21 results on '"Ryan, Neal"'
Search Results
2. Longitudinal Trajectories of ADHD Symptomatology in Offspring of Parents With Bipolar Disorder and Community Controls.
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Jae-Won Kim, Haifeng Yu, Ryan, Neal D., Axelson, David A., Goldstein, Benjamin I., Goldstein, Tina R., Diler, Rasim S., Monk, Kelly, Hickey, Mary Beth, Sakolsky, Dara J., Merranko, John A., and Birmaher, Boris
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- 2015
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3. Examining the Proposed Disruptive Mood Dysregulation Disorder Diagnosis in Children in the Longitudinal Assessment of Manic Symptoms Study.
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Axelson, David, Findling, Robert L., Fristad, Mary A., Kowatch, Robert A., Youngstrom, Eric A., Horwitz, Sarah McCue, Arnold, L. Eugene, Frazier, Thomas W., Ryan, Neal, Demeter, Christine, Gill, Mary Kay, Hauser-Harrington, Jessica C., Depew, Judith, Kennedy, Shawn M., Gron, Brittany A., Rowles, Brieana M., and Birmaher, Boris
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AFFECTIVE disorders ,OUTPATIENT medical care ,PEOPLE with mental illness ,POPULATION ,CHILDREN - Abstract
The article presents a study that examines proposed disruptive mood dysregulation disorder (DMDD) diagnosis in a child psychiatric outpatient population. The domains covered by evaluation of DMDD include clinical phenomenology, delimitation from other diagnoses, longitudinal stability and association with parental psychiatric disorders. Concerns about the diagnostic utility of DMDD in clinical populations are highlighted by the study.
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- 2012
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4. Factors Associated With the Persistence and Onset of New Anxiety Disorders in Youth With Bipolar Spectrum Disorders.
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Sala, Regina, Axelson, David A., Castro-Fomieles, Josefina, Goldstein, Tina R., Goldstein, Benjamin I., Ha, Wonho, Liao, Fangzi, Gill, Mary Kay, lyengar, Satish, Strober, Michael A., Yen, Shirley, Hower, Heather, Hunt, Jeffrey I., Dickstein, Daniel P., Ryan, Neal D., Keller, Martin B., and Birmaher, Boris
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ANXIETY disorders ,BIPOLAR disorder in adolescence ,BIPOLAR disorder ,AFFECTIVE disorders ,MENTAL depression - Abstract
The article discusses a study which assessed the longitudinal course of anxiety disorder in youth and adults with bipolar disorder. It was noted that anxiety disorders tend to persist in youth with bipolar disorder, while those who did not have anxiety disorders at intake developed new-onset anxiety disorders during follow-up. The factors that predict onset of new anxiety disorders among youth with bipolar disorder are discussed.
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- 2012
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5. Concerns Regarding the Inclusion of Temper Dysregulation Disorder With Dysphoria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
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Axelson, David A., Birmaher, Boris, Findling, Robert L., Fristad, Mary A., Kowatch, Robert A., Youngstrom, Eric A., Arnold, L. Eugene, Goldstein, Benjamin I., Goldstein, Tina R., Chang, Kiki D., DelBello, Melissa P., Ryan, Neal D., and Diler, Rasim S.
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TEMPER ,AFFECTIVE disorders ,BIPOLAR disorder ,MENTAL depression - Abstract
The authors express disapproval of the inclusion of temper dysregulation disorder with dysphoria (TDD) as a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). They note that the TDD diagnosis have no symptom criteria specific to TDD as a syndrome. They stress that the inclusion is not justified due to the absence of bipolar disorder in a subset of youths with irritability in a study. They explain the implications for psychotropic medications.
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- 2011
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6. Relationship of Persistent Manic Symptoms to the Diagnosis of Pediatric Bipolar Spectrum Disorders.
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Frazier, Thomas W., Youngstrom, Eric A., Horwitz, Sarah McCue, Demeter, Christine A., Fristad, Mary A., Arnold, L. Eugene, Birmaher, Boris, Kowatch, Robert A., Axelson, David, Ryan, Neal, Gill, Mary Kay, and Findling, Robert L.
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BIPOLAR disorder ,MENTAL illness ,DIAGNOSIS ,MENTAL health ,PSYCHIATRY - Abstract
The article evaluates the possibility that the presence of persistent manic symptoms over a short interval among youth may increase the probability of a bipolar spectrum disorders (BPSD) diagnosis. Youth were assessed for elevated symptoms of mania (ESM) with the Parent General Behavior Inventory-10-Item Mania Scale (PGBI-10M) as the primary outcome measure. The article concludes that the probability of a BPSD diagnosis was substantially altered by obtaining repeated parent report of mania symptoms in many cases.
