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Journal Watch: Antidepressants and Suicide Risk

The controversy continues: Does antidepressant use affect suicidality in depressed children and adolescents, and if so, in which direction? In 2003, researchers reported an association between increased use of antidepressants and decreased suicide in adolescents (Journal Watch Psychiatry Dec 2004, p. 93, and Archives of General Psychiatry 2003; 60:978). To learn more, the same research group examined data among all Medicaid patients, ages 6 to 64, hospitalized for depression during a 2-year period (1999-2000).


Hypersexuality in Children with Bipolar Disorder

Recent research by Barbara Geller, M.D. and colleagues in an ongoing NIMH-financed study at Washington University in St. Louis found that hypersexual behavior was present in 43% of the kids with mania although only 1% of her sample had evidence of sexual abuse. The study included 93 children with mania whose average age was 10.9 years.

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Bipolar Disorder in Children Appears More Severe Than In Most Adults

Child psychiatry researchers from Washington University School of Medicine in St. Louis report that bipolar disorder, formerly called manic-depressive illness, can occur in children as young as 7 years old and that the illness in young bipolar children resembles the most severe form of bipolar disorder in adults.

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Reliability of the KSADS Rating Scale for Mania and Rapid Cycling

Reliability of the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) Mania and Rapid Cycling Sections

BARBARA GELLER, M.D., BETSY ZIMERMAN, M.A., MARLENE WILLIAMS, R.N., KRISTINE BOLHOFNER, B.S., JAMES L. CRANEY, M.P.H., MELISSA P. DELBELLO, M.D., AND CESAR SOUTULLO, M.D.

Reprinted with permission from J Am Acad Child Adolesc Psychiatry, Volume 40, p. 450-455 (2001).

Objective: To investigate the reliability of the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) mania and rapid cycling sections. Method: The 1986 version of the KSADS was modified and expanded to include onset and offset of each symptom for both current and lifetime episodes, expanded prepubertal mania and rapid cycling sections, and categories for attention-deficit/hyperactivity disorder and other DSM-IV diagnoses. To optimize diagnostic research, skip-outs were minimized. Subjects participated in the ongoing “Phenomenology and Course of Pediatric Bipolar Disorder” study. Mothers and children were interviewed separately by research nurses who were blind to diagnostic group status. In addition, ratings of off-site child psychiatrists, made from the narrative documentation given for each WASH-U-KSADS item, were compared with research nurse ratings. This work was performed between 1995 and 2000.

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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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