Behavioral self-regulation in pediatric bipolar disorder and healthy offspring of bipolar patients.

OBJECTIVES: This study investigated behavioral self-regulation problems using the Children's Hostility Inventory (CHI) in pediatric bipolar disorder (PBD), healthy offspring of bipolar disorder patients (HOBD), and healthy controls (HC) without previous history of psychiatric disorders. METHODS: The CHI was administered to 41 consecutive children and adolescents diagnosed with PBD, to 16 HOBD, and to 22 HC. The inventory assessed irritability, expression, hostility, and aggression and was completed by the children with the help of their mothers. Adolescents and their respective parents were interviewed separately using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). RESULTS: All subscales of the CHI presented statistically significant differences, except for the subscale assessing feelings of suspicion. Pairwise comparisons revealed consistently significant differences between the PBD group and controls, indicating more self-regulation difficulties in the PBD group, represented by high levels of hostility and aggressive behavior. There were no significant differences between the PBD and HOBD groups. CONCLUSIONS: Future studies should further investigate if such behavior is state-dependent or a trait of bipolar juvenile expression. Expression of hostility and irritability should be considered relevant targets in psychosocial approaches addressing this population.

Self-regulation in youth with bipolar disorder

Objectives: To examine the composition of self-regulation in pediatric bipolar disorder (PBD) through the relationship between executive functions, emotion processing, and family environmental factors. Methods: 58 participants (36 with PBD and 22 controls), ages 12-17, were assessed using the Barratt Impulsiveness Scale (BIS), Conners' Continuous Performance Test (CPT-II), Wisconsin Cards Sorting Test (WCST), Computerized Neurocognitive Battery Emotion Recognition Test-Facial Emotion Recognition Test (PENNCNB ER-40), and Expressed Emotion Adjective Checklist Questionnaire (EEAC). Results: Adolescents with PBD displayed significant deficits in all three spheres when compared to the control group. Emotion processing correlated negatively with inhibition and attention, and correlated positively with mental flexibility/working memory. Family environmental factors correlated negatively with mental flexibility/working memory and emotion processing, and positively with attention and inhibition. These correlations indicate that better inhibitory control, attention, and mental flexibility/working memory are associated with greater emotion processing and a fitter family environment. Conclusion: This study is the first to investigate all of the components of self-regulation deficits simultaneously in patients with PBD. Results suggest that self-regulation is essential for a comprehensive perspective of PBD and should be assessed in an integrative and multifaceted way. Understanding that self-regulation is impacted by the abovementioned factors should influence treatment and improve the functional impairments of daily life observed in this population.

Self-regulation in youth with bipolar disorder.

OBJECTIVES: To examine the composition of self-regulation in pediatric bipolar disorder (PBD) through the relationship between executive functions, emotion processing, and family environmental factors. METHODS: 58 participants (36 with PBD and 22 controls), ages 12-17, were assessed using the Barratt Impulsiveness Scale (BIS), Conners' Continuous Performance Test (CPT-II), Wisconsin Cards Sorting Test (WCST), Computerized Neurocognitive Battery Emotion Recognition Test-Facial Emotion Recognition Test (PENNCNB ER-40), and Expressed Emotion Adjective Checklist Questionnaire (EEAC). RESULTS: Adolescents with PBD displayed significant deficits in all three spheres when compared to the control group. Emotion processing correlated negatively with inhibition and attention, and correlated positively with mental flexibility/working memory. Family environmental factors correlated negatively with mental flexibility/working memory and emotion processing, and positively with attention and inhibition. These correlations indicate that better inhibitory control, attention, and mental flexibility/working memory are associated with greater emotion processing and a fitter family environment. CONCLUSION: This study is the first to investigate all of the components of self-regulation deficits simultaneously in patients with PBD. Results suggest that self-regulation is essential for a comprehensive perspective of PBD and should be assessed in an integrative and multifaceted way. Understanding that self-regulation is impacted by the abovementioned factors should influence treatment and improve the functional impairments of daily life observed in this population.

