Irritability without elation in a large bipolar youth sample: frequency and clinical description.

OBJECTIVE: To determine whether some children with bipolar disorder (BP) manifest irritability without elation and whether these children differ on sociodemographic, phenotypic, and familial features from those who have elation and no irritability and from those who have both. METHOD: Three hundred sixty-one youths with BP recruited into the three-site Course and Outcome of Bipolar Illness in Youth study were assessed at baseline and for most severe past symptoms using standardized semistructured interviews. Bipolar disorder subtype was identified, and frequency and severity of manic symptoms were quantified. The subjects were required to have episodic mood disturbance to be diagnosed with BP. The sample was then reclassified and compared based on the most severe lifetime manic episode into three subgroups: elated only, irritable only, and both elated and irritable. RESULTS: Irritable-only and elated-only subgroups constituted 10% and 15% of the sample, respectively. Except for the irritable-only subjects being significantly younger than the other two subgroups, there were no other between-group sociodemographic differences. There were no significant between-group differences in the BP subtype, rate of psychiatric comorbidities, severity of illness, duration of illness, and family history of mania in first- or second-degree relatives and other psychiatric disorders in first-degree relatives, with the exception of depression and alcohol abuse occurring more frequently in the irritability-only subgroup. The elated-only group had higher scores on most DSM-IV mania criterion B items. CONCLUSIONS: The results of this study support the DSM-IV A criteria for mania in youths. Irritable-only mania exists, particularly in younger children, but similar to elated-only mania, it occurs infrequently. The fact that the irritable-only subgroup has similar clinical characteristics and family histories of BP, as compared with subgroups with predominant elation, provides support for continuing to consider episodic irritability in the diagnosis of pediatric BP.

Psychiatric correlates of nonsuicidal cutting behaviors in an adolescent inpatient sample.

This archival study of 288 adolescent psychiatric inpatients examined the psychiatric correlates of cutting behavior. Participants were categorized into Threshold cutters (n = 61), Subthreshold cutters (n = 43), and Noncutters (n = 184). Groups were compared on psychiatric diagnoses, suicidality, and self-reported impairment. Results demonstrated that females were more likely to cut relative to males; however, gender did not affect the correlates of cutting behavior. Adolescents in the Threshold group were more likely to be diagnosed with Major Depression and had higher self-reported suicidality, depression, and trauma-related symptoms of depression and dissociation relative to the Noncutting group. The Subthreshold group did not differ from the other groupings except for an elevated risk for Posttraumatic Stress Disorder compared to the Noncutting group.

Validation of the Children's Interview for Psychiatric Syndromes (ChIPS) with psychiatrically hospitalized adolescents.

OBJECTIVE: To examine the concurrent validity of the Children's Interview for Psychiatric Syndromes (ChIPS) for adolescent inpatients. METHOD: Participants included 97 adolescents ages 12 to 18 admitted to an adolescent inpatient unit. Participants were administered the ChIPS and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (present questions only). Participants also completed self-report measures of adjustment (e.g., the Reynolds Adolescent Depression Scale-2). RESULTS: More diagnoses were made with the ChIPS (mean 4.44) compared to the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (mean 3.04; p <.001). The percentage of agreement ranged from 59% to 98%. Kappa coefficients indicated agreement ranging from slight for oppositional defiant disorder (kappa = .18) to substantial for substance use (kappa = .66); the majority of kappa values ranged from .26 to.60. When ChIPS endorsements were examined relative to construct-specific self-report measures of impairment, adolescents diagnosed by the ChIPS with a disorder scored significantly higher than adolescents who were not diagnosed with a disorder. CONCLUSIONS: The findings indicate moderate agreement between ChIPS diagnoses and Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version diagnoses. ChIPS diagnoses appear consistent with self-report measures of adjustment.

Suicide probability scale and its utility with adolescent psychiatric patients.

This study examined the factor structure, reliability, and validity of the Suicide Probability Scale (SPS) in a sample of 226 (80 male, 146 female) adolescent psychiatric inpatients. Confirmatory factor analyses provided only some support for the original subscales. Exploratory factor analyses revealed some overlap with the original scales, but the factors differed by gender. Internal consistency of the original factors was somewhat better than the factors derived from this sample. A negative change in SPS scores over the course of the inpatient admission was related to risk for readmission due to repeat suicidal behavior.

Body dysmorphic disorder and other clinically significant body image concerns in adolescent psychiatric inpatients: prevalence and clinical characteristics.

BACKGROUND: This study assessed prevalence and clinical correlates of body dysmorphic disorder (BDD), eating disorders (ED), and other clinically significant body image concerns in 208 consecutively admitted adolescent inpatients. It was hypothesized that adolescents with BDD would have higher levels of depression, anxiety, and suicidality. Adolescents with eating disorders were expected to have higher levels of depression, anxiety, and trauma-related symptoms. Trauma-related symptoms were also examined in relation to BDD, in the absence of specific hypotheses. METHOD: Participants completed the Body Dysmorphic Disorder Questionnaire (BDDQ) and reliable and valid self-report measures of suicidality, depression, anxiety, post-traumatic stress disorder (PTSD), dissociation, and sexual preoccupation/distress. Prevalence of BDD, eating disorders, and other clinically significant body image concerns was determined, and clinical correlates were examined. RESULTS: 6.7% (n = 14) of participants met DSM-IV criteria for definite (n = 10) or probable (n = 4) DSM-IV BDD, 3.8% (n = 8) met criteria for an eating disorder, and 22.1% (n = 46) had clinically significant shape/weight concerns (SWC) that did not clearly meet criteria for BDD or an eating disorder. Both the BDD and SWC groups scored significantly higher than the group with no significant body image concerns (no BDD/ED/SWC group) on measures of anxiety and suicidality. The BDD, SWC, and ED groups all had significantly higher levels of depression than the no BDD/ED/SWC group. Only the SWC group scored significantly higher than the no BDD/ED/SWC group on measures of PTSD, dissociation, and sexual preoccupation/distress. CONCLUSIONS: A high proportion of participants had clinically significant body image concerns or a body image disorder. These concerns/disorders were associated with higher levels of depression, anxiety, and suicidality. In addition, the group concerned with body shape or weight had significantly greater symptoms of PTSD, dissociation, and sexual preoccupation/distress. These relatively common body image concerns and disorders deserve further study in adolescents.

Frequency of manic symptoms and bipolar disorder in psychiatrically hospitalized adolescents using the K-SADS Mania Rating Scale.

OBJECTIVE: The aim of this study was to assess the frequency of manic symptoms and bipolar spectrum disorders in an adolescent inpatient psychiatric sample using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) Mania Rating Scale (MRS), parent and adolescent measures. METHOD: A total of 391 consecutive admissions to a psychiatric inpatient unit were assessed using the K-SADS MRS, the Childhood Inventory of Psychiatric Syndromes (CHIPS), and other clinically relevant measures. RESULTS: The frequency of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) manic symptoms in this population was generally high. However, only 19.6% received a consensus diagnosis of juvenile bipolar disorder. The K-SADS MRS discriminated bipolar from non-bipolar patients when parents rated symptoms but not when rated by adolescents. CONCLUSIONS: This study of non-selected adolescents over a one-year period demonstrates that bipolar spectrum disorders in an inpatient population are common, and that the use of the KSADS MRS is effective in identifying this syndrome.