593 results on '"Boris, Birmaher"'
Search Results
2. White Matter Correlates of Early-Onset Bipolar Illness and Predictors of One-Year Recurrence of Depression in Adults with Bipolar Disorder
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João Paulo Lima Santos, Michele Bertocci, Genna Bebko, Tina Goldstein, Tae Kim, Satish Iyengar, Lisa Bonar, MaryKay Gill, John Merranko, Anastasia Yendiki, Boris Birmaher, Mary L. Phillips, and Amelia Versace
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bipolar disorder ,early-onset ,recurrence ,depressive episodes ,neural predictors ,dMRI ,Medicine - Abstract
Diffusion Magnetic Resonance Imaging (dMRI) studies have reported abnormalities in emotion regulation circuits in BD; however, no study has examined the contribution of previous illness on these mechanisms. Using global probabilistic tractography, we aimed to identify neural correlates of previous BD illness and the extent to which these can help predict one-year recurrence of depressive episodes. dMRI data were collected in 70 adults with early-onset BD who were clinically followed for up to 18 years and 39 healthy controls. Higher number of depressive episodes during childhood/adolescence and higher percentage of time with syndromic depression during longitudinal follow-up was associated with lower fractional anisotropy (FA) in focal regions of the forceps minor (left, F = 4.4, p = 0.003; right, F = 3.1, p = 0.021) and anterior cingulum bundle (left, F = 4.7, p = 0.002; right, F = 7.0, p < 0.001). Lower FA in these regions was also associated with higher depressive and anxiety symptoms at scan. Remarkably, those having higher FA in the right cluster of the forceps minor (AOR = 0.43, p = 0.017) and in a cluster of the posterior cingulum bundle (right, AOR = 0.50, p = 0.032) were protected against the recurrence of depressive episodes. Previous depressive symptomatology may cause neurodegenerative effects in the forceps minor that are associated with worsening of BD symptomatology in subsequent years. Abnormalities in the posterior cingulum may also play a role.
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- 2022
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3. Predicting bipolar disorder I/II in individuals at clinical high-risk: Results from a systematic review
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Gonzalo Salazar de Pablo, Anna Cabras, Joana Pereira, Henrique Castro Santos, Héctor de Diego, Ana Catalan, Ana González-Pinto, Boris Birmaher, Christoph U. Correll, and Paolo Fusar-Poli
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Psychiatry and Mental health ,Clinical Psychology - Published
- 2023
4. Psychometrics of the Spanish Version of the Screen for Adult Anxiety Related Disorders (SCAARED)
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Sarah Sánchez-Cueva, Yurena Alonso-Esteban, Patricio Sánchez-Cueva, Boris Birmaher, and Francisco Alcantud-Marín
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anxiety disorders ,anxiety measures ,rating scales ,tools translation ,measure of anxiety in adults ,Psychiatry ,RC435-571 - Abstract
Objectives: To translate and validate the Screen for Adult Anxiety Related Disorders (SCAARED) questionnaire into Spanish.Method: The original SCAARED was translated into Spanish and administered to a non-clinical sample of 131 university students (92.4% women, mean age 22 years) in Valencia, Spain. To assess the concurrent validity of the SCAARED, the Depression, Anxiety and Stress Scale−21(DASS) and the Beck's Anxiety Inventory (BAI) were also administered. Test-retest reliability was evaluated 2 weeks after the first administration.Results: The internal consistency of SCAARED was high (α = 0.91) and the stability of the measurement was also high (test-retest 0.81). The results of the Exploratory Factor Analysis showed four factors comparable to the original SCAARED (generalized anxiety disorder, social phobia disorder, panic disorder, and separation anxiety disorder). The Area Under the Curve was excellent (0.88).Conclusions: The Spanish version of the SCAARED showed good psychometric properties comparable to the original SCAARED suggesting that it may be a useful instrument to screen for anxiety disorders in Spanish-speaking adult populations. Future studies are needed to replicate these findings in larger community and clinical samples.
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- 2021
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5. Study Preregistration
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Suneeta Monga, Riddhi Desai, Samantha J. Anthony, Paul D. Arnold, Alexa Bagnell, Boris Birmaher, Leslie Anne Campbell, Rachel Churchill, Kristin Cleverley, Darren B. Courtney, Gina Dimitropoulos, Sarah E. Hetrick, Karolin R. Krause, Lidwine B. Mokkink, Scott B. Patten, Megan C. Patton, Matthew J. Prebeg, Beth K. Potter, Erin Romanchych, Jai L. Shah, Maureen Smith, S. Evelyn Stewart, Peter Szatmari, Andrea C. Tricco, Peter Tugwell, John T. Walkup, Vivian A. Welch, Bonnie T. Zima, Nancy J. Butcher, Martin Offringa, Epidemiology and Data Science, and APH - Methodology
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Psychiatry and Mental health ,Developmental and Educational Psychology - Published
- 2023
6. Decreased functional connectivity in the fronto-parietal network in children with mood disorders compared to children with dyslexia during rest: An fMRI study
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Tzipi Horowitz-Kraus, Mackenzie Woodburn, Akila Rajagopal, Amelia L. Versace, Robert A. Kowatch, Michele A. Bertocci, Genna Bebko, Jorge R.C. Almeida, Susan B. Perlman, Michael J. Travis, Mary Kay Gill, Lisa Bonar, Claudiu Schirda, Vaibhav A. Diwadkar, Jeffrey L. Sunshine, Boris Birmaher, David Axelson, H. Gerry Taylor, Sarah M. Horwitz, Thomas Frazier, L. Eugene Arnold, Mary A. Fristad, Eric A. Youngstrom, Robert L. Findling, Mary L. Phillips, and Scott K. Holland
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: The DSM-5 separates the diagnostic criteria for mood and behavioral disorders. Both types of disorders share neurocognitive deficits of executive function and reading difficulties in childhood. Children with dyslexia also have executive function deficits, revealing a role of executive function circuitry in reading. The aim of the current study is to determine whether there is a significant relationship of functional connectivity within the fronto-parietal and cingulo-opercular cognitive control networks to reading measures for children with mood disorders, behavioral disorders, dyslexia, and healthy controls (HC). Method: Behavioral reading measures of phonological awareness, decoding, and orthography were collected. Resting state fMRI data were collected, preprocessed, and then analyzed for functional connectivity. Differences in the reading measures were tested for significance among the groups. Global efficiency (GE) measures were also tested for correlation with reading measures in 40 children with various disorders and 17 HCs. Results: Significant differences were found between the four groups on all reading measures. Relative to HCs and children with mood disorders or behavior disorders, children with dyslexia as a primary diagnosis scored significantly lower on all three reading measures. Children with mood disorders scored significantly lower than controls on a test of phonological awareness. Phonological awareness deficits correlated with reduced resting state functional connectivity MRI (rsfcMRI) in the cingulo-opercular network for children with dyslexia. A significant difference was also found in fronto-parietal global efficiency in children with mood disorders relative to the other three groups. We also found a significant difference in cingulo-opercular global efficiency in children with mood disorders relative to the Dyslexia and Control groups. However, none of these differences correlate significantly with reading measures. Conclusions/significance: Reading difficulties involve abnormalities in different cognitive control networks in children with dyslexia compared to children with mood disorders. Findings of the current study suggest increased functional connectivity of one cognitive control network may compensate for reduced functional connectivity in the other network in children with mood disorders. These findings provide guidance to clinical professionals for design of interventions tailored for children suffering from reading difficulties originating from different pathologies. Keywords: Mood disorders, Behavioral disorders, Dyslexia, Reading, Resting state functional connectivity, Phonological awareness, Executive function networks
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- 2018
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7. Early clinical staging: Why does it matter, and what do we know?
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Danella M. Hafeman, Tina R. Goldstein, and Boris Birmaher
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Psychiatry and Mental health ,Biological Psychiatry - Published
- 2023
8. Smartphone-based interventions in bipolar disorder
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Gerard Anmella, Maria Faurholt‐Jepsen, Diego Hidalgo‐Mazzei, Joaquim Radua, Ives C. Passos, Flavio Kapczinski, Luciano Minuzzi, Martin Alda, Sandra Meier, Tomas Hajek, Pedro Ballester, Boris Birmaher, Danella Hafeman, Tina Goldstein, Elisa Brietzke, Anne Duffy, Benno Haarman, Carlos López‐Jaramillo, Lakshmi N. Yatham, Raymond W. Lam, Erkki Isometsa, Rodrigo Mansur, Roger S. McIntyre, Benson Mwangi, Eduard Vieta, and Lars Vedel Kessing
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Big Data ,bipolar disorder ,Trastorn bipolar ,Cerca en bases de dades ,efficacy ,task force ,Trastorns afectius ,Database searching ,Affective disorders ,Smartphones ,Psychiatry and Mental health ,Mental depression ,Recurrence ,Engagement (Philosophy) ,Quality of Life ,Humans ,Compromís (Filosofia) ,Manic-depressive illness ,Smartphone ,Depressió psíquica ,smartphone interventions ,Telèfons intel·ligents ,Biological Psychiatry ,engagement - Abstract
Background: The clinical effects of smartphone-based interventions for bipolar disorder (BD) have yet to be established. Objectives: To examine the efficacy of smartphone-based interventions in BD and how the included studies reported user-engagement indicators. Methods: We conducted a systematic search on January 24, 2022, in PubMed, Scopus, Embase, APA PsycINFO, and Web of Science. We used random-effects meta-analysis to calculate the standardized difference (Hedges’ g) in pre-post change scores between smartphone intervention and control conditions. The study was pre-registered with PROSPERO (CRD42021226668). Results: The literature search identified 6034 studies. Thirteen articles fulfilled the selection criteria. We included seven RCTs and performed meta-analyses comparing the pre-post change in depressive and (hypo)manic symptom severity, functioning, quality of life, and perceived stress between smartphone interventions and control conditions. There was significant heterogeneity among studies and no meta-analysis reached statistical significance. Results were also inconclusive regarding affective relapses and psychiatric readmissions. All studies reported positive user-engagement indicators. Conclusion: We did not find evidence to support that smartphone interventions may reduce the severity of depressive or manic symptoms in BD. The high heterogeneity of studies supports the need for expert consensus to establish ideally how studies should be designed and the use of more sensitive outcomes, such as affective relapses and psychiatric hospitalizations, as well as the quantification of mood instability. The ISBD Big Data Task Force provides preliminary recommendations to reduce the heterogeneity and achieve more valid evidence in the field.
