Cognitive flexibility and performance in children and adolescents with threshold and sub-threshold bipolar disorder

Greater understanding of cognitive function in children and adolescents with bipolar disorder (BD) is of critical importance to improve our ability to design targeted treatments to help with real-world impairment, including academic performance. We sought to evaluate cognitive performance among children with either BD type I, II, or “not otherwise specified” (NOS) participating in multi-site Course and Outcome of Bipolar Youth study compared to typically developing controls (TDC) without psycho-pathology. In particular, we sought to test the hypothesis that BD-I and BD-II youths with full threshold episodes of mania or hypomania would have cognitive deficits, including in reversal learning, vs. those BD-NOS participants with sub-threshold episodes and TDCs. N = 175 participants (BD-I = 81, BD-II = 11, BD-NOS = 28, TDC = 55) completed Cambridge Neuropsychological Automated Testing Battery (CANTAB) tasks. A priori analyses of the simple reversal stage of the CANTAB intra-/extra-dimensional shift task showed that aggregated BD-I/II participants required significantly more trials to complete the task than either BD-NOS participants with sub-syndromal manic/hypomanic symptoms or than TDCs. BD participants across sub-types had impairments in sustained attention and information processing for emotionally valenced words. Our results align with prior findings showing that BD-I/II youths with distinct episodes have specific alterations in reversal learning. More broadly, our study suggests that further work is necessary to see the interaction between neurocognitive performance and longitudinal illness course. Additional work is required to identify the neural underpinnings of these differences as targets for potential novel treatments, such as cognitive remediation

Homosexuality and suicide: A case report

Despite the inconsistency in data concerning the higher prevalence of mental disorders among homosexuals than heterosexuals, suicidality in homosexuals, particularly among adolescents and young adults have been consistently reported to be higher over the past 25 years . It has been recently stated that gay youth are 2 to 3 times more likely to attempt suicide than other young people which may comprise up to 30% of completed youth suicides annually. In this case report, we presented a young gay patient who attempted suicide and discussed the major causes of this attempt, primarily sexual prejudice of the society and possible therapeutic approaches.Despite the inconsistency in data concerning the higher prevalence of mental disorders among homosexuals than heterosexuals, suicidality in homosexuals, particularly among adolescents and young adults have been consistently reported to be higher over the past 25 years . It has been recently stated that gay youth are 2 to 3 times more likely to attempt suicide than other young people which may comprise up to 30% of completed youth suicides annually. In this case report, we presented a young gay patient who attempted suicide and discussed the major causes of this attempt, primarily sexual prejudice of the society and possible therapeutic approaches

Evaluation of obsessive and depressive symptoms in children with heart diseases: A comperative clinical study

Bu çalışmanın amacı kalp hastalığı olan çocuklarda obsesif ve depresif belirtilerin değerlendirilmesidir. Çukurova Üniversitesi Tıp Fakültesi Çocuk Kardiyoloji Bilim Dalı'nda tanı konmuş, romatizmal kalp hastalığı olan 19 ve doğumsal kalp hastalığı olan 17 çocuk Ç.Ü.T.F. Çocuk Ruh Sağlığı ve Hastalıkları ABD tarafından değerlendirildi. Karşılaştırma grubu aynı yaş ve cinsiyetten 36 sağlıklı çocuktan oluştu. Her iki gruba çocuklar için depresyon ölçeği ve Maudsley obsesif kompulsif soru listesi verildi. Kalp hastalığı olan grup kendi içinde ve karşılaştırma grubuyla, depresif ve obsesif belirtiler açısından karşılaştırıldı. Çalışmada klinik olarak depresyon ve obsesif kompulsif bozukluk tanısını alan çocuk olmamasına karşın, kalp hastalığı olan çocuklarda toplam, yavaşlık ve kuşku obsesif belirti puanları anlamlı olarak daha yüksek bulundu. Depresif belirti puanları sağaltım almama ve devinim kısıtlılığı olması ile ilişkili olarak yükselmekteydi. Bulgular yurtiçi ve yurtdışı kaynaklar ile birlikte tartışılmıştır.In this study it is aimed to evaluate obsession and depression symptoms in children with heart diseases. 17 children with congenital heart disaeses, 19 children with acute romatismal heart diseases diagnosed in the Pédiatrie Cardiology Department in Çukurova University Faculty of Medicine are evaluated at Child Psychiatry Department, Çukurova University Faculty of Medicine, Adana. Control group consisted of 36 healty children with same age and sex. Depression inventory for children and Maudsley obsessive compulsive questionnaire were administered to both groups. Children with heart diseases were compared by means of depressive and obsessive symptoms, and compared with control group. No children were diagnosed as depressive or obsessive-compulsive, but children with heart diseases got higher total, slowness and doubt obsession scores. Depressive symptom scores were correlated with having no treatment and physical disability. Results are discussed regarding to national and foreign studies

