Childhood and Adolescent Schizophrenic, Bipolar, and Schizoaffective Disorders: A Clinical and Outcome Study

Werry, John S.; McClellan, Jon; Chard, Linda

doi:10.1097/00004583-199105000-00017

Cited by 307 publications

(191 citation statements)

References 18 publications

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“…An article by Carlson (1990) suggested that in some children bipolar disorder might emerge at a young age. Similar speculation followed in an article by Werry, McClellan and Chard (1991).…”

Section: Pediatric Bipolarsupporting

confidence: 76%

Can a Diagnosis Be Epidemic, With Therapeutic Efforts the Catastrophe?

Littrell

2012

Ethical Hum Psychol Psychiatry

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The diagnosis of Bipolar Spectrum Disorders (BSD) given for office visits has risen 40 fold for children and has risen dramatically for adults as well. Some of the growth may have been fueled by re-categorization of individuals who would previously have received diagnoses of major depression along with the widening of diagnostic criteria for BSD. Concomitant with the rise in BSD diagnoses, the number of adults and children receiving atypical antipsychotics has increased dramatically. Recent evidence finds that atypical antipsychotics cause considerable reduction in brain volume. It is thus imperative to ensure that those with diagnoses comprising BSD-Bipolar I, Bipolar II, and Bipolar Not Otherwise specified (NOS)-actually share a common etiology and are being appropriately treated. This paper reviews the history, evidentiary support, and implications associated with the expansion of the Bipolar Spectrum. Can a Diagnosis Be Epidemic, with Therapeutic Efforts the Catastrophe?In the years from 1999 to 2003, the diagnosis of bipolar given in office visits has increased 40 fold for children. Bipolar Disorder diagnoses have increased during the same time period for adults as well rising from 4.77% of office visits to 6.28% of office visits (Moreno et al., 2007).Allen Frances (2009), the Chairperson of the DSM-IV, has suggested that the sharp rise in bipolar diagnoses is attributable to the manner in which criteria for the disorders were written-that it was an issue of taxonomy rather than epidemiology. Obviously, diagnostic criteria have profound implications for who is diagnosed, at what age, and whether they are treated with psychotropic medications. Because psychotropic medications carry substantial risks-if not guarantees-of side effects, those decisions must be judicious, and ever cognizant of Hippocrates' admonishment: First, do no harm. This review constitutes an audit of psychiatry's books, asking if they balance when the substantial risk of harm from such diagnoses and the regimen of medication they entail is taken fully into account. Creation of the Bipolar SpectrumOver the years, those behaviors categorized under the bipolar label have expanded greatly. In the DSM-II (Association, 1968), manic-depression, listed under the heading "affective psychoses", was the only bipolar type diagnosis. With subsequent editions of the DSM, new categories of affect perturbations were included in manuals. The DSM-III (Association, 1980) provided descriptions of the behaviors required to meet criteria for mixed and manic episodes. The DSM-III-R (Association, 1987) added criteria for hypomania (specified in the next paragraph). The literature recognized that some persons who had experienced an episode of depression did have periods when they were enthusiastic, energetic, and animated to the extent that they met criteria for hypomania. Kupfer, Carpenter, and Frank (1988) had argued that such individuals, who were labeled Bipolar II, should be viewed as experiencing a variant of major depression. Dunner (1993) disagr...

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“…An article by Carlson (1990) suggested that in some children bipolar disorder might emerge at a young age. Similar speculation followed in an article by Werry, McClellan and Chard (1991).…”

Section: Pediatric Bipolarsupporting

confidence: 76%

Can a Diagnosis Be Epidemic, With Therapeutic Efforts the Catastrophe?

Littrell

2012

Ethical Hum Psychol Psychiatry

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“…Differential diagnosis of psychotic disorders in the pediatric population is frequently difficult due to the lack of longitudinal information about disease course. Indeed, some studies have found that as many as 55% of individuals initially presenting with psychotic symptoms are given different diagnoses upon follow-up evaluation 2-6 years later (Werry et al, 1991;McKenna et al, 1994). Many investigators and potential participants also have ethical concerns about withholding treatment by utilizing a placebo or limiting the use of concurrent antidepressants and mood stabilizers, which have become the community standard of care, given the significant risk of suicide and violence in this population.…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study of Risperidone, Olanzapine, and Haloperidol in Psychotic Youth: A Double-Blind, Randomized, 8-Week Trial

Sikich

Hamer

Bashford

et al. 2003

Neuropsychopharmacol

278

148

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This pilot study was undertaken to estimate the acute antipsychotic effect size and side effect propensity of risperidone and olanzapine in the pediatric population, in comparison to haloperidol, a conventional antipsychotic with established efficacy. Risperidone and olanzapine are widely used as first-line treatments to ameliorate psychotic symptoms in youth, but their abilities to specifically treat children and adolescents presenting due to psychotic symptoms have not been rigorously studied. Subjects, selected because of prominent positive psychotic symptoms, were randomly assigned to double-blind, parallel treatment with risperidone, olanzapine, or haloperidol for 8 weeks. The primary outcome was reduction in the Brief Psychiatric Rating Scale for Children total score from baseline to termination. An exploratory, descriptive analysis was done to compare the three treatments. A total of 50 patients, 8-19 years, participated. All treatments reduced symptoms significantly with p-values (corrected for multiple comparisons) of 0.0018 for each of the atypical agents and 0.012 for haloperidol. In all, 88% of subjects treated with olanzapine, 74% treated with risperidone, and 53% treated with haloperidol met response criteria. The primary side effects observed in all patients were mild to moderate sedation, extrapyramidal symptoms, and weight gain. Risperidone and olanzapine acutely reduced psychotic symptoms in this pediatric sample. Exploratory comparisons indicate the magnitude of the antipsychotic response with these atypical agents is comparable to that observed with haloperidol. However, youth treated with risperidone and olanzapine experienced weight gain and extrapyramidal effects that appear more prevalent and severe than reported in adults.

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“…EOS is associated with greater disease severity [21][22][23][24], developmental delays [25][26][27][28], higher rates of chromosomal abnormalities and greater burden of copy number variants [29][30][31][32][33], and poor prognosis [34][35][36] compared with the adult onset counterpart.…”

Section: Children and Adolescents With Schizophreniamentioning

confidence: 99%

Theory of Mind in the Early Course of Schizophrenia

Vyas

et al. 2017

CPSR

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Theory of mind deficit is a core feature of schizophrenia and is considered a vulnerability marker of the disorder. The majority of studies measuring theory of mind in schizophrenia involve multiple-episode or chronic schizophrenia patients, and therefore it is important to delineate whether these deficits occur before or following illness-onset by assessing high-risk subjects (clinical high risk and ultra-high risk), early-onset psychosis, and first-degree relatives. We address the question of whether theory of mind impairment is specific or a facet of general cognitive impairment in these clinical populations, and incorporate genetic and neuroimaging studies on theory of mind. The review provides a succinct evaluation of the literature, discusses current limitations and proposes future directions.

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Childhood and Adolescent Schizophrenic, Bipolar, and Schizoaffective Disorders: A Clinical and Outcome Study

Cited by 307 publications

References 18 publications

Can a Diagnosis Be Epidemic, With Therapeutic Efforts the Catastrophe?

Can a Diagnosis Be Epidemic, With Therapeutic Efforts the Catastrophe?

A Pilot Study of Risperidone, Olanzapine, and Haloperidol in Psychotic Youth: A Double-Blind, Randomized, 8-Week Trial

Theory of Mind in the Early Course of Schizophrenia

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