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- 2022
9. The Case for Universal Screening for Suicidal Risk in Adolescents
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Jeffrey A. Bridge, Boris Birmaher, and David A. Brent
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Pediatrics, Perinatology and Child Health - Published
- 2023
10. Reading related white matter structures in adolescents are influenced more by dysregulation of emotion than behavior
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Tzipi Horowitz-Kraus, Scott K. Holland, Amelia L. Versace, Michele A. Bertocci, Genna Bebko, Jorge R.C. Almeida, Susan B. Perlman, Michael J. Travis, Mary Kay Gill, Lisa Bonar, Claudiu Schirda, Jeffrey L. Sunshine, Boris Birmaher, Gerry Taylor, Vaibhav A. Diwadkar, Sarah M. Horwitz, David Axelson, Thomas Frazier, Eugene L. Arnold, Mary A. Fristad, Eric A. Youngstrom, Robert L. Findling, and Mary L. Phillips
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Mood disorders and behavioral are broad psychiatric diagnostic categories that have different symptoms and neurobiological mechanisms, but share some neurocognitive similarities, one of which is an elevated risk for reading deficit. Our aim was to determine the influence of mood versus behavioral dysregulation on reading ability and neural correlates supporting these skills in youth, using diffusion tensor imaging in 11- to 17-year-old children and youths with mood disorders or behavioral disorders and age-matched healthy controls. The three groups differed only in phonological processing and passage comprehension. Youth with mood disorders scored higher on the phonological test but had lower comprehension scores than children with behavioral disorders and controls; control participants scored the highest. Correlations between fractional anisotropy and phonological processing in the left Arcuate Fasciculus showed a significant difference between groups and were strongest in behavioral disorders, intermediate in mood disorders, and lowest in controls. Correlations between these measures in the left Inferior Longitudinal Fasciculus were significantly greater than in controls for mood but not for behavioral disorders. Youth with mood disorders share a deficit in the executive-limbic pathway (Arcuate Fasciculus) with behavioral-disordered youth, suggesting reduced capacity for engaging frontal regions for phonological processing or passage comprehension tasks and increased reliance on the ventral tract (e.g., the Inferior Longitudinal Fasciculus). The low passage comprehension scores in mood disorder may result from engaging the left hemisphere. Neural pathways for reading differ mainly in executive-limbic circuitry. This new insight may aid clinicians in providing appropriate intervention for each disorder. Keywords: Mood disorders, Behavioral disorders, Reading, White matter tracts, Phonological processing, Passage comprehension
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- 2017
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11. White matter predictors of worsening of subthreshold hypomania severity in non-bipolar young adults parallel abnormalities in individuals with bipolar disorder
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João Paulo Lima, Santos, Amelia, Versace, Richelle S, Stiffler, Haris A, Aslam, Jeanette C, Lockovich, Lisa, Bonar, Michele, Bertocci, Satish, Iyengar, Genna, Bebko, Alexander, Skeba, Mary Kay, Gill, Kelly, Monk, Mary Beth, Hickey, Boris, Birmaher, and Mary L, Phillips
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Mania ,Young Adult ,Psychiatry and Mental health ,Clinical Psychology ,Bipolar Disorder ,Diffusion Tensor Imaging ,Anisotropy ,Humans ,White Matter ,Article - Abstract
BACKGROUND: Identifying neural predictors of worsening subthreshold hypomania severity can help identify risk of progression to BD . While diffusion Magnetic Resonance Imaging (dMRI) studies reported white matter microstructural abnormalities in tracts supporting emotional regulation in individuals with BD, it remains unknown whether similar patterns of white matter microstructure predict worsening of subthreshold hypomania severity in non-BD individuals. METHODS: dMRI data were collected in: 81 non-BD individuals recruited across a range of subthreshold depression and hypomania, and followed for six months; and independent samples of 75 BD and 58 healthy individuals. All individuals were assessed using standardized diagnostic assessments, mood and anxiety symptom rating scales. Global probabilistic tractography and a tract-profile approach examined fractional anisotropy(FA), a measure of fiber collinearity, in tracts supporting emotional regulation shown to have abnormalities in BD: forceps minor (FMIN), anterior thalamic radiation (ATR), cingulum bundle (CB), and uncinate fasciculus (UF). RESULTS: Lower FA in left CB (middle,β=−0.22,P=0.022; posterior,β=−0.32,P
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- 2022
12. The role of bipolar polygenic risk score in the familial transmission of bipolar disorder—An updated analysis
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Boris Birmaher, John Merranko, Danella Hafeman, Alyson Zwicker, Benjamin Goldstein, David Axelson, Tina Goldstein, Dara Sakolsky, Rasim Diler, and Rudolf Uher
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Depressive Disorder, Major ,Multifactorial Inheritance ,Psychiatry and Mental health ,Bipolar Disorder ,Risk Factors ,Humans ,Genetic Predisposition to Disease ,Biological Psychiatry - Published
- 2022
13. The impact of familial risk and early life adversity on emotion and reward processing networks in youth at-risk for bipolar disorder.
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Lindsay C Hanford, Kristen Eckstrand, Anna Manelis, Danella M Hafeman, John Merranko, Cecile D Ladouceur, Simona Graur, Alicia McCaffrey, Kelly Monk, Lisa K Bonar, Mary Beth Hickey, Tina R Goldstein, Benjamin I Goldstein, David Axelson, Genna Bebko, Michele A Bertocci, Mary Kay Gill, Boris Birmaher, and Mary L Phillips
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Medicine ,Science - Abstract
A recently developed risk calculator for bipolar disorder (BD) accounts for clinical and parental psychopathology. Yet, it is understood that both familial predisposition and early life adversity contribute to the development of BD. How the interplay between these two factors influence emotion and reward processing networks in youth at risk for BD remains unclear. In this exploratory analysis, offspring of BD parents performed emotion and reward processing tasks while undergoing a fMRI scan. Risk calculator score was used to assess risk for developing BD in the next 5 years. Environmental risk was tabulated using the Stressful Life Events Schedule (SLES). Emotion and reward processing networks were investigated for genetic and/or environment interactions. Interaction effects were found between risk calculator scores, negative SLES score and activity in right amygdala and bilateral fusiform gyri during the emotion processing task, as well as activity in the fronto-, striatal, and parietal regions during the reward processing task. Our findings are preliminary; however, they support the unique and interactive contributions of both familial and environmental risk factors on emotion and reward processing within OBP. They also identify potential neural targets to guide development of interventions for youth at greatest risk for psychiatric disorders.
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- 2019
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14. Do youth anxiety measures assess the same construct consistently throughout treatment? Results are...complicated
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Jonathan C. Rabner, Thomas M. Olino, Anne Marie Albano, Golda S. Ginsburg, Scott N. Compton, John Piacentini, Dara Sakolsky, Boris Birmaher, Elizabeth Gosch, and Philip C. Kendall
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Psychiatry and Mental health ,Pediatrics, Perinatology and Child Health ,Developmental and Educational Psychology - Published
- 2023
15. Risk factors preceding new onset abuse among youth with bipolar disorder: A longitudinal prospective analysis
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Maria Andreu-Pascual, John Merranko, Mary Kay Gill, Jessica C. Levenson, Danella Hafeman, Heather Hower, Shirley Yen, Michael Strober, Benjamin I. Goldstein, Rasim Diler, Neal D. Ryan, Lauren M. Weinstock, Martin B. Keller, David Axelson, Boris Birmaher, and Tina R. Goldstein
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Psychiatry and Mental health ,Clinical Psychology ,Bipolar Disorder ,Adolescent ,Risk Factors ,Humans ,Female ,Child Abuse ,Comorbidity ,Child ,Retrospective Studies - Abstract
Childhood abuse negatively impacts the course of Bipolar Disorder (BD). Yet, no study has examined risk factors associated with prospectively evaluated physical/sexual abuse, specifically, those preceding first abuse among BD youth. We investigate past/intake/follow-up factors preceding first physical/sexual abuse among BD youth.Childhood-onset BD participants (n = 279 youth, mean age at intake = 12, mean length of follow-up = 12 years) enrolled in the Course and Outcome of Bipolar Youth (COBY) study. Demographic, clinical and family history variables were assessed every 7 months on average using Longitudinal Interval Follow-up Evaluation and Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). Abuse was evaluated at intake using the K-SADS-PL, over follow-up with a Traumatic Events Screen. Family psychopathology was assessed using Family History Screen/Structured Clinical Interview for Diagnostic Statistical Manual-IV.Fifteen-percent of youth reported new-onset abuse during follow-up (62% physical, 26% sexual; 12% both). Intake predictors included more severe depressive symptoms (HR = 1.29), low socioeconomic-status (SES) in families with substance abuse (HR = 0.84) (physical abuse), and female sex (HR = 2.41) (sexual abuse). Follow-up predictors preceding physical abuse included: older age (HR = 1.42), disruptive disorders (HR = 1.39), and the interaction between low SES and family substance abuse (HR = 0.86). For sexual abuse, female sex (HR = 4.33) and a non-biologically related father presence in the household (HR = 2.76). Good relationships with friends (prospectively evaluated) protected against physical/sexual abuse (HR = 0.72/0.70, respectively).Prospective data was gathered longitudinally but assessed retrospectively at every follow-up; perpetrator information and abuse severity were not available.Identifying factors temporally preceding new onset physical/sexual abuse may hold promise for identifying high-risk youth with BD.
