Face emotion labeling deficits in children with bipolar disorder and severe mood dysregulation

Rich, Brendan A.; Grimley, Mary E.; Schmajuk, Mariana; Blair, Karina S.; Blair, R. J. R.; Leibenluft, Ellen

doi:10.1017/s0954579408000266

Cited by 139 publications

(145 citation statements)

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“…Moreover, our findings do not exclude the possibility that BD and SMD have common pathophysiologic features. Indeed, previous studies suggest that the two share behavioral deficits in emotion labeling processing 14,22 and cognitive flexibility, 23 although the neural mechanisms mediating these deficits may differ between the two patient groups. 24 In sum, to the extent that the question, "Is SMD a developmental presentation of BD?"…”

Section: Discussionmentioning

confidence: 99%

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

Stringaris

Baroni

Haimm

et al. 2010

Journal of the American Academy of Child & Adolescent Psych

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Objective-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). Method-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.Results-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).Conclusions-These data suggest that, over an approximately 2-year follow-up period, youth with SMD are unlikely to develop (hypo-)manic or mixed episodes. Keywords bipolar disorder; pediatric; severe mood dysregulation; irritability; ADHD In American psychiatric clinics and inpatient settings, dramatic increases in the rates of diagnosis of pediatric bipolar disorder (BD) have been documented over the past decade, 1,2 with a concomitant increase in prescription rates for antipsychotic medication. 3 This rapid increase in the diagnosis of pediatric BD has coincided with the contention that the clinical presentation of BD differs between children and adults. 4,5 The debate regarding the pediatric presentation of BD is complex. One important aspect of it has been the suggestion that marked irritability, even when it does not constitute an episodic change from baseline, is a manifestation of BD in youth. 4,6,7 To provide a framework for research on whether irritable children without distinct manic episodes have a developmental presentation of BD, we operationalized 8 a clinical syndrome, severe mood dysregulation (SMD), designed to capture chronically irritable children whose diagnostic status is in doubt. This paper uses a longitudinal sample to investigate the extent to which subjects with SMD develop episodes of (hypo-)mania, compared to youth with narrowly defined BD.The criteria for SMD require a persistent, nonepisodic clinical presentation of negatively valenced mood with frequent and impairing anger outbursts, combined with at least three of the "B" criteria of mania (pressured speech, agitation, insomnia, and flight of ideas/racing thoughts) and one (distractibility) that is also common to ADHD. 8 A community-based follow-up study suggests that SMD is common, with a lifetime prevalence of 3.3% in youth 9 to 19 years of age. 9 Furthermore, in that sample SMD predicted depressive disorder at 7-year follow-up in youths who were 9 to 19 years old at baseline. 9 Consistent with this finding, another community-based study of nonepisod...

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Section: Discussionmentioning

confidence: 99%

“…SMD was assessed using a specifically developed KSADS supplementary module. 8,14 The Wechsler Abbreviated Scale of Intelligence was used to measure intelligence 15 at initial assessment. WASI data were absent for five patients with SMD and one patient with BD.…”

Section: Initial Assessmentmentioning

confidence: 99%

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

Stringaris

Baroni

Haimm

et al. 2010

Journal of the American Academy of Child & Adolescent Psych

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“…2 Children with BD and SMD show similar behavioural deficits in facial emotion labelling: they are are less accurate in labelling facial emotions, including happy, sad, fearful and angry expressions, than healthy control children. [3][4][5] Behavioural deficits in facial emotion labelling can be mediated by perturbations within the neural circuit encompassing the ventral visual pathway, amygdala and ventrolateral prefrontal regions. [6][7][8] In both adults and children with BD, amygdala dysfunction during facial emotion processing is among the most replicated findings.…”

Section: Introductionmentioning

confidence: 99%

Impaired fixation to eyes during facial emotion labelling in children with bipolar disorder or severe mood dysregulation

Kim

Arizpe²,

Rosen³

et al. 2013

J Psychiatry Neurosci

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IntroductionSevere mood disorders in children, specifically bipolar disorder (BD) and severe mood dysregulation (SMD), have recently received increased attention, as researchers and clin icians acknowledge the substantial impairment and treatment needs of these populations. The BD and SMD phenotypes differ in that BD is characterized by distinct episodes of mania (and, frequently, depression), whereas SMD is characterized by severe, chronic, impairing irritability.1 Importantly, however, the 2 phenotypes are similar in that both are severe pediatric mood disorders that share Background: Children with bipolar disorder (BD) or severe mood dysregulation (SMD) show behavioural and neural deficits during facial emotion processing. In those with other psychiatric disorders, such deficits have been associated with reduced attention to eye regions while looking at faces. Methods: We examined gaze fixation patterns during a facial emotion labelling task among children with pediatric BD and SMD and among healthy controls. Participants viewed facial expressions with varying emotions (anger, fear, sadness, happiness, neutral) and emotional levels (60%, 80%, 100%) and labelled emotional expressions. Results: Our study included 22 children with BD, 28 with SMD and 22 controls. Across all facial emotions, children with BD and SMD made more labelling errors than controls. Compared with controls, children with BD spent less time looking at eyes and made fewer eye fixations across emotional expressions. Gaze patterns in children with SMD tended to fall between those of children with BD and controls, although they did not differ significantly from either of these groups on most measures. Decreased fixations to eyes correlated with lower labelling accuracy in children with BD, but not in those with SMD or in controls. Limitations: Most children with BD were medicated, which precluded our ability to evaluate medication effects on gaze patterns. Conclusion: Facial emotion labelling deficits in children with BD are associated with impaired attention to eyes. Future research should examine whether impaired attention to eyes is associated with neural dysfunction. Eye gaze deficits in children with BD during facial emotion labelling may also have treatment implications. Finally, children with SMD exhibited decreased attention to eyes to a lesser extent than those with BD, and these equivocal findings are worthy of further study.

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“…Youth with BD make more errors identifying emotions, compared to healthy controls (Guyer et al 2007;McClure et al 2005) or youth with anxiety and depression (Guyer et al 2007). These deficits appear to be pervasive across face emotions (Brotman et al 2008b;Rich et al 2008) and mood states (Rich et al 2008;Schenkel et al 2007). Moreover, BD youths, relative to controls, are more likely to rate neutral faces as hostile and fear-inducing (Brotman et al 2010(Brotman et al , 2013Rich et al 2006), and require higher intensity of emotion to be able to identify facial emotions (Brotman et al 2008b).…”

Section: Face Emotion Processingmentioning

confidence: 98%

A Systems Neuroscience Approach to the Pathophysiology of Pediatric Mood and Anxiety Disorders

Tseng¹,

Leibenluft²,

Brotman³

2013

The Neurobiology of Childhood

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Emotional dysregulation is a core feature of pediatric mood and anxiety disorders. Emerging evidence suggests that these disorders are mediated by abnormalities in the functions and structures of the developing brain. This chapter reviews recent behavioral and functional magnetic resonance imaging (fMRI) research on pediatric mood and anxiety disorders, focusing on the neural mechanisms underlying these disorders. Throughout the chapter, we highlight the relationship between neural and behavioral findings, and potential novel treatments. The chapter concludes with directions for future research.

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Face emotion labeling deficits in children with bipolar disorder and severe mood dysregulation

Cited by 139 publications

References 92 publications

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

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

Impaired fixation to eyes during facial emotion labelling in children with bipolar disorder or severe mood dysregulation

A Systems Neuroscience Approach to the Pathophysiology of Pediatric Mood and Anxiety Disorders

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