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- 2011
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7. Long-Term Outcome of Adolescent Depression Initially Resistant to Selective Serotonin Reuptake Inhibitor Treatment: A Follow-Up Study of the TORDIA Sample.
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Vitiello, Benedetto, Emslie, Graham, Clarke, Gregory, Wagner, Karen Dineen, Asarnow, Joan R., Keller, Martin B., Birmaher, Boris, Ryan, Neal D., Kennard, Betsy, Mayes, Taryn L., DeBar, Lynn, Lynch, Frances, Dickerson, John, Strober, Michael, Suddath, Robert, McCracken, James T., Spirito, Anthony, Onorato, Matthew, Zelazny, Jamie, and Porta, Giovanna
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SEROTONIN uptake inhibitors ,DRUG resistance ,MENTAL depression ,DEPRESSION in adolescence ,REGRESSION analysis - Abstract
The article evaluates the long-term consequence of participants in the Treatment of Selective Serotonin Reuptake Inhibitor (SSRI)-Resistant Depression in Adolescents (TORDIA) study. In this study, they employed mixed-effects regression models to calculate alleviation, relapse and functional recovery. The study found that those with extreme depression, greater dysfunction and alcohol or drug use at baseline were less possibly to remit.
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- 2011
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8. Characteristics of Children With Elevated Symptoms of Mania: The Longitudinal Assessment of Manic Symptoms (LAMS) Study.
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Findling, Robert L., Youngstrom, Eric A., Fristad, Mary A., Birmaher, Boris, Kowatch, Robert A., Arnold, L. Eugene, Frazier, Thomas W., Axelson, David, Ryan, Neal, Demeter, Christine A., Gill, Mary Kay, Fields, Benjamin, Depew, Judith, Kennedy, Shawn M., Marsh, Linda, Rowles, Brieana M., and Horwitz, Sarah McCue
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MANIA ,PSYCHOSES in children ,CHILD psychology ,MENTAL health ,PATHOLOGICAL psychology ,PSYCHIATRY - Abstract
This article discusses a study which examined the differences in psychiatric symptomatology, diagnoses, demographics, functioning and psychotropic medication exposure in children with elevated symptoms of mania (ESM) compared to youth without ESM. A review of previous related literature is included. The data, methods and results of the study are explored.
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- 2010
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9. Comorbid Anxiety in Children and Adolescents With Bipolar Spectrum Disorders: Prevalence and Clinical Correlates.
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Sala, Regina, Axelson, David A., Castro-Fornieles, Josefina, Goldstein, Tina R., Ha, Wonho, Liao, Fangzi, Gill, Mary Kay, Iyengar, Satish, Strober, Michael A., Goldstein, Benjamin I., Yen, Shirley, Hower, Heather, Hunt, Jeffrey, Ryan, Neal D., Dickstein, Daniel, Keller, Martin B., and Birmaher, Boris
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ANXIETY disorders ,BIPOLAR disorder in children ,BIPOLAR disorder in adolescence ,MENTAL health of youth ,NEUROSES - Abstract
The article presents a study which examines the prevalence and correlates of comorbid anxiety disorders in children and adolescents with bipolar spectrum disorders. In the study, researchers analyzed 446 youth, ages 7-17 years, who were diagnosed with bipolar I or bipolar II disorder. They observed that youth with bipolar II disorder were more likely to develop comorbid anxiety disorder compared to those with bipolar I or bipolar disorder. They concluded that comorbid anxiety disorders are frequently present in youth with bipolar disorder.
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- 2010
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10. Negative Life Events in Children and Adolescents With Bipolar Disorder.
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Romero, Soledad, Birmaher, Boris, Axelson, David A., Iosif, Ana-Maria, Williamson, Douglas E., Gill, Mary Kay, Goldstein, Benjamin I., Strober, Michael A., Hunt, Jeffrey, Goldstein, Tina R., Esposito-Smythers, Christianne, Iyengar, Satish, Ryan, Neal D., and Keller, Martin
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LIFE change events ,DEVELOPMENTAL psychology ,BIPOLAR disorder in adolescence ,PSYCHOSES in adolescence ,BIPOLAR disorder - Abstract
The article discusses the relationship between negative life events and demographic, as well as clinical variables in adolescents with bipolar I disorder, bipolar II disorder, and bipolar disorder not otherwise specified (NOS). It also compares the rate of life events in adolescents with bipolar disorder and depressive and/or anxiety disorders versus healthy individuals. Results showed that bipolar youth patients are subjected to excessive negative independent and dependent life events that could have an effect on the disease in the long term.
