Pediatric Bipolar Disorder Versus Severe Mood Dysregulation: Risk for Manic Episodes on Follow-Up

Stringaris, Argyris; Baroni, Argelinda; Haimm, Caroline; Brotman, Melissa; Lowe, Catherine H.; Myers, Frances; Rustgi, Eileen; Wheeler, Wanda; Kayser, Reilly; Towbin, Kenneth; Leibenluft, Ellen

doi:10.1016/j.jaac.2010.01.013

« Previous Next »Journal of the American Academy of Child & Adolescent Psychiatry
Volume 49, Issue 4 , Pages 397-405, April 2010

Pediatric Bipolar Disorder Versus Severe Mood Dysregulation: Risk for Manic Episodes on Follow-Up

Argyris Stringaris, M.D., M.R.C.Psych.
- Mood and Anxiety Program, National Institute of Mental Health, Bethesda, MD
- Institute of Psychiatry, King's College London, United Kingdom
- Correspondence to Dr. A. Stringaris, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, Denmark Hill, London, SE5 8AF United Kingdom
Argelinda Baroni, M.D.
- Mood and Anxiety Program, National Institute of Mental Health, Bethesda, MD
Caroline Haimm, B.A.
- Mood and Anxiety Program, National Institute of Mental Health, Bethesda, MD
Melissa Brotman, Ph.D.
- Mood and Anxiety Program, National Institute of Mental Health, Bethesda, MD
Catherine H. Lowe, M.S.W.
- Mood and Anxiety Program, National Institute of Mental Health, Bethesda, MD
Frances Myers, R.N., M.S.N.
- Mood and Anxiety Program, National Institute of Mental Health, Bethesda, MD
Eileen Rustgi, Ph.D.
- Mood and Anxiety Program, National Institute of Mental Health, Bethesda, MD
Wanda Wheeler, M.S.W.
- Mood and Anxiety Program, National Institute of Mental Health, Bethesda, MD
Reilly Kayser, B.A.
- Mood and Anxiety Program, National Institute of Mental Health, Bethesda, MD
Kenneth Towbin, M.D.
- Mood and Anxiety Program, National Institute of Mental Health, Bethesda, MD
Ellen Leibenluft, M.D.
- Mood and Anxiety Program, National Institute of Mental Health, Bethesda, MD

Accepted 26 January 2010. published online 08 March 2010.

Objective

An important question in pediatric bipolar research is whether marked nonepisodic irritability is a manifestation of bipolar disorder in youth. This study tests the hypothesis that youth with severe mood dysregulation (SMD), a category created for the purpose of studying children presenting with severe nonepisodic irritability, will be significantly less likely to develop (hypo-)manic or mixed episodes over time than will youth with bipolar disorder (BD).

Method

Patients with SMD (N = 84) and narrowly defined BD (N = 93) at baseline were followed up in 6-monthly intervals using the relevant K-SADS modules to ascertain (hypo-)manic or mixed episodes.

Results

Only one of 84 SMD subjects (1/84 [1.2%]; 95% confidence interval CI = 0.0003 to 0.064) experienced a (hypo-)manic or mixed episode during the study (median follow-up = 28.7 months). The frequency of such episodes was more than 50 times higher in those with narrowly defined BD (58/93 [62.4%]; 95% CI 0.52 to 0.72).

Conclusions

These data suggest that, over an approximately 2-year follow-up period, youth with SMD are unlikely to develop (hypo-)manic or mixed episodes.

Key Words: bipolar disorder, pediatric, severe mood dysregulation, irritability, ADHD

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This article was reviewed under and accepted by Ad Hoc Editor David R. Rosenberg, M.D.

This work was supported by the National Institute of Mental Health, Intramural Program.

Disclosure: Drs. Stringaris, Baroni, Brotman, Rustgi, Towbin, and Leibenluft, and Ms. Haimm, Mr. Lowe, Ms. Myers, Ms. Wheeler, and Mr. Kayser report no biomedical financial interests or potential conflicts of interest.

This article is discussed in an editorial by Dr. Robert Althoff on page 302.

PII: S0890-8567(10)00090-0

doi:10.1016/j.jaac.2010.01.013

Refers to article:

Dysregulated Children Reconsidered
Robert R. Althoff
Journal of the American Academy of Child & Adolescent Psychiatry April 2010 (Vol. 49, Issue 4, Pages 302-305)
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