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Special Issue "Bipolar Disorder in Children and Adolescents"

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383).

Deadline for manuscript submissions: closed (20 December 2013)

Special Issue Editor

Guest Editor
Dr. Constance M. Moore

Center for Comparative NeuroImaging, University of Massachusetts Medical School, 303 Belmont Street, Worcester, MA 01604, USA
Website | E-Mail

Special Issue Information

Dear Colleagues,

The prevalence of bipolar disorder among children and adolescents is thought to be similar to that among adults: 0.6% to 1.1%. However, there are many differences in the presentation and course of bipolar disorder in youth versus adults: In adults, bipolar disorder frequently presents with a manic episode, and then continues with periods of recovery in-between episodes. Childhood onset bipolar disorder, on the other hand, can present with continuous, mixed manic, rapid cycling states or, conversely, with an initial depressive episode. In addition, children may experience mood episodes differently from those who present in adulthood. For example, children in manic episodes are more likely to be irritable, with aggressive outbursts and behaviors while manic adults tend to be euphoric, or elated, while a depressed child may cry, scratch, and whine constantly, while a depressed adult will appear unhappy, sluggish, and may even exhibit suicidal behavior. Children and adolescents with bipolar illness can experience substantial distress and high degrees of morbidity and mortality. In recent years, the majority of calls to the National Alliance for the Mentally Ill and the National Depressive and Manic Depressive Association have been looking for advice on the diagnosis and treatment of bipolar disorder in very young children. Given the variation in presentation and course, as well as the public health implications for this demographic, it is critical that we as researchers understand the underlying pathophysiology of early-onset bipolar disorder so that we can help develop more effective and targeted treatments for children and adolescents with this illness.

These reviews will cover the following important topics spanning the diagnosis, course, and treatment of early-onset bipolar disorder:
• Risk and/or impact of bipolar disorder in children and adolescents
• Novel diagnostic techniques/development of biomarkers for early-onset bipolar disorder
• Monitoring of symptoms of early-onset bipolar disorder
• Mechanisms of therapy for early-onset bipolar disorder
• Management of patients with early-onset bipolar disorder

Dr. Constance M. Moore
Guest Editor

Submission

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed Open Access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 300 CHF (Swiss Francs). English correction and/or formatting fees of 250 CHF (Swiss Francs) will be charged in certain cases for those articles accepted for publication that require extensive additional formatting and/or English corrections.

Keywords

  • bipolar disorder
  • children and adolescents
  • early onset
  • biomarkers
  • novel therapies
  • diagnostic techniques
  • clinical care
  • cognition
  • imaging

Published Papers (8 papers)

