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Effects of Early Intervention on the Course of Bipolar Disorder: Theories and Realities

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Abstract

Given the severity and early onset of pediatric bipolar disorder, early intervention is important to bring about recovery and alter the course of the illness. There is a new and burgeoning body of literature on the biological basis of early signs of the illness and the mechanistic understanding of treatment interventions. Biological findings based on multimodal imaging, genomic studies of cellular proteins, and performance-based findings of neurocognitive studies are beginning to assemble a cohesive and interlinked model of systems neuroscience. This offers the promise of identifying biomarkers, predictors of illness, and treatment outcomes. In complement, at the tier of clinical application is a multitude of efficacy trials, yet neither a single medication nor a combination of choices seems to suffice in reality. The current review develops a point of view bridging scientific developments to where comprehensive, multipronged treatment strategies find their clinical application—a model that is similarly applicable in adult bipolar disorder.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Chen YW, Dilsaver SC: Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other Axis I disorders. Biol Psychiatry 1996, 39:896–899.

    Article  CAS  PubMed  Google Scholar 

  2. Gray SM, Otto MW: Psychosocial approaches to suicide prevention: applications to patients with bipolar disorder. J Clin Psychiatry 2001, 62(Suppl 25):56–64.

    PubMed  Google Scholar 

  3. Birmaher B, Axelson D: Course and outcome of bipolar spectrum disorder in children and adolescents: a review of the existing literature. Dev Psychopathol 2006, 18:1023–1035.

    Article  PubMed  Google Scholar 

  4. Stringaris A, Baroni A, Haimm C, et al.: Pediatric bipolar disorder versus severe mood dysregulation: risk for manic episodes on follow-up. J Am Acad Child Adolesc Psychiatry 2010, 49:397–405.

    Article  PubMed  Google Scholar 

  5. Skirrow C, McLoughlin G, Kuntsi J, Asherson P: Behavioral, neurocognitive and treatment overlap between attention-deficit/hyperactivity disorder and mood instability. Expert Rev Neurother 2009, 9:489–503.

    Article  PubMed  Google Scholar 

  6. Barkley RA, Mutphy KR, Dupaul GI, Brus T: Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive function. J Int Neuropsychol Soc 2002, 8:655–672.

    Article  PubMed  Google Scholar 

  7. •• Pavuluri MN, West A, Hill K, et al.: Neurocognitive function in pediatric bipolar disorder: three-year follow-up shows cognitive development lagging behind healthy youth. J Am Acad Child Adolesc Psychiatry 2009, 48:299–307. This study shows the longitudinal profile of neurocognitive function and illustrates the importance of intervening with BD youth beyond addressing the mood symptoms.

  8. Pavuluri MN, Schenkel LS, Aryal S, et al.: Neurocognitive function in unmedicated manic and medicated euthymic pediatric bipolar patients. Am J Psychiatry 2006, 163:286–293.

    Article  PubMed  Google Scholar 

  9. McClure EB, Treland JE, Snow J, et al.: Deficits in social cognition and response flexibility in pediatric bipolar disorder. Am J Psychiatry 2005, 162:1644–1651.

    Article  PubMed  Google Scholar 

  10. Dickstein DP, Finger EC, Brotman MA, et al.: Impaired probabilistic reversal learning in youths with mood and anxiety disorders. Psychol Med 2010, 40:1089–1100.

    Article  CAS  PubMed  Google Scholar 

  11. Pavuluri MN, Marlow-O’Connor M, Harral EM, et al.: Impact of neurocognitive functioning on academic difficulties in pediatric bipolar disorder: a clinical translation. Biol Psychiatry 2006, 60:951–956.

    Article  PubMed  Google Scholar 

  12. Schenken LS, Marlow-O’Connor M, Moss M, et al.: Theory of mind and social inference in children and adolescents with bipolar disorder. Psychol Med 2008, 38:791–800.

    Google Scholar 

  13. Schenkel LS, Pavuluri MN, Herbener ES, et al.: Facial emotion processing in acutely ill and euthymic patients with pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 2007, 46:1070–1079.

    Article  PubMed  Google Scholar 

  14. McClure EB, Pope K, Hoberman AJ, et al.: Facial expression recognition in adolescents with mood and anxiety disorders. Am J Psychiatry 2003, 160:1172–1174.

    Article  PubMed  Google Scholar 

  15. LaPalme M, Hodgins S, LaRoche C: Children of parents with bipolar disorder: a meta-analysis of risk for mental disorders. Can J Psychiatry 1997, 42:623–631.

    CAS  PubMed  Google Scholar 

  16. Smoller JW, Finn CT: Family, twin, and adoption studies of bipolar disorder. Am J Med Genet 2003, 123:48–58.

    Article  Google Scholar 

  17. Chang K, Steiner H, Ketter T: Studies of offspring of parents with bipolar disorder. Am J Med Genet C Semin Med Genet 2003, 123:26–35.