Depression and anxiety in chronic renal failure

Çocukların organik hastalıklara tepkisi; yaş, gelişim evresi, hastalığın getirdiği zorluklar, sağaltımın türü ve yan etkileri, kısıtlamalar, hastalığın algılanması, diğer insanların tepkileri, duygularını yeniden düzenleme ve kişilik gibi etmenlerin sonucu olarak gelişmektedir. Hemodiyaliz, son dönem böbrek yetmezliği olan çocuğun yaşamını uzatmış, ancak çocuğun hastalığa verdiği tepkileri de etkilemiştir. Bu çalışmada, Çocuklar İçin Depresyon Ölçeği ve Durumluk-Sürekli Kaygı Ölçeği ile son dönem böbrek yetmezliği olan ve hemodiyaliz sağaltımındaki 20 ergen değerlendirildi. Kronik böbrek yetmezliği olan ve konservatif sağaltım yöntemleri ile izlenen 20 ergenle karşılaştırıldı. Depresif belirti puanları ortalama değerlerde, kaygı puanları her iki grupta da yüksek olarak belirlendi. Sonuçlar, hemodiyaliz ve konservatif sağaltım alan hastaların depresyon ve kaygı puanları arasında istatiksel olarak anlamlı bir fark olmadığını göstermektedir.How children react to an illness is a reflection of their age; stage of development; discomfort from the illness; the type of treatment and its side effects; the limitations placed on them; their understanding of the illness; the reactions of other other persons and their emotional makeup and personality. Hemodialysis has prolonged the lifetime of children with endstage renal disease, but it effects most of the factors related with children reaction to the illness. In this study, State-Trait Anxiety Inventory and Depression Scale For Children administered to twenty adolescent with endstage renal disease who receive hemodialysis therapy, and as a control group twenty adolescent with chronic renal failure who had followed with conservative therapy. Depression scores were moderate , but anxiety scores were high in both groups. The results showed that the group receiving hemodialysis therapy and the group going on conservative therapy had no statistically difference according depression and anxiety scores

Parsing cyclothymic disorder and other specified bipolar spectrum disorders in youth

ObjectiveMost studies of pediatric bipolar disorder (BP) combine youth who have manic symptoms, but do not meet criteria for BP I/II, into one "not otherwise specified" (NOS) group. Consequently, little is known about how youth with cyclothymic disorder (CycD) differ from youth with BP NOS. The objective of this study was to determine whether youth with a research diagnosis of CycD (RDCyc) differ from youth with operationalized BP NOS.MethodParticipants from the Course and Outcome of Bipolar Youth study were evaluated to determine whether they met RDCyc criteria. Characteristics of RDCyc youth and BP NOS youth were compared at baseline, and over eight-years follow-up.ResultsOf 154 youth (average age 11.96 (3.3), 42% female), 29 met RDCyc criteria. RDCyc youth were younger (p = .04) at baseline. Over follow-up, RDCyc youth were more likely to have a disruptive behavior disorder (p = .01), and were more likely to experience irritability (p = .03), mood reactivity (p = .02), and rejection sensitivity (p = .03). BP NOS youth were more likely to develop hypomania (p = .02), or depression (p = .02), and tended to have mood episodes earlier in the eight-year follow-up period.LimitationsRDCyc diagnoses were made retrospectively and followed stringent criteria, which may highlight differences that, under typical clinical conditions and more vague criteria, would not be evident.ConclusionThere were few differences between RDCyc and BP NOS youth. However, the ways in which the groups diverged could have implications; chronic subsyndromal mood symptoms may portend a severe, but ultimately non-bipolar, course. Longer follow-up is necessary to determine the trajectory and outcomes of CycD symptoms

A Risk Calculator to Predict the Individual Risk of Conversion From Subthreshold Bipolar Symptoms to Bipolar Disorder I or II in Youth