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Research

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Open AccessArticle Alterations in Skin Temperature and Sleep in the Fear of Harm Phenotype of Pediatric Bipolar Disorder
J. Clin. Med. 2014, 3(3), 959-971; doi:10.3390/jcm3030959
Received: 9 April 2014 / Revised: 30 May 2014 / Accepted: 19 June 2014 / Published: 22 August 2014
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Abstract
In children diagnosed with pediatric bipolar disorder (PBD), disturbances in the quality of sleep and wakefulness are prominent. A novel phenotype of PBD called Fear of Harm (FOH) associated with separation anxiety and aggressive obsessions is associated with sleep onset insomnia, parasomnias (nightmares,
[...] Read more.
In children diagnosed with pediatric bipolar disorder (PBD), disturbances in the quality of sleep and wakefulness are prominent. A novel phenotype of PBD called Fear of Harm (FOH) associated with separation anxiety and aggressive obsessions is associated with sleep onset insomnia, parasomnias (nightmares, night-terrors, enuresis), REM sleep-related problems, and morning sleep inertia. Children with FOH often experience thermal discomfort (e.g., feeling hot, excessive sweating) in neutral ambient temperature conditions, as well as no discomfort during exposure to the extreme cold, and alternate noticeably between being excessively hot in the evening and cold in the morning. We hypothesized that these sleep- and temperature-related symptoms were overt symptoms of an impaired ability to dissipate heat, particularly in the evening hours near the time of sleep onset. We measured sleep/wake variables using actigraphy, and nocturnal skin temperature variables using thermal patches and a wireless device, and compared these data between children with PBD/FOH and a control sample of healthy children. The results are suggestive of a thermoregulatory dysfunction that is associated with sleep onset difficulties. Further, they are consistent with our hypothesis that alterations in neural circuitry common to thermoregulation and emotion regulation underlie affective and behavioral symptoms of the FOH phenotype. Full article
(This article belongs to the Special Issue Bipolar Disorder in Children and Adolescents)
Open AccessArticle Cortical Volume Alterations in Conduct Disordered Adolescents with and without Bipolar Disorder
J. Clin. Med. 2014, 3(2), 416-431; doi:10.3390/jcm3020416
Received: 24 December 2013 / Revised: 28 February 2014 / Accepted: 3 March 2014 / Published: 16 April 2014
Cited by 2 | PDF Full-text (562 KB) | HTML Full-text | XML Full-text
Abstract
Background: There is increasing evidence that bipolar disorder (BD) and conduct disorder (CD) are co-occurring disorders. Magnetic resonance imaging has revealed differences in the structure and function of the frontal cortex in these disorders when studied separately; however, the impact of BD comorbidity
[...] Read more.
Background: There is increasing evidence that bipolar disorder (BD) and conduct disorder (CD) are co-occurring disorders. Magnetic resonance imaging has revealed differences in the structure and function of the frontal cortex in these disorders when studied separately; however, the impact of BD comorbidity on brain structure in adolescents with CD has not yet been examined. Method: We conducted an optimized voxel based morphometry (VBM) study of juvenile offenders with the following diagnoses: conduct disorder with comorbid bipolar disorder (CD-BD; n = 24), conduct disorder without bipolar disorder (CD; n = 24) and healthy controls (HC, n = 24). Participants were 13–17 years of age, in a residential treatment facility for repeat offenders. The three groups in this study were similar in age, gender, socioeconomic status and ethnicity. Results: We found CD-BD subjects had decreased volume relative to controls at the voxel level in the right medial prefrontal cortex (PFC). Using a Threshold-Free Cluster Enhancement (TFCE) technique, the CD-BD subjects had significantly decreased volumes of the right medial prefrontal cortex and portions of the superior and inferior frontal gyrus, anterior cingulate and temporal gyrus. The CD subjects did not have differences in brain volume compared to control subjects or CD-BD subjects. Conclusions: Our findings suggest the comorbidity between CD and BD is associated with neurobiological impact namely volumetric differences from healthy controls. Furthermore subjects with this comorbidity had poorer lifetime functioning, more mood and attentional dysfunction, and more medication exposure than subjects with CD who were not BD. Full article
(This article belongs to the Special Issue Bipolar Disorder in Children and Adolescents)
Figures

Open AccessArticle Pediatric Bipolar Disorder: Subtype Trend and Impact of Behavioral Comorbidities
J. Clin. Med. 2014, 3(1), 310-322; doi:10.3390/jcm3010310
Received: 13 December 2013 / Revised: 5 February 2014 / Accepted: 11 February 2014 / Published: 20 March 2014
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Abstract
The diagnosis of pediatric bipolar disorder (PBD) has increased dramatically in community-treated youth in the past 20 years. No previous study has assessed the trend in PBD subtype diagnoses or the impact of clinician-reported behavioral comorbidities (BC) on psychotropic medication prescribing patterns. This
[...] Read more.
The diagnosis of pediatric bipolar disorder (PBD) has increased dramatically in community-treated youth in the past 20 years. No previous study has assessed the trend in PBD subtype diagnoses or the impact of clinician-reported behavioral comorbidities (BC) on psychotropic medication prescribing patterns. This study aims: (1) to characterize national trends in PBD visits in relation to PBD subtypes; and (2) to assess differences in socio-demographic PBD subtype diagnostic patterns and psychotropic medications prescribed in PBD visits with and without behavioral comorbidities (w/w/o BC). PBD visits for 1999–2010 from the National Ambulatory Medical Care Survey (NAMCS) data were assessed using population-weighted chi-square and logistic regression analyses. While PBD visit rates were stable across 12 years, the proportional shift of subtype diagnosis from Bipolar I (89.0%) in 1999–2002 to Bipolar Not Otherwise Specified (NOS) (74.1%) in 2007–2010 was notable. Compared with PBD without behavioral comorbidities (w/o BC), PBD visits w/BC had greater proportions of the bipolar-NOS subtype, more males, 2–14-year-olds, and more publicly-insured visits. The prescription of antipsychotics (60% vs. 61%) was common in PBD visits regardless of the presence of behavioral comorbidities. Stimulants were the predominant class prescribed for PBD visits with BC (67.8% vs. 9.4%). Antidepressants were significantly greater in PBD visits without BC (41.6% vs. 21.0%). Overall one-third of PBD youth visits were prescribed antipsychotics concomitant with other psychotropic classes. Behavioral conditions accompanying PBD visits were prominent, suggesting the need for monitoring and evaluating the outcomes of complex medication regimens in community populations. Full article
(This article belongs to the Special Issue Bipolar Disorder in Children and Adolescents)
Figures

