Family-based association study of early growth response gene 3 with child bipolar I disorder.

Background: The risk for relapse of child bipolar I disorder (BP-I) is highly correlated with environmental factors. Immediate early genes of the early growth response (EGR) gene family are activated at high levels in the brain in response to environmental events, including stress, and mediate numerous neurobiological processes that have been associated with mental illness risk. The objective of this study is to evaluate whether single nucleotide polymorphisms (SNPs) in EGR genes are associated with the risk to develop child bipolar I disorder.

A randomized controlled trial of risperidone, lithium, or divalproex sodium for initial treatment of bipolar I disorder, manic or mixed phase, in children and adolescents.

Context: There was a paucity of comparative pharmacological research for initial treatment of bipolar I disorder, manic or mixed phase, in children and adolescents.

Objective: To investigate which medication to administer first to antimanic medication-naive subjects.

Design, Setting, And Participants: The Treatment of Early Age Mania (TEAM) study recruited 6- to 15-year-old children and adolescents with DSM-IV bipolar I disorder (manic or mixed phase) at 5 US sites from 2003 to 2008 into a controlled, randomized, no-patient-choice, 8-week protocol.

Pharmacological and non-drug treatment of child bipolar I disorder during prospective eight-year follow-up.

Objectives: The Phenomenology and Course of Pediatric Bipolar Disorders study, a National Institute of Mental Health-funded study of child bipolar I disorder (BP-I) begun in 1995, is a prospective follow-up study that included collecting pharmacological and non-drug treatment data.

Methods: There were 115 first-episode subjects who fit full DSM-IV criteria for BP-I, mixed or manic phase, with severity scores in the clinically impaired range, ascertained by consecutive new case ascertainment. Subjects were assessed with the Washington University in St.

Effects of age, sex, and independent life events on amygdala and nucleus accumbens volumes in child bipolar I disorder.

Background: Relationships between environment and cortical-limbic-striatal pathways are not well-researched in child bipolar I disorder (BP-I).

Methods: This was a controlled, blindly rated magnetic resonance imaging study of children with DSM-IV BP-I, manic or mixed type, compared with matched typically developing children (TC).

Results: There were 47 subjects (21 BP-I, 26 TC) aged 14.

Child bipolar I disorder: prospective continuity with adult bipolar I disorder; characteristics of second and third episodes; predictors of 8-year outcome.

Context: Child bipolar I disorder (BP-I) is a contentious diagnosis.

Objective: To investigate continuity of child and adult BP-I and characteristics of later episodes.

Design: Inception cohort longitudinal study.

GAD1 single nucleotide polymorphism is in linkage disequilibrium with a child bipolar I disorder phenotype.

Background: Pediatric bipolar I disorder (BP-I) and childhood schizophrenia (SZ) share certain symptoms (e.g., psychosis, aggression/irritability [A/I]), and the psychotic and A/I features are treated with neuroleptics in both disorders.

Psychotic phenomena in 257 young children and adolescents with bipolar I disorder: delusions and hallucinations (benign and pathological).

Objectives: In contrast to studies of adult bipolar I disorder (BP-I), there is a paucity of data on psychotic phenomena in child BP-I. Therefore, the aim of this work was to describe delusions and hallucinations in pediatric BP-I.

Methods: Subjects were 257 participants, aged 6-16, in either of two large, ongoing, NIMH-funded studies, 'Phenomenology and Course of Pediatric Bipolar Disorders' or 'Treatment of Early Age Mania (TEAM)'.

Proposed definitions of bipolar I disorder episodes and daily rapid cycling phenomena in preschoolers, school-aged children, adolescents, and adults.

Objective: Recent data from several large studies of pediatric bipolar I disorder reported baseline (current) episode duration ranging from less than a month to >or=1 year. These data may reflect actual sample differences, but the absence of uniformly applied definitions of episode duration, number of lifetime episodes and daily rapid cycling patterns during episodes may also account for these differences.

Method: Proposals for definitions of episode and cycling phenomena were based upon data from the Washington University in St.