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- 2022
16. Polygenic Risk Score and Individual Risk Prediction of Bipolar Disorder
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Danella Hafeman, Rudolf Uher, John Merranko, Alyson Zwicker, Benjamin Goldstein, Tina Goldstein, David Axelson, Kelly Monk, Dara Sakolsky, Satish Iyengar, Rasim Diler, Vishwajit Nimgoankar, and Boris Birmaher
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Biological Psychiatry - Published
- 2023
17. Validation of the youth mood recurrences risk calculator in an adult sample with bipolar disorder
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Martin B. Keller, Heather Hower, Tina R. Goldstein, Jess G. Fiedorowicz, Satish Iyengar, Jeffrey Hunt, Danella Hafeman, Michael Strober, Mary Kay Gill, Boris Birmaher, John Merranko, Benjamin I. Goldstein, Rasim Somer Diler, and Shirley Yen
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Adult ,Pediatrics ,medicine.medical_specialty ,Bipolar Disorder ,Adolescent ,business.industry ,medicine.disease ,Mental health ,Affect ,Young Adult ,Psychiatry and Mental health ,Clinical Psychology ,Mood ,Recurrence ,Risk Factors ,medicine ,Humans ,Generalizability theory ,Personalized medicine ,Bipolar disorder ,Young adult ,business ,Prospective cohort study ,Depression (differential diagnoses) - Abstract
Background The ability to predict an individual's risk of mood episode recurrence can facilitate personalized medicine in bipolar disorder (BD). We sought to externally validate, in an adult sample, a risk calculator of mood episode recurrence developed in youth/young adults with BD from the Course and Outcome of Bipolar Youth (COBY) study. Methods Adult participants from the National Institute of Mental Health Collaborative Depression Study (CDS; N=258; mean(SD) age=35.5(12.0) years; mean follow-up=24.9 years) were utilized as a sample to validate the youth COBY risk calculator for onset of depressive, manic, or any mood episodes. Results In this older validation sample, the risk calculator predicted recurrence of any episode over 1, 2, 3, or 5-year follow-up intervals, with Area Under the Curves (AUCs) approximating 0.77. The AUC for prediction of depressive episodes was about 0.81 for each of the time windows, which was higher than for manic or hypomanic episodes (AUC=0.72). While the risk calculator was well-calibrated across the range of risk scores, it systematically underestimated risk in the CDS sample by about 20%. The length of current remission was a highly significant predictor of recurrence risk in the CDS sample. Limitations Predominantly self-reported White samples may limit generalizability; the risk calculator does not assess more proximal risk (e.g., 1 month). Conclusions Risk of mood episode recurrence can be predicted with good accuracy in youth and adults with BD in remission. The risk calculators may help identify higher risk BD subgroups for treatment and research.
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- 2021
18. Consensus on nomenclature for clinical staging models in bipolar disorder: A narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force
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Danella Hafeman, Anne Duffy, Jorge R. C. Almeida, Flávio Kapczinski, David J. Bond, Martin Alda, Afra van der Markt, Michael Berk, Ralph Kupka, Iria Grande, Robert M. Post, Benicio N. Frey, Gustavo Vazquez, Rodrigo B. Mansur, Manon H.J. Hillegers, Inês Chendo, Vicent Balanzá-Martínez, Márcia Kauer-Sant'Anna, Tomas Hajek, Eduard Vieta, Lakshmi N. Yatham, Hailey Tremain, Mauricio Tohen, Elisa Brietzke, Jan Scott, and Boris Birmaher
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medicine.medical_specialty ,Bipolar Disorder ,Consensus ,Heterogeneous group ,Task force ,Advisory Committees ,Disease progression ,Scientific literature ,Prognosis ,International Standard Bibliographic Description ,medicine.disease ,Terminology ,Psychiatry and Mental health ,SDG 3 - Good Health and Well-being ,Disease Progression ,medicine ,Humans ,Narrative review ,Medical physics ,Bipolar disorder ,Psychology ,Biological Psychiatry - Abstract
Objectives Clinical staging is widely used in medicine to map disease progression, inform prognosis and guide treatment decisions; in psychiatry, however, staging remains a hypothetical construct. To facilitate future research in bipolar disorders (BD), a well-defined nomenclature is needed, especially since diagnosis is often imprecise with blurred boundaries, and a full understanding of pathophysiology is lacking. Methods Under the auspices of the International Society of Bipolar Disorders, a Task Force of international experts was convened to review, discuss, and integrate findings from the scientific literature relevant to the development of a consensus staging model and standardize a terminology that could be used to advance future research including staging of BD and related disorders. Results Consensus opinion and areas of uncertainty or difference were identified in regard to terms referring to staging as it may apply to BD, to at-risk status and subthresholdhold stages, and to various clinical stages of BD as it is currently diagnosed. Conclusion The use of a standardized nomenclature about the clinical stages of BD will facilitate communication about research on clinical and pathological components of this heterogeneous group of disorders. The concepts presented are based on current evidence, but the template provided allows for further refinements as etiological advances come to light.
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- 2021
19. Early indicators of bipolar risk in preschool offspring of parents with bipolar disorder
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Danella M. Hafeman, John Merranko, Heather M. Joseph, Tina R. Goldstein, Benjamin I. Goldstein, Jessica Levenson, David Axelson, Kelly Monk, Dara Sakolsky, Satish Iyengar, and Boris Birmaher
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Psychiatry and Mental health ,Pediatrics, Perinatology and Child Health ,Developmental and Educational Psychology - Abstract
Offspring of parents with bipolar disorder (BD-I/II) are at increased risk to develop the disorder. Previous work indicates that bipolar spectrum disorder (BPSD) is often preceded by mood/anxiety symptoms. In school-age offspring of parents with BD, we previously built a risk calculator to predict BPSD onset, which generates person-level risk scores. Here, we test whether preschool symptoms predict school-age BPSD risk.We assessed 113 offspring of parents with BD 1-3 times during preschool years (2-5 years old) and then approximately every 2 years for a mean of 10.6 years. We used penalized (lasso) regression with linear mixed models to assess relationships between preschool mood, anxiety, and behavioral symptoms (parent-reported) and school-age predictors of BPSD onset (i.e., risk score, subthreshold manic symptoms, and mood lability), adjusting for demographics and parental symptomatology. Finally, we conducted survival analyses to assess associations between preschool symptoms and school-age onset of BPSD and mood disorder.Of 113 preschool offspring, 33 developed new-onset mood disorder, including 19 with new-onset BPSD. Preschool irritability, sleep problems, and parental factors were lasso-selected predictors of school-age risk scores. After accounting for demographic and parental factors, preschool symptoms were no longer significant. Lasso regressions to predict mood lability and subthreshold manic symptoms yielded similar predictors (irritability, sleep problems, and parental affective lability), but preschool symptoms remained predictive even after adjusting for parental factors (ps .005). Exploratory analyses indicated that preschool irritability univariately predicted new-onset BPSD (p = .02) and mood disorder (p = .02).These results provide initial prospective evidence that, as early as preschool, youth who will develop elevated risk scores, mood lability, and subthreshold manic symptoms are already showing symptomatology; these preschool symptoms also predict new-onset BPSD. While replication of findings in larger samples is warranted, results point to the need for earlier assessment of risk and development of early interventions.
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- 2022
20. Role of Polygenic Risk Score in the Familial Transmission of Bipolar Disorder in Youth
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Boris Birmaher, Danella Hafeman, John Merranko, Alyson Zwicker, Benjamin Goldstein, Tina Goldstein, David Axelson, Kelly Monk, Mary Beth Hickey, Dara Sakolsky, Satish Iyengar, Rasim Diler, Vishwajit Nimgaonkar, and Rudolf Uher
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Adult ,Male ,Multifactorial Inheritance ,Bipolar Disorder ,Genotype ,Correction ,Middle Aged ,Psychiatry and Mental health ,Child of Impaired Parents ,Case-Control Studies ,Humans ,Female ,Genetic Predisposition to Disease ,Longitudinal Studies ,Child ,Genome-Wide Association Study - Abstract
Establishing genetic contributions to the transmission of bipolar disorder (BD) from parents to offspring may inform the risk of developing this disorder and further serve to validate BD in youth.To evaluate the specific association of BD polygenic risk scores (PRSs) on the familial transmission and validity of pediatric BD.This community-based case-control longitudinal study (Pittsburgh Biological Offspring Study) included parents with BD I/II and their offspring and parents without BD (healthy or non-BD psychopathology) and their offspring. Participants were recruited between March 2001 and May 2007, and analysis took place from December 2020 to September 2021.PRSs for BD, major depressive disorder, schizophrenia, and attention-deficit/hyperactivity disorder.Participants were prospectively evaluated using standardized interviews blind to parental diagnosis. DNA was extracted from saliva and genotyped. PRSs were constructed based on independent large-scale genome-wide association studies.A total of 156 parents with BD I/II and 180 parents without BD (mean [SD] age, 39.6 [7.9] years; 241 female [72%]) as well as 251 offspring of parents with BD and 158 offspring of parents without BD (mean [SD] age, 10.4 [4.7] years; 213 female [52%]) of European ancestry were analyzed. Participants were assessed a mean of 6.7 times during a mean (SD) of 13 (3.4) years of follow-up (84% retention). More offspring of parents with BD developed BD (58 [23.1%] vs 8 [5.1%]; P .001) and depression (126 [50.2%] vs 52 [32.9%]; P .001) compared with offspring of parents without BD. BD PRS was higher in both parents and offspring with BD than parents and offspring without BD (parents: odds ratio, 1.50; 95% CI, 1.19-1.89; P .001; explained 4.8% of the phenotypic variance vs offspring: hazard ratio, 1.34; 95% CI, 1.03-1.7; P = .02; explained 5.0% of the phenotypic variance). BD PRS did not differ across BD subtypes. In a model combining parental and offspring BD PRS, the parental BD PRS association with offspring BD was fully mediated by offspring BD PRS (hazard ratio, 1.40; 95% CI, 1.05-1.86; P = .02). Parental BD had a stronger direct association than parental or offspring BD PRS with offspring BD risk (hazard ratio, 5.21; 95% CI, 1.86-14.62; P = .002), explaining 30% of the variance. Parental and offspring BD PRS explained 6% of the BD onset variance beyond parental diagnosis. There were no significant between-group differences in PRSs for major depressive disorder, schizophrenia, and attention-deficit/hyperactivity disorder in parents or offspring and they were not significantly associated with BD onset.The findings of this study add to the extant clinical validation of BD in youth. Parental BD and offspring BD PRS independently associated with the risk of BD in offspring. Although this is promising, the association of BD PRS was relatively small and cannot be used alone to determine BD risk until further developments occur.
