scholarly journals Do We Really Know How to Treat a Child with Bipolar Disorder or One with Severe Mood Dysregulation? Is There a Magic Bullet?

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Rajeev Jairam ◽  
Mukesh Prabhuswamy ◽  
Pravin Dullur
Keyword(s):  
Bipolar Disorder ◽  
Maintenance Treatment ◽  
Mood Stabilizers ◽  
Disruptive Behaviour ◽  
Magic Bullet ◽  
Dsm V ◽  
Disruptive Behaviour Disorders ◽  
The Status ◽  
Severe Mood Dysregulation ◽  
Mood Dysregulation

Background. Despite controversy, bipolar disorder (BD) is being increasingly diagnosed in under 18s. There is scant information regarding its treatment and uncertainty regarding the status of “severe mood dysregulation (SMD)” and how it overlaps with BD. This article collates available research on treatment of BD in under 18s and explores the status of SMD.Methods. Literature on treatment of BD in under 18s and on SMD were identified using major search engines; these were then collated and reviewed.Results. Some markers have been proposed to differentiate BD from disruptive behaviour disorders (DBD) in children. Pharmacotherapy restricted to short-term trials of mood-stabilizers and atypical-antipsychotics show mixed results. Data on maintenance treatment and non-pharmacological interventions are scant. It is unclear whether SMD is an independent disorder or an early manifestation of another disorder.Conclusions. Valproate, lithium, risperidone, olanzapine, aripiprazole and quetiapine remain first line treatments for acute episodes in the under 18s with BD. Their efficacy in maintenance treatment remains unclear. There is no validated treatment for SMD. It is likely that some children who are currently diagnosed with BD and DBD and possibly most children currently diagnosed with SMD will be subsumed under the proposed category in the DSM V of disruptive mood dysregulation disorder with dysphoria.

Bipolar Disorder in Children and Adolescents: Current Challenges

1997 ◽  
Vol 42 (6) ◽  
pp. 632-636 ◽  
Author(s):  
Margaret Steele ◽  
Sandra Fisman
Keyword(s):  
Bipolar Disorder ◽  
Children And Adolescents ◽  
Lithium Carbonate ◽  
Mood Stabilizers ◽  
Disruptive Behaviour ◽  
Juvenile Onset ◽  
Case Examples ◽  
Developmental Factors ◽  
Disruptive Behaviour Disorders ◽  
Case Vignettes

Objective: To demonstrate the diagnostic and treatment challenges in juvenile-onset bipolar disorder. Method: Three case vignettes are outlined to demonstrate different bipolar presentations in children and adolescents. Results: These case examples illustrate important issues in the diagnosis and management of juvenile-onset bipolar disorder. These issues include diagnostic confusion with atypical initial presentation and the effect of developmental factors on symptom expression. The relationship among genetic risk, early affective instability, and the stress generated by affectively ill family members is complex and circular. Comorbidity with disruptive behaviour disorders, as well as anxiety disorders, is demonstrated by the cases discussed. Comorbid disorders may affect outcome and require separate treatment intervention. There is evidence for the prophylactic antimanic effect of lithium carbonate in children and adolescents, but its specificity as an antimanic agent is still uncertain. There is less evidence, at present, for effectiveness of other mood stabilizers in this age group, although sodium valproate may prove more effective in mixed mania and rapid cycling, which are so often seen with early-onset bipolar disorder. Conclusions: While the existence of juvenile-onset bipolar disorder is no longer in dispute, several outstanding issues related to diagnosis and long-term management remain. Careful prospective research will be necessary to sort out these issues definitively.

Prescribing practices of Indian psychiatrists in the treatment of bipolar disorder

2019 ◽  
Vol 53 (5) ◽  
pp. 458-469 ◽  
Author(s):  
YC Janardhan Reddy ◽  
Venugopal Jhanwar ◽  
Rajesh Nagpal ◽  
MS Reddy ◽  
Nilesh Shah ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Maintenance Treatment ◽  
Bipolar Depression ◽  
Mood Stabilizer ◽  
Self Report ◽  
Mood Stabilizers ◽  
Prescribing Practices ◽  
Term Outcome ◽  
Cross Sectional ◽  
Long Term Outcome

Objective: The treatment of bipolar disorder is challenging because of its clinical complexity and availability of multiple treatment options, none of which are ideal mood stabilizers. This survey studies prescription practices of psychiatrists in India and their adherence to guidelines. Method: In total, 500 psychiatrists randomly selected from the Indian Psychiatric Society membership directory were administered a face-to-face 22-item questionnaire pertaining to the management of bipolar disorder. Results: For acute mania, most practitioners preferred a combination of a mood stabilizer and an atypical antipsychotic to monotherapy. For acute depression, there was a preference for a combination of an antidepressant and a mood stabilizer over other alternatives. Electroconvulsive therapy was preferred in the treatment of severe episodes and to hasten the process of recovery. Approximately, 50% of psychiatrists prescribe maintenance treatment after the first bipolar episode, but maintenance therapy was rarely offered lifelong. While the majority (85%) of psychiatrists acknowledged referring to various clinical guidelines, their ultimate choice of treatment was also significantly determined by personal experience and reference to textbooks. Limitations: The study did not study actual prescriptions. Hence, the responses to queries in the survey are indirect measures from which we have tried to understand the actual practices, and of course, these are susceptible to self-report and social-desirability biases. This was a cross-sectional study; therefore, temporal changes in responses could not be considered. Conclusion: Overall, Indian psychiatrists seemed to broadly adhere to recommendations of clinical practice guidelines, but with some notable exceptions. The preference for antidepressants in treating depression is contrary to general restraint recommended by most guidelines. Therefore, the efficacy of antidepressants in treating bipolar depression in the context of Indian psychiatrists’ practice needs to be studied systematically. Not initiating maintenance treatment early in the course of illness may have serious implications on the long-term outcome of bipolar disorder.