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- 2009
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11. Preliminary Findings Regarding Overweight and Obesity in Pediatric Bipolar Disorder.
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Goldstein, Benjamin I., Birmaher, Boris, Axelson, David A., Goldstein, Tina R., Esposito-Smythers, Christianne, Strober, Michael A., Hunt, Jeffrey, Leonard, Henrietta, Gill, Mary Kay, Iyengar, Satish, Grimm, Colleen, Mei Yang, Ryan, Neal D., and Keller, Martin B.
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MENTAL health of youth ,BIPOLAR disorder ,ADOLESCENT obesity ,OVERWEIGHT teenagers ,COMORBIDITY ,EPIDEMIOLOGY - Abstract
The article focuses on a study which investigated the prevalence of overweight/obesity in youth diagnosed with bipolar disorder. The study included 348 youths aged seven to 17 years and was conducted from October 2000 to July 2006. It found that obesity or overweight was prevalent in 42 percent of the study population. Study findings emphasize the need for the early identification of obesity/overweight among youths with bipolar disorder.
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- 2008
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12. Sex Differences in the Longitudinal Course and Outcome of Bipolar Disorder in Youth.
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Mitchell RHB, Hower H, Birmaher B, Strober M, Merranko J, Rooks B, Goldstein TR, Hunt JI, Dickstein DP, Diler RS, Ryan ND, Gill MK, Axelson D, Keller MB, Yen S, and Goldstein BI
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- Adolescent, Adult, Age of Onset, Anxiety Disorders epidemiology, Attention Deficit Disorder with Hyperactivity epidemiology, Bipolar Disorder epidemiology, Child, Female, Humans, Longitudinal Studies, Male, Self-Injurious Behavior epidemiology, Sex Factors, Substance-Related Disorders epidemiology, Young Adult, Anxiety Disorders physiopathology, Attention Deficit Disorder with Hyperactivity physiopathology, Bipolar Disorder physiopathology, Disease Progression, Self-Injurious Behavior physiopathology, Substance-Related Disorders physiopathology
- Abstract
Objective: Despite substantial literature on sex differences in adults with bipolar disorder (BD), little is known about this topic in youth; this study examines sex differences in mood symptomatology and psychiatric comorbidity in prospectively followed youth with BD., Methods: A subsample of the Course and Outcome of Bipolar Youth study (N = 370; female n = 199, male n = 171) enrolled October 2000-July 2006 (age at intake = 7-17.11 years) who met DSM-IV criteria for bipolar I disorder (BD-I; n = 221), bipolar II disorder (BD-II; n = 26), or operationalized BD not otherwise specified (BD-NOS; n = 123) with ≥ 4 years follow-up was included. Analyses examined sex differences at intake and, prospectively, in mood symptomatology and psychiatric comorbidity for a mean ± SD follow-up of 10.5 ± 1.72 years., Results: Females were older than males at intake (mean ± SD age = 13.33 ± 3.32 vs 12.04 ± 3.16 years; P = .0002) and at age at mood onset (9.33 ± 4.22 vs 7.53 ± 3.74 years; P < .0001). After adjustment for confounders, males spent more time with syndromal ADHD (Padjusted = .001) and females spent more time with syndromal anxiety (Padjusted = .02). There were trends toward males spending more time with substance use disorder and females having more non-suicidal self-injurious behavior (Padjusted = .07 and .09, respectively). There were no sex differences on outcome variables, including rate of or time to recovery and recurrence., Conclusions: Contrasting with adult literature, this study identified minimal sex differences in the course of youth with BD. Longer-term studies are needed to clarify if youth-onset BD remains a "sex neutral" subtype of BD or diverges according to sex in adulthood., (© Copyright 2020 Physicians Postgraduate Press, Inc.)
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- 2020
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13. Correction.
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Vitiello B, Emslie G, Clarke G, Wagner KD, Asarnow JR, Keller MB, Birmaher B, Ryan ND, Kennard B, Mayes TL, DeBar L, Lynch F, Dickerson J, Strober M, Suddath R, McCracken JT, Spirito A, Onorato M, Zelazny J, Porta G, Iyengar S, and Brent DA
- Abstract
This corrects the article DOI: 10.4088/JCP.09m05885blu.., (© Copyright 2019 Physicians Postgraduate Press, Inc.)
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- 2019
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14. High Prevalence of Metabolic Syndrome Among Adolescents and Young Adults With Bipolar Disorder.