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- 2022
21. Diagnostic accuracy of the Child and Adolescent Symptom Inventory (CASI-4R) substance use subscale in detecting substance use disorders in youth
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Angelina Pei-Tzu Tsai, Eric A. Youngstrom, Kenneth D. Gadow, Sarah M. Horwitz, Mary A. Fristad, Stacey B. Daughters, Andrea S. Young, L. Eugene Arnold, Boris Birmaher, Stephanie Salcedo, null The LAMS Group, and Robert L. Findling
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Psychiatry and Mental health ,Clinical Psychology - Abstract
Identifying substance use disorders (SUDs) early and accurately improves case formulation and treatment. Previous studies have investigated validity and reliability of the Child and Adolescent Symptom Inventory (CASI) for anxiety, mood, and behavior problems. The present study's aim was to test if the embedded CASI Substance Use (SU) subscale can discriminate adolescents and young adults (AYA) with and without a SUD diagnosis accurately enough to justify clinical application within an evidence-based assessment framework.
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- 2022
22. Mood Instability in Youth at High Risk for Bipolar Disorder
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David J. Miklowitz, Marc J. Weintraub, Manpreet K. Singh, Patricia D. Walshaw, John A. Merranko, Boris Birmaher, Kiki D. Chang, and Christopher D. Schneck
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emotion regulation ,Bipolar Disorder ,Adolescent ,Family Conflict ,Clinical Trials and Supportive Activities ,Developmental & Child Psychology ,Medical and Health Sciences ,mania ,Clinical Research ,Behavioral and Social Science ,Developmental and Educational Psychology ,Humans ,Child ,Pediatric ,Depressive Disorder, Major ,Depressive Disorder ,Depression ,Prevention ,Psychology and Cognitive Sciences ,Major ,Serious Mental Illness ,Brain Disorders ,Psychiatry and Mental health ,Affect ,Mental Health ,Good Health and Well Being ,Family Therapy ,Female ,family therapy ,affective reactivity - Abstract
ObjectiveMood instability is associated with the onset of bipolar disorder (BD) in youth with a family history of the illness. In a clinical trial with youth at high risk for BD, we examined the association between mood instability and symptomatic, psychosocial, and familial functioning over an average of 2 years.MethodYouth (aged 9-17 years) with major depressive disorder or other specified BD, current mood symptoms, and a family history of BD were rated by parents on a mood instability scale. Participants were randomly assigned to 4 months of family-focused therapy or enhanced care psychoeducation, both with medication management as needed. Independent evaluators rated youth every 4-6 months for up to 4 years on symptom severity and psychosocial functioning, whereas parents rated mood instability of the youth and levels of family conflict.ResultsHigh-risk youth (N= 114; mean age 13.3 ± 2.6 years; 72 female) were followed for an average of 104.3 ± 65.8 weeks (range, 0-255 weeks) after randomization. Youth with other specified BD (vs major depressive disorder), younger age, earlier symptom onset, more severe mood symptoms, lower psychosocial functioning, and more familial conflict over time had higher mood instability ratings throughout the study period. Mood instability mediated the association between baseline diagnosis and mother/offspring conflict at follow-up (Z= 2.88, p= .004, αβ= 0.19, 95% CI= 0.06-0.32). Psychosocial interventions did not moderate these associations.ConclusionA questionnaire measure of mood instability tracked closely with symptomatic, psychosocial, and family functioning in youth at high risk for BD. Interventions that are successful in reducing mood instability may enhance long-term outcomes among high-risk youth.Clinical trial registration informationEarly Intervention for Youth at Risk for Bipolar Disorder; https://clinicaltrials.gov/; NCT01483391.
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- 2022
23. Pediatric Bipolar Disorder – Misinformation with Unintended Negative Consequences for Children and Adolescents
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Mohamed Elhosary and Boris Birmaher
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Pharmacology ,Psychiatry and Mental health ,Bipolar Disorder ,Adolescent ,Neurology ,Communication ,Humans ,Pharmacology (medical) ,Neurology (clinical) ,Child ,Biological Psychiatry - Published
- 2022
24. Differentiating white matter measures that protect against vs. predispose to bipolar disorder and other psychopathology in at-risk youth
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Halimah Abdul-Waalee, Lisa Bonar, Mary L. Phillips, Genna Bebko, Kelly Monk, Danella Hafeman, Jay C. Fournier, Cecile D. Ladouceur, Dara Sakolsky, Tina R. Goldstein, Amelia Versace, Boris Birmaher, Michele A. Bertocci, and Renata Rozovsky
- Subjects
medicine.medical_specialty ,Bipolar Disorder ,Adolescent ,Offspring ,Uncinate fasciculus ,Prefrontal cortex ,Article ,White matter ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Fractional anisotropy ,Humans ,Medicine ,Bipolar disorder ,Pharmacology ,Psychopathology ,business.industry ,Emotional regulation ,medicine.disease ,White Matter ,Pathophysiology ,030227 psychiatry ,Psychiatry and Mental health ,Diffusion Tensor Imaging ,medicine.anatomical_structure ,Anisotropy ,business ,030217 neurology & neurosurgery - Abstract
Bipolar disorder (BD) is highly heritable. Identifying objective biomarkers reflecting pathophysiological processes predisposing to, versus protecting against BD, can help identify BD risk in offspring of BD parents. We recruited 21 BD participants with a first-degree relative with BD, 25 offspring of BD parents, 27 offspring of comparison parents with non-BD psychiatric disorders, and 32 healthy offspring of healthy parents. In at-risk groups, 23 had non-BD diagnoses and 29, no Axis-I diagnoses(healthy). Five at-risk offspring who developed BD post scan(Converters) were included. Diffusion imaging(dMRI) analysis with tract segmentation identified between-group differences in the microstructure of prefrontal tracts supporting emotional regulation relevant to BD: forceps minor, anterior thalamic radiation(ATR), cingulum bundle(CB), and uncinate fasciculus(UF). BD participants showed lower fractional anisotropy (FA) in the right CB (anterior portion) than other groups (q q qs qs qs
- Published
- 2021
25. Risk factors for pre-adolescent onset suicidal behavior in a high-risk sample of youth
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Giovanna Porta, Jamie Zelazny, J. John Mann, Maria A. Oquendo, Nadine M. Melhem, Boris Birmaher, David A. Brent, and Barbara Stanley
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Adult ,Adolescent ,Offspring ,Suicide, Attempted ,Article ,Suicidal Ideation ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Suicidal ideation ,Multinomial logistic regression ,First episode ,Mood Disorders ,business.industry ,medicine.disease ,030227 psychiatry ,Psychiatry and Mental health ,Clinical Psychology ,Exact test ,Mood disorders ,Adolescent Behavior ,Suicidal behavior ,Female ,Analysis of variance ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
OBJECTIVE: To identify risk factors for preadolescent onset suicidal behavior compared with adolescent/young adult onset suicidal behavior in a longitudinal sample of youth with parental history of mood disorders. METHODS: The sample includes 545 youth who were age 21 years or less at the time of their baseline assessment. Participants underwent baseline and yearly study assessments. Observations were censored at the time point closest to the first episode of suicidal behavior for youth with suicidal behavior and at the time of last observation for youth without suicidal behavior. Youth were categorized into 3 groups: first onset of suicidal behavior before the age of 13 (n=32), first onset of suicidal behavior between the ages of 13–21 (n=51) and those without suicide related behaviors (n=462). ANOVA, Chi-square, Fisher’s exact test and multinomial regression were used to test the hypotheses. RESULTS: Significant predictors of preadolescent onset suicidal behavior were diagnosis of depressive disorder (RRR=11.41, p
- Published
- 2021
26. Neural substrates of child irritability in typically developing and psychiatric populations
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Susan B. Perlman, Brianna M. Jones, Lauren S. Wakschlag, David Axelson, Boris Birmaher, and Mary L. Phillips
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Irritability ,Developmental psychopathology ,fMRI ,Frustration ,Emotion ,Anterior cingulate ,Neurophysiology and neuropsychology ,QP351-495 - Abstract
Irritability is an aspect of the negative affectivity domain of temperament, but in severe and dysregulated forms is a symptom of a range of psychopathologies. Better understanding of the neural underpinnings of irritability, outside the context of specific disorders, can help to understand normative variation but also characterize its clinical salience in psychopathology diagnosis. This study assessed brain activation during reward and frustration, domains of behavioral deficits in childhood irritability. Children (age 6–9) presenting in mental health clinics for extreme and impairing irritability (n = 26) were compared to healthy children (n = 28). Using developmentally sensitive methods, neural activation was measured via a negative mood induction paradigm during fMRI scanning. The clinical group displayed more activation of the anterior cingulate and middle frontal gyrus during reward, but less activation during frustration, than healthy comparison children. The opposite pattern was found in the posterior cingulate. Further, in clinical subjects, parent report of irritability was dimensionally related to decreased activation of the anterior cingulate and striatum during frustration. The results of this study indicate neural dysfunction within brain regions related to reward processing, error monitoring, and emotion regulation underlying clinically impairing irritability. Results are discussed in the context of a growing field of neuroimaging research investigating irritable children.
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- 2015
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27. A risk calculator to predict suicide attempts among individuals with early-onset bipolar disorder
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Tina R. Goldstein, John Merranko, Danella Hafeman, Mary Kay Gill, Fangzi Liao, Craig Sewall, Heather Hower, Lauren Weinstock, Shirley Yen, Benjamin Goldstein, Martin Keller, Michael Strober, Neal Ryan, and Boris Birmaher
- Subjects
Psychiatry and Mental health ,Bipolar Disorder ,Adolescent ,Substance-Related Disorders ,Risk Factors ,Humans ,Suicide, Attempted ,Prospective Studies ,Biological Psychiatry ,Suicidal Ideation - Abstract
To build a one-year risk calculator (RC) to predict individualized risk for suicide attempt in early-onset bipolar disorder.Youth numbering 394 with bipolar disorder who completed ≥2 follow-up assessments (median follow-up length = 13.1 years) in the longitudinal Course and Outcome of Bipolar Youth (COBY) study were included. Suicide attempt over follow-up was assessed via the A-LIFE Self-Injurious/Suicidal Behavior scale. Predictors from the literature on suicidal behavior in bipolar disorder that are readily assessed in clinical practice were selected and trichotomized as appropriate (presence past 6 months/lifetime history only/no lifetime history). The RC was trained via boosted multinomial classification trees; predictions were calibrated via Platt scaling. Half of the sample was used to train, and the other half to independently test the RC.There were 249 suicide attempts among 106 individuals. Ten predictors accounted for90% of the cross-validated relative influence in the model (AUC = 0.82; in order of relative influence): (1) age of mood disorder onset; (2) non-suicidal self-injurious behavior (trichotomized); (3) current age; (4) psychosis (trichotomized); (5) socioeconomic status; (6) most severe depressive symptoms in past 6 months (trichotomized none/subthreshold/threshold); (7) history of suicide attempt (trichotomized); (8) family history of suicidal behavior; (9) substance use disorder (trichotomized); (10) lifetime history of physical/sexual abuse. For all trichotomized variables, presence in the past 6 months reliably predicted higher risk than lifetime history.This RC holds promise as a clinical and research tool for prospective identification of individualized high-risk periods for suicide attempt in early-onset bipolar disorder.
