Frances S. Myers

Clinical correlates of episodicity in juvenile mania.

OBJECTIVE Researchers debate whether the diagnostic criteria for mania should differ between children and adults. Specifically, although the Diagnostic and Statistical Manual of Mental Disorders (fourth edition; DSM-IV) requires episodic mood changes, children commonly are diagnosed as manic on the basis of chronic irritability. In this preliminary study, children carrying a diagnosis of bipolar disorder (BPD) in the community were classified as having either episodic or chronic symptoms. We hypothesized that the episodic group would be more likely to have a history of psychosis and a parental history of BPD, whereas the chronic group would be more likely to have conduct disorder. METHODS Parents of children carrying the BPD diagnosis were interviewed on the telephone to obtain psychiatric and family histories. Children were considered episodic (n = 34) if they had a history of one or more DSM-IV manic/hypomanic episodes meeting full duration criteria and chronic (n = 53) if they had no discernable episodes. RESULTS The episodic group was more likely to have had psychosis, parental history of BPD, and to have experienced each manic symptom except for irritability and psychomotor agitation. Children in the episodic group were also more likely to have had a depressive episode meeting full DSM-IV criteria and were more likely to have made a suicide attempt. Children in the chronic group were not more likely to meet criteria for conduct disorder but were more likely to exhibit violence toward others. CONCLUSIONS These preliminary data indicate that, among children being treated for BPD in the community, those with discrete episodes of mania may be more likely to have a lifetime history of psychosis and a parental history of BPD. The latter hypothesis should be tested in a sample where relatives are interviewed directly.

Agreement between face-to-face and telephone-administered mood ratings in patients with rapid cycling bipolar disorder

We examined the reliability and level of agreement between the telephone and face-to-face administration of two mood-rating scales (HIGH-SAD and SIGH-SAD) in patients with rapid cycling bipolar disorder (RCBD). Two clinicians administered the HIGH-SAD and SIGH-SAD to 14 outpatients with RCBD. Patients received consecutive phone and face-to-face mood ratings in a randomized order. Using a paired t-test, no significant differences were found when comparing HIGH-SAD and SIGH-SAD scores administered face-to-face and over the phone. There was a high correlation between the face-to-face and phone administration of both scales as measured by intraclass correlation (r = 0.94 for SIGH-SAD; r = 0.85 for HIGH-SAD). Our results support the use of phone-administered mood ratings as a reliable and convenient method to monitor patients with RCBD.

Double-blind, placebo-controlled study of single-dose metergoline in depressed patients with Seasonal Affective Disorder

A role for serotonin in season affective disorder (SAD) has been explored with a variety of serotonergic pharmacologic agents. The authors initially hypothesized that metergoline, a nonspecific serotonin antagonist, would exacerbate depressive symptoms. In a small, open-label pilot study, the authors observed the opposite effect. They decided to follow up on this finding with this formal study. The study followed a double-blind, randomized cross-over design. Sixteen untreated, depressed patients with SAD received single oral doses of metergoline 8 mg and of placebo, spaced 1 week apart. Fourteen patients were restudied after 2 weeks of light treatment. Depression ratings using the Structured Interview Guide for the Hamilton Depression Rating Scale—Seasonal Affective Disorder Version were performed at baseline and at 3 and 6 days after each intervention. These data were analyzed by baseline-corrected repeated measures with analysis of variance. In the off-lights condition, severity of depression was diminished after metergoline compared with placebo administration (p = 0.001). Patient daily self-ratings suggested that the peak effect occurred 2 to 4 days after study drug administration. In contrast, after 2 weeks of treatment with bright artificial light, metergoline did not dem-onstrate a significant effect on mood. These data suggest that single doses of metergoline may have antidepressant effects that last several days. Possible mechanisms include 5-hydroxytryptamine2 receptor downregulation and dopamine agonism.

The reproducibility of depressive and hypomanic symptoms across repeated episodes in patients with rapid-cycling bipolar disorder

The purpose of this study is to determine the stability of symptoms of hypomania and depression across repeated affective episodes in patients with rapid-cycling bipolar disorder. Nine patients had a total of 30 depressive episodes and 31 hypomanic episodes during the period of observation. Standardized observer ratings indicated that the three symptoms most consistently reported during depressive episodes were fatiguability, decreased work activities and hypersomnia. These results as well as those from the standardized observer ratings of hypomania indicate that depression in this population consists of a lethargic, hypoactive state while hypomania may be a heightened state of activation. The clinical and theoretical implications of these findings are discussed.

The emergence of childhood bipolar disorder: a prospective study from 4 months to 7 years of age

Abstract The present study reviews the development from 4 to 84 months of age of a boy diagnosed with bipolar mood disorder (BPD) and attention deficit hyperactivity disorder (ADHD) at 7 years of age. Extensive data were collected in four central domains: psychophysiology (EEG and ECG), child temperament, mother–child interactions, and peer interactions. The target childs development was traced across time and compared with a cohort of 81 normally developing children. The target child displayed an unusual psychophysiological pattern from early infancy. His highly active central nervous system was coupled with an under-aroused autonomic nervous system. By preschool, his social interactions were marked by inappropriate affect and behavioral disinhibition, along with impulsivity and aggression. Possible links between the childs psychophysiological pattern and his behavior are discussed.

Validation of the hypomania interview guide-seasonal affective disorder (HIGH-SAD) version in patients with rapid cycling bipolar disorder.

We validated the Hypomania Interview Guide‐Seasonal Affective Disorder (HIGH‐SAD) version in patients with rapid cycling bipolar disorder (RCBD). Fourteen outpatients were rated on six separate occasions (total= 84 visits). On each visit the patients were rated with the HIGH‐SAD and the Young Mania Rating Scale (YMRS) in a counterbalanced order. Clinical assessment was completed at the end of the visit by the treating psychiatrist. Patients were assessed as hypomanic/manic on 22 of the visits. Pearson correlation coefficient between the YMRS total scores and the HIGH‐SAD total scores for those 22 visits in which patients were hypomanic/manic was r= 0.629 (P< 0.05) and for all visits was r= 0.769 (P<0.0001). Analysis with only one rating per patient yielded a Pearson correlation coefficient of r=0.792 (P<0.0004). We found that the HIGH‐SAD was a valid scale for the measurement of hypomania in patients with RCBD. However, the scale does not differentiate hypomania from mania in this group of patients. Depression and Anxiety 8:166–168, 1998. Published 1998 Wiley‐Liss, Inc. This article is a US Government work and, as such, is in the public domain in the United States of America.