[Adta] Fw: EXTREME IRRITABILITY: IS IT CHILDHOOD BIPOLAR DISORDER?

Thu Feb 1 12:30:39 EST 2007

Thought this would be of interest to some of you.  I would be curious to
know if you you think it has any implications for dance therapists?
Barbara Busse
----- Forwarded by Barbara A Busse/MCLibrary/mc/Duke on 02/01/2007 12:28 PM
-----

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             H.GOV>                    EXTREME IRRITABILITY:  IS IT        
                                       CHILDHOOD BIPOLAR DISORDER?         

             02/01/2007 09:26                                              
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U.S. Department of Health and Human Services
NATIONAL INSTITUTES OF HEALTH
NIH News
National Institute of Mental Health (NIMH)
<http://www.nimh.nih.gov/>

EMBARGOED FOR RELEASE: Thursday, February 1, 2007, 12:01 a.m. ET

CONTACT: Susan Cahill, 301-443-4536, <e-mail: NIMHpress at nih.gov>

EXTREME IRRITABILITY:  IS IT CHILDHOOD BIPOLAR DISORDER?
Brain's electrical signals provide clues.

Results of a new study may help improve the diagnosis and treatment of two
debilitating childhood mental disorders -- pediatric bipolar disorder (BD)
and a syndrome called severe mood dysregulation (SMD).  When the brain's
electrical signals were measured during mildly frustrating situations,
researchers from the National Institute of Mental Health (NIMH), of the
National Institutes of Health, found a very different pattern in children
with SMD, compared with children who had BD.  The results indicate that
different brain mechanisms may lead to irritability in children with SMD,
suggesting that they may have an illness other than BD and may require
different treatments.

"These aren't children with the occasional bad moods you see in most kids.
They're typically very ill, with symptoms that interfere with their lives
in major ways.  Establishing clear diagnostic criteria is an essential step
toward making sure they get the help they need," said NIMH Director Thomas
R. Insel, M.D.

Children have a comparatively low rate of BD, but the rate increases with
age, to approximately 1 percent among adolescents.  About 3 percent of
pre-adolescent and adolescent youth are estimated to have SMD.
Mood-stabilizing and antipsychotic medications are used to treat children
with BD, although the data on their effectiveness are limited and several
studies are underway.  Since SMD was only recently defined, there are no
systematic studies on its treatment, and children with SMD are often
treated as if they have BD.

Defining pediatric BD is a major issue in child psychiatry, because the
disorder tends to be severe in this age group and the rate of diagnosed
cases is rising.  Until recent years, most studies of BD were conducted in
adults.  Some researchers maintain that pediatric BD should be defined more
broadly to include children with SMD, an assertion countered by the new
finding.  Results of the study were published in the February 2007 issue of
the "American Journal of Psychiatry."

The classic definition of BD <
http://www.nimh.nih.gov/publicat/bipolarupdate.cfm> includes extreme,
sustained mood swings that range from over-excited, elated moods and
irritability -- the manic phase of the disorder -- to depression.  In
contrast, children with SMD are extremely irritable and hyperactive, but do
not have clear-cut manic episodes.

One component of irritability is the tendency to get acutely frustrated
when a goal is not met.  Thus, through electroencephalograms (EEGs), the
researchers could observe the brain's electrical signals that occurred
during frustration while children with either disorder performed simple
tasks.

The new study shows that clinicians some day could use biological
measurements, such as EEGs, to help make psychiatric diagnoses, in
combination with clinical symptoms.  Currently, clinicians diagnose mental
illnesses based on symptoms alone.  The difficulty of diagnosing BD in
children is compounded by the frequent co-occurrence of one or more other
mental disorders.

"We're approaching the day when we'll be able to use neuroscience
techniques to improve psychiatric diagnoses.  Pediatric BD has some of the
most pressing needs in this regard, because of its severity and because of
questions about how to best make the diagnosis," said senior author Ellen
Leibenluft, M.D., Chief of the Unit on Bipolar Spectrum Disorders in the
Emotion and Development Branch of the NIMH Mood and Anxiety Disorders
Research Program.

In this study, scientists obtained EEGs of 35 children with classic BD, 21
children with SMD, and 26 healthy children (average age 12 to13) while they
performed a task repeatedly; each time they did the task, they won or lost
10 cents.  The task was frustrating because the children often lost money.

The researchers found that while both the children with BD and those with
SMD became more frustrated than did healthy children performing the same
task, the brain mechanisms associated with their frustration differed.
Children with BD had an abnormality in the brain's P3 electrical signals,
which measure ability to purposefully direct attention, but children with
SMD had abnormalities in N1 signals, which occur when a stimulus grabs
someone's attention.  Both abnormalities suggest deficits in the brain's
attention-related activity, but in different phases of that activity.

"If future research indicates that BD and SMD are two separate disorders,
this could guide parents and physicians toward the right treatments," said
first author Brendan Rich, Ph.D., of the NIMH Unit on Bipolar Spectrum
Disorders.  "A good example is that medication prescribed for symptoms seen
in SMD, such as stimulant medication, might be inappropriate for a child
with classically defined bipolar disorder," he said.

NIMH scientists Mariana Schmajuk, B.S., and Daniel Pine, M.D., also
contributed to the research, as did University of Maryland scientists
Koraly E. Perez-Edgar, Ph.D., ("currently at George Mason University") and
Nathan A. Fox, Ph.D.

The National Institute of Mental Health (NIMH) mission is to reduce the
burden of mental and behavioral disorders through research on mind, brain,
and behavior. More information is available at the NIMH website: <
http://www.nimh.nih.gov/>.

The National Institutes of Health (NIH) -- The Nation's Medical Research
Agency -- includes 27 Institutes and Centers and is a component of the U.S.
Department of Health and Human Services. It is the primary federal agency
for conducting and supporting basic, clinical and translational medical
research, and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and its programs,
visit <www.nih.gov>.

###

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<http://www.nih.gov/news/pr/feb2007/nimh-01.htm>.

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