Parental Diagnoses in Youth With Narrow Phenotype Bipolar Disorder or Severe Mood Dysregulation

Brotman, Melissa A.; Kassem, Layla; Reising, B.A. Michelle M.; Guyer, Amanda E.; Dickstein, Daniel P.; Rich, Brendan A.; Towbin, Kenneth E.; Pine, Daniel S.; McMahon, Francis J.; Leibenluft, Ellen

doi:10.1176/appi.ajp.2007.06101619

Cited by 138 publications

(106 citation statements)

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“…24 In sum, to the extent that the question, "Is SMD a developmental presentation of BD?" is framed categorically, the conclusion from this and previous studies 9,20,24 is "no." Because treatment decisions are categorical, there is value to framing the question categorically.…”

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 94%

“…20 These studies indicate that irritable youth are at risk for developing depressive and anxiety disorders in adulthood, and that youth with SMD are less likely than those with BD to have a parent with BD. 20 Moreover, our findings are in keeping with those of a recent clinic study showing that, for children with severe persistent irritability, a diagnosis of BD is rarely justified upon careful clinical assessment. 21 However, it should be noted that the current study was not designed to test the hypothesis that the occurrence of (hypo-)manic or mixed episodes in SMD was no more than would occur by chance; this would require a much larger sample.…”

Section: Discussionmentioning

confidence: 94%

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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: 66%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

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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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“…Comparing this category against classical bipolar disorder (i.e. bipolar cases with episodic mood changes) has shown that the two differ in their longitudinal course 6,7 family history 8 and neural mechanisms 9 . Outside the US, children with severe irritability are more often diagnosed with oppositional defiant disorder (ODD), a label that implies a behavioural disturbance rather than a mood problem.…”

Section: Irritabilitymentioning

confidence: 99%

Mood regulation in youth

Leigh

Smith

Milavić

et al. 2012

Current Opinion in Psychiatry

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Purpose of review-Mood regulation problems, such as severe chronic irritability or short episodes of mania like symptoms are common, impairing and a topic of intense recent interest to clinicians, researchers and the DSM-5 process. Here we review the most recent findings about these two presentations and discuss approaches to their treatment.Recent findings-Longitudinal and genetic findings suggest that chronic irritability should be regarded as a mood problem that is distinct from bipolar disorder.A proportion of children with short (less than 4 days) episodes of mania like symptoms seem to progress to classical (Type I or II) bipolar disorder over time in US clinic samples. In a UK sample, such episodes were independently associated with psychosocial impairment.The evidence base for the treatment of either irritability or short-lived episodes to mania-like symptoms is still small. Clinicians should be cautious with extrapolating treatments from classical bipolar disorder to these mood regulation problems. CBT-based approaches targeting general mood regulation processes may be effective for cases with severe irritability or short episodes of mania like symptoms.Summary-There is increasing research evidence for the importance of mood regulation problems in the form of either irritability or short episodes of mania like symptoms in youth. The evidence base for their drug treatment has yet to be developed. CBT-based interventions to modify processes of mood regulation may be a useful and safe intervention for patients with these presentations.

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“…15 Children with SMD were 7 times more likely to develop depression as young adults compared with those without SMD. Compared with children with narrow phenotype bipolar disorder, subjects with SMD had different psychopathological measures and were less likely to have parents with bipolar disorder, 16 suggesting that SMD is a disorder distinct from narrow phenotype bipolar disorder.…”

Section: Bipolar Disorder Not Otherwise Specifiedmentioning

confidence: 99%

Collaborative Role of the Pediatrician in the Diagnosis and Management of Bipolar Disorder in Adolescents

Shain¹

2012

Pediatrics

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Despite the complexity of diagnosis and management, pediatricians have an important collaborative role in referring and partnering in the management of adolescents with bipolar disorder. This report presents the classification of bipolar disorder as well as interviewing and diagnostic guidelines. Treatment options are described, particularly focusing on medication management and rationale for the common practice of multiple, simultaneous medications. Medication adverse effects may be problematic and better managed with collaboration between mental health professionals and pediatricians. Case examples illustrate a number of common diagnostic and management issues.

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Parental Diagnoses in Youth With Narrow Phenotype Bipolar Disorder or Severe Mood Dysregulation

Abstract: These data suggest that narrow phenotype bipolar disorder may be distinct from severe mood dysregulation in terms of familial aggregation. Additionally, the familiality of narrow phenotype bipolar disorder and adult DSM-IV bipolar disorder is high.

Cited by 138 publications

References 14 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

Mood regulation in youth

Collaborative Role of the Pediatrician in the Diagnosis and Management of Bipolar Disorder in Adolescents

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