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Li C, Birmaher B, Rooks B, Gill MK, Hower H, Axelson DA, Dickstein DP, Goldstein TR, Liao F, Yen S, Hunt J, Iyengar S, Ryan ND, Strober MA, Keller MB, and Goldstein BI
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- Adolescent, Blood Pressure Determination statistics & numerical data, Cholesterol, HDL blood, Comorbidity, Cross-Sectional Studies, Female, Humans, Male, Prevalence, Psychiatric Status Rating Scales, Retrospective Studies, Risk Factors, Triglycerides blood, United States epidemiology, Waist Circumference, Young Adult, Bipolar Disorder epidemiology, Bipolar Disorder metabolism, Metabolic Syndrome blood, Metabolic Syndrome diagnosis, Metabolic Syndrome epidemiology, Metabolic Syndrome psychology, Obesity epidemiology, Obesity psychology
- Abstract
Objective: Despite abundant literature demonstrating increased metabolic syndrome (MetS) prevalence and important clinical correlates of MetS among middle-age adults with bipolar disorder, little is known about this topic among adolescents and young adults early in their course of bipolar disorder. We therefore examined this topic in the Course and Outcome of Bipolar Youth (COBY) study., Methods: A cross-sectional, retrospective study was conducted of 162 adolescents and young adults (mean ± SD age = 20.8 ± 3.7 years; range, 13.6-28.3 years) with bipolar disorder (I, II, or not otherwise specified, based on DSM-IV) enrolled in COBY between 2000 and 2006. MetS measures (blood pressure, glucose, high-density lipoprotein cholesterol [HDL-C], triglycerides, and waist circumference), defined using the International Diabetes Federation criteria, were obtained at a single timepoint. Mood, comorbidity, and treatment over the 6 months preceding the MetS assessment were evaluated using the Longitudinal Interval Follow-Up Evaluation., Results: The prevalence of MetS in the sample was 19.8% (32/162). Low HDL-C (56.5%) and abdominal obesity (46.9%) were the most common MetS criteria. MetS was nominally associated with lower lifetime global functioning at COBY intake (odds ratio [OR] = 0.97, P = .06). MetS was significantly associated with percentage of weeks in full-threshold pure depression (OR = 1.07, P = .02) and percentage of weeks receiving antidepressant medications (OR = 1.06, P = .001) in the preceding 6 months. MetS was not associated with manic symptoms or medications other than antidepressants., Conclusions: The prevalence of MetS in this sample was at least double compared to the general population. Moreover, MetS is associated with increased burden of depression symptoms in this group. Management of early-onset bipolar disorder should integrate strategies focused on modifying MetS risk factors., (© Copyright 2019 Physicians Postgraduate Press, Inc.)
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- 2019
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15. Longitudinal trajectories of ADHD symptomatology in offspring of parents with bipolar disorder and community controls.
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Kim JW, Yu H, Ryan ND, Axelson DA, Goldstein BI, Goldstein TR, Diler RS, Monk K, Hickey MB, Sakolsky DJ, Merranko JA, and Birmaher B
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- Adolescent, Anxiety Disorders epidemiology, Attention Deficit Disorder with Hyperactivity epidemiology, Child, Comorbidity, Female, Humans, Longitudinal Studies, Male, Mood Disorders epidemiology, Adolescent Development physiology, Attention Deficit Disorder with Hyperactivity physiopathology, Bipolar Disorder, Child of Impaired Parents psychology, Disease Progression, Parents psychology
- Abstract
Objective: To compare the psychopathology and longitudinal course of attention-deficit/hyperactivity disorder (ADHD) symptomatology and global functioning between the offspring with ADHD of parents with bipolar disorder and the offspring with ADHD of community control parents., Method: One hundred twenty-two offspring with ADHD of parents with bipolar disorder and 48 offspring with ADHD of control parents from the Pittsburgh Bipolar Offspring Study (BIOS) were included. DSM-IV lifetime psychiatric disorders were ascertained through the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). The outcome measures of ADHD symptoms were ascertained at intake and every other year for a period of 6 years using the ADHD section of the K-SADS-PL and the Disruptive Behavior Disorder rating scale (DBD). Global functioning was assessed using the Children's Global Assessment Scale (CGAS)., Results: The offspring with ADHD of parents with bipolar disorder showed higher lifetime prevalence of mood and anxiety disorders relative to the offspring with ADHD of control parents (P values ≤ .03). For both groups of offspring with ADHD, the hyperactivity, impulsivity, and total K-SADS-PL ADHD scores decreased over time (P values < .001) without differences between the 2 groups. There were no between- or within-group differences in the inattention scores over time. The DBD ADHD scores decreased with age in both groups (P values < .002) without differences between the 2 groups. For both groups of offspring with ADHD, the global functioning did not improve over time., Conclusions: Offspring with ADHD of parents with bipolar disorder have more psychopathology relative to offspring with ADHD of control parents. However, there were no differences in the developmental courses of ADHD symptomatology between these 2 groups of ADHD youth., (© Copyright 2015 Physicians Postgraduate Press, Inc.)
