Validating cyclothymic disorder in a youth sample

Four subtypes of pediatric bipolar disorder (PBD) - bipolar I, bipolar II, cyclothymia and bipolar not otherwise specified (NOS) - are defined in DSM-IV-TR. However, these definitions are not followed consistently by research investigators or clinicians, resulting in a lack of agreement and understanding regarding the diagnosis of PBD. The present study uses the diagnostic validation method first proposed by Robins and Guze (1970), to systematically evaluate cyclothymic disorder as a distinct diagnostic subtype of bipolar disorder (BP). Using a clinical sample (N= 827), participants with cyclothymic disorder (N=52) were compared to participants with other BP disorders and to participants with non-affective disorders. Results indicate that cyclothymic disorder shares many characteristics with other bipolar subtypes, supporting its inclusion on the spectrum. Additionally, cyclothymia could be reliably differentiated from non-bipolar disorders based on irritability, sleep disturbance, age of symptom onset, comorbid diagnoses, and family history. These results highlight areas for future research

Does a Sensitive Palate Beget Sensitive Mmood? The Relation Between Supertasting and Disordered Mood

Objective: Prevalence rates of bipolar disorder may be as high as 11% (Angst et al., 2003); currently, research is being conducted on biologically-based traits, with the goal to find ways to ascertain a person’s risk for bipolar disorder, or to lend greater certainty to a diagnosis. One trait of interest is an individual’s ability to taste phenothioureas, a family of bitter-tasting compounds (Wooding, 2006). The aim of the present study is to determine whether this taste sensitivity has utility as a biomarker for mood disorder risk and, if so, whether emotional reactivity and regulation moderate this relation. Method: Participants (N=499) were undergraduates at the University of North Carolina at Chapel Hill. Participants completed a series of questionnaires related to their mood, emotion regulation, and family history of psychiatric disorder. Next, participants completed a mood induction paradigm. Finally, participants’ taste sensitivity was measured. Results: Three groups, based on taste sensitivity, were identified. Ratings of hypomania, family history of psychiatric disorder, psychological treatment seeking, and emotion regulation did not differ across groups. Scores on the BDI were related to taste sensitivity (p<.05), but this relation was driven primarily by outliers. Using regression, tasting predicted stronger responses to both positive and negative mood inductions (p<.05). Additionally, the interaction of negative emotion regulation and tasting predicted weaker responses to the mood inductions. Finally, emotion regulation strategies were predictive of both depression and hypomania scores (p<.05). Testing the effect sizes against the zone of indifference (r= ±0.2), only the emotion regulation strategies showed promise as predictors of mood disorder. Discussion: The present study represents the largest sample investigating mood and supertasting. Therefore, the low – or absent – effect size of taste sensitivity in the present analyses sheds doubt on the utility of taste sensitivity as a biomarker for mood disorder risk. However, there were trends to suggest that supertasters are more sensitive to their environment than nontasters and that they may have increased risk for depression. Additionally, taste – or threat – sensitivity may interact with negative emotion regulation strategies in intriguing ways. Future studies, using a clinical sample, may help to better elaborate the trends found in this study.Doctor of Philosoph

Cyclothymic disorder in youth: why is it overlooked, what do we know and where is the field headed?

Cyclothymic disorder is a chronic and impairing subtype of bipolar disorder, largely neglected in pediatric research. Consequently, it is rarely diagnosed clinically despite potentially being the most prevalent form of bipolar disorder. Lack of attention has added to confusion about the diagnosis and clinical presentation of cyclothymic disorder. In pediatric studies, cyclothymic disorder is commonly grouped with ‘subthreshold’ presentations of bipolar disorder under the undifferentiated label ‘bipolar disorder not otherwise specified’. However, research indicates that cyclothymic disorder can be reliably distinguished from the other forms of bipolar disorder and from other childhood disorders. Importantly, cyclothymic disorder may be a diathesis for more acute presentations of bipolar disorder, warranting a prominent role in dimensional models of mood and psychopathology. Current evidence suggests that cyclothymic disorder has the potential to make unique contributions to our understanding of the risk factors and outcomes associated with bipolar disorder. This potential has yet to be fully realized, limiting our knowledge and ability to intervene in a meaningful way with youth who are exhibiting symptoms of a major mood disorder. Including cyclothymic disorder in future research studies of children – particularly longitudinal outcome studies – is essential for understanding the developmental trajectory of bipolar spectrum disorders and learning how to accurately diagnosis and treat the full spectrum of bipolar disorders

Impact of Irritability and Impulsive Aggressive Behavior on Impairment and Social Functioning in Youth with Cyclothymic Disorder

Objective: Research on adults with cyclothymic disorder (CycD) suggests that irritability and impulsive aggression (IA) are highly prevalent among this population. Less is known about whether these behaviors might also distinguish youth with CycD from youth without CycD. Additionally, little is known about how irritability and IA relate to one another, and whether they are associated with different outcomes. This study aimed to compare irritability and IA across diagnostic subtypes to determine whether CycD is uniquely associated with these behaviors, and to assess how irritability and IA relate to youth social and general functioning

What goes up must come down: The burden of bipolar depression in youth

In the pediatric bipolar disorder literature, mania has eclipsed depression as the mood state of most interest. Though depressive episodes tend to be more prevalent and persisting than manic episodes, research about the associated consequences is limited. The goal of the present study was to compare the influences of depressive and manic symptoms on domains of functioning in which youth with bipolar disorder often demonstrate deficits

Blue blocking glasses worn at night in first year higher education students with sleep complaints: a feasibility study

Abstract Background Late adolescence and early adulthood is a period of highest incidence for onset of mental health problems. Transition to college environment has been associated with many risk factors such as the initial disruption—and subsequent irregularity—of the student’s sleep and activity schedule. We tested the feasibility of using blue blocking glasses (BBG) at night in first year higher education students with sleep complaints, to obtain preliminary evidence for the impact of BBG on sleep, activity, and mood. Methods Participants were 13 first year undergraduates (from 10 different academic courses) living on campus for the first time with sleep complaints/disorders confirmed at screening via the Duke Structured Interview Schedule for Sleep Disorders. We used a 2-week, balanced crossover design (BBG vs placebo glasses; participants were unaware which was the active intervention) with computer-generated random allocation. Exploratory analyses provided descriptive and frequency summaries to evaluate feasibility of the intervention. Results Preliminary evidence supports the feasibility and acceptability of the trial; almost all screened participants consented and completed the protocol with high adherence; missing data were negligible. Additionally, the effectiveness of BBGs to enhance sleep, mood, and activity levels in young adults was supported. Conclusions The results of this feasibility trial suggest that BBG have potential as an inexpensive and feasible intervention for reducing sleep and circadian dysregulation in young adult students. A larger trial, following this successfully implemented protocol, is necessary to fully test the efficacy of BBG

Clinical Decision Making About Child and Adolescent Anxiety Disorders Using the Achenbach System of Empirically Based Assessment

Anxiety disorders are common among children, but can be difficult to diagnose. An actuarial approach to the diagnosis of anxiety may improve the efficiency and accuracy of the process. The objectives of this study were to determine the clinical utility of the Achenbach CBCL and YSR, two widely used assessment tools, for diagnosing anxiety disorders in youth, and to aid clinicians in incorporating scale scores into an actuarial approach to diagnosis through a clinical vignette

Examining the validity of cyclothymic disorder in a youth sample: Replication and extension

Four subtypes of bipolar disorder (BP) – bipolar I, bipolar II, cyclothymia and bipolar not otherwise specified (NOS) – are defined in DSM-IV-TR. Though the diagnostic criteria for each subtype are intended for both adults and children, research investigators and clinicians often stray from the DSM when diagnosing pediatric bipolar disorder (PBD) (Youngstrom, 2009), resulting in a lack of agreement and understanding regarding the PBD subtypes

Blue Blocking Glasses Worn at Night in First Year Higher Education Students with Sleep Complaints:A Feasibility Study

Background: Late adolescence and early adulthood is a period of highest incidence for onset of mental health problems. Transition to college environment has been associated with many risk factors such as the initial disruption - and subsequent irregularity - of the student's sleep and activity schedule. We tested the feasibility of using blue blocking glasses (BBG) at night in first year higher education students with sleep complaints, to obtain preliminary evidence for the impact of BBG on sleep, activity and mood. Methods: Participants were thirteen first year undergraduates (from 10 different academic courses) living on campus for first time with sleep complaints/disorders confirmed at screening via the Duke Structured Interview Schedule for Sleep Disorders. We used a two-week, balanced crossover design (BBG vs placebo glasses; participants were unaware which was the active intervention) with computer-generated random allocation. Exploratory analyses provided descriptive and frequency summaries to evaluate feasibility of the intervention. Results: Preliminary evidence supports the feasibility and acceptability of the trial; almost all screened participants consented and completed the protocol with high adherence, missing data were negligible. Additionally, the effectiveness of BBGs to enhance sleep, mood and activity levels in young adults was supported. Conclusions: The results of this feasibility trial suggest that BBG have potential as an inexpensive and feasible intervention for reducing sleep and circadian dysregulation in young adult students. A larger trial, following this successfully-implemented protocol, is necessary to fully test the efficacy of BBG