Studies of Brain Function and Course of Illness in Pediatric Bipolar Disorder

This study is currently recruiting participants. (see Contacts and Locations)
Verified February 2014 by National Institutes of Health Clinical Center (CC)
Sponsor:
Information provided by:
National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov Identifier:
NCT00025935
First received: October 31, 2001
Last updated: August 28, 2014
Last verified: February 2014

October 31, 2001
August 28, 2014
October 2001
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Complete list of historical versions of study NCT00025935 on ClinicalTrials.gov Archive Site
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Studies of Brain Function and Course of Illness in Pediatric Bipolar Disorder
Characterization and Pathophysiology of Severe Mood and Behavioral Dysregulation in Children and Youth

We study the course of child bipolar illness and how brain function differs between youth with bipolar disorder, those 'at-risk,' and healthy volunteers.

Objective

The past decade has seen a dramatic increase in focus on pediatric bipolar disorder (BD), as the number of children receiving the diagnosis has escalated (Blader and Carlson, 2007; Leibenluft, 2008; Moreno et al., 2007). Discussion has centered on the diagnostic boundaries of bipolar disorder, and whether nonepisodic severe irritability is a developmental presentation of mania. Beginning in 2002, our work defined a specific phenotype [severe mood dysregulation (SMD)] including youth with chronic angry mood with behavioral outbursts and hyperarousal symptoms (Leibenluft, 2011; Leibenluft et al., 2003). The purpose of this work has been to examine similarities and differences between youth with BD and SMD, and address the nosological question of whether the diagnosis of BD should be separated from a chronic angry mood with behavioral outbursts and hyperarousal symptoms similar to those present in children and adolescents with attention deficit hyperactivity disorder (ADHD). Before this work began, there was substantial debate (Baroni et al., 2009; Biederman et al., 1998; Carlson, 1998; Leibenluft et al., 2003; Nottelman, 2001), with little evidence to support either position.

Over the last decade, there has been substantial progress suggesting these might be best viewed a separate conditions, but important questions remain. Future work needs to address the relationship between classic presentations of BD (as in protocol 00-M-0198) and SMD, as defined in this protocol. We are examining the developmental trajectory, phenomenology, behavioral correlates, and underlying neural mechanisms of chronic irritability in youth. Our overall goal is to gain a clearer understanding of the course and neurophysiology the disorder to inform treatment and improve the outcome for children with SMD. In order to advance this aim this protocol has 3 objectives:

  1. to use longitudinal techniques to characterize the clinical and physiological manifestations of SMD
  2. to identify and follow longitudinally behavioral, neuropsychological, neurophysiological, and neuroanatomical correlates of SMD, and compare them to pediatric disorders that bear some similarities (BD, and attention deficit hyperactivity disorder (ADHD)) and to typically developing youth.
  3. to examine genetic and familial correlates of SMD

Study population

There are 3 separate populations being studied in this protocol:

  1. Children and adolescents between the ages of 7-17 years old who meet criteria for SMD
  2. Healthy volunteer children and adolescents between the ages of 7-17 years old
  3. Healthy volunteer adults between the ages of 18-25 years old.

Design

For children and adolescents with SMD, this study is an outpatient characterization and longitudinal follow-along design. Once determined to be eligible, individuals come for an initial assessment, and then return at 1-2-year intervals until age 25 for clinical interviews, behavioral tasks, and structural and functional MRI.

For healthy volunteer children, adults and parents of healthy volunteer children, this study is an outpatient cross-sectional study that includes clinical interviews, behavioral tasks, and structural and functional MRI.

For all individuals, genetic material from saliva or blood is obtained under protocol 01-M-0254.

Outcome measures

This study will examine between-group differences in clinical, behavioral, genetic, neuroanatomical, and neurophysiological variables in individuals with SMD, BD (BD, see protocol 00-M-0198) (Leibenluft et al., 2003), and healthy volunteers.

Children with SMD may also be compared on these features to those with other disorders (e.g. anxiety, depression) who are studied under Dr. Daniel Pine s protocol 01-M-0192 in order to elucidate differences between SMD and these conditions.

Longitudinal clinical, behavioral, and neuroanatomical data will also be obtained.

