Bipolar Disorder In Children And Teens, Landmark Study Released
19 Feb 2006

Children and teen-agers with bipolar disorder suffer from the illness differently than adults do. Their symptoms last longer and swing more swiftly from hyperactivity and recklessness to lethargy and depression.

This is the first major finding published from the Course and Outcome of Bipolar Illness in Youth, or COBY, research program. Under COBY, psychiatrists from Brown Medical School, the University of Pittsburgh, and the University of California-Los Angeles have studied more than 400 pediatric patients, some for as long as five years, to determine the course of bipolar disorder as well as gauge its behavioral and social effects. COBY is the largest and most comprehensive pediatric study of bipolar disorder to date.

In their first COBY publication, in the Archives of General Psychiatry, researchers report on 263 subjects aged 7 to 17 with bipolar spectrum disorder. Subjects were studied over a roughly two-year period and asked about mood, behavior, and medical treatment. The aim: Determine how bipolar disorder, in all its forms, progresses in children and teens.

Martin Keller, M.D., a pioneer in designing and conducting long-term studies of major psychiatric disorders, is principal investigator for the Brown Medical School research team.

"Bipolar disorder severely impairs functioning and has a high rate of related psychiatric and physical health issues, such as anxiety and substance abuse," said Keller, the Mary E. Zucker Professor and chair of the Department of Psychiatry and Human Behavior and psychiatrist-in-chief of Brown's seven affiliated hospitals. "These data are essential to improving diagnosis and treatment for a vulnerable population. The data can also inform the design of clinical drug trials so the trials have a maximum likelihood of identifying effective treatments."

Also known as manic-depressive illness, bipolar disorder is marked by dramatic changes in mood, energy level and behavior. One extreme is mania, which can be accompanied by extreme irritability, lack of sleep, poor judgment, restlessness and impulsiveness. The other extreme is depression, which can be characterized by hopelessness, fatigue and, in some cases, suicidal thoughts. These manic and depressive episodes are interspersed with milder symptoms and impaired function in a majority of patients.

Bipolar disorder often begins in late adolescence or early adulthood, although it can develop as early as the preschool years. According to the National Institute of Mental Health, about 2 million American adults suffer from bipolar disorder. At least another 750,000 children and teen-agers live with the illness, the Child & Adolescent Bipolar Foundation estimates.

The COBY study, however, shows that the illness runs a different course in young people than it does in adults. For example, study subjects with bipolar I - the classic form of the illness marked by swings between severe mania and major depression - had symptoms that lasted significantly longer than typically seen in adults.

Mood swings were also more frequent than reported in adults. In fact, researchers noted that many children and teens switched illness sub-types during the study period. For example, one-third of subjects diagnosed with bipolar disorder not otherwise specified - a milder version of the illness - converted to bipolar I or bipolar II during the course of follow-up. This was an important finding. While researchers suspected that such conversions might occur, this is the first large-scale study to clearly document the phenomenon.

"Although moodiness and irritability can be common and normal in teenagers, this study helps to clarify that when these symptoms are excessive, persistent and impairing, a bipolar spectrum illness should be considered," said Henrietta Leonard, M.D., professor of psychiatry and human behavior at Brown and a child psychiatrist with the Bradley Hasbro Children's Research Center.

Jeffrey Hunt, M.D., a clinical associate professor of psychiatry and human behavior and a child psychiatrist at Bradley Hospital, agreed: "For clinicians and parents, this study demonstrates the importance of systematic assessment and follow-up."

Other findings from the COBY study:

* more than two-thirds of subjects recovered from their first major manic or depressive episode in the first two years of follow-up;

* subjects had an average of 1.5 recurrences, particularly depressive episodes, each year during the two-year follow-up;

* subjects displayed symptoms about 60 percent of the time during follow-up visits;

* subjects whose illness starts in childhood displayed more symptoms at follow-up visits compared with subjects whose illness began in their teens.

Sylvia Valeri, a former assistant professor of psychiatry and human behavior at Brown Medical School, rounded out the Brown team. The National Institute of Mental Health funded the work.

Contact: Wendy Lawton
Wendy_Lawton@brown.edu
Brown University

What is Bipolar Disorder?

Study: Bipolar Kids Often More Creative
By Jennifer Warner
WebMD Medical News Reviewed By Louise Chang, MD
on Monday, November 14, 2005

LINK

Nov. 14, 2005 -- Children with or at risk for bipolar disorder may be more creative than other, healthy children, according to a new study.

Researchers found that a small group of children of bipolar parents scored significantly higher on a creativity index than other children. They say the findings add to a growing evidence of a link between mood disorders, like bipolar disorder, and creativity.

