Early Bipolar Disorder Markers Target of Long-Term Study

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.”▪