Sleep Disturbances in Pediatric Bipolar Disorder: A Comparison between Bipolar I and Bipolar NOS

Introduction: The diagnosis of bipolar disorder (BD) in youths has been controversial, especially for the subtype BD not otherwise specified (BD-NOS). In spite of growing evidence that sleep is a core feature of BD, few studies characterize and compare sleep disturbances in youth with BD type I (BD-I) and BD-NOS. Sleep disturbances are frequently reported in clinical descriptions of children and adolescents with BD, however the reporting of the frequency and characteristics of sleep symptoms in youth with BD-NOS and BD-I during episodes remain poor. This study compares symptom of sleep disturbance as occurring in manic and depressive episodes in BD-I and BD-NOS youth using Kiddie-schedule for affective disorders and schizophrenia, present and lifetime version (K-SADS-PL) interview data. The study also addresses whether symptoms of sleep disturbance vary in different age groups. Materials and Methods: The sample consisted of 70 children and adolescent outpatients at an urban specialty clinic (42M/28F, 10.8 ± 3.6 years old) including 24 BD-I and 46 BD-NOS assessed using K-SADS-PL-parent interview. Results: Sleep disturbances including insomnia and decreased need for sleep were reported by 84.3% of the sample. Enuresis was diagnosed in 27% of sample. There were no significant differences in frequency of sleep symptoms between BD-I and BD-NOS. Regardless of BD subtype, current functioning was negatively correlated with decreased need for sleep but not insomnia, and regardless of BD subtype. Conclusion: The majority of youth with BD presents with sleep symptoms during mood episodes. BD-NOS presents with the same proportion of sleep symptoms as BD-I in our sample

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

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

Establishing average values for actigraphy or normal ones?

In “Establishing normal values for pediatric nighttime sleep measured by actigraphy: a systematic review and meta-analysis,” Galland et al. compiled evidence on sleep norms from 87 articles which used actigraphy in youth aged 0 to 18 [1]. The authors suggest that the resulting average actigraphic sleep duration could serve as normative data [1]. Although this effort has enormous value given the dearth of data on sleep duration in children and adolescents and the authors acknowledge that their findings are not “sufficient to guide sleep recommendations,” the implications of their results must be considered with caution. The terms normative and normal can have two distinct meanings. Normal or normative can be descriptive, i.e. characterizing reality, or prescriptive, i.e. informing behavioral objectives or treatment needs. The American Academy of Pediatrics (AAP) recently provided an instructive example of how this distinction can affect clinical practice. The AAP lowered the normal (i.e. prescriptive) blood pressure values in children and adolescents after excluding obese youth from the reference sample [2]. Similarly, guidelines for desirable BMI have not been adjusted upwards despite widespread evidence of increasing population BMI. As sleep scientists and clinicians, we are all aware that sleep cannot be assessed in a vacuum. Optimal sleep durations need to address the issues of functioning, mental health, and, ideally for youth, of development. The American Academy of Sleep Medicine (AASM) released consensus recommendations for pediatric sleep 2 years ago [3]. Galland et al. found significantly shorter sleep durations than those suggested by AASM

Sleep quality and in-person versus online social interaction during the early COVID-19 pandemic lockdown: Impact on affect and interpersonal needs among young adults

We examined relationships among sleep quality and forms of social interaction (in-person vs. online) as predictors of change in affect and interpersonal needs (perceived burdensomeness, thwarted belongingness) – correlates of suicidal thoughts and behaviors – during the early COVID-19 pandemic lockdown. New York City undergraduates (N ​= ​58) from four public colleges completed a baseline survey and daily diaries up to 30 days in April-June 2020. Adjusting for relevant covariates, better sleep quality and in-person communication predicted greater positive affect and lower negative affect over time, but online social interaction only predicted greater positive affect and did not predict negative affect. Better sleep quality predicted lower perceived burdensomeness but not thwarted belongingness. Both in-person and online social interaction – but not total hours on social media – predicted lower thwarted belonging and perceived burdensomeness. Greater hours spent on social media each day lessened the relationship between in-person interaction and positive affect and lessened the buffering effect of in-person interaction on perceived burdensomeness. Improving sleep quality and increasing in-person interaction may ameliorate psychological variables that increase risk for suicidal thoughts and behaviors. However, when in-person interaction is limited, such as during the COVID-19 pandemic, online social interaction might be encouraged – depending on the nature of the interactions – to increase positive affect and buffer against suicide-related factors

Teaching evidence-based approaches to suicide risk assessment and prevention that enhance psychiatric training.

This report describes one in a series of National Institute of Health (NIH) supported conferences aimed at enhancing the ability of leaders of psychiatry residency training to teach research literacy and produce both clinician-scholars and physician-scientists in their home programs. Most psychiatry training directors would not consider themselves research scholars or even well-schooled in evidence based practice. Yet they are the front line educators to prepare tomorrow's psychiatrists to keep up with, critically evaluate, and in some cases actually participate in the discovery of new and emerging psychiatric knowledge. This annual conference is meant to help psychiatry training directors become more enthusiastic, knowledgeable and pedagogically prepared to create research-friendly environments at their home institutions, so that more trainees will, in turn, become research literate, practice evidence-based psychiatry, and enter research fellowships and careers. The overall design of each year's meeting is a series of plenary sessions introducing participants to new information pertaining to the core theme of that year's meeting, integrated with highly interactive small group teaching sessions designed to consolidate knowledge and provide pragmatic teaching tools appropriate for residents at various levels of training. The theme of each meeting, selected to be a compelling and contemporary clinical problem, serves as a vehicle to capture training directors' attention while teaching relevant brain science, research literacy and effective pedagogy. This report describes the content and assessment of the 2011 annual pre-meeting, "Evidence-based Approaches to Suicide Risk Assessment and Prevention: Insights from the Neurosciences and Behavioral Sciences for use in Psychiatry Residency Training.

Teaching evidence-based approaches to suicide risk assessment and prevention that enhance psychiatric training

This report describes one in a series of National Institute of Health (NIH) supported conferences aimed at enhancing the ability of leaders of psychiatry residency training to teach research literacy and produce both clinician-scholars and physician-scientists in their home programs. Most psychiatry training directors would not consider themselves research scholars or even well-schooled in evidence based practice. Yet they are the front line educators to prepare tomorrow’s psychiatrists to keep up with, critically evaluate, and in some cases actually participate in the discovery of new and emerging psychiatric knowledge. This annual conference is meant to help psychiatry training directors become more enthusiastic, knowledgeable and pedagogically prepared to create research-friendly environments at their home institutions, so that more trainees will, in turn, become research literate, practice evidence-based psychiatry, and enter research fellowships and careers. The overall design of each year’s meeting is a series of plenary sessions introducing participants to new information pertaining to the core theme of that year’s meeting, integrated with highly interactive small group teaching sessions designed to consolidate knowledge and provide pragmatic teaching tools appropriate for residents at various levels of training. The theme of each meeting, selected to be a compelling and contemporary clinical problem, serves as a vehicle to capture training directors’ attention while teaching relevant brain science, research literacy and effective pedagogy. This report describes the content and assessment of the 2011 annual pre-meeting, “Evidence-based Approaches to Suicide Risk Assessment and Prevention: Insights from the Neurosciences and Behavioral Sciences for use in Psychiatry Residency Training.