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- 2015
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16. Irritability and elation in a large bipolar youth sample: relative symptom severity and clinical outcomes over 4 years.
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Hunt JI, Case BG, Birmaher B, Stout RL, Dickstein DP, Yen S, Goldstein TR, Goldstein BI, Axelson DA, Hower H, Strober M, Ryan N, Swenson L, Topor DR, Gill MK, Weinstock LM, and Keller MB
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- Adolescent, Age of Onset, Bipolar Disorder classification, Bipolar Disorder epidemiology, Child, Cohort Studies, Cross-Sectional Studies, Depressive Disorder, Major classification, Depressive Disorder, Major diagnosis, Depressive Disorder, Major epidemiology, Depressive Disorder, Major psychology, Female, Follow-Up Studies, Humans, Male, Prospective Studies, Psychiatric Status Rating Scales statistics & numerical data, Psychometrics, Recurrence, Suicide, Attempted psychology, Suicide, Attempted statistics & numerical data, Syndrome, Treatment Outcome, United States, Bipolar Disorder diagnosis, Bipolar Disorder psychology, Euphoria, Irritable Mood
- Abstract
Objective: To assess whether relative severity of irritability symptoms versus elation symptoms in mania is stable and predicts subsequent illness course in youth with DSM-IV bipolar I or II disorder or operationally defined bipolar disorder not otherwise specified., Method: Investigators used the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children to assess the most severe lifetime manic episode in bipolar youth aged 7-17 years who were recruited from 2000 to 2006 as part of the Course and Outcomes of Bipolar Youth prospective cohort study (N = 361), conducted at university-affiliated mental health clinics. Subjects with at least 4 years of follow-up (N = 309) were categorized as irritable-only (n = 30), elated-only (n = 42), or both irritable and elated (n = 237) at baseline. Stability of this categorization over follow-up was the primary outcome. The course of mood symptoms and episodes, risk of suicide attempt, and functioning over follow-up were also compared between baseline groups., Results: Most subjects experienced both irritability and elation during follow-up, and agreement between baseline and follow-up group assignment did not exceed that expected by chance (κ = 0.03; 95% CI, -0.06 to 0.12). Elated-only subjects were most likely to report the absence of both irritability and elation symptoms at every follow-up assessment (35.7%, versus 26.7% of irritable-only subjects and 16.9% of those with both irritability and elation; P = .01). Baseline groups experienced mania or hypomania for a similar proportion of the follow-up period, but irritable-only subjects experienced depression for a greater proportion of the follow-up period than did subjects who were both irritable and elated (53.9% versus 39.7%, respectively; P = .01). The groups did not otherwise differ by course of mood episode duration, polarity, bipolar diagnostic type, suicide attempt risk, or functional impairment., Conclusions: Most bipolar youth eventually experienced both irritability and elation irrespective of history. Irritable-only youth were at similar risk for mania but at greater risk for depression compared with elated-only youth and youth who had both irritability and elation symptoms., (© Copyright 2013 Physicians Postgraduate Press, Inc.)
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- 2013
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17. Suicidality and risk of suicide--definition, drug safety concerns, and a necessary target for drug development: a brief report.