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- 2022
28. 1. Controlled Study of Metabolic Syndrome Among Offspring of Parents With Bipolar Disorder
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Nidhi Kulkarni, Mikaela K. Dimick, Kody Kennedy, David Axelson, Dara Sakolsky, Rasim Diler, Tina Goldstein, Danella Hafeman, Kelly Monk, John Merranko, Boris Birmaher, and Benjamin I. Goldstein
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Biological Psychiatry - Published
- 2023
29. Developmental Phenotypes of Sequential Comorbidity Leading to Major Mood Disorders
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Rudolf Uher, Janice Fullerton, Alyson Zwicker, Kathryn Freeman, Elena de la Serna, Josefina Castro-Fornieles, Neeltje van Haren, Manon Hillegers, Frances Rice, Anita Thapar, Lukas Propper, Danella Hafeman, Boris Birmaher, Philip Mitchell, Martin Alda, and John Nurnberger
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Biological Psychiatry - Published
- 2023
30. Transdiagnostic Polygenic Risk Scores in Youth With Bipolar Disorder
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Xinyue Jiang, Clement C. Zai, James Kennedy, Boris Birmaher, and Benjamin Goldstein
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Biological Psychiatry - Published
- 2023
31. 187. Precuneus Lactate Metabolism in Bipolar Disorder Depression: Preliminary 7T MRSI Data
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Michele Bertocci, Rasim Somer Diler, Chan Hong Moon, Hoby Hetherington, Mary Phillips, Boris Birmaher, and Jullie Pan
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Biological Psychiatry - Published
- 2023
32. 25.3 41031: Polygenic Risk Score and Bipolar Onset in Youth at Familial Risk
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Danella Hafeman, John Merranko, and Boris Birmaher
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Psychiatry and Mental health ,Developmental and Educational Psychology - Published
- 2022
33. 5.3 Review of Papers About Risk to Develop and Treatment of Bipolar Disorder, Recognizing Psychosis, Irritability and Depression, Disparities Treating Suicidality, and Consequences of COVID
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Boris Birmaher
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Psychiatry and Mental health ,Developmental and Educational Psychology - Published
- 2022
34. Using machine learning and surface reconstruction to accurately differentiate different trajectories of mood and energy dysregulation in youth.
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Amelia Versace, Vinod Sharma, Michele A Bertocci, Genna Bebko, Satish Iyengar, Amanda Dwojak, Lisa Bonar, Susan B Perlman, Claudiu Schirda, Michael Travis, Mary Kay Gill, Vaibhav A Diwadkar, Jeffrey L Sunshine, Scott K Holland, Robert A Kowatch, Boris Birmaher, David Axelson, Thomas W Frazier, L Eugene Arnold, Mary A Fristad, Eric A Youngstrom, Sarah M Horwitz, Robert L Findling, and Mary L Phillips
- Subjects
Medicine ,Science - Abstract
Difficulty regulating positive mood and energy is a feature that cuts across different pediatric psychiatric disorders. Yet, little is known regarding the neural mechanisms underlying different developmental trajectories of positive mood and energy regulation in youth. Recent studies indicate that machine learning techniques can help elucidate the role of neuroimaging measures in classifying individual subjects by specific symptom trajectory. Cortical thickness measures were extracted in sixty-eight anatomical regions covering the entire brain in 115 participants from the Longitudinal Assessment of Manic Symptoms (LAMS) study and 31 healthy comparison youth (12.5 y/o;-Male/Female = 15/16;-IQ = 104;-Right/Left handedness = 24/5). Using a combination of trajectories analyses, surface reconstruction, and machine learning techniques, the present study aims to identify the extent to which measures of cortical thickness can accurately distinguish youth with higher (n = 18) from those with lower (n = 34) trajectories of manic-like behaviors in a large sample of LAMS youth (n = 115; 13.6 y/o; M/F = 68/47, IQ = 100.1, R/L = 108/7). Machine learning analyses revealed that widespread cortical thickening in portions of the left dorsolateral prefrontal cortex, right inferior and middle temporal gyrus, bilateral precuneus, and bilateral paracentral gyri and cortical thinning in portions of the right dorsolateral prefrontal cortex, left ventrolateral prefrontal cortex, and right parahippocampal gyrus accurately differentiate (Area Under Curve = 0.89;p = 0.03) youth with different (higher vs lower) trajectories of positive mood and energy dysregulation over a period up to 5years, as measured by the Parent General Behavior Inventory-10 Item Mania Scale. Our findings suggest that specific patterns of cortical thickness may reflect transdiagnostic neural mechanisms associated with different temporal trajectories of positive mood and energy dysregulation in youth. This approach has potential to identify patterns of neural markers of future clinical course.
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- 2017
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35. Factors Influencing Emerging Adults' Use of Outpatient Mental Health Services
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Boris Birmaher, Sarah M. Horwitz, Eric A. Youngstrom, L. Eugene Arnold, Sarah R. Black, Mary A. Fristad, and Robert L. Findling
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Gerontology ,Psychiatry and Mental health ,Treatment utilization ,business.industry ,Pediatrics, Perinatology and Child Health ,Medicine ,Young adult ,business ,Mental health ,Article - Abstract
Rates of treatment utilization decline as adolescents make the transition to adulthood even though young adults are particularly vulnerable to the negative outcomes of untreated mental illness. Although a variety of factors have been explored to explain decreased treatment utilization in this age group, previous research has almost exclusively employed cross-sectional methods rather than following a group of youth as they enter adulthood. The current study aims to address this methodological limitation by assessing treatment utilization in emerging adults who began participating in a longitudinal study during childhood. One hundred and thirty seven youth who turned 18 during the 96-month follow-up period were included in the current analyses. Demographic and socioeconomic variables such as sex, race, and insurance status and clinical variables such as psychiatric diagnoses and perceptions of treatment effectiveness were investigated as factors potentially associated with outpatient treatment use before and after age 18. Prior to age 18, youth reported using outpatient services at 75% of their visits, but after age 18, outpatient treatment utilization dropped to around 50%. White race, increased parental stress, and increased parental perception of treatment usefulness were associated with greater treatment use prior to age 18, whereas only increased youth perception of symptom-related dysfunction were associated with increased treatment use after age 18. Findings point to the importance of including youth preferences and perceptions of dysfunction in treatment decisions across adolescence in order to optimize treatment use following the transition to adulthood.
- Published
- 2022
36. Reduced reward anticipation in youth at high-risk for unipolar depression: A preliminary study
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Thomas M. Olino, Dana L. McMakin, Judith K. Morgan, Jennifer S. Silk, Boris Birmaher, David A. Axelson, Douglas E. Williamson, Ronald E. Dahl, Neal D. Ryan, and Erika E. Forbes
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Depression ,High-risk ,Reward function ,Positive affect ,fMRI ,Neurophysiology and neuropsychology ,QP351-495 - Abstract
Offspring of depressed parents are at risk for depression and recent evidence suggests that reduced positive affect (PA) may be a marker of risk. We investigated whether self-reports of PA and fMRI-measured striatal response to reward, a neural correlate of PA, are reduced in adolescent youth at high familial risk for depression (HR) relative to youth at low familial risk for depression (LR). Functional magnetic resonance imaging assessments were conducted with 14 HR and 12 LR youth. All youth completed an ecological momentary assessment protocol to measure PA in natural settings and a self-report measure of depression symptomatology. Analyses found that HR youth demonstrated lower striatal response than LR youth during both reward anticipation and outcome. However, after controlling for youth self-reports of depression, HR youth demonstrated lower striatal response than LR youth only during reward anticipation. No significant differences were found between HR and LR youth on subjective ratings of PA or depressive symptoms. Results are consistent with previous findings that reduced reward response is a marker of risk for depression, particularly during reward anticipation, even in the absence of (or accounting for) disrupted subjective mood. Further examinations of prospective associations between reward response and depression onset are needed.
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- 2014
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37. Improving Clinical Prediction of Bipolar Spectrum Disorders in Youth
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Thomas W. Frazier, Eric A. Youngstrom, Mary A. Fristad, Christine Demeter, Boris Birmaher, Robert A. Kowatch, L. Eugene Arnold, David Axelson, Mary K. Gill, Sarah M. Horwitz, and Robert L. Findling
- Subjects
bipolar disorder ,children ,risk factors ,clinical decision making ,classification tree analysis ,Medicine - Abstract
This report evaluates whether classification tree algorithms (CTA) may improve the identification of individuals at risk for bipolar spectrum disorders (BPSD). Analyses used the Longitudinal Assessment of Manic Symptoms (LAMS) cohort (629 youth, 148 with BPSD and 481 without BPSD). Parent ratings of mania symptoms, stressful life events, parenting stress, and parental history of mania were included as risk factors. Comparable overall accuracy was observed for CTA (75.4%) relative to logistic regression (77.6%). However, CTA showed increased sensitivity (0.28 vs. 0.18) at the expense of slightly decreased specificity and positive predictive power. The advantage of CTA algorithms for clinical decision making is demonstrated by the combinations of predictors most useful for altering the probability of BPSD. The 24% sample probability of BPSD was substantially decreased in youth with low screening and baseline parent ratings of mania, negative parental history of mania, and low levels of stressful life events (2%). High screening plus high baseline parent-rated mania nearly doubled the BPSD probability (46%). Future work will benefit from examining additional, powerful predictors, such as alternative data sources (e.g., clinician ratings, neurocognitive test data); these may increase the clinical utility of CTA models further.
