Recently, researchers and clinicians have focused increased attention on a group of children with severe mood and behavioral dysregulation. These children are characterized by impairing symptoms that include abnormal baseline mood (i.e. irritability, anger, and/or sadness), hyperarousal (e.g. insomnia, agitation, distractibility), and increased reactivity to negative emotional stimuli. Because this syndrome shares many clinical features with bipolar disorder (BPD), there is considerable debate as to whether these children should be diagnosed with BPD. However, children with this syndrome lack the cardinal symptoms of BPD, and other DSM-IV diagnoses (ADHD, ODD, etc.) capture heterogeneous clinical populations that include many children who do not exhibit the symptoms noted above. Therefore, the goals of this project are 1) to identify reliably a group of children with severe mood and behavioral dysregulation in order to characterize them clinically and follow them longitudinally; 2) to conduct a double-blinded, placebo-controlled trial of lithium in this population; and 3) investigate whether lithium response, which has been associated with neurotrophic effects and with changes in phosphoinositide signaling in bipolar patients, has similar effects in this group of patients. Standardized interview modules and rating scales will be used to rate the clinical features of mood dysregulation. A double-blind, placebo-controlled trial of lithium will be conducted, and spectroscopy to measure NAA and mI will be preformed before and after treatment. Recruitment for the treatment trial is beginning, and the first patients are being screened and enrolled. In addition, we are establishing a collaboration with Children?s National Medical Center in order to allow us to apply, in the setting of a tertiary care child psychiatric clinic, standardized instruments designed to characterize children with severe mood dysregulation.
| Leibenluft, Ellen; Rich, Brendan A (2008) Pediatric bipolar disorder. Annu Rev Clin Psychol 4:163-87 |
| Brotman, Melissa A; Kassem, Layla; Reising, Michelle M et al. (2007) Parental diagnoses in youth with narrow phenotype bipolar disorder or severe mood dysregulation. Am J Psychiatry 164:1238-41 |
| Rich, Brendan A; Schmajuk, Mariana; Perez-Edgar, Koraly E et al. (2007) Different psychophysiological and behavioral responses elicited by frustration in pediatric bipolar disorder and severe mood dysregulation. Am J Psychiatry 164:309-17 |
| Guyer, Amanda E; McClure, Erin B; Adler, Abby D et al. (2007) Specificity of facial expression labeling deficits in childhood psychopathology. J Child Psychol Psychiatry 48:863-71 |
| Dickstein, Daniel P; Nelson, Eric E; McClure, Erin B et al. (2007) Cognitive flexibility in phenotypes of pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 46:341-55 |
| Brotman, Melissa A; Schmajuk, Mariana; Rich, Brendan A et al. (2006) Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children. Biol Psychiatry 60:991-7 |
| Leibenluft, Ellen; Cohen, Patricia; Gorrindo, Tristan et al. (2006) Chronic versus episodic irritability in youth: a community-based, longitudinal study of clinical and diagnostic associations. J Child Adolesc Psychopharmacol 16:456-66 |
| Dickstein, Daniel P; Leibenluft, Ellen (2006) Emotion regulation in children and adolescents: boundaries between normalcy and bipolar disorder. Dev Psychopathol 18:1105-31 |
| Rich, Brendan A; Schmajuk, Mariana; Perez-Edgar, Koraly E et al. (2005) The impact of reward, punishment, and frustration on attention in pediatric bipolar disorder. Biol Psychiatry 58:532-9 |
| Rich, Brendan A; Bhangoo, Robinder K; Vinton, Deborah T et al. (2005) Using affect-modulated startle to study phenotypes of pediatric bipolar disorder. Bipolar Disord 7:536-45 |
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