Open AccessArticle Circadian Phase Preference in Pediatric Bipolar Disorder
J. Clin. Med. 2014, 3(1), 255-266; doi:10.3390/jcm3010255
Received: 10 December 2013 / Revised: 11 February 2014 / Accepted: 19 February 2014 / Published: 11 March 2014
Cited by 1 | PDF Full-text (210 KB) | HTML Full-text | XML Full-text
Abstract
Pediatric bipolar disorder (BD) rates have notably increased over the past three decades. Given the significant morbidity and mortality associated with BD, efforts are needed to identify factors useful in earlier detection to help address this serious public health concern. Sleep is particularly
[...] Read more.
Pediatric bipolar disorder (BD) rates have notably increased over the past three decades. Given the significant morbidity and mortality associated with BD, efforts are needed to identify factors useful in earlier detection to help address this serious public health concern. Sleep is particularly important to consider given the sequelae of disrupted sleep on normative functioning and that sleep is included in diagnostic criteria for both Major Depressive and Manic Episodes. Here, we examine one component of sleep—i.e., circadian phase preference with the behavioral construct of morningness/eveningness (M/E). In comparing 30 BD and 45 typically developing control (TDC) participants, ages 7–17 years, on the Morningness-Eveningness Scale for Children (MESC), no between-group differences emerged. Similar results were found when comparing three groups (BD−ADHD; BD+ADHD; TDC). Consistent with data available on circadian phase preference in adults with BD, however, we found that BD adolescents, ages 13 years and older, endorsed significantly greater eveningness compared to their TDC peers. While the current findings are limited by reliance on subjective report and the high-rate of comorbid ADHD among the BD group, this finding that BD teens demonstrate an exaggerated shift towards eveningness than would be developmentally expected is important. Future studies should compare the circadian rhythms across the lifespan for individuals diagnosed with BD, as well as identify the point at which BD youth part ways with their healthy peers in terms of phase preference. In addition, given our BD sample was overall euthymic, it may be that M/E is more state vs. trait specific in latency age youth. Further work would benefit from assessing circadian functioning using a combination of rating forms and laboratory-based measures. Improved understanding of sleep in BD may identify behavioral targets for inclusion in prevention and intervention protocols. Full article
(This article belongs to the Special Issue Bipolar Disorder in Children and Adolescents)
Open AccessArticle Improving Clinical Prediction of Bipolar Spectrum Disorders in Youth
J. Clin. Med. 2014, 3(1), 218-232; doi:10.3390/jcm3010218
Received: 13 December 2013 / Revised: 8 February 2014 / Accepted: 12 February 2014 / Published: 10 March 2014
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Abstract
This report evaluates whether classification tree algorithms (CTA) may improve the identification of individuals at risk for bipolar spectrum disorders (BPSD). Analyses used the Longitudinal Assessment of Manic Symptoms (LAMS) cohort (629 youth, 148 with BPSD and 481 without BPSD). Parent ratings of
[...] Read more.
This report evaluates whether classification tree algorithms (CTA) may improve the identification of individuals at risk for bipolar spectrum disorders (BPSD). Analyses used the Longitudinal Assessment of Manic Symptoms (LAMS) cohort (629 youth, 148 with BPSD and 481 without BPSD). Parent ratings of mania symptoms, stressful life events, parenting stress, and parental history of mania were included as risk factors. Comparable overall accuracy was observed for CTA (75.4%) relative to logistic regression (77.6%). However, CTA showed increased sensitivity (0.28 vs. 0.18) at the expense of slightly decreased specificity and positive predictive power. The advantage of CTA algorithms for clinical decision making is demonstrated by the combinations of predictors most useful for altering the probability of BPSD. The 24% sample probability of BPSD was substantially decreased in youth with low screening and baseline parent ratings of mania, negative parental history of mania, and low levels of stressful life events (2%). High screening plus high baseline parent-rated mania nearly doubled the BPSD probability (46%). Future work will benefit from examining additional, powerful predictors, such as alternative data sources (e.g., clinician ratings, neurocognitive test data); these may increase the clinical utility of CTA models further. Full article
(This article belongs to the Special Issue Bipolar Disorder in Children and Adolescents)
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Review

