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. 2010 Apr;49(4):397-405.

Pediatric bipolar disorder versus severe mood dysregulation: risk for manic episodes on follow-up

Argyris Stringaris  1 , Argelinda Baroni, Caroline Haimm, Melissa Brotman, Catherine H Lowe, Frances Myers, Eileen Rustgi, Wanda Wheeler, Reilly Kayser, Kenneth Towbin, Ellen Leibenluft
Affiliations

Pediatric bipolar disorder versus severe mood dysregulation: risk for manic episodes on follow-up

Argyris Stringaris et al. J Am Acad Child Adolesc Psychiatry. 2010 Apr.

Abstract

Objective: An important question in pediatric bipolar research is whether marked nonepisodic irritability is a manifestation of bipolar disorder in youth. This study tests the hypothesis that youth with severe mood dysregulation (SMD), a category created for the purpose of studying children presenting with severe nonepisodic irritability, will be significantly less likely to develop (hypo-)manic or mixed episodes over time than will youth with bipolar disorder (BD).

Method: Patients with SMD (N = 84) and narrowly defined BD (N = 93) at baseline were followed up in 6-monthly intervals using the relevant K-SADS modules to ascertain (hypo-)manic or mixed episodes.

Results: Only one of 84 SMD subjects (1/84 [1.2%]; 95% confidence interval CI = 0.0003 to 0.064) experienced a (hypo-)manic or mixed episode during the study (median follow-up = 28.7 months). The frequency of such episodes was more than 50 times higher in those with narrowly defined BD (58/93 [62.4%]; 95% CI 0.52 to 0.72).

Conclusions: These data suggest that, over an approximately 2-year follow-up period, youth with SMD are unlikely to develop (hypo-)manic or mixed episodes.

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Conflict of interest statement

Disclosure: Drs. Stringaris, Baroni, Brotman, Rustgi, Towbin, and Leibenluft, and Ms. Haimm, Mr. Lowe, Ms. Myers, Ms. Wheeler, and Mr. Kayser report no biomedical financial interests or potential conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Percentage of patients with severe mood dysregulation (SMD) and bipolar disorder (BD) at each follow-up point is shown in the bars. Note: Underneath each pair of bars are the raw number proportions for each category.
FIGURE 2
FIGURE 2
Bars with standard errors show the percentage of patients with either severe mood dysregulation (SMD) or bipolar disorder (BD) who developed a (hypo-)manic or mixed episode during the follow-up period.
See this image and copyright information in PMC

Comment in

  • Dysregulated children reconsidered.
    Althoff RR. Althoff RR. J Am Acad Child Adolesc Psychiatry. 2010 Apr;49(4):302-5. J Am Acad Child Adolesc Psychiatry. 2010. PMID: 20410722 No abstract available.

References

    1. Blader JC, Carlson GA. Increased rates of bipolar disorder diagnoses among U.S. child, adolescent, and adult inpatients, 1996–2004. Biol Psychiatry. 2007;62:107–114. - PMC - PubMed
    1. Moreno C, Laje G, Blanco C, et al. National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch Gen Psychiatry. 2007;64:1032–1039. - PubMed
    1. Olfson M, Blanco C, Liu L, Moreno C, Laje G. National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Arch Gen Psychiatry. 2006;63:679–685. - PubMed
    1. Biederman J, Klein RG, Pine DS, Klein DF. Resolved: mania is mistaken for ADHD in prepubertal children. J Am Acad Child Adolesc Psychiatry. 1998;37:1091–1096. - PubMed
    1. Carlson GA, Meyer SE. Phenomenology and diagnosis of bipolar disorder in children, adolescents, and adults: complexities and developmental issues. Dev Psychopathol. 2006;18:939–969. - PubMed

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