"I think it's fascinating," says researcher Kiki Chang, MD, assistant professor of psychiatry and behavioral sciences at Stanford University, in a news release. "There is a reason that many people who have bipolar disorder become very successful."

Researchers say many eminent artists, writers, and other creative individuals have been diagnosed with bipolar disorder, which is marked by dramatic shifts in a person's mood, energy, and ability to function.

But they say this is the first study to look at creativity in the children of bipolar parents, who are at increased risk of developing the disorder.

Bipolar Disorder May Contribute to Creativity

In the study, which appears in the Journal of Psychiatric Research, researchers examined creative characteristics in 40 families with at least one parent with bipolar disorder and their children. They compared them with 18 healthy adults and 18 of their healthy children. The children in the study ranged in age from 9 to 18.

Half of the children of bipolar parents also had the disorder, and the other half had attention deficit hyperactivity disorder (ADHD). Researchers say ADHD is often considered an early sign of bipolar disorder in children of parents with the condition.

All of the participants received a psychological evaluation and then completed a test that objectively measures creativity. The scoring is based on how people like or dislike figures of varying complexity and symmetry. Studies suggest that more creative people tend to "dislike" simple and symmetrical figures.

The results showed that the bipolar parents had 120% higher "dislike" scores than the healthy parents. Children with bipolar disorder and those with ADHD scored 107% and 91% higher, respectively, than the healthy children.

Researchers say the creativity found in people with bipolar disorder may stem from the mobilizing energy needed to transform negative emotion into some sort of solution to their problems.

"In this case, discontent is the mother of invention," says researcher Terence Ketter, MD, professor of psychiatry and behavioral sciences at Stanford, in the release.

SOURCES: Simeonova, D. Journal of Psychiatric Research, November 2005; vol 39: pp 623-631. News release, Stanford University.

Daily Routine May Help Bipolar Disorder
By Salynn Boyles, WebMD Medical News Reviewed By Brunilda Nazario, MD
on Thursday, September 08, 2005

LINK

Sept. 8, 2005 -- Most of us function better when we maintain a regular daily routine, but for people with bipolar disorder, routine may make a big difference in recovery.

Researchers from the University of Pittsburgh School of Medicine report that bipolar patients fared better when their treatment stressed the importance of establishing daily routines for things like sleeping and eating.

Social rhythm therapy, as it has been dubbed by the researchers, is based on the idea that irregular sleeping habits and those associated with other daily activities can trigger manic episodes by disturbing the body's sleep-wake (circadian system) clock.

"We see patients with bipolar disorder as having exquisitely sensitive and fragile body clocks," researcher Ellen Frank, PhD, tells WebMD. "They need to be more attentive than the rest of us to things like when they get up and go to bed and when they eat their meals."

'A Manageable Problem'

Once known as manic depression, bipolar disorder is characterized by extreme swings in mood, energy, and ability to function. Periods of highs and lows are referred to as manic or depressive episodes. Medications such as lithium are prescribed to people with bipolar disorder; these drugs can help stabilize mood swings.

According to the National Institute of Mental Health, more than 2 million Americans have bipolar disorder.

The study by Frank and colleagues included 175 severely ill patients with the disorder, all of whom were treated with medications. In addition, about half of the patients got social rhythm therapy from the beginning of the study.

The Importance of Routine

These patients learned the importance of establishing regular routines, and they also learned strategies for anticipating and coping with stress.

"We teach them to think of their illness the way someone with diabetes or asthma would; as a health problem that can be managed," Frank says. "A diabetic has to be careful about what they eat and when they eat. And people with asthma probably shouldn't have three dogs and two cats in the house."

The study is published in the September issue of the journal Archives of General Psychiatry.

No difference was seen between the two treatment groups in the time it took to emerge from a manic episode. But patients who got the social rhythm therapy had longer periods of stability between such episodes. Those who were most successful in establishing regular routines saw the most improvement.

The intervention translated into a 72% increase in time between manic events, Frank says.

A Holistic Approach

Depression and bipolar disorder patient advocate Sue Bergeson, who suffers from depression herself, says the study by Frank and colleagues shows for the first time in scientific terms what many patients have long understood.

Bergeson is vice president of the Chicago-based Depression and Bipolar Support Alliance.

"It is clear that medication can take you only so far," she says. "An effective wellness strategy for bipolar disorder and depression has to go beyond that. We know that we have to get enough sleep and understand our triggers. And travel can be problematic."

Bergeson watched her sister Barbie battle undiagnosed bipolar disorder for years. Five years ago, Barbie took her own life, a few months after her disease was finally identified.