scholarly journals Cross-sectional and longitudinal abnormalities in brain structure in children with severe mood dysregulation or bipolar disorder

2012 ◽  
Vol 53 (11) ◽  
pp. 1149-1156 ◽  
Author(s):  
Nancy E. Adleman ◽  
Stephen J. Fromm ◽  
Varun Razdan ◽  
Reilly Kayser ◽  
Daniel P. Dickstein ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Brain Structure ◽  
Cross Sectional ◽  
Severe Mood Dysregulation ◽  
Mood Dysregulation

scholarly journals Different neural pathways to negative affect in youth with pediatric bipolar disorder and severe mood dysregulation

2011 ◽  
Vol 45 (10) ◽  
pp. 1283-1294 ◽  
Author(s):  
Brendan A. Rich ◽  
Frederick W. Carver ◽  
Tom Holroyd ◽  
Heather R. Rosen ◽  
Jennifer K. Mendoza ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Negative Affect ◽  
Pediatric Bipolar Disorder ◽  
Neural Pathways ◽  
Severe Mood Dysregulation ◽  
Mood Dysregulation

Differential Diagnosis of Borderline Personality Disorder from Bipolar Disorder

2010 ◽  
Vol 32 (3) ◽  
pp. 189-205 ◽  
Author(s):  
Gregory Hatchett
Keyword(s):  
Bipolar Disorder ◽  
Differential Diagnosis ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Atypical Antipsychotics ◽  
Treatment Approach ◽  
Borderline Personality ◽  
Mood Stabilizers ◽  
Health Counseling ◽  
Dsm V

Many psychiatrists have reconceptualized borderline personality disorder (BPD) as a variant of bipolar disorder and, consistent with the treatment of bipolar disorder, emphasize the use of mood stabilizers and atypical antipsychotics in treatment. This change in diagnostic practice is unfortunate. BPD is a distinct diagnostic construct, and clients who fit this pattern require a fundamentally different treatment approach than what is typically recommended for bipolar disorder. The purpose of this article is to update counselors on the expansion of bipolar disorder in the psychiatric literature, present evidence for the validity of BPD, discuss strategies for the differential diagnosis of it from bipolar disorder, review proposed changes in DSM-V, and integrate the literature into a mental health counseling framework.

scholarly journals Affective prosody labeling in youths with bipolar disorder or severe mood dysregulation

2011 ◽  
Vol 53 (3) ◽  
pp. 262-270 ◽  
Author(s):  
Christen M. Deveney ◽  
Melissa A. Brotman ◽  
Ann Marie Decker ◽  
Daniel S. Pine ◽  
Ellen Leibenluft
Keyword(s):  
Bipolar Disorder ◽  
Affective Prosody ◽  
Severe Mood Dysregulation ◽  
Mood Dysregulation

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

2013 ◽  
Vol 38 (6) ◽  
pp. 407-416 ◽  
Author(s):  
Pilyoung Kim ◽  
Joseph Arizpe ◽  
Brooke Rosen ◽  
Varun Razdan ◽  
Catherine Haring ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Facial Emotion ◽  
Severe Mood Dysregulation ◽  
Mood Dysregulation

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

2008 ◽  
Vol 20 (2) ◽  
pp. 529-546 ◽  
Author(s):  
Brendan A. Rich ◽  
Mary E. Grimley ◽  
Mariana Schmajuk ◽  
Karina S. Blair ◽  
R. J. R. Blair ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Emotional Expression ◽  
Family Relationships ◽  
Manic Episode ◽  
Dysfunctional Family ◽  
Social Reciprocity ◽  
History Of ◽  
Severe Mood Dysregulation ◽  
Intensity Of Emotion ◽  
Mood Dysregulation

AbstractChildren with narrow phenotype bipolar disorder (NP-BD; i.e., history of at least one hypomanic or manic episode with euphoric mood) are deficient when labeling face emotions. It is unknown if this deficit is specific to particular emotions, or if it extends to children with severe mood dysregulation (SMD; i.e., chronic irritability and hyperarousal without episodes of mania). Thirty-nine NP-BD, 31 SMD, and 36 control subjects completed the emotional expression multimorph task, which presents gradations of facial emotions from 100% neutrality to 100% emotional expression (happiness, surprise, fear, sadness, anger, and disgust). Groups were compared in terms of intensity of emotion required before identification occurred and accuracy. Both NP-BD and SMD youth required significantly more morphs than controls to label correctly disgusted, surprised, fearful, and happy faces. Impaired face labeling correlated with deficient social reciprocity skills in NP-BD youth and dysfunctional family relationships in SMD youth. Compared to controls, patients with NP-BD or SMD require significantly more intense facial emotion before they are able to label the emotion correctly. These deficits are associated with psychosocial impairments. Understanding the neural circuitry associated with face-labeling deficits has the potential to clarify the pathophysiology of these disorders.

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