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Meyer RE, Salzman C, Youngstrom EA, Clayton PJ, Goodwin FK, Mann JJ, Alphs LD, Broich K, Goodman WK, Greden JF, Meltzer HY, Normand SL, Posner K, Shaffer D, Oquendo MA, Stanley B, Trivedi MH, Turecki G, Beasley CM Jr, Beautrais AL, Bridge JA, Brown GK, Revicki DA, Ryan ND, and Sheehan DV
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- Adolescent, Adult, Antidepressive Agents adverse effects, Cause of Death, Child, Consensus Development Conferences as Topic, Drug-Related Side Effects and Adverse Reactions, Humans, Mental Disorders drug therapy, Mental Disorders mortality, Mental Disorders psychology, Meta-Analysis as Topic, Middle Aged, Risk Factors, Selective Serotonin Reuptake Inhibitors adverse effects, Suicide statistics & numerical data, Terminology as Topic, United States, United States Food and Drug Administration, Suicide Prevention, Drug Discovery statistics & numerical data, Suicide psychology
- Abstract
Objective: To address issues concerning potential treatment-emergent "suicidality," a consensus conference was convened March 23-24, 2009., Participants: This gathering of participants from academia, government, and industry brought together experts in suicide prevention, clinical trial design, psychometrics, pharmacoepidemiology, and genetics, as well as research psychiatrists involved in studies in studies of psychiatric disorders associated with elevated suicide risk across the life cycle. The process involved reviews of the relevant literature, and a series of 6 breakout sessions focused on specific questions of interest., Evidence: Each of the participants at the meeting received references relevant to the formal presentations (as well as the slides for the presentations) for their review prior to the meeting. In addition, the assessment instruments of suicidal ideation/behavior were reviewed in relationship to standard measures of validity, reliability, and clinical utility, and these findings were discussed at length in relevant breakout groups, in the final plenary session, and in the preparation of the article. Consensus and dissenting views were noted., Consensus Process: Discussion and questions followed each formal presentation during the plenary sessions. Approximately 6 questions per breakout group were prepared in advance by members of the Steering Committee and each breakout group chair. Consensus in the breakout groups was achieved by nominal group process. Consensus recommendations and any dissent were reviewed for each breakout group at the final plenary session. All plenary sessions were recorded and transcribed by a court stenographer. Following the transcript, with input by each of the authors, the final paper went through 14 drafts. The output of the meeting was organized into this brief report and the accompanying full article from which it is distilled. The full article was developed by the authors with feedback from all participants at the meeting and represents a consensus view. Any areas of disagreement at the conference have been noted in the text., Conclusions: The term suicidality is not as clinically useful as more specific terminology (ideation, behavior, attempts, and suicide). Most participants applauded the FDA's encouragement of standard definitions and definable expectations for investigators and industry sponsors. Further research of available assessment instruments is needed to verify their utility, reliability, and validity in identifying suicide-associated treatment-emergent adverse effects and/or a signal of efficacy in suicide prevention trials. The FDA needs to systematically monitor postmarketing events by encouraging the development of a validated instrument for postmarketing surveillance of suicidal ideation, behavior, and risk. Over time, the FDA, industry, and clinical researchers should evaluate the impact of the requirement that all central nervous system clinical drug trials must include a Columbia Classification Algorithm of Suicide Assessment (C-CASA)-compatible screening instrument for assessing and documenting the occurrence of treatment-emergent suicidal ideation and behavior. Finally, patients at high risk for suicide can safely be included in clinical trials, if proper precautions are followed., (Copyright 2010 Physicians Postgraduate Press, Inc.)
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- 2010
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18. Suicidality and risk of suicide--definition, drug safety concerns, and a necessary target for drug development: a consensus statement.
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Meyer RE, Salzman C, Youngstrom EA, Clayton PJ, Goodwin FK, Mann JJ, Alphs LD, Broich K, Goodman WK, Greden JF, Meltzer HY, Normand SL, Posner K, Shaffer D, Oquendo MA, Stanley B, Trivedi MH, Turecki G, Beasley CM Jr, Beautrais AL, Bridge JA, Brown GK, Revicki DA, Ryan ND, and Sheehan DV
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- Adolescent, Adult, Age Factors, Antidepressive Agents therapeutic use, Child, Clinical Trials as Topic ethics, Depressive Disorder, Major drug therapy, Depressive Disorder, Major psychology, Drug Discovery, Drug-Related Side Effects and Adverse Reactions, Humans, Mental Disorders psychology, Meta-Analysis as Topic, Psychometrics, Randomized Controlled Trials as Topic ethics, Randomized Controlled Trials as Topic statistics & numerical data, Reproducibility of Results, Risk Assessment, Suicide classification, Suicide, Attempted classification, Suicide, Attempted psychology, Suicide, Attempted statistics & numerical data, Terminology as Topic, United States, United States Food and Drug Administration, Antidepressive Agents adverse effects, Clinical Trials as Topic standards, Consensus Development Conferences as Topic, Mental Disorders drug therapy, Suicide psychology, Suicide statistics & numerical data
- Abstract