    Article  Google Scholar 

  18. Egeland JA, Hostetter AM, Pauls DL, Sussex JN: Prodromal symptoms before onset of manic-depressive disorder suggested by first hospital admission histories. J Am Acad Child Adolesc Psychiatry 2000, 39:1245–1252.

    Article  CAS  PubMed  Google Scholar 

  19. Frazier JA, Breeze JL, Makris N, et al.: Cortical gray matter differences identified by structural magnetic resonance imaging in pediatric bipolar disorder. Bipolar Disord 2005, 7:555–569.

    Article  PubMed  Google Scholar 

  20. Pavuluri MN, Sweeney JA: Integrating functional brain neuroimaging and developmental cognitive neuroscience in child psychiatry research. J Am Acad Child Adolesc Psychiatry 2008, 47:1273–1288.

    Article  PubMed  Google Scholar 

  21. Chang K, Barnea-Goraly N, Karchemskiy A, et al.: Cortical magnetic resonance imaging findings in familial pediatric bipolar disorder. Biol Psychiatry 2005, 58:197–203.

    Article  PubMed  Google Scholar 

  22. Pavuluri MN, Yang S, Kamineni K, et al.: Diffusion tensor imaging study of white matter fiber tracts in pediatric bipolar disorder and attention-deficit/hyperactivity disorder. Biol Psychiatry 2009, 65:586–593.

    Article  PubMed  Google Scholar 

  23. Frazier JA, Ahn MS, DeJong S, et al.: Magnetic resonance imaging studies in early-onset bipolar disorder: a critical review. Harv Rev Psychiatry 2005, 13:125–140.

    Article  PubMed  Google Scholar 

  24. Pavuluri MN, Marlow-O’Connor M, Harral E, Sweeney JA: Affective neural circuitry during facial emotion processing in pediatric bipolar disorder. Biol Psychiatry 2007, 62:158–167.

    Article  PubMed  Google Scholar 

  25. • Rich BA, Holroyd T, Carver FW, et al.: A preliminary study of the neural mechanisms of frustration in pediatric bipolar disorder using magnetoencephalography. Depress Anxiety 2010, 27:276–286. This study is important in that the interface between affect and cognition is illustrated, which is where frustration tolerance is probed.

  26. West AE, Schenkel LS, Pavuluri MN: Early childhood temperament in pediatric bipolar disorder and attention deficit hyperactivity disorder. J Clin Psychol 2008, 64:402–421.

    Article  PubMed  Google Scholar 

  27. Thomas A, Chess S: Temperament and Development. New York: Brunner/Mazel; 1977.

    Google Scholar 

  28. Hirshfeld-Becker DR, Biederman J, Faraone SV, et al.: Temperamental correlates of disruptive behavior disorders in young children: preliminary findings. Biol Psychiatry 2002, 50:563–574.

    Article  Google Scholar 

  29. Kochman FJ, Hantouche EG, Ferrari P, et al.: Cyclothymic temperament as a prospective predictor of bipolarity and suicidality in children and adolescents with major depressive disorder. J Affect Disord 2005, 85:181–190.

    Article  CAS  PubMed  Google Scholar 

  30. Chang KD, Wagner C, Garret A, et al.: A preliminary functional magnetic resonance imaging study of prefrontal-amygdalar activation changes in adolescents with bipolar depression treated with lamotrigine. Bipolar Disord 2008, 10:426–431.

    Article  CAS  PubMed  Google Scholar 

  31. Pavuluri MN, Henry DB, Moss M, et al.: Effectiveness of lamotrigine in maintaining symptom control in pediatric bipolar disorder. J Child Adolesc Psychopharmacol 2009, 19:75–82.

    Article  PubMed  Google Scholar 

  32. Haldane M, Jogia J, Cobb A, et al.: Changes in brain activation during working memory and facial recognition tasks in patients with bipolar disorder with lamotrigine monotherapy. Eur Neuropsychopharmacol 2008, 18:48–54.

    Article  CAS  PubMed  Google Scholar 

  33. Pavuluri MN, Passarotti AM, Harral EM, Sweeney JA: An fMRI study of the neural correlates of incidental versus directed emotion processing in pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 2009, 48:308–319.

    Article  PubMed  Google Scholar 

  34. Fitzgerald J, Passaroti A, Pullagurla K, et al.: Risperidone vs. divalproex in pediatric mania using affective working memory task: preliminary fMRI outcomes [poster]. Poster presented at the Annual Meeting of the American Academy of Child and Adolescent Psychiatry. New York; October 26–31, 2010.

  35. Szulc A, Galinska B, Tarasow E, et al.: The effect of risperidone on metabolite measures in the frontal lobe, temporal lobe, and thalamus in schizophrenic patients. A proton magnetic resonance spectroscopy (1H MRS). Pharmacopsychiatry 2005, 38:214–219.

