EARLY AGE MANIA Anything New ? Paramjit T. Joshi, M.D. PJOSHI@cnmc
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Transcript of EARLY AGE MANIA Anything New ? Paramjit T. Joshi, M.D. PJOSHI@cnmc
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EARLY AGE MANIAAnything New ?
Paramjit T. Joshi, [email protected]
Childrens National Medical Center George Washington University School of Medicine
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EPIDEMIOLOGY PEDIATRIC BIPOLAR DISORDERSNo prevalence studies in pre-pubertal BPD1% lifetime prevalence rate in adolescents5.7% lifetime prevalence of sub-syndromal BPDIrritability the rule rather than the exceptionGrandiosity, poor judgementImpaired concentrationDO NOT MEET DURATION CRITERIAAdolescents with BPD and sub-syndromal BPD had significant psychosocial impairment by age 24 yearsLewinshon et al., 2000
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As Adults !Childhood onset subjects were MOST likely to:Have non-remitting BPDProlonged episodesAntisocial PDChildhood & adolescent onset subjects had increased prevalence of Drug Use DisordersPrevalence of mixed episodes or irritability did not differ significantly between groups
Goldstein & Levitt, AJP 163:1633-1636, 2006
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MANIC EPISODEDSM - IV: Lasting at least one week with A and three of B persistent symptoms:A. Expansive mood / irritabilityB. 1. Inflated self-esteem / grandiosity 2. Decreased need for sleep 3. More talkative / pressured speech than normal 4. Racing thoughts / flight of ideas 5. Easily distracted 6. Increase in goal-directed activity 7. Poor judgement or excessively involved in pleasurable but risky activities, hypersexuality
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Core Symptoms of Bipolar Disorder
Extremely elevated mood Racing thoughts / flight of ideas Decreased need for sleep Grandiosity Poor judgement: hypersexualitydaredevil actssilliness, laughing uninhibited people seeking
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BPD vs ADHDGeller et al., 2002
MANIA ITEMS
BPD(%)
ADHD(%)
Irritability
97
72
Grandiosity **
85
7
Elated mood **
87
5
Dare devil acts *
70
13
Uninhibited people
seeking
68
21
Silliness / laughing
65
21
Flight of ideas *
66
10
Accelerated speech
97
78
Hypersexuality **
45
8
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Robert Post et al., Presented at the 3rd Annual NIMH P-BPD Conference, 2005
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Rx of Early Age Mania (TEAM STUDY)Funded by the NIMH (2003-2009)AIM: To investigate the effectiveness of medications for C&A who have DSM-IV BP-1 (manic or mixed phase) mania540 subjects aged 6-15 years of ageNarrow BP phenotype based on WASH-U K-SADS interviews video-taped and reviewed by the coordinating site for consensus diagnosis
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RESEARCH PLANInvestigate the effectiveness of Lithium (Li), Valproate (Val) and Risperidone (Rsp) as monotherapy and as add-on agents for childhood BP-1 (manic or mixed phase) mania
Explore the effects of psychosocial factors (e.g. parental warmth, parental BPD, family tension), discontinuation, compliance and outcome
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TREATMENT OF EARLY AGE MANIA (TEAM) FLOW CHARTStratum OneDrug free strategy
Baseline: Antimanic drug freeRandomize: Li, Val, RspStratum TwoAdd-on strategyBaseline: On one drug withpartial responseRandomize: To add-on oneof two other drugsStratum ThreeCross-taper strategyBaseline: On one drug withpoor responseRandomize: To Cross-taper one of two other drugsScreening for EligibilityBaseline AssessmentsIneligible GivenClinical ReferralsBaseline AssessmentsIf eligible, assigned to one of Three Strata8 Week ProtocolIneligible GivenClinical ReferralsPartial RespondersRe-randomize: Within stratum two for another 8 weeksPoor RespondersRe-randomize: Within stratum three for another 8 weeks
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Subjects Randomized: (All sites 315)AT CNMC:Total number of baseline subjects = 101Males 74%C: 46%AA: 44% H: 5% Other: 5%Number of randomized subjects = 67Strata 1 = 48Strata 2 = 5Strata 3 =14(Lost 34 due to either lack of diagnostic consensusagreement between sites or not meeting diagnostic criteriaat the completion of the baseline interviews)