ObjectiveYouth with subthreshold mania are at increased risk of conversion to bipolar disorder (BP) I/II. Predictors for conversion have been published for the group as a whole. However, risk factors are heterogeneous, indicating the need for personalized risk assessment.MethodOne hundred forty youth with BP not otherwise specified (BP-NOS; 6-17 years old) followed through the Course and Outcome of Bipolar Youth (COBY) study with at least 1 follow-up assessment before conversion to BP-I/II were included. Youths were assessed on average every 7 months (median 11.5 years) using standard instruments. Risk predictors reported in the literature were used to build a 5-year risk calculator. Discrimination was measured using the time-dependent area under the curve after 1,000 bootstrap resamples. Calibration was evaluated by comparing observed with predicted probability of conversion. External validation was performed using an independent sample of 58 youths with BP-NOS recruited from the Pittsburgh Bipolar Offspring Study.ResultsSeventy-five (53.6%) COBY youths with BP-NOS converted to BP-I/II, of which 57 (76.0%) converted within 5 years. Earlier-onset BP-NOS, familial hypomania/mania, and high mania, anxiety, and mood lability symptoms were important predictors of conversion. The calculator showed excellent consistency between the predicted and observed risks of conversion, good discrimination between converters and non-converters (area under the curve 0.71, CI 0.67-0.74), and a proportionally increasing rate of converters at each successive risk class. Discrimination in the external validation sample was good (area under the curve 0.75).ConclusionIf replicated, the risk calculator would provide a useful tool to predict personalized risk of conversion from subsyndromal mania to BP-I/II and inform individualized interventions and research

Longitudinal Course of Bipolar Disorder in Youth With High-Functioning Autism Spectrum Disorder

ObjectiveTo provide the first longitudinal characterization of mood and psychosocial functioning in youth with comorbid bipolar (BD) and autism spectrum (ASD) disorders.MethodThe Course and Outcome of Bipolar Youth study followed 368 youth (aged 7-17 years) with DSM-IV bipolar I (BP-I), BP-II, or Not Otherwise Specified (NOS) for, on average, 9 years using the Longitudinal Interval Follow-up Evaluation. This subgroup analysis compared youth with and without ASD on clinical presentation, percentage of time with mood symptomatology, and psychosocial functioning.ResultsThirty youth (∼8%) met DSM-IV criteria for Asperger's disorder or pervasive developmental disorder-NOS (referred to here as ASD). Lifetime worst episode severity was similar in both groups, but youth with both BD and ASD (BD+ASD) had elevated rates of comorbid attention-deficit/hyperactivity and obsessive-compulsive disorders, were younger at intake, and had an earlier onset of mood symptoms. Over time, in both groups, the proportion of predominantly euthymic youth increased, and episode recurrence decreased. Compared to youth with BD, the clinical presentation of youth with BD+ASD more frequently involved distractibility, racing thoughts, depressed mood, social withdrawal, and low reactivity of negative mood states. ASD-related symptomatic differences were generally strongest early and decreased over time. Youth with BD+ASD had significantly greater impairment in friendships throughout follow-up.ConclusionYouth with BD+ASD exhibit typical BD mood symptoms but with earlier onset, mixed symptom presentation, and additive functional impairments. Significant amelioration of clinical symptoms occurred over time, suggesting that early recognition and treatment of mood disorders in youth with ASD may improve clinical outcomes

Sex Differences in the Longitudinal Course and Outcome of Bipolar Disorder in Youth.

Despite substantial literature on sex differences in adults with bipolar disorder (BD), little is known about this topic in youth; this study examines sex differences in mood symptomatology and psychiatric comorbidity in prospectively followed youth with BD. A subsample of the Course and Outcome of Bipolar Youth study (N = 370; female n = 199, male n = 171) enrolled October 2000-July 2006 (age at intake = 7-17.11 years) who met DSM-IV criteria for bipolar I disorder (BD-I; n = 221), bipolar II disorder (BD-II; n = 26), or operationalized BD not otherwise specified (BD-NOS; n = 123) with ≥ 4 years follow-up was included. Analyses examined sex differences at intake and, prospectively, in mood symptomatology and psychiatric comorbidity for a mean ± SD follow-up of 10.5 ± 1.72 years. Females were older than males at intake (mean ± SD age = 13.33 ± 3.32 vs 12.04 ± 3.16 years; P = .0002) and at age at mood onset (9.33 ± 4.22 vs 7.53 ± 3.74 years; P < .0001). After adjustment for confounders, males spent more time with syndromal ADHD (Padjusted = .001) and females spent more time with syndromal anxiety (Padjusted = .02). There were trends toward males spending more time with substance use disorder and females having more non-suicidal self-injurious behavior (Padjusted = .07 and .09, respectively). There were no sex differences on outcome variables, including rate of or time to recovery and recurrence. Contrasting with adult literature, this study identified minimal sex differences in the course of youth with BD. Longer-term studies are needed to clarify if youth-onset BD remains a "sex neutral" subtype of BD or diverges according to sex in adulthood