    Article  CAS  PubMed  Google Scholar 

  36. Patel NC, DelBello MP, Cecil KM, et al.: Temporal changes in N-acetyl-aspartate concentrations in adolescents with bipolar depression treated with lithium. J Child Adolesc Psychopharmacol 2008, 18:132–139.

    Article  PubMed  Google Scholar 

  37. Yildiz-Yesiloglu A, Ankerst DP: Review of 1H magnetic resonance spectroscopy findings in major depressive disorder: a meta-analysis. Psychiatry Res 2006, 147:1–25.

    Article  CAS  PubMed  Google Scholar 

  38. DelBello MP, Cecil KM, Adler CM, et al.: Neurochemical effects of olanzapine in first-hospitalization manic adolescents: a proton magnetic resonance spectroscopy study. Neuropsychopharmacology 2006, 31:1264–1273.

    CAS  PubMed  Google Scholar 

  39. Chang K, Karchemskiy A, Barnea-Goraly N, et al.: Reduced amygdalar gray matter volume in familial pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 2005, 44:565–573.

    Article  PubMed  Google Scholar 

  40. Lyoo IK, Dager SR, Kim JE, et al.: Lithium-induced gray matter volume increase as a neural correlate of treatment response in bipolar disorder: a longitudinal brain imaging study. Neuropsychopharmacology 2010, 35:1743–1750.

    CAS  PubMed  Google Scholar 

  41. Pandey GN, Ren X, Dwivedi Y, Pavuluri MN: Decrease protein kinase C (pkc) in platelets of pediatric bipolar patients: effect of treatment with mood stabilizing drugs. J Psychiatr Res 2008, 42:106–116.

    Article  PubMed  Google Scholar 

  42. Pandey GN, Dwivedi Y, Rizavi HS, et al.: Brain-derived neurotrophic factor gene and protein expression in pediatric and adult depressed subjects. Prog Neuropsychopharmacol Biol Psychiatry 2010, 34:645–651.

    Article  CAS  PubMed  Google Scholar 

  43. •• Correll CU, Sheridan EM, DelBello MP: Antipsychotic and mood stabilizer efficacy and tolerability in pediatric and adult patients with bipolar I mania: a comparative analysis of acute, randomized, placebo-controlled trials. Bipolar Disord 2010, 12:116–141. This article is an excellent review of the efficacy and safety of drugs commonly prescribed in youth with BD.

  44. Pavuluri MN, Henry DB, Devineni B, et al.: A pharmacotherapy algorithm for stabilization and maintenance of pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 2004, 43:859–867.

    Article  PubMed  Google Scholar 

  45. • Pavuluri MN, Passarotti AM, Mohammed T, et al.: Enhanced working and verbal memory after lamotrigine treatment in pediatric bipolar disorder. Bipolar Disord 2010, 12:213–220. This is the first study showing that medication enhances cognitive function. It illustrates the importance of choosing medications to maximize the outcome.

  46. Klingberg T, Fernell E, Olesen PJ, et al.: Computerized training of working memory in children with ADHD: a randomized control trial. J Am Acad Child Adolesc Psychiatry 2005, 44:177–186.

    Article  PubMed  Google Scholar 

  47. Fristad MA, Goldberg-Arnold JS, Gavazzi SM: Multi-family psychoeducation groups in the treatment of children with mood disorders. J Marital Fam Ther 2003, 29:491–504.

    Article  PubMed  Google Scholar 

  48. Miklowitz DJ, Axelson DA, Birmaher B, et al.: Family-focused treatment for adolescents with bipolar disorder: results of a 2-year randomized trial. Arch Gen Psychiatry 2008, 65:1053–1061.

    Article  PubMed  Google Scholar 

  49. • West AE, Henry DB, Pavuluri MN: Maintenance model of integrated psychosocial treatment in pediatric bipolar disorder: a pilot feasibility study. J Am Acad Child Adolesc Psychiatry 2007, 46:205–212. This study includes a table that illustrates barriers in long-term treatment of PBD and offers strategies to address them.

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Acknowledgment

This research was funded by National Institute of Mental Health grants 1R01MH85639-01A1, 5R01MH081019, and 1RC1MH088462.

Disclosure

Dr. Pavuluri has served on speakers’ bureaus for Ortho-McNeil and Bristol-Myers Squibb.

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  1. Department of Psychiatry, Institute for Juvenile Research, 1747 West Roosevelt Road, M/C 747, Chicago, IL, 60612, USA

    Mani N. Pavuluri

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Correspondence to Mani N. Pavuluri.

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Pavuluri, M.N. Effects of Early Intervention on the Course of Bipolar Disorder: Theories and Realities. Curr Psychiatry Rep 12, 490–498 (2010). https://doi.org/10.1007/s11920-010-0155-1

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