Negative emotion impairs working memory in pediatric patients with bipolar disorder type I.

BACKGROUND: We investigated affect recognition and the impact of emotional valence on working memory (using happy, angry, and neutral faces) in pediatric patients with bipolar disorder (BD) and healthy control (HC) subjects. METHOD: Subjects (N=70) consisted of unmedicated patients with BD type I (BD I, n=23) and type II (BD II, n=16) and matched HC subjects (n=31). All subjects completed tasks of emotion recognition (Chicago Pediatric Emotional Acuity Task; Chicago PEAT) and working memory for happy, angry, and neutral faces (Affective N-Back Memory Task; ANMT). RESULTS: Compared to HC subjects, BD patients performed significantly more poorly when identifying the intensity of happy and angry expressions on the Chicago PEAT, and demonstrated working-memory impairments regardless of the type of facial emotional stimuli. Pediatric BD patients displayed the most impaired accuracy and reaction time performance with negative facial stimuli relative to neutral stimuli, but did not display this pattern with positive stimuli. Only BD I patients displayed working-memory deficits, while both BD I and BD II patients displayed emotion-identification impairments. Results remained significant after controlling for co-morbid ADHD and mood state. CONCLUSIONS: Both BD I and BD II youth demonstrate emotion-identification deficits. BD youth also demonstrate working-memory impairments for facial stimuli irrespective of emotional valence; however, working-memory deficits were the most pronounced with negative emotional stimuli. These deficits appear to be specific to BD I patients, and suggest therefore that a more severe form of illness is characterized by more severe social-cognitive impairment.

Complementary medicines in pediatric bipolar disorder.

The increasing number and availability of various complementary and alternative medicines (CAM) has resulted in an exponentially growing utilization of these products for everything from minor aches and pains to the treatment of mental illness. Difficulties in treating mental illnesses in children, averseness to having children take psychiatric medications, and stigma all drive patients and their families to research alternative treatments. As a result, there has been an increased utilization of CAM in psychiatry, particularly for hard to treat conditions like pediatric BD. It is important for the health care providers to be aware of the alternative treatments by some of their patients. A review of studies investigating the utility of complementary and alternative medicines in bipolar patients was conducted and selected studies were included. Omega-3 fatty acids and lecithin/ choline have preliminary data indicating potential utility in the CAM treatment for bipolar disorder while S-adenosyl methionine (SAM-e) and inositol have some data supporting their efficacy in the treatment of depressive symptoms. Some data for CAM suggest they may be useful adjunctive treatments but only little data are available to support their use as stand-alone therapy. Thus, the conventional medicines remain the first choice in pediatric bipolar management. Healthcare providers need to routinely inquire about the utilization of these treatments by their patients and become familiar with the risks and benefits involved with their use in children.

Theory of mind and social inference in children and adolescents with bipolar disorder.

BACKGROUND: Deficits in theory of mind (ToM), or the ability to infer what another person is thinking or feeling, have been reported in manic and euthymic adults with bipolar disorder. To date, there have been no investigations of ToM in pediatric bipolar disorder (PBD). The aim of the current study was to investigate this ability in PBD patients and healthy controls. METHOD: PBD patients (n=26) and intellectually and demographically similar healthy comparison subjects (n=20) were administered two ToM tasks. In the Affective Story Task, subjects were read positive-, negative- and neutral-valenced stories, and were assessed on their ability to recognize that a misleading series of events could lead one character to develop a false belief about another character. On the Hinting Task, subjects were required to infer the real intentions behind subtle hints. RESULTS: The PBD group performed significantly more poorly than controls on the Hinting Task and the positive and negative conditions of the Affective Story Task. In the PBD group only, younger age, earlier illness onset and manic symptoms were associated with poorer ToM performance. CONCLUSIONS: Consistent with past findings in adult bipolar disorder (BD), PBD youth performed more poorly than controls on ToM tasks. Data suggest that ToM ability may be more impaired in affectively charged contexts. Additionally, an earlier onset of illness among PBD youth may interfere with the development of social-cognitive skills. ToM disturbances may be a useful treatment target in PBD, with the aim of facilitating more accurate assessment of social cues and better interpersonal functioning.

Parent reported preschool attention deficit hyperactivity: measurement and validity.

This is a two stage community study of 320 preschool children aged between two and a half to five years. An Attention Deficit Hyperactivity Scale (ADH-P) was constructed. A first stage sample was screened by asking parents to fill in the ADH-P and the Behaviour Check List (BCL) for behaviour problems; 116 children were included in the second stage. Reliability of the ADH-P was tested and found to be satisfactory. Its validity was also supported by teacher's report and clinical observation. Based on the parent report, the children were divided into four groups: pure hyperactive, pure behaviour problem, mixed and no problem groups. External correlates and psychopathology were examined among them. The mixed group had more symptoms, poor maternal mental health, high social adversities, poor prosocial behaviour and high help seeking. Whilst significant associations were also present between these correlates and pure behaviour problems, the situation was substantially worse when hyperactivity co-existed with behaviour problems.

Recognition and classification of psychopathology in preschool children.