Objective: To address issues concerning potential treatment-emergent "suicidality," a consensus conference was convened March 23-24, 2009., Participants: This gathering of participants from academia, government, and industry brought together experts in suicide prevention, clinical trial design, psychometrics, pharmacoepidemiology, and genetics, as well as research psychiatrists involved in studies of major depression, bipolar disorder, schizophrenia, substance abuse/dependence, and other psychiatric disorders associated with elevated suicide risk across the life cycle. The process involved reviews of the relevant literature, and a series of 6 breakout sessions focused on specific questions of interest., Evidence: Each of the participants at the meeting received references relevant to the formal presentations (as well as the slides for the presentations) for their review prior to the meeting. In addition, the assessment instruments of suicidal ideation/behavior were reviewed in relationship to standard measures of validity, reliability, and clinical utility, and these findings were discussed at length in relevant breakout groups, in the final plenary session, and in the preparation of the article. Consensus and dissenting views were noted., Consensus Process: Discussion and questions followed each formal presentation during the plenary sessions. Approximately 6 questions per breakout group were prepared in advance by members of the Steering Committee and each breakout group chair. Consensus in the breakout groups was achieved by nominal group process. Consensus recommendations and any dissent were reviewed for each breakout group at the final plenary session. All plenary sessions were recorded and transcribed by a court stenographer. Following the transcript, with input by each of the authors, the final paper went through 14 drafts. The output of the meeting was organized into this scholarly article, which has been developed by the authors with feedback from all participants at the meeting and represents a consensus view. Any areas of disagreement have been noted., Conclusions: The term suicidality is not as clinically useful as more specific terminology (ideation, behavior, attempts, and suicide). Most participants applauded the FDA's effort to promote standard definitions and definable expectations for investigators and industry sponsors by endorsing the terminology in the Columbia Classification Algorithm of Suicide Assessment (C-CASA). Further research of available assessment instruments is needed to verify their utility, reliability, and validity in identifying suicide-associated treatment-emergent adverse effects and/or a signal of efficacy in suicide prevention trials. The FDA needs to build upon its new authority to systematically monitor postmarketing events by encouraging the development of a validated instrument for postmarketing surveillance of suicidal ideation, behavior, and risk within informative large health care-related databases in the United States and abroad. Over time, the FDA, industry, and clinical researchers should evaluate the impact of the current Agency requirement that all CNS clinical drug trials must include a C-CASA-compatible screening instrument for assessing and documenting the occurrence of treatment-emergent suicidal ideation and behavior. Finally, patients at high risk for suicide can safely be included in clinical trials, if proper precautions are followed, and they need to be included to enable premarket assessments of the risks and benefits of medications related to suicidal ideation, suicidal behavior, and suicide in such patients., (Copyright 2010 Physicians Postgraduate Press, Inc.)
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- 2010
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19. Clinical differences between suicidal and nonsuicidal depressed children and adolescents.
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Barbe RP, Williamson DE, Bridge JA, Birmaher B, Dahl RE, Axelson DA, and Ryan ND
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- Adolescent, Age Factors, Anxiety Disorders diagnosis, Anxiety Disorders epidemiology, Anxiety Disorders psychology, Attention Deficit and Disruptive Behavior Disorders diagnosis, Attention Deficit and Disruptive Behavior Disorders epidemiology, Attention Deficit and Disruptive Behavior Disorders psychology, Child, Comorbidity, Depressive Disorder, Major epidemiology, Depressive Disorder, Major psychology, Diagnosis, Differential, Dysthymic Disorder diagnosis, Dysthymic Disorder epidemiology, Dysthymic Disorder psychology, Female, Humans, Male, Psychiatric Status Rating Scales, Puberty psychology, Severity of Illness Index, Sex Factors, Sleep Initiation and Maintenance Disorders diagnosis, Sleep Initiation and Maintenance Disorders epidemiology, Suicide statistics & numerical data, Depressive Disorder, Major diagnosis, Suicide psychology
- Abstract
Objective: To examine the clinical symptoms and comorbid psychiatric disorders of depressed children and adolescents with and without clinically significant suicidal ideation., Method: Children and adolescents aged 7 to 17 years with current DSM-III-R major depressive disorder (MDD) (N = 135) were recruited between January 1987 and April 2002. Current MDD symptoms and lifetime comorbid psychiatric disorders were assessed using either a combination of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiologic and -Present Episode versions or the -Present Lifetime version. Thirty-two percent (N = 43) of the depressed subjects were classified as suicidal (at least suicidal ideation with a plan)., Results: Depressed suicidal youth presented with a more severe episode (p = .001) and a poorer functional status (p = .019), were more hopeless (p = .001), and presented more frequently with insomnia (p = .011). There was an interaction between suicide x sex x pubertal status for severity of MDD (p = .013), the presence of hopelessness (p < .001), poor functional status (p = .023), and comorbidity with a lifetime history of any disruptive behavior (p = .019). Among pre-pubertal depressed males, suicidal boys had significantly increased severity of MDD (p = .025) and poorer functional status (p = .044) than non-suicidal boys. Among postpubertal depressed females, suicidal girls were more frequently hopeless (p = .008) and presented an increased severity of MDD (p = .022) and more frequent lifetime history of any disruptive behavior (p = .03) when compared with nonsuicidal girls., Conclusion: There appears to be a sex difference for some clinical features, particularly hopelessness, among depressed suicidal children and adolescents. Whether hopelessness is a sex-specific characteristic of depressed suicidal children and adolescents requires further study.