Behavioral self-regulation in pediatric bipolar disorder and healthy offspring of bipolar patients

Objectives: This study investigated behavioral self-regulation problems using the Children's Hostility Inventory (CHI) in pediatric bipolar disorder (PBD), healthy offspring of bipolar disorder patients (HOBD), and healthy controls (HC) without previous history of psychiatric disorders. Methods: The CHI was administered to 41 consecutive children and adolescents diagnosed with PBD, to 16 HOBD, and to 22 HC. The inventory assessed irritability, expression, hostility, and aggression and was completed by the children with the help of their mothers. Adolescents and their respective parents were interviewed separately using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). Results: All subscales of the CHI presented statistically significant differences, except for the subscale assessing feelings of suspicion. Pairwise comparisons revealed consistently significant differences between the PBD group and controls, indicating more self-regulation difficulties in the PBD group, represented by high levels of hostility and aggressive behavior. There were no significant differences between the PBD and HOBD groups. Conclusions: Future studies should further investigate if such behavior is state-dependent or a trait of bipolar juvenile expression. Expression of hostility and irritability should be considered relevant targets in psychosocial approaches addressing this population.

Quality of life in youth with bipolar disorder and unaffected offspring of parents with bipolar disorder.

BACKGROUND: There have been few studies investigating quality of life (QoL) in pediatric bipolar disorder (BD) patients and none comparing it with that observed in unaffected offspring of parents with BD and healthy controls. METHODS: The self-report Youth Quality of Life Instrument-Research version (YQoL-R) was administered in 26 pediatric BD patients, 17 unaffected offspring of parents with BD, and 24 individuals with no history of DSM-IV Axis I psychiatric disorders. All diagnoses were determined through interviews based on the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version. RESULTS: There were statistical differences among the groups for all YQoL-R domains. Pairwise comparisons showed that perceived QoL was significantly worse in the BD group than in the unaffected offspring and healthy subjects, a difference that persisted even when only euthymic subjects were analyzed. There were no significant differences between the unaffected offspring and healthy subjects for any YQoL-R domain. LIMITATIONS: Our sample was small. There was no QoL report from subjects parents nor data about family environment or BD parents' mood state. CONCLUSIONS: There is a need for studies to investigate in greater detail the relationship between QoL and psychological resilience, particularly in the unaffected offspring of parents with BD.

Attention-based classification pattern, a research domain criteria framework, in youths with bipolar disorder and attention-deficit/hyperactivity disorder.

OBJECTIVE: The National Institute of Mental Health has initiated the Research Domain Criteria (RDoC) project. Instead of using disorder categories as the basis for grouping individuals, the RDoC suggests finding relevant dimensions that can cut across traditional disorders. Our aim was to use the RDoC's framework to study patterns of attention deficit based on results of Conners' Continuous Performance Test (CPT II) in youths diagnosed with bipolar disorder (BD), attention-deficit/hyperactivity disorder (ADHD), BD+ADHD and controls. METHOD: Eighteen healthy controls, 23 patients with ADHD, 10 with BD and 33 BD+ADHD aged 12-17 years old were assessed. Pattern recognition was used to partition subjects into clusters based simultaneously on their performance in all CPT II variables. A Fisher's linear discriminant analysis was used to build a classifier. RESULTS: Using cluster analysis, the entire sample set was best clustered into two new groups, A and B, independently of the original diagnoses. ADHD and BD+ADHD were divided almost 50% in each subgroup, and there was an agglomeration of controls and BD in group B. Group A presented a greater impairment with higher means in all CPT II variables and lower Children's Global Assessment Scale. We found a high cross-validated classification accuracy for groups A and B: 95.2%. Variability of response time was the strongest CPT II measure in the discriminative pattern between groups A and B. CONCLUSION: Our classificatory exercise supports the concept behind new approaches, such as the RDoC framework, for child and adolescent psychiatry. Our approach was able to define clinical subgroups that could be used in future pathophysiological and treatment studies.