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- 2014
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38. Neural function during emotion regulation and future depressive symptoms in youth at risk for affective disorders
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Cecile D. Ladouceur, Kelly Monk, Jay C. Fournier, Amelia Versace, Halimah Abdul-Waalee, Lisa Bonar, Boris Birmaher, Mary L. Phillips, João Paulo Lima Santos, Satish Iyengar, and Michele A. Bertocci
- Subjects
Adolescent ,Offspring ,Article ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Bipolar disorder ,Depression (differential diagnoses) ,Depressive symptoms ,Pharmacology ,Depressive Disorder, Major ,Depression ,Mood Disorders ,business.industry ,medicine.disease ,Magnetic Resonance Imaging ,Emotional Regulation ,030227 psychiatry ,Psychiatry and Mental health ,Neural function ,Major depressive disorder ,medicine.symptom ,business ,Mania ,030217 neurology & neurosurgery ,Psychopathology ,Clinical psychology - Abstract
Affective disorders (AD, including bipolar disorder, BD, and major depressive disorder) are severe recurrent illnesses. Identifying neural markers of processes underlying AD development in at-risk youth can provide objective, “early-warning” signs that may predate onset or worsening of symptoms. Using data (n = 34) from the Bipolar Offspring Study, we examined relationships between neural response in regions supporting executive function, and those supporting self-monitoring, during an emotional n-back task (focusing on the 2-back face distractor versus the 0-back no-face control conditions) and future depressive and hypo/manic symptoms across two groups of youth at familial risk for AD: Offspring of parents with BD (n = 15, age = 14.15) and offspring of parents with non-BD psychopathology (n = 19, age = 13.62). Participants were scanned and assessed twice, approximately 4 years apart. Across groups, less deactivation in the mid-cingulate cortex during emotional regulation (Rate Ratio = 3.07(95% CI:1.09–8.66), χ(2)(1) = 4.48, p = 0.03) at Time-1, and increases in functional connectivity from Time-1 to 2 (Rate Ratio = 1.45(95% CI:1.15–1.84), χ(2)(1) = 8.69, p = 0.003) between regions that showed deactivation during emotional regulation and the right caudate, predicted higher depression severity at Time-2. Both effects were robust to sensitivity analyses controlling for clinical characteristics. Decreases in deactivation between Times 1 and 2 in the right putamen tail were associated with increases in hypo/mania at Time-2, but this effect was not robust to sensitivity analyses. Our findings reflect neural mechanisms of risk for worsening affective symptoms, particularly depression, in youth across a range of familial risk for affective disorders. They may serve as potential objective, early-warning signs of AD in youth.
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- 2021
39. Impact of treatment improvement on long-term anxiety: Results from CAMS and CAMELS
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Courtney P. Keeton, Scott N. Compton, Dara Sakolsky, John Piacentini, Philip C. Kendall, Golda S. Ginsburg, Joshua Klugman, Lesley A. Norris, Tara S. Peris, Hannah E. Frank, Margaret E. Crane, Anne Marie Albano, and Boris Birmaher
- Subjects
Male ,050103 clinical psychology ,Adolescent ,medicine.medical_treatment ,Dysfunctional family ,PsycINFO ,Placebo ,Article ,Sertraline ,Adaptation, Psychological ,medicine ,Humans ,0501 psychology and cognitive sciences ,Longitudinal Studies ,Child ,Cognitive Behavioral Therapy ,05 social sciences ,Anxiety Disorders ,Combined Modality Therapy ,Cognitive behavioral therapy ,Psychiatry and Mental health ,Clinical Psychology ,Treatment Outcome ,Caregivers ,Anxiety ,Female ,medicine.symptom ,Psychology ,Selective Serotonin Reuptake Inhibitors ,medicine.drug ,Psychopathology ,Clinical psychology ,Coping Cat - Abstract
Objective This article examined associations between change in youth and family characteristics during youth anxiety treatment and long-term anxiety severity and overall functioning. Method Participants (N = 488; age 7-17 years; 45% male; 82% white) were randomized to 12 weeks of cognitive behavioral therapy (Coping Cat), medication (sertraline), their combination, or pill placebo in the Child/Adolescent Anxiety Multimodal Study (CAMS). A subset participated in the naturalistic follow-up Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS; n = 319; 3.70-11.83 years post-treatment). The current secondary analyses examined how change in anxiety severity (Child Global Impression-Severity), overall functioning (Children's Global Assessment Scale), caregiver psychopathology (Brief Symptom Inventory), caregiver strain (Family Burden Assessment Scale), and family dysfunction (Brief Family Assessment Measure) during CAMS was associated with anxiety severity and overall functioning years later (M = 7.72 years). CAMS procedures were registered on clinialtrials.gov. Results Improvements in factors related to functioning (i.e., overall functioning, family dysfunction, caregiver strain) were associated with improvements in anxiety severity in CAMELS (|βys| ≥ .04, ps ≤ .04). Improvements in factors related to psychopathology (i.e., anxiety severity, caregiver psychopathology) were associated with improvements in overall functioning in CAMELS (|βys| ≥ .23, ps ≤ .04). It was changes in each of the variables examined (rather than baseline values) that predicted anxiety severity and overall functioning. Conclusions Both youth and family factors play a significant role in long-term treatment outcomes. Therapists would be wise to monitor how these factors change throughout treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
- Published
- 2021
40. White Matter Correlates of Suicidality in Adults With Bipolar Disorder Who Have Been Prospectively Characterized Since Childhood
- Author
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Vilde Chaya Fenster-Ehrlich, Michele A. Bertocci, John Merranko, Sarrah Mailliard, David A. Brent, Tina R. Goldstein, Boris Birmaher, Lisa Bonar, Amelia Versace, João Paulo Lima Santos, Danella Hafeman, Mary L. Phillips, Tae Kim, Genna Bebko, MaryKay Gill, Halimah Abdul-Waalee, Alexander Skeba, and Satish Iyengar
- Subjects
Adult ,medicine.medical_specialty ,Bipolar Disorder ,Multivariate analysis ,Adolescent ,Cognitive Neuroscience ,Suicide, Attempted ,Article ,050105 experimental psychology ,Suicidal Ideation ,White matter ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Fractional anisotropy ,medicine ,Humans ,0501 psychology and cognitive sciences ,Radiology, Nuclear Medicine and imaging ,Bipolar disorder ,Child ,Suicidal ideation ,Biological Psychiatry ,medicine.diagnostic_test ,business.industry ,05 social sciences ,Magnetic resonance imaging ,medicine.disease ,Emotional dysregulation ,White Matter ,Right cingulum bundle ,Suicide ,medicine.anatomical_structure ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background Prevention of suicide in individuals with early-onset bipolar disorder (BD) remains a challenge. Diffusion magnetic resonance imaging studies in BD have identified neural correlates of emotional dysregulation implicated in BD and suicide. Using diffusion magnetic resonance imaging, we sought to identify neural signatures of suicide attempts in adults with childhood-onset BD who have been clinically followed for up to 19 years as part of the COBY (Course and Outcome of Bipolar Youth) study. Methods Diffusion magnetic resonance imaging data were collected in 68 adults with BD: 20 in the suicide attempter (SA+) group and 48 in the non–suicide attempter (SA−) group. Multivariate analysis of covariance was used to identify the effect of group (SA+, SA−) on mean fractional anisotropy (indirect index of fiber collinearity) in key white matter tracts of emotional regulation. The effect of suicidal ideation and other clinical factors was further explored. False discovery rate was used to account for multiple comparison. Forty healthy control subjects were included. Results Analyses revealed a main effect of group on fractional anisotropy (F5,59 = 3.0, p = .017). Specifically, the SA+ group showed lower fractional anisotropy than the SA− and healthy control groups in the middle portion of the forceps minor (FMIN) (F1,63 = 8.5, p = .010) and in the anterior (F1,63 = 7.8, p = .010) and posterior (F1,63 = 8.7, p = .006) portion of the right cingulum bundle (CB). Abnormalities in the FMIN, but not CB, were also associated with suicidal ideation (F1,64 = 10.6, p = .002) and levels of emotional distress at scan. Conclusions FMIN and CB abnormalities have been associated with emotional dysregulation in BD. Our findings suggest that the FMIN may represent a generic marker of suicidal ideation and, more broadly, emotional distress, while CB may represent a specific marker of attempted suicide.
- Published
- 2021
41. Emotional regulation neural circuitry abnormalities in adult bipolar disorder: dissociating effects of long-term depression history from relationships with present symptoms
- Author
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Jeffrey Bergman, João Paulo Lima Santos, Jeanette Lockovich, Haris Aslam, Michele A. Bertocci, Mary Kay Gill, Mary L. Phillips, Richelle Stiffler, Satish Iyengar, Rasim Somer Diler, John Merranko, Boris Birmaher, Genna Bebko, Cecile D. Ladouceur, Lisa Bonar, Amelia Versace, and Halimah Abdul-Waalee
- Subjects
Adult ,medicine.medical_specialty ,Bipolar Disorder ,Adolescent ,Emotions ,Temporoparietal junction ,Thalamus ,Precuneus ,Prefrontal Cortex ,Audiology ,Article ,lcsh:RC321-571 ,Premotor cortex ,Prognostic markers ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Social cognition ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,Bipolar disorder ,Child ,lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry ,Biological Psychiatry ,Depression ,business.industry ,medicine.disease ,Magnetic Resonance Imaging ,Emotional Regulation ,030227 psychiatry ,Dorsolateral prefrontal cortex ,Psychiatry and Mental health ,medicine.anatomical_structure ,Female ,business ,Insula ,030217 neurology & neurosurgery - Abstract
Bipolar disorder (BD) is common and debilitating and confounding effects of depression history on neural activity in BD are unknown. We aimed to dissociate neural activity reflecting past depression-load vs. present symptom severity using the Course and Outcome of Bipolar Youth (COBY), a prospective longitudinal cohort study of pediatric-onset BD. In n = 54 COBY (18–32 years), we modeled depression scores over time (up to 17.5 years) using a standardized autoregressive moving average (ARMA) model, followed by k-means cluster analysis. N = 36 healthy participants (HC, 20–36 years) were included. Using two factorial analyses, we parsed the impact of ARMA-defined past depression-load on neural activity from the impact of current symptoms on neural activity (p k > 30) and examined relationships with past and present symptoms (ps FDR-corrected). ARMA identified three COBY groups based on past depression-load. ARMA-defined COBY participants with the greatest past depression-load vs. other groups showed greater activity in right temporoparietal junction, thalamus, insula, premotor cortex, left fusiform gyrus, bilateral precuneus and cerebellum. In contrast, BD-COBY participants vs. HC showed greater activity in left hippocampus, dorsolateral prefrontal cortex, and right somatosensory cortex, plus the above thalamus, premotor cortex and cerebellum; activity positively correlated with present symptom severity in most regions. Past depression-load was related to social cognition and salience perception network activity, potentially reflecting heightened attention to socially relevant distracters, while present symptoms were associated with emotion processing and reappraisal network activity, potentially reflecting abnormal emotional experience and regulation. Differentiating aberrant neural activity related to long-term depression vs. present affective symptoms can help target interventions to networks associated with pathophysiological processes, rather than long-term illness effects.