OBJECTIVE: The aim of this paper is to offer a critical overview of research on preschool psychopathology, and to propose a working classification based on the empirical evidence. METHOD: All of the existing factor and cluster analytic studies, and those studies that attempted to establish the reliability and validity of the subcategories in preschool behaviour disorder were reviewed. Applicability of the current classifications (DSM-IV and ICD-10) to preschool age was examined. RESULTS: Empirical evidence suggests a well-established, externalising and internalising dichotomy, and a developmental problems factor where the instrument included these problems. There was also a strong tendency for the externalising and internalising symptoms to overlap. Within the externalising factor, there is evidence suggesting that attention deficit hyperactivity should be separated out and recognised. Categories in the DSM-IV and ICD-10 classification did not correspond with the statistically derived groups. CONCLUSION: A classification of preschool psychopathology that incorporates the age-specific disorders and risk factors is proposed. This is likely to increase the awareness of researchers, taxonomists and clinicians of psychopathology in preschool children, thereby leading to an early recognition.

A neuroimmune hypothesis for the aetiopathology of viral illness and manic depression: a case report of an adolescent.

This paper explores the unifying aetiopathology between disorders of the immune system and the CNS, using a case example. An adolescent had a 2-year history of chronic-active Epstein-Barr virus infection and recurrent acute pancreatitis that resolved following a course of immunotherapy. Subsequently, she redeveloped acute symptoms of infectious mononucleosis and pancreatitis, along with manic depression, and then made a complete recovery with combination of lithium carbonate and electroconvulsive therapy. On follow-up, lithium carbonate effectively controlled the previous neuroimmune dysfunction.

Pattern of preschool behavior problems in New Zealand, using the Behavior Check List.

OBJECTIVE: The main aim of the study was to identify the pattern of behaviour problems in preschool children to enable early recognition and intervention. METHODOLOGY: Three hundred and twenty children, in eight randomly selected preschool centres, aged between 2.5 and 5 years, were included in the study. Parents completed the Behaviour Check List (BCL),a screening measure for preschool behaviour problems. RESULTS: Dependency, temper tantrums, and being difficult to manage were the commonly rated symptoms when moderate-severe problems were examined. Developmental problems decreased with increasing age, while relationship problems and worries that were cognitively mediated worsened. There were no major differences in the patterns between boys and girls. On cross-cultural comparison, parents in New Zealand rated their children lower on the BCL compared to those in the UK. Factor analysis of the BCL yielded seven factors. The two main factors 'predominantly conduct' and 'predominantly emotional' consisted of a mixture of conduct (difficulty in managing, temper tantrums, sibling rivalry) and emotional (unhappy mood, worry, fears) problems. The other five factors were related to developmental problems. CONCLUSIONS: These results help clinicians identify the emerging pattern of preschool behaviour problems that change with increasing age and vary with differing cultures. Categorical presentation of preschool behaviour problems support the view that they should be included in a classification system.

Help-seeking for behavior problems by parents of preschool children: a community study.

OBJECTIVE: To identify barriers to seeking help for preschool behavior problems and understand the pattern of service utilization. METHOD: Altogether, 320 preschool children from eight preschool centers were studied using a two-stage design. After the initial screening, a more detailed assessment was carried out in the second stage involving semistructured interviews with parents and children. Parents also completed a service utilization questionnaire during the first stage and General Health Questionnaire, Family Assessment Device, and life events questions during the second stage. RESULTS: Only 19% of those with preschool behavior disorder crossed all the filters in reaching for help. The most common perceived barriers to help-seeking were that problems would get better by themselves or that parents should be strong enough to handle them. The major blocks to help-seeking were at two levels, in parents recognizing the presence of a problem and in overcoming the perceived barriers by the parents. Parents sought help from the informal agencies more often than from the formal. Help was sought significantly less often by those who had parental separation, low income, or multiple adversities, all of which were known to be significantly associated with behavior disorder. CONCLUSION: These findings indicate the need to educate and influence the parents' attitude to help-seeking, target those at risk to develop behavior disorder, and develop better consultation-liaison service with the informal agencies.

A community study of preschool behaviour disorder in New Zealand.

A two stage epidemiological study of 320 children aged between 2.5 and 5 years of age, from eight randomly selected preschool centres, was performed in order (1) to test the psychometrics of the Behaviour Check List (BCL), a parent report instrument for preschool children, (2) to estimate the prevalence, and (3) to describe the correlates of preschool behaviour disorder. After the initial screening using the BCL, the Hyperactivity Scale (HAS) and the Internalising Disorder Scale (IDS), parents were interviewed using the Behaviour Screening Questionnaire (BSQ); the children were examined using the Rutter and Graham's interview. Data was also collected on family functioning, maternal mental health, social adversity, development, physical health and perinatal history. The BCL was found to be a reliable and valid screening measure. A cut off point of 8+ was established for New Zealand preschoolers; this is lower than that in the UK sample, illustrating the importance of retesting the instruments in a different culture. The prevalence rate of behaviour problems based on clinical diagnosis was 22.5%. Results of logistic regression analysis showed that poor family functioning, poor maternal mental health and parental separation were associated significantly with behaviour disorder. This study emphasises the need to identify preschool behaviour disorder and associated risk factors to enable an early intervention.