Article

Pediatric Bipolar Disorder Versus Severe Mood Dysregulation: Risk for Manic Episodes on Follow-Up

National Institute of Mental Health, Bethesda, MD, USA.
Journal of the American Academy of Child and Adolescent Psychiatry (Impact Factor: 7.26). 04/2010; 49(4):397-405. DOI: 10.1016/j.jaac.2010.01.013
Source: PubMed

ABSTRACT

An important question in pediatric bipolar research is whether marked nonepisodic irritability is a manifestation of bipolar disorder in youth. This study tests the hypothesis that youth with severe mood dysregulation (SMD), a category created for the purpose of studying children presenting with severe nonepisodic irritability, will be significantly less likely to develop (hypo-)manic or mixed episodes over time than will youth with bipolar disorder (BD).
Patients with SMD (N = 84) and narrowly defined BD (N = 93) at baseline were followed up in 6-monthly intervals using the relevant K-SADS modules to ascertain (hypo-)manic or mixed episodes.
Only one of 84 SMD subjects (1/84 [1.2%]; 95% confidence interval CI = 0.0003 to 0.064) experienced a (hypo-)manic or mixed episode during the study (median follow-up = 28.7 months). The frequency of such episodes was more than 50 times higher in those with narrowly defined BD (58/93 [62.4%]; 95% CI 0.52 to 0.72).
These data suggest that, over an approximately 2-year follow-up period, youth with SMD are unlikely to develop (hypo-)manic or mixed episodes.

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Available from: Argyris Stringaris, May 13, 2014
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    • "Thus, the SMD phenotype was defined to facilitate research on youth with this controversial phenotype (Leibenluft, 2011). Studies of family history and longitudinal course suggest that BD and SMD are dissociable (Brotman et al., 2006, 2007; Stringaris et al., 2010). However, both SMD and BD youth, but not those with other psychiatric illnesses, show perturbed face-emotion labeling ability (McClure et al., 2003, 2005; Guyer et al., 2007; Schenkel et al., 2007; Rich et al., 2008), although evidence suggests that the neural activity mediating face processing may differ between SMD and BD (Brotman et al., 2010; Thomas et al., 2012, 2013). "

    Full-text · Conference Paper · Dec 2014
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    • "Thus, the SMD phenotype was defined to facilitate research on youth with this controversial phenotype (Leibenluft, 2011). Studies of family history and longitudinal course suggest that BD and SMD are dissociable (Brotman et al., 2006, 2007; Stringaris et al., 2010). However, both SMD and BD youth, but not those with other psychiatric illnesses, show perturbed face-emotion labeling ability (McClure et al., 2003, 2005; Guyer et al., 2007; Schenkel et al., 2007; Rich et al., 2008), although evidence suggests that the neural activity mediating face processing may differ between SMD and BD (Brotman et al., 2010; Thomas et al., 2012, 2013). "
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    ABSTRACT: Youth with bipolar disorder (BD) and those with severe, non-episodic irritability (severe mood dysregulation, SMD) show face-emotion labeling deficits. These groups differ from healthy volunteers (HV) in neural responses to emotional faces. It is unknown whether awareness is required to elicit these differences. We compared activation in BD (N=20), SMD (N=18), and HV (N=22) during "Aware" and "Non-aware" priming of shapes by emotional faces. Subjects rated how much they liked the shape. In aware, a face (angry, fearful, happy, neutral, blank oval) appeared (187ms) before the shape. In non-aware, a face appeared (17ms), followed by a mask (170ms), and shape. A Diagnosis-by-Awareness-by-Emotion ANOVA was not significant. There were significant Diagnosis-by-Awareness interactions in occipital regions. BD and SMD showed increased activity for non-aware vs. aware; HV showed the reverse pattern. When subjects viewed angry or neutral faces, there were Emotion-by-Diagnosis interactions in face-emotion processing regions, including the L precentral gyrus, R posterior cingulate, R superior temporal gyrus, R middle occipital gyrus, and L medial frontal gyrus. Regardless of awareness, BD and SMD differ in activation patterns from HV and each other in multiple brain regions, suggesting that BD and SMD are distinct developmental mood disorders.
    Full-text · Article · Apr 2014
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    • "Therefore, not finding an association between BP and chronic irritability may have been due to the lack of statistical power. To address this, Stringaris et al. [11] used a referred sample to compare the course of children with SMD and those with BP over a median period of 29 months. The authors found that only one out of 84 (1.2 %) patients with SMD experienced a manic episode over this time period. "
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    ABSTRACT: The publication of the DSM-5 is nearing, yet a debate continues about the boundaries of bipolar disorder (BP) in children and adolescents. This article focuses on two key components of this debate that are often treated under the collective term mood dysregulation: the first is chronic irritability (and the proposed DSM-5 category of disruptive mood dysregulation disorder) and the other concerns short episodes of mania-like symptoms. We update our previous review [Stringaris in Eur Child Adolesc Psychiatry 20(2):61-66, 2011] and also present relevant neurobiological evidence. Most findings so far suggests that chronic, severe irritability is not a developmental presentation of mania. The diagnostic status of brief duration hypomania is less clear, with some evidence in support of its clinical relevance to BP. We end with recommendations for future research to inform classification and treatment.
    Full-text · Article · Dec 2012 · European Child & Adolescent Psychiatry
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