Observational
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  • Mood Disorder
  • Bipolar Disorder
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*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
850
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  • CHILDREN WITH SEVERE MOOD AND BEHAVIORAL DYSREGULATION (SMD)

INCLUSION CRITERIA (all must be met):

  1. Ages 7-17 at the time of recruitment; will be followed in the longitudinal component of the study until age 25.
  2. Abnormal mood (specifically, anger, sadness, and/or irritability), present at least half of the day most days, and of sufficient severity to be noticeable by people in the child s environment (e.g. parents, teachers, peers).
  3. Hyperarousal, as defined by at least three of the following symptoms: insomnia, agitation, distractibility, racing thoughts or flight of ideas, pressured speech, intrusiveness
  4. Compared to his/her peers, the child exhibits markedly increased reactivity to negative emotional stimuli that is manifest verbally or behaviorally. For example, the child responds to frustration with extended temper tantrums (inappropriate for age and/or precipitating event), verbal rages, and/or aggression toward people or property. Such events occur, on average, at least three times a week.

    • The symptoms in # 2, 3, and 4 above are currently present and have been present for at least 12 months without any symptom-free periods exceeding two months.
    • The onset of symptoms must be prior to age 12 years.
    • The symptoms are severe in at least in one setting (e.g. violent outbursts, assaultiveness at home, school, or with peers). In addition, there are at least mild symptoms (distractibility, intrusiveness) in a second setting.

    CHILDREN WITH SMD ENTERING TREATMENT:

    In addition to criteria above, the child is failing his/her treatment as defined as:

    • The child s current CGAS score < 60.
    • The child s psychiatrist/treater agrees that the child s response to his/her current treatment makes it clinically appropriate to change the child s current treatment.
    • On the basis of record review and interviews with child and parent, the research team agrees that the child s response to his/her current treatment is no more than minimal (i.e. CGI-I> 2).

    EXCLUSION CRITERIA:

    The individual exhibits any of these cardinal bipolar symptoms:

    • Elevated or expansive mood
    • Grandiosity or inflated self-esteem
    • Decreased need for sleep
    • Increase in goal-directed activity (this can result in the excessive involvement in pleasurable activities that have a high potential for painful consequences)
    • Has BD symptoms in distinct periods lasting more than 1 day.

    Meets criteria for schizophrenia, schizophreniform disorder, schizoaffective illness, PDD, or PTSD.

    IQ< 70

    The symptoms are due to the direct physiological effects of a drug of abuse, or to a general medical or neurological condition.

    Currently pregnant or lactating

    Subjects who are ineligible for MRI scanning (e.g. braces, implanted metal devices) will be excluded from treatment.

    Meets criteria for alcohol or substance abuse with the last three months.

    HEALTHY VOLUNTEER CONTROLS (Children):

    INCLUSION CRITERIA:

    Control subjects will be group matched to the patients.

    Have an identified primary care physician.

    Speaks English

    EXCLUSION CRITERIA:

    I.Q. < 70;

    Any serious medical condition or condition that interferes with fMRI scanning

    Pregnant or lactating;

    Past or current diagnosis of any anxiety disorder (panic disorder, GAD, Separation Anxiety Disorder, Social Phobia), mood disorder (manic or hypomanic episode, major depression), OCD, PTSD, Conduct Disorder, psychosis, current suicidal ideation, Tourette Disorder, Autism Spectrum Disorder or ADHD.

    Substance abuse within two months prior to study participation or present substance abuse

    History of sexual abuse.

    Parent or sibling with Bipolar Disorder, recurrent MDD, or any disorder with psychosis.

    HEALTHY VOLUNTEER (ADULTS)

    INCLUSION CRITERIA:

    Control subjects will be group matched to the patients.

    They will have normal physical and neurological examinations by history or checklist

    Have an identified primary care physician.

    Speaks English

    EXCLUSION CRITERIA:

    IQ< 70

    Pregnant

    Any past or current history of Bipolar Disorder (any manic or hypomanic episode), recurrent MDD, or any disorder with psychosis

Both
7 Years to 25 Years
Yes
Contact: Ellen Leibenluft, M.D. (301) 496-9435 leibs@mail.nih.gov
United States
 
NCT00025935
020021, 02-M-0021
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National Institute of Mental Health (NIMH)
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Principal Investigator: Ellen Leibenluft, M.D. National Institute of Mental Health (NIMH)
National Institutes of Health Clinical Center (CC)
February 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP