Psychiatry - October 2008 - (Page 41)

appeared to have a more significant past histories, including more risk factors for suicidality, more medication trials, and more psychiatric hospitalizations. As such, they looked more like adults with bipolar disorder. Despite these factors, they improved much better under the current treatment conditions. One wonders if this finding is related to a better understanding of the treatment needs of bipolar patients compared to severely mood disordered patients. In this regard, upon reviewing the specific medications, it is of note that, at endpoint, there were significant differences in the pharmacotherapy of the two conditions: Many more patients with bipolar disorder were taking anticonvulsant mood stabilizers (42% versus 5%), while 14 percent of mood disorder NOS patients received no longer mood stabilization (0% in bipolar group). One finding, contrary to research results, was the increased incidence of a family history of bipolar disorder in mood disorder NOS patients. This finding, however, is difficult to interpret without direct evaluation of the family members. Indeed, in realworld settings, not only youth but also adults may be overdiagnosed with bipolar disorder, as such inflating the reported family histories. In summary, this study shows the feasibility of putting standardized assessment tools into place in a busy clinic setting. In doing so, guidelines for diagnosing youth with different mood problems can be followed. This has led to the identification of significant differences in the outcome between patients with bipolar disorder and mood disorder NOS. 8. 9. REFERENCES 1. Blader JC, Carlson GA. Increased rates of bipolar disorder diagnoses among US child, adolescent, and adult inpatients, 1996–2004. Biol Psychiatry. 2007; Feb 16 (ePub). Youngstrom EA, Birmaher B, Findling RL. Pediatric bipolar disorder: validity, phenomenology, and recommendations for diagnosis. Bipolar Disorders. 2008;10:194–214. Weller EB, Calvert SM, Weller RA. Bipolar disorder in children and adolescents: diagnosis and treatment. Curr Opin Psychiatry. 2003;16(4):383–388. Kuehn BM. Scientists probe child bipolar disorder. JAMA. 2007;297:1181. Brotman MA, Schmajuk M, Rich BA, et al. Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children. Biol Psychiatry. 2006;60:991–997. Leibenluft E, Charney DS, Towbin KE, et al. Defining clinical phenotypes of juvenile mania. Am J Psychiatry. 2003;160:430–437. Sheehan DV, Lecrubier Y, Sheehan K, et al. The validity of the Mini 2. 10. 3. 11. 4. 5. 12. 6. 13. 7. International Neuropsychiatric Interview (MINI), according to the SCID-P and its reliability. Eur Psychiatry. 1997;12:232–241. Gadow KD, Sprafkin J. Adolescent Symptom Inventory-4. Stony Brook, NY: Checkmate Plus LTD, 1997. Geller B, Zimmerman B, Williams M, et al. Phenomenology of prepubertal and early adolescent bipolar disorder: examples of elated mood, grandiose behaviors, decreased need for sleep, racing thoughts and hypersexuality. J Child Adolesc Psychopharmacol. 2002;12:3–9. Bastiaens L. A non-randomized, open study with aripiprazole and ziprasidone for the treatment of aggressive behaviors in youth in a community clinic. Comm Ment Health J. 2008, in press. Rich BA, Schmajuk M, Perez-Edgar KE, et al. Different psychophysiological and behavioral responses elicited by frustration in pediatric bipolar disorder and severe mood dysregulation. Am J Psychiatry. 2007;164:309–317. Brotman MA, Kassem L, Reising MM, et al. Parental diagnoses in youth with narrow phenotype bipolar disorder or severe mood dysregulation. Am J Psychiatry. 2007;164:1238–1241 Carlson GA. Who are the children with severe mood dysregulation, a.k.a. “rages”? Am J Psychiatry. 2007;164:1140–1142. [OCTOBER] Psychiatry 2008 41

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Psychiatry - October 2008 Editor’s Message Editorial Advisory Board Contents Psych Rx Treatment of Migraine and the Role of Psychiatric Medications Play Therapy: A Case-based Example of a Nondirective Approach Delirium and Antipsychotics: A Systematic Review of Epidemiologyand Somatic Treatment Options Severely Mood-disordered Youth Respond Less Well to Treatment in a Community Clinic than Youth with Bipolar Disorder Beyond Informed Consent: The Ethics of Informing, Anticipating, and Warning Asthma: Wheezing, Woes, and Worries Classified Advertising Journal Watch Information for Authors

Psychiatry - October 2008

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