"She had been misdiagnosed for years," Bergeson says. "She had gone through decades of struggle with no light to be seen, and she was just worn out."

Her sister's suicide led Bergeson to learn as much as she could about her own illness and become a voice for others with depression and bipolar disorder.

"It is not OK that so many people die of this," she says.

She recommends a holistic approach to treatment that includes drug therapy, talk therapy, and maintaining a healthy lifestyle.

Bergeson says paying attention to routine doesn't mean life has to be boring.

"In fact, I just got back today from a trip to Las Vegas," she says. "I can have a good time and do fun stuff just like anybody else. I just have to make a plan and think it through and take steps to minimize the impact."

SOURCES: Frank, E. Archives of General Psychiatry, September 2005; vol 62: pp 996-1004. Ellen Frank, PhD, professor of psychiatry and psychology, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine. Sue Bergeson, vice president, Depression and Bipolar Support Alliance, Chicago.

Daily Routine May Help Bipolar Disorder
By Salynn Boyles
WebMD Medical News Reviewed By Brunilda Nazario, MD
on Thursday, September 08, 2005

LINK

Sept. 8, 2005 -- Most of us function better when we maintain a regular daily routine, but for people with bipolar disorder, routine may make a big difference in recovery.

Researchers from the University of Pittsburgh School of Medicine report that bipolar patients fared better when their treatment stressed the importance of establishing daily routines for things like sleeping and eating.

Social rhythm therapy, as it has been dubbed by the researchers, is based on the idea that irregular sleeping habits and those associated with other daily activities can trigger manic episodes by disturbing the body's sleep-wake (circadian system) clock.

"We see patients with bipolar disorder as having exquisitely sensitive and fragile body clocks," researcher Ellen Frank, PhD, tells WebMD. "They need to be more attentive than the rest of us to things like when they get up and go to bed and when they eat their meals."

'A Manageable Problem'

Once known as manic depression, bipolar disorder is characterized by extreme swings in mood, energy, and ability to function. Periods of highs and lows are referred to as manic or depressive episodes. Medications such as lithium are prescribed to people with bipolar disorder; these drugs can help stabilize mood swings.

According to the National Institute of Mental Health, more than 2 million Americans have bipolar disorder.

The study by Frank and colleagues included 175 severely ill patients with the disorder, all of whom were treated with medications. In addition, about half of the patients got social rhythm therapy from the beginning of the study.

The Importance of Routine

These patients learned the importance of establishing regular routines, and they also learned strategies for anticipating and coping with stress.

"We teach them to think of their illness the way someone with diabetes or asthma would; as a health problem that can be managed," Frank says. "A diabetic has to be careful about what they eat and when they eat. And people with asthma probably shouldn't have three dogs and two cats in the house."

The study is published in the September issue of the journal Archives of General Psychiatry.

No difference was seen between the two treatment groups in the time it took to emerge from a manic episode. But patients who got the social rhythm therapy had longer periods of stability between such episodes. Those who were most successful in establishing regular routines saw the most improvement.

The intervention translated into a 72% increase in time between manic events, Frank says.

A Holistic Approach

Depression and bipolar disorder patient advocate Sue Bergeson, who suffers from depression herself, says the study by Frank and colleagues shows for the first time in scientific terms what many patients have long understood.

Bergeson is vice president of the Chicago-based Depression and Bipolar Support Alliance.

"It is clear that medication can take you only so far," she says. "An effective wellness strategy for bipolar disorder and depression has to go beyond that. We know that we have to get enough sleep and understand our triggers. And travel can be problematic."

Bergeson watched her sister Barbie battle undiagnosed bipolar disorder for years. Five years ago, Barbie took her own life, a few months after her disease was finally identified.

"She had been misdiagnosed for years," Bergeson says. "She had gone through decades of struggle with no light to be seen, and she was just worn out."

Her sister's suicide led Bergeson to learn as much as she could about her own illness and become a voice for others with depression and bipolar disorder.

"It is not OK that so many people die of this," she says.

She recommends a holistic approach to treatment that includes drug therapy, talk therapy, and maintaining a healthy lifestyle.

Bergeson says paying attention to routine doesn't mean life has to be boring.

"In fact, I just got back today from a trip to Las Vegas," she says. "I can have a good time and do fun stuff just like anybody else. I just have to make a plan and think it through and take steps to minimize the impact."

SOURCES: Frank, E. Archives of General Psychiatry, September 2005; vol 62: pp 996-1004. Ellen Frank, PhD, professor of psychiatry and psychology, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine. Sue Bergeson, vice president, Depression and Bipolar Support Alliance, Chicago.