Diagnostic characteristics of child bipolar I disorder: does the "Treatment of Early Age Mania (team)" sample generalize?

Objective: To examine the representativeness of a randomized controlled trial (RCT) sample versus one obtained by consecutive new case ascertainment, for subjects with child bipolar I disorder.

Method: Subjects (N = 247) were outpatients who participated in either the National Institute of Mental Health-funded Phenomenology and Course of Pediatric Bipolar Disorders study or the Treatment of Early Age Mania (TEAM) study. Both studies required that subjects have current DSM-IV bipolar I disorder (manic or mixed phase) and a Children's Global Assessment Scale (CGAS) score View Article and Find Full Text PDF

Adaptive strategies for treating childhood mania.

The conduct of trials in children is beset with special difficulties associated with the dearth of treatment data, the considerable heterogeneity of pediatric patient populations connected with (for example) developmental stage, and the strong desire of parents to see that children are provided with the best possible care at all times. To address these issues, we propose the adaptive treatment strategy (ATS) study in which medication changes are adaptively determined according to the evolving treatment response of the individual child. To formalize this methodological approach, we parameterize an ATS as a "threshold" decision rule that monitors whether the patient's response trajectory crosses some threshold of failure.

Controlled study of switching from attention-deficit/hyperactivity disorder to a prepubertal and early adolescent bipolar I disorder phenotype during 6-year prospective follow-up: rate, risk, and predictors.

Rate, risk, and predictors of switching from attention-deficit/hyperactivity disorder (ADHD) to a prepubertal and early adolescent bipolar I disorder phenotype (PEA-BP-I) were examined in a blindly rated, controlled, prospective 6-year follow-up that included assessments at 2-year intervals. Subjects were outpatients obtained by consecutive new case ascertainment. There were 81 subjects who were 9.

Controlled, blindly rated, direct-interview family study of a prepubertal and early-adolescent bipolar I disorder phenotype: morbid risk, age at onset, and comorbidity.

Context: A key question is whether a prepubertal and early-adolescent bipolar I disorder phenotype (PEA-BP-I) is the same illness as adult BP-I. This question arises because of the greater severity, longer current episode duration, preponderance of mania, and high rates of ultradian rapid cycling and comorbid attention-deficit/hyperactivity disorder (ADHD) in PEA-BP-I.

Objectives: To examine morbid risk (MR) of BP-I in first-degree relatives of PEA-BP-I, ADHD, and healthy control probands, as well as imprinting, sibling recurrence risk, and anticipation.

Are the arginine vasopressin V1a receptor microsatellites related to hypersexuality in children with a prepubertal and early adolescent bipolar disorder phenotype?

Objective: To examine family-based transmission of the number of 5' flanking arginine vasopressin V1a receptor (AVPR1A) microsatellites, which include [(GATA)(14)] and complex [(CT)(4)-TT-(CT)(8)-(GT)(24)] repeats, in probands with a prepubertal and early adolescent bipolar disorder phenotype (PEA-BP). Preferential transmission of the number of AVPR1A microsatellite repeats to hypersexual and uninhibited people-seeking probands was hypothesized, based on reports from preclinical work in the literature.

Methods: Probands were 83 participants in an ongoing controlled study of PEA-BP.

Controlled study of encopresis and enuresis in children with a prepubertal and early adolescent bipolar-I disorder phenotype.

Objective: To examine the prevalence of encopresis/enuresis, relationship between maternal hostility and encopresis, parent-child concordance of reporting encopresis/enuresis, and familial aggregation of enuresis in subjects with a prepubertal and early adolescent bipolar-I disorder phenotype (PEA-BP), attention-deficit/hyperactivity disorder (ADHD), and healthy controls (HC).

Method: There were 268 consecutively ascertained subjects (93 PEA-BP, 81 ADHD, and 94 HC). PEA-BP was defined as DSM-IV BP-I (manic or mixed phase) with elation and/or grandiosity.

Prepubertal and early adolescent bipolar I disorder: review of diagnostic validation by Robins and Guze criteria.