- Published
- 2020
42. KSADS-COMP Perspectives on Child Psychiatric Diagnostic Assessment and Treatment Planning
- Author
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Joan Kaufman, Boris Birmaher, Nina de Lacy, and Ken Kobak
- Subjects
medicine.medical_specialty ,Adolescent ,behavioral disciplines and activities ,mental disorders ,Developmental and Educational Psychology ,medicine ,Humans ,0501 psychology and cognitive sciences ,Child ,Psychiatry ,Psychiatric Status Rating Scales ,Psychopathology ,05 social sciences ,Reproducibility of Results ,Schedule for Affective Disorders and Schizophrenia ,medicine.disease ,Anxiety Disorders ,Psychiatry and Mental health ,Hypomania ,Convergent validity ,Attention Deficit Disorder with Hyperactivity ,Conduct disorder ,Anxiety ,Computerized adaptive testing ,Psychiatric interview ,medicine.symptom ,Psychology ,Mania ,050104 developmental & child psychology - Abstract
Gibbons et al.1 demonstrated the utility of computerized adaptive tests (CATs) based on multidimensional item response theory for the assessment of depression, anxiety, mania/hypomania, attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, and suicidality in children and adolescents. The Kiddie-Computerized Adaptive Test (K-CAT) demonstrated good convergent validity, test-retest reliability, and diagnostic concordance with diagnoses derived using the paper-and-pencil Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) child psychiatric interview.
- Published
- 2021
43. Can Emotional and Behavioral Dysregulation in Youth Be Decoded from Functional Neuroimaging?
- Author
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Liana C L Portugal, Maria João Rosa, Anil Rao, Genna Bebko, Michele A Bertocci, Amanda K Hinze, Lisa Bonar, Jorge R C Almeida, Susan B Perlman, Amelia Versace, Claudiu Schirda, Michael Travis, Mary Kay Gill, Christine Demeter, Vaibhav A Diwadkar, Gary Ciuffetelli, Eric Rodriguez, Erika E Forbes, Jeffrey L Sunshine, Scott K Holland, Robert A Kowatch, Boris Birmaher, David Axelson, Sarah M Horwitz, Eugene L Arnold, Mary A Fristad, Eric A Youngstrom, Robert L Findling, Mirtes Pereira, Leticia Oliveira, Mary L Phillips, and Janaina Mourao-Miranda
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Medicine ,Science - Abstract
IntroductionHigh comorbidity among pediatric disorders characterized by behavioral and emotional dysregulation poses problems for diagnosis and treatment, and suggests that these disorders may be better conceptualized as dimensions of abnormal behaviors. Furthermore, identifying neuroimaging biomarkers related to dimensional measures of behavior may provide targets to guide individualized treatment. We aimed to use functional neuroimaging and pattern regression techniques to determine whether patterns of brain activity could accurately decode individual-level severity on a dimensional scale measuring behavioural and emotional dysregulation at two different time points.MethodsA sample of fifty-seven youth (mean age: 14.5 years; 32 males) was selected from a multi-site study of youth with parent-reported behavioral and emotional dysregulation. Participants performed a block-design reward paradigm during functional Magnetic Resonance Imaging (fMRI). Pattern regression analyses consisted of Relevance Vector Regression (RVR) and two cross-validation strategies implemented in the Pattern Recognition for Neuroimaging toolbox (PRoNTo). Medication was treated as a binary confounding variable. Decoded and actual clinical scores were compared using Pearson's correlation coefficient (r) and mean squared error (MSE) to evaluate the models. Permutation test was applied to estimate significance levels.ResultsRelevance Vector Regression identified patterns of neural activity associated with symptoms of behavioral and emotional dysregulation at the initial study screen and close to the fMRI scanning session. The correlation and the mean squared error between actual and decoded symptoms were significant at the initial study screen and close to the fMRI scanning session. However, after controlling for potential medication effects, results remained significant only for decoding symptoms at the initial study screen. Neural regions with the highest contribution to the pattern regression model included cerebellum, sensory-motor and fronto-limbic areas.ConclusionsThe combination of pattern regression models and neuroimaging can help to determine the severity of behavioral and emotional dysregulation in youth at different time points.
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- 2016
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44. The Effect of Traumatic Events on the Longitudinal Course and Outcomes of Youth with Bipolar Disorder
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Michael Strober, Lauren M. Weinstock, Maria Andreu Pascual, John Merranko, Benjamin I. Goldstein, Tina R. Goldstein, Shirley Yen, Boris Birmaher, Heather Hower, David Axelson, Neal D. Ryan, Jessica C. Levenson, Martin B. Keller, and Mary Kay Gill
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Longitudinal study ,Pediatrics ,Bipolar Disorder ,sexual abuse ,Comorbidity ,Medical and Health Sciences ,0302 clinical medicine ,Prospective Studies ,Aetiology ,Suicidal ideation ,Pediatric ,Psychiatry ,youth ,Depression ,longitudinal study ,food and beverages ,Serious Mental Illness ,Psychiatry and Mental health ,Clinical Psychology ,Mental Health ,Physical abuse ,social and economic factors ,medicine.symptom ,Psychosocial ,Psychopathology ,medicine.medical_specialty ,Physical Injury - Accidents and Adverse Effects ,Adolescent ,Article ,Suicidal Ideation ,03 medical and health sciences ,Clinical Research ,2.3 Psychological ,Behavioral and Social Science ,medicine ,Humans ,Bipolar disorder ,Retrospective Studies ,business.industry ,Prevention ,Psychology and Cognitive Sciences ,traumatic events ,medicine.disease ,Brain Disorders ,030227 psychiatry ,Good Health and Well Being ,Mood ,Sexual abuse ,physical abuse ,business ,030217 neurology & neurosurgery - Abstract
BackgroundExposure to severe Traumatic Events (TEs) has been associated with poor course and outcomes among individuals with Bipolar Disorder (BD). However, there is limited research on TEs among youth with BD, and few studies are longitudinal. This study prospectively followed a large sample of BD youth, examining the associations of lifetime TEs with their mood and functioning.MethodsBD participants (n=375; mean age=17; range 8-25y) were assessed, on average, every 7 months for a median 8.7 years. Psychopathology and lifetime trauma history were prospectively evaluated using the Longitudinal Interval Follow-Up Evaluation, and a traumatic events screening.ResultsAccounting for covariates, participants with one or more lifetime TEs (84%) showed earlier BD onset, poorer psychosocial functioning, worse mood symptoms, and more suicidal ideation, comorbidities, and family psychopathology than those without TEs. TEs during recovery periods increased recurrence risk (p
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- 2020
45. Toward prevention of bipolar disorder in at-risk children: Potential strategies ahead of the data
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Robert M. Post, David J. Miklowitz, Melissa P. DelBello, Boris Birmaher, Benjamin I. Goldstein, Robert L. Findling, and Benicio N. Frey
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medicine.medical_specialty ,Bipolar Disorder ,Psychological intervention ,Prodromal Symptoms ,03 medical and health sciences ,0302 clinical medicine ,Intervention (counseling) ,medicine ,Humans ,Bipolar disorder ,Medical diagnosis ,Family history ,Child ,Psychiatry ,business.industry ,medicine.disease ,030227 psychiatry ,Psychiatry and Mental health ,Clinical Psychology ,Tolerability ,Child, Preschool ,Anxiety ,medicine.symptom ,business ,Psychosocial ,030217 neurology & neurosurgery - Abstract
Background Despite the well-documented negative impact of untreated bipolar illness, approaches to early intervention in childhood-onset bipolar and related disorders are not well delineated. Methods We reviewed the extant treatment literature on children at high risk for bipolar disorder, with definitions based on family history, childhood adversity, and prodromal symptoms. Results A panoply of approaches have been described, but most interventions are based on an inadequate database to support their routine implementation. We classify early stage interventions as a function of their safety and tolerability with the hope that these might generate more rigorous study and a stronger database. Limitations Critics may rightly argue that identifying viable treatment methods is premature given our lack of ability to reliably predict illness trajectory in very young children. However, many of the psychosocial and pharmacological interventions we present could have nonspecific positive effects across a variety of symptoms, syndromes, and diagnoses, further enhancing the rationale for more rigorous study. Conclusions Early stage interventions have the potential to improve functioning in prodromal illness and exert long-term positive effects on the course of illness. Many of the safest interventions deserve consideration for implementation and dissemination studies.
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- 2020
46. Correlates, Course, and Outcomes of Increased Energy in Youth with Bipolar Disorder
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Boris Birmaher, Daniel P. Dickstein, Mary Kay Gill, Heather Hower, Rasim Somer Diler, Lauren M. Weinstock, Benjamin I. Goldstein, Jeffrey Hunt, Shirley Yen, David Axelson, Martin B. Keller, Elisabeth A. Frazier, Neal D. Ryan, Tina R. Goldstein, Richard N. Jones, and Michael Strober
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medicine.medical_specialty ,Bipolar Disorder ,Adolescent ,behavioral disciplines and activities ,Article ,Rating scale ,mental disorders ,Child and adolescent psychiatry ,Humans ,Medicine ,Bipolar disorder ,Child ,Psychiatric Status Rating Scales ,business.industry ,Not Otherwise Specified ,Schedule for Affective Disorders and Schizophrenia ,medicine.disease ,Diagnostic and Statistical Manual of Mental Disorders ,Psychiatry and Mental health ,Clinical Psychology ,Mood ,medicine.symptom ,business ,Psychosocial ,Mania ,Clinical psychology - Abstract
Objectives Compare longitudinal trajectories of youth with Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV Bipolar Disorder (BD), grouped at baseline by presence/absence of increased energy during their worst lifetime mood episode (required for DSM-5). Methods Participants from the parent Course and Outcome of Bipolar Youth study (N = 446) were assessed utilizing The Schedule for Affective Disorders and Schizophrenia for School-Age Children (KSADS), KSADS Mania Rating Scale (KMRS), and KSADS Depression Rating Scale (KDRS). Youth were grouped at baseline into those with increased energy (meeting DSM-5 Criteria A for mania) vs. without increased energy (meeting DSM-IV, but not DSM-5, Criteria A for mania), for those who had worst lifetime mood episode recorded (n = 430). Youth with available longitudinal data had the presence/absence of increased energy measured, as well as psychiatric symptomatology/clinical outcomes (evaluated via the Adolescent Longitudinal Interval Follow-Up Evaluation), at each follow-up for 12.5 years (n = 398). Results At baseline, the increased energy group (based on endorsed increased energy during worst lifetime mood episode; 86% of participants) vs. the without increased energy group, were more likely to meet criteria for BD-I and BD Not Otherwise Specified, had higher KMRS/KDRS total scores, and displayed poorer family/global psychosocial functioning. However, frequency of increased energy between groups was comparable after 5 years, and no significant group differences were found on clinical/psychosocial functioning outcomes after 12.5 years. Limitations Secondary data limited study design; groupings were based on one time point. Conclusions Results indicate no clinically relevant longitudinal group differences.