Preserved white matter in unmedicated pediatric bipolar disorder.

White matter (WM) abnormalities have been reported in bipolar disorder (BD) patients, as well as in their non-BD relatives, both children and adults. Although it is considered an emerging vulnerability marker for BD, there are no studies investigating WM alterations in pediatric unmedicated patients and young healthy offspring. In this study, we evaluated the presence of WM alterations in 18 pediatric, non medicated BD patients, as well as in 18 healthy offspring of BD type I parents and 20 healthy controls. 3T DT-MRI data were acquired and scans were processed with tract-based spatial statistics to provide measures of fractional anisotropy and diffusivity. We found no significant differences in WM microstructure between BD patients, healthy offspring and healthy controls. Previous studies that reported WM alterations investigated older subjects, either on medication (BD patients) or with psychiatric diagnoses other than BD (unaffected offspring). Our findings highlight the importance of the understanding of disease ontogeny and brain development dynamics in the search for early vulnerability markers for psychiatric disorders.

Dysfunctional family environment in affected versus unaffected offspring of parents with bipolar disorder.

OBJECTIVE: Children of parents with bipolar disorder (BD) are at heightened risk for developing mood and other psychiatric disorders. We proposed to evaluate the environment of families with at least one parent with BD type I (BDF) with affected offspring (aBDF) and unaffected offspring (uBDF) compared with control families without a history of DSM-IV Axis I disorder (CF). METHOD: We used the Family Environment Scale (FES) to evaluate 47 BDF (aBDF + uBDF) and 30 CF. Parents were assessed through the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Diagnosis of the offspring was determined through the Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL) interview. RESULTS: There were statistically significant differences between aBDF, uBDF and CF in cohesion (p = 0.003), intellectual-cultural orientation (p = 0.01), active-recreational orientation (p = 0.007), conflict (p = 0.001), control (p = 0.01), moral-religious emphasis (p = 0.01) and organization (p = 0.001). The aBDF showed higher levels of control (p = 0.02) when compared to the uBDF. CONCLUSIONS: Families with a BD parent presented more dysfunctional interactions among members. Moreover, the presence of BD or other psychiatric disorders in the offspring of parents with BD is associated with higher levels of control. These results highlight the relevance of psychosocial interventions to improve resilience and family interactions.

Negative expressed emotion best discriminates families with bipolar disorder children.

BACKGROUND: Children and adolescents with bipolar disorder (BD) live in family environments with high levels of expressed emotion (EE), conflict, and tension; as well as low maternal warmth and cohesion. These family characteristics have been evaluated in research settings using different scales. Nonetheless, empirically supported assessment instruments are not always feasible to be used in clinical settings. Our aim was to identify the best characteristics that discriminate BD families from control by building a classifier with the main characteristics found from different scales. We also built a classifier based on the adjective check-list scale (ACL) because this scale would be the most feasible one to be used in clinical setting. METHODS: We evaluated 33 families of pediatric BD patients and 29 control families. Two self-report scales, ACL and the Family Environment Scale (FES), and a direct interview scale, the Psychosocial Schedule for School Age Children-Revised (PSS-R), were administered. RESULTS: BD families presented lower positive EE and higher negative EE, less cohesion, organization, greater conflict and control; lower rate of intact family, higher maternal and paternal tension compared to control families. Both classifiers demonstrated high accuracy. The offspring's EE toward the mother was the family characteristic that best discriminated BD from control families. LIMITATIONS: Small sample size and cross-sectional design. CONCLUSIONS: Families of BD children presented altered communication and functioning. The high accuracy of the ACL-based classifier highlights a feasible scale to be used in clinical settings. Further studies assessing prognosis associated with the patterns of communication in such families are needed.

Relationship between intestinal parasitic infection in children and soil contamination in an urban slum.

