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Category: Symptoms

Neurodevelopmental Antecedents of Early-Onset Bipolar Affective Disorder

Siggurdsson, Engilbert; Eric Fombonne, Kapil Sayal, Stuart Checkley
British Journal of Psychiatry, 1999, 174, l2l-l27

38 cases of hospitalized adolescent mania, bipolar disorder, or depression with psychotic features (ages 11-18 at first hospitalization) were compared with 41 controls with unipolar depression. Cases were significantly more likely than controls to have lower IQ scores, a difference between verbal (higher) and performance (lower) subtest IQ scores, to have experienced childhood developmental impairments such as language delay, social delay, and motor skills delay, have a family history of bipolar disorder or a family history of psychosis. About 14% of kids in both groups had experienced "perinatal insults."

The article summaries other articles which found an association between neurodevelopmental delays and mood disorders, such as van Os, J., Jones, P.,Lewis, G., et al (l997), "Developmental precursors of affective illness in a general population birth cohort," Archives of General Psychiatry, 54,625-631. This study looked at 5,362 individuals born in the UK during the same week in 1946. Subjects with mood disorders by ages 13 and 15 years "attained motor milestones significantly later in early childhood than controls, and had double the risk of speech abnormalities." The authors concluded that "affective disturbances, especially the early-onset forms, are preceded by impaired neurodevelopment." The authors summarize several other studies with similar findings, including studies that found obstetric complications (birth difficulties) to be associated with early onset of mood disorders, and conclude that "our findings add to the increasing evidence that neurodevelopmental impairments act as vulnerability factors for early-onset affective disturbances, particularly the more severe ones."

(Abstract by Martha Hellander, The Balanced Mind Parent Network Executive Director)

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Disentangling Disinhibition

Reprinted with permission from J Am Acad Child Adolesc Psychiatry, Volume 37(11).November 1998.1225-1227. Journal of the American Academy of Child & Adolescent Psychiatry Copyright 1998; American Academy of Child and Adolescent Psychiatry

R.J. is a 14-year-old female who was referred for severe separation anxiety, school phobia, and the recent onset of panic attacks. Despite 6 months of aggressive behavioral modification, she continued to be severely impaired by her symptoms. Pharmacotherapy with a benzodiazepine was initiated. Immediately after receiving her initial dose of 0.5 mg of clonazepam, R.J. started laughing inappropriately and was giddy, agitated, and anxious. These symptoms spontaneously abated 4 hours later. Follow-up history indicated no previous reaction in R.J. or any family member. Treatment with chlordiazepoxide was helpful in reducing her anxiety symptoms without untoward adverse effects. With the increased use of medications for emotional and behavioral disorders in youth, one of the most disturbing, nonfatal, adverse outcomes is an unpredictable and generally idiosyncratic reaction to the medication leading to rapid worsening of emotional or behavioral symptoms. Although not commonly written about, behavioral adverse effects of medication can be significantly impairing. Behavioral reactions can be traumatic to the child and family, leading to parental and youth concerns about the use of medications in general and, more specifically, the competence of the practitioner!

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Prepubertal and Early Adolescent Bipolarity Differentiate from ADHD

Prepubertal and early adolescent bipolarity differentiate from ADHD by manic symptoms, grandiose delusions, ultra-rapid or ultradian cycling.

Geller, B., Williams M., Zimmerman B., Frazier J., Beringer L., Warner Kathy. Journal of Affective Disorders 51 (1998) 81-91.

This paper reports on the differences between early-onset bipolar disorder and ADHD. The symptoms of 60 children with Bipolar Disorder (with or without ADHD) were compared with those of 60 children with ADHD (without mood disorders) as part of the National Institute of Mental Health (NIMH)-funded study, "Phenomenology and Course of Pediatric Bipolarity." The most significant differences were found in the following symptoms: Grandiosity (occurred in 85% of the children with BP v. only 6.7% in children with ADHD), Elated Mood (86% v. 5%), Daredevil Acts (70% v. 13%), Flight of Ideas (66.7% v. 10%), Racing Thoughts (48.3% v. 0%), Hypersexuality (45% v. 8.3%), and Decreased Need for Sleep (43.3% v. 5%). In the BP children, 26.7% had suicidality with plan or intent (no children in the ADHD group were suicidal). A striking finding was how rapidly the children's moods changed from one state to another. 45 of the 60 subjects cycled an average of 4 times per day (called "ultradian cycling") with some cycling up to 10 times per day. 5 of the 60 were ultra-rapid cyclers with episodes lasting a few days to a few weeks. Hypersexuality was present in 24% of the BP children before puberty, and in 70% of postpubertal subjects.

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Child and Adolescent Bipolar Disorder: a Review of the Past 10 Years

by Barbara Geller, M.D. and Joan Luby, M.D.
J Am Acad Child Adoles Psychiatry 36:1168-1176, 1997

Objective: To provide a review of the epidemiology, phenomenology, natural course, comorbidity, neurobiology, and treatment of child and adolescent bipolar disorder (BP) for the past 10 years. This review is provided to prepare applicants for recertification by the American Board of Psychiatry and Neurology. Method: Literature from Medline and other searches for the past 10 years, earlier relevant articles, and the authors' experience and ongoing National Institute of Mental Health-funded project "Phenomenology and Course of Pediatric Bipolarity" were used. Results: Age-specific,developmental (child, adolescent, and adult) DSM-IV criteria manifestations; comorbidity and differential diagnoses; and episode and course features are provided. Included are age-specific examples of childhood grandiosity, hypersexuality, and delusions. Differential diagnoses (e.g. specific language disorders, sexual abuse, conduct disorder [CD], schizophrenia, substance abuse), suicidality, and BP-II are discussed. Conclusion: Available data strongly suggest that prepubertal onset BP is a nonepisodic, chronic, rapid cycling, mixed manic state that may be comorbid with attention-deficit hyperactivity disorder(ADHD) and CD or have features of ADHD and/or CD as initial manifestations. Systematic research on pediatric BP is in its infancy and will require ongoing and future studies to provide developmentally relevant diagnostic methods and treatment. J Am Acad Child AdolesPsychiatry, 1997, 36(9):1168-1176.

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Complex and Rapid Cycling in Bipolar Children and Adolescents

Complex and Rapid Cycling in Bipolar Children and Adolescents:
A Preliminary Study

by Barbara Geller, M.D.; Kai Sun, Ph.D.; Betsy Zimerman, M.A.; Joan Luby, M.D.; Jeanne Frazier, B.S.N.; Marlene Williams, R.N.

Twenty-six subjects aged 7-18 years old were studied. Diagnoses of bipolar disorders were established using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present Episode Version-1986 modified for DSM-III-R criteria and for rating the number and duration of manic and hypomanic episodes. Complex cycling patterns were observed. These included numerous, brief episodes suggesting continuous, rapid-cycling in 80.8% of cases. Mean age of onset was early (8.5±4.4 years). Psychotic phenomena, suicidality, hyperactivity, and "mixed mania" were highly prevalent. Data in this report provide support for complex and rapid-cycling patterns in childhood onset BP.

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