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Hilary P Blumberg,
Carolyn Fredericks,
Fei Wang,
Jessica H Kalmar,
Linda Spencer,
Xenophon Papademetris,
Brian Pittman, Andres Martin,
Bradley S Peterson,
Robert K Fulbright,
John H Krystal
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ABSTRACT: Abnormalities in volumes of the amygdala have been reported previously in adolescents and adults with bipolar disorder (BD). Several studies have reported reduced volumes in adolescents with BD; however, both decreases and increases in volumes have been reported in adults with BD. Understanding of potential developmental contributions to these disturbances in morphology of the amygdala has been limited by the absence of longitudinal data in persons with BD. Here we use a within-subject longitudinal design to investigate whether amygdala volume abnormalities persist in adolescents and young adults with BD over a time interval of approximately 2 years.
Participants included 18 adolescents and young adults: 10 participants with BD I and 8 healthy comparison participants. Amygdala volumes were measured on high-resolution magnetic resonance imaging scans acquired twice for each subject over intervals of approximately 2 years. Amygdala volumes were the dependent measures in a mixed-model statistical analysis to compare amygdala volumes between groups over time while covarying for total brain volume.
Amygdala volumes were significantly smaller in adolescents and young adults with BD compared with healthy participants (p = 0.018). The effect of time was not significant.
Although the sample size is modest, this study provides preliminary evidence to support the presence of decreased amygdala volumes in adolescents and young adults with BD that persist during this developmental epoch.
Bipolar Disorders 01/2006; 7(6):570-6. · 5.29 Impact Factor
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ABSTRACT: This study examined changes in the prevalence of psychiatric diagnoses at admission among children and adolescents treated for mental health problems in psychiatric inpatient settings between 1995 and 2000. Using a large, nationwide database (MarketScan) of private health insurance claims, our sample consisted of 5,346 children under the age of 18 who received psychiatric inpatient services, out of a total of 1,723,681 covered children. Odds ratios were used to measure changes in the prevalence of specific mental health disorders between 1995 and 2000. The study identified several significant changes, most notably, that the proportion of hospitalized children treated for bipolar or eating disorder doubled between 1995 and 2000. Significant decreases were observed for adjustment, anxiety, oppositional, and substance abuse disorders. This study lends support to recent concerns that the prevalence of bipolar disorder among the youth is increasing. Further research is needed to identify the underlying reasons for these observed changes.
Social Psychiatry and Psychiatric Epidemiology 09/2005; 40(8):642-7. · 2.70 Impact Factor
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ABSTRACT: The deficits of executive control of emotions and impulses of adult BD implicate involvement of a ventral prefrontal cortex (VPFC) neural system that subserves these functions that include the VPFC, as well as its subcortical connection sites of amygdala, striatum, and thalamus. Differences in the timing of major developmental changes in the structures within this neural system suggest that abnormalities in particular components of this neural system may emerge during critical developmental epochs during the course of the illness. Our recent neuroimaging data suggest that abnormalities in the subcortical components of VPFC neural systems may be evident by early adolescence in BD, whereas VPFC deficits progress over the course of adolescence and may be difficult to detect prior to late adolescence or early adulthood. This potential neurodevelopmental model for BD could have important implications for the recognition of early signs of the disorder and for age-specific treatment strategies.
Annals of the New York Academy of Sciences 07/2004; 1021:376-83. · 3.15 Impact Factor
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ABSTRACT: The purported functions of medial temporal lobe structures suggest their involvement in the pathophysiology of bipolar disorder (BD). Previous reports of abnormalities in the volume of the amygdala and hippocampus in patients with BD have been inconsistent in their findings and limited to adult samples. Appreciation of whether volumetric abnormalities are early features of BD or whether the abnormalities represent neurodegenerative changes associated with illness duration is limited by the paucity of data in juvenile samples.
To investigate amygdala and hippocampal volume in adults and adolescents with BD. Setting and
Subjects included 36 individuals (14 adolescents and 22 adults) in outpatient treatment for BD type I at a university hospital or Veterans Affairs medical center or in the surrounding community, and 56 healthy comparison subjects (23 adolescents and 33 adults). Design and
Amygdala and hippocampal volumes were defined and measured on high-resolution anatomic magnetic resonance imaging scans. We used a mixed-model, repeated-measures statistical analysis to compare amygdala and hippocampal volumes across groups while covarying for total brain volume, age, and sex. Potential effects of illness features were explored, including rapid cycling, medication, alcohol or other substance dependence, duration, and mood state.
For both the amygdala and hippocampal regions, we found an overall significant volume reduction in the BD compared with the control group (P<.0001). Amygdala volume reductions (15.6%) were highly significant (P<.0001). We observed a nonsignificant trend (P =.054) toward reductions in hippocampal volumes of lesser magnitude (5.3%). Effects of illness features were not detected.
These results suggest that BD is associated with decreased volumes of medial temporal lobe structures, with greater effect sizes in the amygdala than in the hippocampus. These abnormalities are likely manifested early in the course of illness, as they affected adolescent and adult subjects similarly in this sample.
Archives of General Psychiatry 01/2004; 60(12):1201-8. · 12.02 Impact Factor
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ABSTRACT: Atypical antipsychotic medications are increasingly prescribed for child and adolescent patients. Relatively little information on adverse events (AEs), specifically in children or adolescents taking atypical antipsychotics, is available.
The Food and Drug Administration spontaneous AE reporting postmarketing surveillance database was queried for olanzapine until March 31, 2000. Patient exposure estimates as of the same date were provided by the manufacturer. AE complaints and exposure estimates were divided by age: children (birth-9 years), adolescents (10-19), and adults (20+). AE complaint risks per 10,000 patients exposed were calculated along with risk ratios across age groups and their 95% confidence intervals.
Extrapyramidal syndrome complaint risks were similar across development, and tardive dyskinesia complaint risks were comparable in adolescents and adults. Overrepresented AE complaints in children included sedation, weight gain, liver function abnormalities, and tardive dyskinesia. Overrepresented AE complaints in adolescents included sedation, weight gain, liver function abnormalities, and prolactin increase.
Extrapyramidal syndromes may be no more common in children and adolescents with olanzapine than in adults. The frequency of some other AEs may differ across development. Caution is warranted because of the likelihood of reporting bias. Similar analyses should be conducted with other atypical antipsychotics.
Journal of the American Academy of Child & Adolescent Psychiatry 01/2003; 41(12):1439-46. · 6.44 Impact Factor
