Balloons Game, when there were no demands for self-regulation, children with severe outbursts showed reduced positive expressivity, and also showed significant deficits in controlling negative facial expressions when asked to do so. Anxiety disorders were the only diagnoses significantly elevated in probands' mothers. Conclusions: Overall, young children with severe temper outbursts do not present with bipolar disorder. Rather, disruptive behavior disorders with anxiety and depressive mood are common. In children with severe outbursts, deficits in regulating emotional facial expressions may reflect deficits controlling negative affect. This work represents a first step towards elucidating mechanisms underlying severe outbursts in young children.

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“…Many studies indicate that pediatric bipolar disorder causes significant emotional, academic, and social impairment in preschool, prepubertal, and adolescent youth Geller et al 2000a;Geller et al 2000b;Wilens et al 2003a;Craney and Geller 2003;Pavuluri et al 2005;Axelson et al 2006;Kowatch and DelBello 2006;Danielyan et al 2007;Goldstein et al 2009). Studies across many sites document the utility of pharmacotherapy treatment for pediatric bipolar disorder (Kowatch et al 2000;Delbello et al 2002b;Kowatch et al 2003;Biederman et al 2005b;Biederman et al 2005c;Findling et al 2005;Biederman et al 2007a;Biederman et al 2007b;DelBello et al 2006;Findling et al 2006).…”

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confidence: 99%

Prescribing Patterns for Treatment of Pediatric Bipolar Disorder in a Specialty Clinic

Potter

Liu

Monuteaux

et al. 2009

Journal of Child and Adolescent Psychopharmacology

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Objective: The aim of this study was to describe prescribing practices in the treatment of pediatric bipolar disorder in a university practice setting. Method: A retrospective chart review was performed on 53 youths diagnosed using Diagnostic and Statistical Manual of Mental Disorders, 4 th edition (DSM-IV), criteria with bipolar spectrum disorder under the active care of child psychiatrists practicing in a pediatric psychopharmacology specialty clinic. Current medications, doses, and related adverse events were recorded. Clinicians were asked to provide a target disorder (bipolar mania=mixed state, depression, attention deficit hyperactivity disorder [ADHD], or anxiety) for each medication to the best of their ability. The Clinical Global ImpressionsSeverity (CGI-S) scale was used to measure severity of each disorder before treatment and the Clinical Global ImpressionsImprovement (CGI-I) was used to quantify the magnitude of improvement with treatment. Meaningful improvement of the disorder was defined by CGI-I score of 1 or 2. Results: The mean number of psychotropic medications per patient was 3.0 AE 1.6. A total of 68% of patients were treated for co-morbid disorders; 23% of patients were treated with monotherapy, primarily with second-generation antipsychotics. Mania improved in 80% of cases, mixed state improved in 57% of cases, ADHD improved in 56% of cases, anxiety improved in 61% of cases, and depression improved in 90% of cases. Conclusion: The management of pediatric bipolar disorder often requires multiple medications. For the treatment of mania= mixed states, clinicians prescribed second-generation antipsychotics more frequently than mood stabilizers, especially in the context of monotherapy. Co-morbidity was a frequent problem with moderate success obtained with combined pharmacotherapy approaches. Further psychosocial strategies to augment pharmacotherapy may improve outcome while reducing the medication burden in pediatric bipolar disorder.

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Patterns of Comorbidity and Dysfunction in Clinically Referred Preschool and School-Age Children with Bipolar Disorder

Cited by 72 publications

References 58 publications

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

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

Clinical Features of Young Children Referred for Impairing Temper Outbursts

Prescribing Patterns for Treatment of Pediatric Bipolar Disorder in a Specialty Clinic

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