Despite low prevalence rates in epidemiological studies, recent research suggests that bipolar di... more Despite low prevalence rates in epidemiological studies, recent research suggests that bipolar disorder (BD) is being diagnosed at increasingly high rates in children and adolescents. To clarify the nosological boundaries of the disorder, studies of the clinical presentation of bipolar youth should be complemented with examinations of cognitive and neural functioning. More specifically, delineating the neurocognitive functioning of youth with BD when processing emotional stimuli may best elucidate how certain emotional contexts elicit symptoms that characterize pediatric BD. This information has the potential to clarify causes of pediatric BD, and to confirm the diagnosis of BD in youth. In this article, we discuss the affective, behavioral, cognitive, and neurological functioning of youth with BD when processing emotional stimuli. We focus on studies that have employed paradigms involving pictures and words with emotional valence, faces with emotional expressions, and responses to ...
Journal of Child and Adolescent Psychopharmacology, 2005
There has been limited research on anxiety in pediatric bipolar disorder (BPD). Adult BPD studies... more There has been limited research on anxiety in pediatric bipolar disorder (BPD). Adult BPD studies suggest comorbid anxiety disorders are common and impact treatment outcome. We explored the association of comorbid anxiety with two phenotypes of pediatric BPD. We studied two groups of children. The first group (BPD; N = 31) represents the "narrow phenotype" of pediatric BPD, meeting stringent DSM-IV criteria for mania, including duration and elevated/expansive mood. The second group (ED; N = 32) exhibited chronic, non-episodic irritability without elation or grandiosity ("broad phenotype"). Both samples demonstrate high prevalence of anxiety (BPD 77.4%; ED 46.9%). In the BPD sample, anxiety predates BPD onset, and those with comorbid anxiety have earlier age of onset of BPD than those without. Children with BPD plus anxiety have more hospitalizations than those without anxiety. ED subjects with and without comorbid anxiety did not differ with respect to onset of ED symptoms or number of hospitalizations. Narrow and broad phenotype BPD children have high rates of comorbid anxiety, although only in the narrow phenotype group is comorbid anxiety associated with greater functional impairment BPD plus comorbid anxiety may represent a particularly severe phenotype of pediatric BPD.
Irritability is prevalent and impairing in pediatric bipolar disorder (BD) but has been minimally... more Irritability is prevalent and impairing in pediatric bipolar disorder (BD) but has been minimally studied using neuroimaging techniques. We used magnetoencephalography (MEG) to study theta band oscillations in the anterior cingulate cortex (ACC) during frustration in BD youth. ACC theta power is associated with attention to emotional stimuli, and the ACC may mediate responses to frustrating stimuli. We used the affective Posner task, an attention paradigm that uses rigged feedback to induce frustration, to compare 20 medicated BD youth (14.9+/-2.0 years; 45% male) and 20 healthy controls (14.7+/-1.7 years; 45% male). MEG measured neuronal activity after negative and positive feedback; we also compared groups on reaction time, response accuracy, and self-reported affect. Patients met strict DSM-IV BD criteria and were euthymic. Controls had no psychiatric history. BD youth reported more negative affective responses than controls. After negative feedback, BD subjects, relative to controls, displayed greater theta power in the right ACC and bilateral parietal lobe. After positive feedback, BD subjects displayed lower theta power in the left ACC than did controls. Correlations between MEG, behavior, and affect were nonsignificant. In this first MEG study of BD youth, BD youth displayed patterns of theta oscillations in the ACC and parietal lobe in response to frustration-inducing negative feedback that differed from healthy controls. These data suggest that BD youth may display heightened processing of negative feedback and exaggerated self-monitoring after frustrating emotional stimuli. Future studies are needed with unmedicated bipolar youth, and comparison ADHD and anxiety groups.
Despite low prevalence rates in epidemiological studies, recent research suggests that bipolar di... more Despite low prevalence rates in epidemiological studies, recent research suggests that bipolar disorder (BD) is being diagnosed at increasingly high rates in children and adolescents. To clarify the nosological boundaries of the disorder, studies of the clinical presentation of bipolar youth should be complemented with examinations of cognitive and neural functioning. More specifically, delineating the neurocognitive functioning of youth with BD when processing emotional stimuli may best elucidate how certain emotional contexts elicit symptoms that characterize pediatric BD. This information has the potential to clarify causes of pediatric BD, and to confirm the diagnosis of BD in youth. In this article, we discuss the affective, behavioral, cognitive, and neurological functioning of youth with BD when processing emotional stimuli. We focus on studies that have employed paradigms involving pictures and words with emotional valence, faces with emotional expressions, and responses to ...
Journal of Child and Adolescent Psychopharmacology, 2005
There has been limited research on anxiety in pediatric bipolar disorder (BPD). Adult BPD studies... more There has been limited research on anxiety in pediatric bipolar disorder (BPD). Adult BPD studies suggest comorbid anxiety disorders are common and impact treatment outcome. We explored the association of comorbid anxiety with two phenotypes of pediatric BPD. We studied two groups of children. The first group (BPD; N = 31) represents the "narrow phenotype" of pediatric BPD, meeting stringent DSM-IV criteria for mania, including duration and elevated/expansive mood. The second group (ED; N = 32) exhibited chronic, non-episodic irritability without elation or grandiosity ("broad phenotype"). Both samples demonstrate high prevalence of anxiety (BPD 77.4%; ED 46.9%). In the BPD sample, anxiety predates BPD onset, and those with comorbid anxiety have earlier age of onset of BPD than those without. Children with BPD plus anxiety have more hospitalizations than those without anxiety. ED subjects with and without comorbid anxiety did not differ with respect to onset of ED symptoms or number of hospitalizations. Narrow and broad phenotype BPD children have high rates of comorbid anxiety, although only in the narrow phenotype group is comorbid anxiety associated with greater functional impairment BPD plus comorbid anxiety may represent a particularly severe phenotype of pediatric BPD.
Irritability is prevalent and impairing in pediatric bipolar disorder (BD) but has been minimally... more Irritability is prevalent and impairing in pediatric bipolar disorder (BD) but has been minimally studied using neuroimaging techniques. We used magnetoencephalography (MEG) to study theta band oscillations in the anterior cingulate cortex (ACC) during frustration in BD youth. ACC theta power is associated with attention to emotional stimuli, and the ACC may mediate responses to frustrating stimuli. We used the affective Posner task, an attention paradigm that uses rigged feedback to induce frustration, to compare 20 medicated BD youth (14.9+/-2.0 years; 45% male) and 20 healthy controls (14.7+/-1.7 years; 45% male). MEG measured neuronal activity after negative and positive feedback; we also compared groups on reaction time, response accuracy, and self-reported affect. Patients met strict DSM-IV BD criteria and were euthymic. Controls had no psychiatric history. BD youth reported more negative affective responses than controls. After negative feedback, BD subjects, relative to controls, displayed greater theta power in the right ACC and bilateral parietal lobe. After positive feedback, BD subjects displayed lower theta power in the left ACC than did controls. Correlations between MEG, behavior, and affect were nonsignificant. In this first MEG study of BD youth, BD youth displayed patterns of theta oscillations in the ACC and parietal lobe in response to frustration-inducing negative feedback that differed from healthy controls. These data suggest that BD youth may display heightened processing of negative feedback and exaggerated self-monitoring after frustrating emotional stimuli. Future studies are needed with unmedicated bipolar youth, and comparison ADHD and anxiety groups.
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Papers by Brendan Rich