The phenomenology of pediatric bipolar disorder is a controversial topic in the field of child psychiatry. The first National Institute of Mental Health-funded study in the field, Phenomenology and Course of Pediatric Bipolar Disorders, selected a conservative phenotype for credibility in a contentious field. To address the problems of differentiation of mania from attention-deficit/hyperactivity disorder (ADHD) and of the ubiquitous manifestation of irritability across child psychiatry diagnoses, a prepubertal and early adolescent bipolar I disorder phenotype (PEA-BP) was defined by DSM-IV bipolar I disorder (manic or mixed phase) with elation and/or grandiosity as one criterion.

Children with a prepubertal and early adolescent bipolar disorder phenotype from pediatric versus psychiatric facilities.

Objective: To examine characteristics between subjects with a prepubertal and early adolescent bipolar disorder phenotype from pediatric versus psychiatric venues.

Method: Subjects (N = 93) with a prepubertal and early adolescent bipolar disorder phenotype were obtained through consecutive new case ascertainment from designated pediatric and psychiatric sites from 1995 to 1998. Children needed DSM-IV bipolar I disorder (manic or mixed phase) with elation and/or grandiosity as one criterion to avoid diagnosing mania only by symptoms that overlapped with those of attention-deficit/hyperactivity disorder.

A brief screening tool for a prepubertal and early adolescent bipolar disorder phenotype.

Objective: Although there has recently been increased interest in child mania, there is as yet no brief screening tool that separates a prepubertal and early adolescent bipolar disorder phenotype from attention deficit hyperactivity disorder (ADHD), the most relevant differential diagnosis.

Method: Parents of 268 consecutively ascertained subjects (93 with a prepubertal and early adolescent bipolar disorder phenotype, 81 with ADHD, 94 in a healthy comparison group) completed the 10-item Conners' Abbreviated Parent Questionnaire, before separate Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia interviews of parents and children.

Practical Clues to Early Recognition of Bipolar Disorder: A Primary Care Approach.

Early treatment can favorably impact the course of bipolar disorder, a lifelong illness. Because bipolar disorder can masquerade as various mental and physical illnesses-primarily major depressive disorder-patients with this condition frequently go unrecognized for years. During this recognition lag, such patients may present to their primary care physician on multiple occasions.

Linkage disequilibrium of the brain-derived neurotrophic factor Val66Met polymorphism in children with a prepubertal and early adolescent bipolar disorder phenotype.

Objective: Transmission of the brain-derived neurotrophic factor (BDNF) Val66 allele in children with a prepubertal and early adolescent bipolar disorder phenotype was examined.

Method: The prepubertal and early adolescent bipolar disorder phenotype was defined as current DSM-IV bipolar I disorder (manic or mixed phase) with at least one cardinal mania criterion (i.e.

Relationship of parent and child informants to prevalence of mania symptoms in children with a prepubertal and early adolescent bipolar disorder phenotype.

Objective: A controversy regarding pediatric bipolar disorder is whether to use child in addition to parent informants. To investigate this issue, the authors conducted a study comparing separate child and parent interview data for child bipolar disorder.

Method: Responses on the Washington University in St.

Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype.

Background: Diagnosis of child mania has been contentious.

Objective: To investigate natural history and prospective validation of the existence and long-episode duration of mania in children.

Design: Four-year prospective longitudinal study of 86 subjects with intake episode mania who were all assessed at 6, 12, 18, 24, 36, and 48 months.

Temperament and character factors in a prepubertal and early adolescent bipolar disorder phenotype compared to attention deficit hyperactive and normal controls.

Objective: To compare temperament and character (T/C) factors in a prepubertal and early adolescent bipolar disorder phenotype (PEA-BP), attention deficit hyperactivity disorder (ADHD), and normal community controls (NC).

Methods: Subjects in PEA-BP (n = 101), ADHD (n = 68), and NC (n = 94) groups were diagnostically assessed with the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia given separately to mothers about their children and to children about themselves.