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Open AccessArticle

Alterations in Skin Temperature and Sleep in the Fear of Harm Phenotype of Pediatric Bipolar Disorder

by Patricia J. Murphy, Mark G. Frei and Demitri Papolos

J. Clin. Med. 2014, 3(3), 959-971; https://doi.org/10.3390/jcm3030959 - 22 Aug 2014

Cited by 9 | Viewed by 7534

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)

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562 KiB

Open AccessArticle

Cortical Volume Alterations in Conduct Disordered Adolescents with and without Bipolar Disorder

by Rene L. Olvera, David C. Glahn, Louise O'Donnell, Carrie E. Bearden, Jair C. Soares, Anderson M. Winkler and Steven R. Pliszka

J. Clin. Med. 2014, 3(2), 416-431; https://doi.org/10.3390/jcm3020416 - 16 Apr 2014

Cited by 6 | Viewed by 7002

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)

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Open AccessArticle

Pediatric Bipolar Disorder: Subtype Trend and Impact of Behavioral Comorbidities

by Thiyagu Rajakannan, Julie M. Zito, Mehmet Burcu and Daniel J. Safer

J. Clin. Med. 2014, 3(1), 310-322; https://doi.org/10.3390/jcm3010310 - 20 Mar 2014

Viewed by 10053

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)

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210 KiB

Open AccessArticle

Circadian Phase Preference in Pediatric Bipolar Disorder

by Kerri L. Kim, Alexandra B. Weissman, Megan E. Puzia, Grace K. Cushman, Karen E. Seymour, Ezra Wegbreit, Mary A. Carskadon and Daniel P. Dickstein

J. Clin. Med. 2014, 3(1), 255-266; https://doi.org/10.3390/jcm3010255 - 11 Mar 2014

Cited by 10 | Viewed by 7446

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)

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Open AccessArticle

Improving Clinical Prediction of Bipolar Spectrum Disorders in Youth

by Thomas W. Frazier, Eric A. Youngstrom, Mary A. Fristad, Christine Demeter, Boris Birmaher, Robert A. Kowatch, L. Eugene Arnold, David Axelson, Mary K. Gill, Sarah M. Horwitz and Robert L. Findling

J. Clin. Med. 2014, 3(1), 218-232; https://doi.org/10.3390/jcm3010218 - 10 Mar 2014

Viewed by 8399

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

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238 KiB

Open AccessReview

Frontotemporal White Matter in Adolescents with, and at-Risk for, Bipolar Disorder

by Sonja M. C. De Zwarte, Jennifer A. Y. Johnston, Elizabeth T. Cox Lippard and Hilary P. Blumberg

J. Clin. Med. 2014, 3(1), 233-254; https://doi.org/10.3390/jcm3010233 - 10 Mar 2014

Cited by 9 | Viewed by 8337

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)

176 KiB

Open AccessReview

Clinical Guidelines on Long-Term Pharmacotherapy for Bipolar Disorder in Children and Adolescents

by Joanna H. Cox, Stefano Seri and Andrea E. Cavanna

J. Clin. Med. 2014, 3(1), 135-143; https://doi.org/10.3390/jcm3010135 - 21 Jan 2014

Cited by 9 | Viewed by 6834

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

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190 KiB

Open AccessOpinion

Biologism in Psychiatry: A Young Man’s Experience of Being Diagnosed with “Pediatric Bipolar Disorder”

by Peter Parry

J. Clin. Med. 2014, 3(2), 334-347; https://doi.org/10.3390/jcm3020334 - 28 Mar 2014

Cited by 1 | Viewed by 9930

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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