Jump to: Research, Other

Open AccessReview Frontotemporal White Matter in Adolescents with, and at-Risk for, Bipolar Disorder
J. Clin. Med. 2014, 3(1), 233-254; doi:10.3390/jcm3010233
Received: 20 December 2013 / Revised: 13 February 2014 / Accepted: 17 February 2014 / Published: 10 March 2014
Cited by 2 | PDF Full-text (238 KB) | HTML Full-text | XML Full-text
Abstract
Frontotemporal neural systems are highly implicated in the emotional dysregulation characteristic of bipolar disorder (BD). Convergent genetic, postmortem, behavioral and neuroimaging evidence suggests abnormalities in the development of frontotemporal white matter (WM) in the pathophysiology of BD. This review discusses evidence for the
[...] Read more.
Frontotemporal neural systems are highly implicated in the emotional dysregulation characteristic of bipolar disorder (BD). Convergent genetic, postmortem, behavioral and neuroimaging evidence suggests abnormalities in the development of frontotemporal white matter (WM) in the pathophysiology of BD. This review discusses evidence for the involvement of abnormal WM development in BD during adolescence, with a focus on frontotemporal WM. Findings from diffusion tensor imaging (DTI) studies in adults and adolescents are reviewed to explore possible progressive WM abnormalities in the disorder. Intra- and interhemispheric frontotemporal abnormalities were reported in adults with BD. Although evidence in children and adolescents with BD to date has been limited, similar intrahemispheric and interhemispheric findings have also been reported. The findings in youths suggest that these abnormalities may represent a trait marker present early in the course of BD. Functional connectivity studies, demonstrating a relationship between WM abnormalities and frontotemporal dysfunction in BD, and DTI studies of vulnerability in first-degree relatives of individuals with BD, are discussed. Together, findings suggest the involvement of abnormal frontotemporal WM development in the pathophysiology of BD and that these abnormalities may be early trait markers of vulnerability; however, more studies are critically needed. Full article
(This article belongs to the Special Issue Bipolar Disorder in Children and Adolescents)
Open AccessReview Clinical Guidelines on Long-Term Pharmacotherapy for Bipolar Disorder in Children and Adolescents
J. Clin. Med. 2014, 3(1), 135-143; doi:10.3390/jcm3010135
Received: 9 December 2013 / Revised: 27 December 2013 / Accepted: 9 January 2014 / Published: 21 January 2014
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Abstract
Bipolar disorder is a severe affective disorder which can present in adolescence, or sometimes earlier, and often requires a pharmacotherapeutic approach. The phenomenology of bipolar disorder in children and adolescents appears to differ from that of adult patients, prompting the need for specific
[...] Read more.
Bipolar disorder is a severe affective disorder which can present in adolescence, or sometimes earlier, and often requires a pharmacotherapeutic approach. The phenomenology of bipolar disorder in children and adolescents appears to differ from that of adult patients, prompting the need for specific pharmacotherapy guidelines for long-term management in this patient population. Current treatment guidelines were mainly developed based on evidence from studies in adult patients, highlighting the requirement for further research into the pharmacotherapy of children and adolescents with bipolar disorder. This review compares and critically analyzes the available guidelines, discussing the recommended medication classes, their mechanisms of action, side effect profiles and evidence base. Full article
(This article belongs to the Special Issue Bipolar Disorder in Children and Adolescents)

Other

Jump to: Research, Review

Open AccessOpinion Biologism in Psychiatry: A Young Man’s Experience of Being Diagnosed with “Pediatric Bipolar Disorder”
J. Clin. Med. 2014, 3(2), 334-347; doi:10.3390/jcm3020334
Received: 9 December 2013 / Revised: 1 March 2014 / Accepted: 5 March 2014 / Published: 28 March 2014
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Abstract
Pediatric bipolar disorder is a diagnosis that arose in the mid 1990s in the USA and has mostly remained confined to that nation. In this article a young American man (under a pseudonym) describes his experience of having the diagnosis throughout his adolescent
[...] Read more.
Pediatric bipolar disorder is a diagnosis that arose in the mid 1990s in the USA and has mostly remained confined to that nation. In this article a young American man (under a pseudonym) describes his experience of having the diagnosis throughout his adolescent years. His story was conveyed via correspondence and a meeting with the author, an Australian child psychiatrist. The young American’s story reveals several issues that afflict contemporary psychiatry, particularly in the USA, where social and economic factors have contributed to the rise of a dominant biomedical paradigm—or “biologism”. This focus on the “bio” to the relative exclusion of the “psychosocial” in both diagnosis and treatment can have serious consequences as this young man’s story attests. The author explores aspects of his tale to analyze how the pediatric bipolar disorder “epidemic” arose and became emblematic of a dominant biologism. This narrative points to the need, depending on the service and country, to return to or retain/improve a balanced biopsychosocial perspective in child and adolescent mental health. Child psychiatry needs to advocate for health systems that support deeper listening to our patients. Then we can explore with them the full range of contextual factors that contribute to symptoms of individual and family distress. Full article
(This article belongs to the Special Issue Bipolar Disorder in Children and Adolescents)

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