Psychiatr News April 7, 2006
Volume 41, Number 7, page 33
© 2006 American Psychiatric Association
Early Bipolar Disorder Markers Target of Long-Term Study
Joan Arehart-Treichel
A team of scientists is attempting to see whether medication or
psychotherapy might be able to counter pediatric bipolar disorder in its
earliest stages, or perhaps even prevent it.
While there is a thrust throughout the world to treat schizophrenia in its
earliest phases, or even prevent it, a similar strategy is being deployed for
a mental illness that, while rare, no longer seems to be in
dispute—pediatric bipolar disorder (Psychiatric News, December
2, 2005).
So reported Kiki Chang, M.D., an assistant professor of psychiatry at
Stanford University and a pediatric bipolar disorder authority, at a recent
child-resilience meeting. The meeting was sponsored by the New York Academy of
Sciences and held in Arlington, Va.
Eight years ago, Chang explained, he and his colleagues came up with the
"grandiose idea" of preventing pediatric bipolar disorder. And as
a first step toward reaching their goal, they launched a study that now
includes 254 children from 138 families in which at least one parent has
bipolar disorder. Chang and his group hoped that the study would reveal the
extent to which such youngsters are at risk of developing bipolar disorder as
well as some of the earliest signs of pediatric bipolar disorder—that
is, possible markers for early intervention and perhaps even prevention of the
illness.
The youngsters in the study, he continued, have about a three- to
four-times greater risk of developing bipolar disorder than youngsters without
a family history of the illness. Early signs that children are developing the
illness appear to be irritability, anger, attention difficulties,
hyperactivity, and possibly a smaller amygdala. But unfortunately, none of
these markers signals bipolar disorder exclusively.
Nonetheless, these markers may give Chang and his group some leads on how
to intervene early in children with bipolar disorder. For example, they found
that children with bipolar disorder who were treated with lithium had
relatively normal amygdala volumes compared with children with bipolar
disorder who had not gotten lithium. Thus, lithium and other neuroprotective
agents might be capable of correcting some of the brain deficits caused by
bipolar disorder, Chang and his team reason. Furthermore, they envision that
if lithium were given to youngsters thought to be developing bipolar disorder,
it might not only mitigate severity of illness, but even stop it in its
tracks.
In fact, Chang said, the anticonvulsant divalproex already looks promising
for this purpose. When he and his group put 24 children with early signs of
bipolar disorder on the medication for 12 weeks, 83 percent improved.
Chang and his team are also exploring, in a pilot trial, the possible value
of psychotherapy in preventing pediatric bipolar disorder. Children at high
risk of the illness are receiving 12 weeks of psychotherapy directed toward
reducing family stress.
"Some people say it is too early to try to prevent pediatric bipolar
disorder," Chang concluded. "But I do not. Nor do the parents of
children at high risk of the illness."
Nor does Daniel Pine, M.D., who commented on Chang's presentation at the
meeting. Pine is affiliated with the National Institute of Mental Health's
Mood and Anxiety Program.
Nonetheless, Pine stressed, more needs to be learned about the brain
abnormalities underlying pediatric bipolar disorder, and then "we will
come up with better ideas for intervention." Also, he emphasized,
"We should not declare victory until we have results from randomized,
controlled clinical trials showing that an intervention is effective."
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