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EARLY AGE MANIA Anything New ? Paramjit T. Joshi, M.D. [email protected] Children’s National Medical Center George Washington University School of Medicine. EPIDEMIOLOGY PEDIATRIC BIPOLAR DISORDERS. No prevalence studies in pre-pubertal BPD 1% lifetime prevalence rate in adolescents - PowerPoint PPT Presentation
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EARLY AGE MANIAAnything New ?
Paramjit T. Joshi, [email protected]
Childrens National Medical Center George Washington University School of Medicine
EPIDEMIOLOGY PEDIATRIC BIPOLAR DISORDERSNo prevalence studies in pre-pubertal BPD1% lifetime prevalence rate in adolescents5.7% lifetime prevalence of sub-syndromal BPDIrritability the rule rather than the exceptionGrandiosity, poor judgementImpaired concentrationDO NOT MEET DURATION CRITERIAAdolescents with BPD and sub-syndromal BPD had significant psychosocial impairment by age 24 yearsLewinshon et al., 2000
As Adults !Childhood onset subjects were MOST likely to:Have non-remitting BPDProlonged episodesAntisocial PDChildhood & adolescent onset subjects had increased prevalence of Drug Use DisordersPrevalence of mixed episodes or irritability did not differ significantly between groups
Goldstein & Levitt, AJP 163:1633-1636, 2006
MANIC EPISODEDSM - IV: Lasting at least one week with A and three of B persistent symptoms:A. Expansive mood / irritabilityB. 1. Inflated self-esteem / grandiosity 2. Decreased need for sleep 3. More talkative / pressured speech than normal 4. Racing thoughts / flight of ideas 5. Easily distracted 6. Increase in goal-directed activity 7. Poor judgement or excessively involved in pleasurable but risky activities, hypersexuality
Core Symptoms of Bipolar Disorder
Extremely elevated mood Racing thoughts / flight of ideas Decreased need for sleep Grandiosity Poor judgement: hypersexualitydaredevil actssilliness, laughing uninhibited people seeking
BPD vs ADHDGeller et al., 2002
MANIA ITEMS
BPD(%)
ADHD(%)
Irritability
97
72
Grandiosity **
85
7
Elated mood **
87
5
Dare devil acts *
70
13
Uninhibited people
seeking
68
21
Silliness / laughing
65
21
Flight of ideas *
66
10
Accelerated speech
97
78
Hypersexuality **
45
8
Robert Post et al., Presented at the 3rd Annual NIMH P-BPD Conference, 2005
Rx of Early Age Mania (TEAM STUDY)Funded by the NIMH (2003-2009)AIM: To investigate the effectiveness of medications for C&A who have DSM-IV BP-1 (manic or mixed phase) mania540 subjects aged 6-15 years of ageNarrow BP phenotype based on WASH-U K-SADS interviews video-taped and reviewed by the coordinating site for consensus diagnosis
RESEARCH PLANInvestigate the effectiveness of Lithium (Li), Valproate (Val) and Risperidone (Rsp) as monotherapy and as add-on agents for childhood BP-1 (manic or mixed phase) mania
Explore the effects of psychosocial factors (e.g. parental warmth, parental BPD, family tension), discontinuation, compliance and outcome
TREATMENT OF EARLY AGE MANIA (TEAM) FLOW CHARTStratum OneDrug free strategy
Baseline: Antimanic drug freeRandomize: Li, Val, RspStratum TwoAdd-on strategyBaseline: On one drug withpartial responseRandomize: To add-on oneof two other drugsStratum ThreeCross-taper strategyBaseline: On one drug withpoor responseRandomize: To Cross-taper one of two other drugsScreening for EligibilityBaseline AssessmentsIneligible GivenClinical ReferralsBaseline AssessmentsIf eligible, assigned to one of Three Strata8 Week ProtocolIneligible GivenClinical ReferralsPartial RespondersRe-randomize: Within stratum two for another 8 weeksPoor RespondersRe-randomize: Within stratum three for another 8 weeks
Subjects Randomized: (All sites 315)AT CNMC:Total number of baseline subjects = 101Males 74%C: 46%AA: 44% H: 5% Other: 5%Number of randomized subjects = 67Strata 1 = 48Strata 2 = 5Strata 3 =14(Lost 34 due to either lack of diagnostic consensusagreement between sites or not meeting diagnostic criteriaat the completion of the baseline interviews)