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Bipolar at any age

The mood swings of bipolar disorder – from mania to depression and back again – aren’t limited to adults. A new Brown study aims to identify biological and behavioral markers to improve the diagnosis and treatment of young bipolar sufferers.

By TAB staff  |  December 8, 2009  |  Email to a friend

During the last decade, the number of visits to doctors’ offices that resulted in diagnoses of bipolar disorder in children and adolescents has increased by 40 times, researchers report.  

Characterized by moods that fluctuate from extended bouts of mania to depression, bipolar disorder in children can cause cognitive impairment, psychiatric hospitalization, psychosis, and even suicidal tendencies. An ability to predict the severity with which children might develop the disorder would help doctors begin appropriate treatment as early as possible.

Daniel Dickstein: Looking for bio-markers.: Daniel Dickstein: Looking for bio-markers. With the support of a large NIMH grant, a Brown psychiatrist and pediatrician hopes to find just such a predictor.

“If we identified a marker – such as performance on a behavioral task, a finding on a brain scan, or a gene – to differentiate children who develop full-blown bipolar disorder from those who would remain less severely affected,” says Assistant Professor of Psychiatry and Pediatrics Daniel Dickstein, ”it would greatly improve the specificity of both diagnosis and treatment.”

Dickstein, who is head of the Pediatric Mood, Imaging, and Neurodevelopment Program at Brown-affiliated Bradley Hospital in East Providence, Rhode Island, has been awarded a $1.87 million, five-year grant from the NIMH’s BRAINS program to identify biological and behavioral markers that influence the development of bipolar disorder in children. Most of his research will take place at Bradley, one of the nation’s only free-standing psychiatric hospitals dedicated to the treatment of children and adolescents. The research program at Bradley uses such techniques as brain-imaging, behavorial tasks, and
genetic analyses to identify markers of bipolar disorder.

Sean Deoni: Using MRI to study early brain development: Sean Deoni: Using MRI to study early brain development Only seven BRAINS (Biobehavioral Research Awards for Innovative New Scientists) grants were awarded nationally in 2009, the program’s inaugural year. Brown was the only university to receive two of the awards: Besides Dickstein, one other Brown faculty member received a BRAINS award: Sean Deoni, assistant professor of engineering. Deoni plans to use his $2.5 million grant to study neurodevelopment throughout infancy and early childhood, from two months to age five, using an MRI imaging technique he developed with colleagues at Brown.

The two will collaborate: Dickstein will contribute his expertise in pediatric brain imaging and neurobehavioral data to Deoni’s research program. In turn, Deoni will assist with Dickstein’s project, which will include a team from Bradley Hospital, Rhode Island Hospital, and Brown. Scientists from New York University, Yale, and NIMH also will be involved.

Recently Today at Brown talked with Dickstein about young people and bipolar disorder.

How does diagnosing bipolar disorder in children differ from diagnosing adults?

The criteria used to diagnose bipolar disorder are the same for children and adults. However, it is much more difficult to obtain the necessary psychiatric history for children.

How and when does the disorder first manifest?

Bipolar disorder is unique among psychiatric disorders because it involves mania – distinct episodes of elevated, expansive, or irritable mood accompanied by other symptoms such as a decreased need for sleep, grandiosity, racing thoughts, and high-risk pleasurable activities such as shopping sprees, drug use, or running away. Besides mania, people with bipolar disorder also suffer from episodes of sustained depression.

There is no minimum age requirement to diagnose bipolar disorder. However, as children develop into adolescence and adulthood their verbal skills and self-awareness improve, increasing the likelihood of a valid diagnosis.

How does bipolar disorder affect children’s learning, relationships, and adult lives?

Early studies suggest that pediatric bipolar disorder involves high rates of functional impairment, including cognitive function and a risk for suicidality. Ongoing research, including that by the Course and Outcome of Bipolar Youth (COBY) study at Brown, the University of Pittsburgh, and UCLA, among others, has been following children with bipolar disorder as they move into adolescence and adulthood in hopes of addressing long-term functional outcomes across the lifespan. I am grateful to partner with the COBY study for my BRAINS grant project.

What is the current treatment protocol for bipolar children?

The treatment involves both therapy and medication aimed at reducing dysfunction, which is more complicated in children because they have multiple [environmental] layers – family, peers, school – and are going through more development than adults. Treatment goals include reducing mania as well as treating co-occurring conditions such as anxiety, ADHD, and substance abuse.

How will your brain research aid medical professionals in assessing bipolar risk among children?

In the future, any bio-behavioral markers we discover will augment a child’s clinical history, enabling earlier intervention and making treatment more specific and effective.