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- 2020
47. In-Session Involvement in Anxious Youth Receiving CBT with/without Medication
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Dara Sakolsky, John T. Walkup, Tara S. Peris, Scott N. Compton, Anne Marie Albano, Thomas M. Olino, Elizabeth A. Gosch, John Piacentini, Courtney P. Keeton, Golda S. Ginsburg, Philip C. Kendall, Boris Birmaher, and Erika A. Chiappini
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050103 clinical psychology ,Sertraline ,medicine.medical_treatment ,05 social sciences ,Multilevel model ,Treatment outcome ,Moderation ,behavioral disciplines and activities ,Session (web analytics) ,Clinical Psychology ,medicine ,Psychoeducation ,Anxiety ,0501 psychology and cognitive sciences ,medicine.symptom ,Psychology ,Reuptake inhibitor ,050104 developmental & child psychology ,Clinical psychology ,medicine.drug - Abstract
Although in-session factors of CBT for youth anxiety (e.g., youth involvement; therapist behaviors) have demonstrated significant associations with treatment outcomes, no study has examined the role of concurrent selective-serotonin reuptake inhibitors (SSRI) on in-session behavior affecting youth outcomes. The combination of SSRI and CBT have demonstrated robust outcomes over either treatment alone. Research has also neglected to examine in-session behavior based on treatment phase (i.e., psychoeducation, exposure) and the association between in-session factors and treatment outcome. Youth (N = 190) were participants in the Children/Adolescent Anxiety Multimodal Study (Walkup et al. New England Journal of Medicine, 359, 2753-2766, 2008) who completed CBT; of these, n = 94 received concurrent sertraline. Tapes of psychoeducation/skill-building (first half) and exposure sessions (second half) were rated by reliable coders for positive youth involvement (e.g., participation, understanding), negative youth involvement (e.g., safety-behaviors, negative affect), and therapist behaviors. Youth and therapist in-session behaviors were examined as predictors of the trajectory of anxiety outcomes using multilevel modeling. Medication (sertraline) was examined as a moderator. Results indicated that positive and negative youth involvement in CBT was significantly associated with outcomes. Positive youth involvement during psychoeducation and exposure sessions predicted better outcomes, and negative youth involvement during psychoeducation sessions predicted less favorable outcomes. Sertraline did not moderate these findings. Therapist behaviors were not significantly associated with outcomes, likely due to limited variability and low frequency of observed behaviors. Youth in-sessions behaviors are associated with treatment outcomes in anxiety treatment. However, medication does not appear to have a differential impact on youth in-session behaviors.
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- 2020
48. Antidepressant Use in a 3- to 12-Year Follow-up of Anxious Youth: Results from the CAMELS Trial
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Erika A. Chiappini, Anne Marie Albano, Hannah E. Frank, Tara S. Peris, John Piacentini, Philip C. Kendall, Mark J. Knepley, Margaret E. Crane, Boris Birmaher, Golda S. Ginsburg, Dara Sakolsky, Elana R. Kagan, Katherine E. Phillips, Lesley A. Norris, Scott N. Compton, Courtney P. Keeton, and Sophie A. Palitz
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Adult ,Male ,050103 clinical psychology ,medicine.medical_specialty ,Adolescent ,Patient characteristics ,Anxiety ,Article ,Young Adult ,Developmental and Educational Psychology ,medicine ,Humans ,0501 psychology and cognitive sciences ,Longitudinal Studies ,Child ,Psychiatry ,Depression (differential diagnoses) ,Depressive Disorder ,Medication use ,05 social sciences ,Anxiety Disorders ,Antidepressive Agents ,Discontinuation ,Psychiatry and Mental health ,Pediatrics, Perinatology and Child Health ,Antidepressant ,Single episode ,medicine.symptom ,Psychology ,Follow-Up Studies ,050104 developmental & child psychology - Abstract
The current study explored whether patient characteristics predicted patterns of antidepressant use (i.e., never used, single episode of use, or two or more episodes) in a naturalistic follow-up. Participants in the child/adolescent multimodal (CAMS) extended long-term study. (n = 318) indicated medication use over the course of eight follow-up visits, 3-12 years after receiving treatment in CAMS. 40.6% of participants reported never using an antidepressant during follow-up, 41.4% reported a single episode of antidepressant use, and 18.0% reported multiple episodes of antidepressant use. Greater baseline anxiety severity marginally predicted a single episode of antidepressant use; baseline depression severity predicted multiple episodes of use. Reasons for discontinuing antidepressants included perceived ineffectiveness (31.8%), side effects (25.5%), and improvement in symptoms (18.5%). Exploratory analyses examined predictors of medication use. Findings suggest that antidepressant use is common among anxious youth, as is discontinuation of antidepressant use. Clinical implications and future directions are discussed.
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- 2020
49. Characteristics of youth at high risk for bipolar disorder compared to youth with bipolar I or II disorder
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Patricia D. Walshaw, Boris Birmaher, Christopher D. Schneck, Marc J. Weintraub, David Axelson, Kiki D. Chang, David J. Miklowitz, and Manpreet K. Singh
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medicine.medical_specialty ,Bipolar Disorder ,Adolescent ,Poison control ,Anxiety ,Medical and Health Sciences ,Article ,03 medical and health sciences ,0302 clinical medicine ,Clinical Research ,2.3 Psychological ,Behavioral and Social Science ,Humans ,Medicine ,Bipolar disorder ,Aetiology ,Psychiatry ,Biological Psychiatry ,Pediatric ,Depressive Disorder ,Depressive Disorder, Major ,Depression ,business.industry ,Psychology and Cognitive Sciences ,Not Otherwise Specified ,Major ,Serious Mental Illness ,medicine.disease ,Anxiety Disorders ,Brain Disorders ,030227 psychiatry ,Psychiatry and Mental health ,Mental Health ,Mood ,Attention Deficit Disorder with Hyperactivity ,Conduct disorder ,Major depressive disorder ,social and economic factors ,medicine.symptom ,business ,Psychosocial ,030217 neurology & neurosurgery - Abstract
Significant efforts have been undertaken to characterize the phenomenology of the high-risk period for bipolar disorder (BD) through the examination of youth at familial risk (i.e., having a first- or second-degree relative with BD) or clinical high risk for the disorder (i.e., youth with BD Not Otherwise Specified [NOS] or major depressive disorder [MDD]). However, little is known about the phenomenology of youth at both familial and clinical high risk for BD. In this study, we examined the clinical and psychosocial characteristics of youth at familial and clinical high risk (HR) for BD, and compared these characteristics to those of youth with BD I and II. Both groups were recruited based on current, active mood symptoms from separate randomized trials of family therapy. A total of 127 HR youth were evaluated: 52 (40.9%) were diagnosed with BD-NOS and 75 (59.1%) were diagnosed with MDD. Compared to adolescents with BD I and II (n=145), HR youth had higher rates of anxiety disorders, and comparable rates of attention-deficit/hyperactivity disorder and oppositional defiant disorder/conduct disorder. Mood symptom severity and psychosocial functioning were progressively more impaired consistent with diagnostic severity: BD I>BD II>BD-NOS>MDD. Nonetheless, HR youth exhibited significant depressive symptom severity compared to adolescents with BD I and overall impairment in psychosocial functioning. These results provide further support for the high rates of anxiety disorders and premorbid dysfunction in addition to active mood symptoms for youth at risk for BD, and suggest anxiety is an important phenological characteristics and treatment target of the high-risk period.
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- 2020
50. A brief motivational intervention for enhancing medication adherence for adolescents with bipolar disorder: A pilot randomized trial
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Megan Krantz, Antoine Douaihy, Loren Sobel, John Merranko, David Axelson, Boris Birmaher, Rachael K. Fersch-Podrat, Tina R. Goldstein, and Nina J. Hotkowski
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medicine.medical_specialty ,Bipolar Disorder ,Future studies ,Adolescent ,Medication adherence ,Pilot Projects ,Article ,Medication Adherence ,law.invention ,Motivational interventions ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Intervention (counseling) ,medicine ,Humans ,Bipolar disorder ,Motivation ,Psychotropic Drugs ,business.industry ,medicine.disease ,030227 psychiatry ,Psychiatry and Mental health ,Clinical Psychology ,Mood ,Physical therapy ,Brief intervention ,business ,030217 neurology & neurosurgery - Abstract
BACKGROUND: Youth with bipolar disorder (BP) exhibit poor medication adherence, contributing to affective recurrence. Brief Motivational Interventions (BMIs) improve adherence among adolescents with chronic conditions. METHODS: In an open pilot series, we developed a 3-session BMI for BP adolescents targeting medication adherence and conducted a pilot randomized trial comparing Standard Care (SC) versus SC+BMI. Participants include 43 adolescents with BP prescribed psychotropic medications. We assessed medication adherence objectively via bluetooth-enabled electronic pillbox (MedTracker). A blinded evaluator assessed mood symptoms at intake, 3- and 6-months. RESULTS: The BMI was well-received. Average objective medication adherence increased with time in SC+BMI, but decreased in SC-Alone (p
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- 2020
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