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- 2005
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20. Major depressive disorder in children and adolescents: clinical trial design and antidepressant efficacy.
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Emslie GJ, Ryan ND, and Wagner KD
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- Adolescent, Age Factors, Age of Onset, Antidepressive Agents adverse effects, Child, Controlled Clinical Trials as Topic standards, Depressive Disorder, Major psychology, Fluoxetine therapeutic use, Humans, Multicenter Studies as Topic, Outcome Assessment, Health Care standards, Placebos, Practice Patterns, Physicians' standards, Research Design standards, Suicide psychology, Treatment Outcome, Antidepressive Agents therapeutic use, Depressive Disorder, Major drug therapy
- Abstract
Major depressive disorder is a common, chronic, recurring, and disabling illness in children and adolescents. Epidemiologic data suggest that the mean age at onset for depression is becoming younger. Antidepressants are widely used in pediatric patients despite a relatively small evidence base from randomized, controlled studies. Compared with the adult population, there are very few controlled studies of antidepressants in children and adolescents, and the studies that have been conducted do not unambiguously demonstrate efficacy. These findings in general are contrary to clinicians' experiences with antidepressants in this population. The different factors associated with the outcome of antidepressant studies in children and adolescents are reviewed. Developmental issues in pediatric patients, such as age of puberty and maturity of neural circuitry, are considered in the context of failed clinical trials. Review of existing controlled trials demonstrates a wide variety in study methodology. Factors such as the study location, methods of patient recruitment, small sample sizes, inclusion/exclusion criteria, study design, and choice of outcome measures all influence the ability of a study to detect differences between an antidepressant and placebo. In the current atmosphere of increased concern about antidepressant side effects, including suicidality, it is increasingly important that clinicians who treat depressed children and adolescents make informed therapeutic decisions based on data from well-controlled clinical trials.
- Published
- 2005
21. Clinical characteristics of depressive symptoms in children and adolescents with major depressive disorder.
- Author
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Yorbik O, Birmaher B, Axelson D, Williamson DE, and Ryan ND
- Subjects
- Adolescent, Affective Symptoms diagnosis, Affective Symptoms epidemiology, Age Factors, Ambulatory Care, Anxiety Disorders diagnosis, Anxiety Disorders epidemiology, Child, Comorbidity, Conduct Disorder diagnosis, Conduct Disorder epidemiology, Conduct Disorder psychology, Depressive Disorder diagnosis, Depressive Disorder epidemiology, Depressive Disorder psychology, Depressive Disorder, Major epidemiology, Depressive Disorder, Major psychology, Factor Analysis, Statistical, Female, Humans, Male, Pennsylvania epidemiology, Principal Component Analysis, Psychiatric Status Rating Scales statistics & numerical data, Sex Factors, Suicide psychology, Depressive Disorder, Major diagnosis
- Abstract
Objective: Very few studies have compared the symptoms of major depressive disorder (MDD) and rates of comorbid psychiatric disorders between depressed children and adolescents. The aim of this study was to reproduce and extend these findings., Method: The Kiddie Schedule for Affective Disorders and Schizophrenia, present version (KSADS-P) was administered to parents (about their children) and in face-to-face interviews with 916 subjects aged 5.6 to 17.9 years with MDD (DSM criteria) (715 adolescents and 201 children; 348 male and 568 female). The subjects were consecutive referrals to an outpatient mood and anxiety disorders clinic., Results: Depressed adolescents had significantly more hopelessness/helplessness, lack of energy/tiredness, hypersomnia, weight loss, and suicidality compared with children (p values < or = .001). In comparison with children, adolescents had significantly more substance abuse and less comorbid separation anxiety disorder and attention-deficit/hyperactivity disorder (p values < or = .001). Depressed female adolescents had significantly more suicidality than depressed male adolescents (p < or = .001). There were no other sex differences between males and females. The symptoms of depressed adolescents grouped into 3 factors (endogenous, negative cognitions/suicidality, and appetite/weight), whereas the symptoms in children grouped into 2 factors (endogenous/negative cognitions/suicidality and appetite/weight)., Conclusions: These results provide further evidence for the continuity of MDD from childhood to adolescence.
- Published
- 2004
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