PURPOSE: Urban slums are well known for their high infant mortality and morbidity rates, and parasitic infections seem to be a common problem among these children. The aim of the present study was to determine protozoa and nematodes prevalence among children of a selected community located in São Paulo, Brazil, and access the relation between soil and children infection. METHODS: Soil contamination samples from 15 strategic locations in the slum area as well as stool samples (examined for protozoa and nematodes through five different methods) from 120 children aged 2-14 years (49% M: 51% F, mean +/- SD = 7.9 +/- 3.8 years) were assessed in a cross-sectional study. Children's domicile locations were determined, and a comparative analysis was undertaken to correlate children and soil infection. RESULTS: Overall infection rate was 30.8% (n = 37), without difference between genders. The most frequent intestinal protozoa were Endolimax nana (20.8%), Entamoeba coli (15.8%) and Giardia lamblia (16.7%). Frequencies of Ascaris lumbricoides and Enterobius vermicularis in stool samples were 2.5 and 1.7%, respectively. No cases of hookworms, Schistosoma mansoni or Tricuris trichiura were identified. Polyparasitism occurred in 10.8% of the children, while 69.2% were free of parasitic infections. Out of the 15 soil samples analyzed, Ascaris sp. eggs were found in 20% and hookworm eggs in 6.7%. CONCLUSION: Helminth infection is not as prevalent as previously reported in urban slums in São Paulo, neither as clinical disease nor in soil samples. Protozoa intestinal infection, however, is still frequent in some marginalized populations in São Paulo. Improvement in living standards, mostly sanitation might decrease the prevalence of these diseases.

Preschool Bipolar Disorder: Brazilian children case reports.

OBJECTIVE: This study describes the clinical phenomenology and family history of preschool age onset Bipolar Disorder (BD). METHODS: Eight children and adolescents out of 118 cases (6.78%), both genders, meeting current DSM-IV criteria diagnosis of BD were described. The clinical assessment, CBCL, DICA-IV and CGAS were performed directly with each patient and their parents. RESULTS: Most (87.5%) presented classical symptoms of mania: euphoria, grandiosity, irritability, psychomotor agitation and agitated sleep or, in the same proportion, sleeplessness. Hyperactivity and increase of energy were found in all eight cases. The clinical course varied from a rapid, ultra-rapid, ultradian cycle to a continued pattern. Five out of eight children (62.5%) presented aggressiveness toward others and one deliberate self-harm. Most (87.5%) had psychiatric family history. The average number of medications used during their life was 4.5 drugs. LIMITATION: The small sample and retrospective reports of the first manic symptoms in three of the cases (cases V, VI and VII). CONCLUSION: An important incidence of classical manic features was found in very young children. The clinical course tended to be continuous, and preschool BD seems to have a strong association with affective disorder family history.

Rapidly induced dopaminergic supersensitivity: D1/D2 receptor participation and its prevention by an MAO-inhibitor.

The dopaminergic system requires combined dopamine D1/D2 receptor stimulation to express its activity; a phenomenon called synergism D1/D2. Dopamine receptors develop supersensitivity following dopamine de-afferentation and/or reserpine treatment. Acute supersensitivity occurs with reserpine treatment. The breakdown of D1/D2 synergism has been proposed implicating the genesis of this kind of supersensitivity. We sought to determine the best conditions for inducing acute dopaminergic supersensitivity evaluated by apomorphine-induced stereotyped behaviour, to examine whether D1/D2 synergism breakdown occurs in this reserpine-induced acute supersensitivity model, and whether it can be prevented by the monoamino-oxidase (MAO) inhibitor selegiline. Reserpine (2.0 mg/kg) was injected 3 h before apomorphine (0.6 mg/kg) induced stereotypy. D1/D2 synergism was investigated using specific antagonists (D1-SKF 83566 2.5 mg/kg, D2-haloperidol 2.0 mg/kg) and selegiline (10 mg/kg) was used to analyze the influence of dopamine "de-novo" synthesis. All antagonist treatments suppressed stereotypy and selegiline prevented supersensitivity. These data suggest that reserpine-induced acute dopaminergic supersensitivity is not due to the breakdown of D1/D2 synergism and such supersensitivity can be prevented by recently synthesised dopamine.