{"id":35493,"date":"2013-04-18T19:33:47","date_gmt":"2013-04-18T23:33:47","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=35493"},"modified":"2013-04-18T19:33:47","modified_gmt":"2013-04-18T23:33:47","slug":"another-view","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/04\/18\/another-view\/","title":{"rendered":"another view…"},"content":{"rendered":"\n

Among the misadventures of alliances between the pharmaceutical industry and academic psychiatry, the saga of Dr. Biederman’s group at Harvard and their Pediatric Bipolar Disorder craze is in the running as the paradigm of the genre. I recently looked back on it [the sound and the fury<\/em>…<\/a>] when I ran across some latter day ripples in the January JAACAP. The claim was that a large cohort of out of control, disruptive kids had a variant of Mania, were genetically Bipolar, and were treatable with atypical antipsychotics. If you don’t know the story, start with bipolar kids: not someone to jerk around…<\/a> from a couple of years ago and read the series that follows.<\/p>\n

When I looked at the preliminary program for next month’s APA Meeting [a discouraging outing…<\/a>], I noticed that Drs. Biederman and Wosniak had a presentation I presume derived from these recent publications:<\/div>\n
\n
Further evidence for robust familiality of pediatric bipolar I disorder: results from a very large controlled family study of pediatric bipolar I disorder and a meta-analysis<\/a>.
by Wozniak J, Faraone SV, Martelon M, McKillop HN, and Biederman J.<\/strong><\/sup>
Journal of Clinical Psychiatry<\/font><\/strong>. 2012 73[10]:1328-34.<\/div>\n

<\/p>\n

OBJECTIVE<\/font><\/u>: To determine the risk for bipolar I disorder in first-degree relatives of children with DSM-IV bipolar I disorder via meta-analysis and expanded controlled study.<\/strong><\/sup><\/div>\n
<\/div>\n
CONCLUSIONS<\/font><\/u>: Our results document an increased familial risk for bipolar I disorder in relatives of pediatric probands with DSM-IV bipolar I disorder.<\/strong><\/sup><\/div>\n<\/blockquote>\n
\n
Examining the comorbidity between attention deficit hyperactivity disorder and bipolar I disorder: a meta-analysis of family genetic studies.<\/a>
Faraone SV, Biederman J, and Wozniak J.<\/strong><\/sup>
American Journal of Psychiatry<\/font><\/strong>. 2012 169[12]:1256-66.<\/div>\n

<\/p>\n

OBJECTIVE:<\/font><\/u> The existence of comorbidity between attention deficit hyperactivity disorder [ADHD] and bipolar I disorder has been documented in clinical and epidemiological studies, in studies of children and adults, and in diagnosed ADHD and bipolar I patient samples. Yet questions remain about the validity of diagnosing bipolar I disorder in ADHD youth. The authors aim to clarify these issues by reviewing family genetic studies of ADHD and bipolar I disorder. <\/strong><\/sup><\/div>\n
<\/div>\n
CONCLUSIONS:<\/font><\/u> The results suggest that ADHD plus bipolar comorbidity cannot be accounted for by misdiagnoses, but additional research is needed to rule out artifactual sources of comorbidity. More research is also needed to determine whether comorbidity of ADHD and bipolar I disorder constitutes a familial subtype distinct from its constituent disorders, which if confirmed would have implications for diagnostic nosology and genetic studies. <\/strong><\/sup><\/div>\n<\/blockquote>\n
That session is on the left in the graphic below [S36.]. But I got a comment<\/a> pointing me to another one I missed which is on the right [S119.]. And I really did miss it, because I was interested in the status of the whole bipolar child thing, but I guess I searched for "Biederman<\/em>," not "Pediatric Bipolar<\/em>":<\/div>\n

<\/p>\n

I appreciate Dr. Levin<\/a> [organizer of the S119. session] sending this because it’s a topic that is of interest to me over and above the whole Pediatric Bipolar controversy and the resultant overmedication question. As a volunteer in a child and adolescent clinic over the last 5 years I’ve seen some of the kids they’re describing – the "super<\/font><\/strong>·<\/font><\/strong><\/font><\/strong>angry\/grouchy\/cranky<\/font><\/strong>·<\/font><\/strong>irritable<\/font><\/strong>" kids that Dr. Biederman called bipolar [bipolar kids: biedermania and super·<\/font><\/strong><\/font><\/strong>angry\/grouchy\/cranky·<\/font><\/strong>irritability…<\/a>]. Many were in the Foster·Care\/Adoption<\/font><\/strong> set. Had I not been writing this blog, I wouldn’t have thought of Bipolar Disorder on my own as they weren’t euphoric, grandiose, or periodic – but they fit the Biederman description. They struck me as kids with various combinations of adHd<\/font><\/strong>, ptsd<\/font><\/strong>, and attachment disorder<\/font><\/strong> consistent with their histories. A couple had whatever we now are calling educable mental retardation<\/font><\/strong>. Some had been put on atypicals, some not.<\/p>\n

So I was glad to read attachment<\/em> and trauma<\/em> pieces in the mix in that APA S119. That’s where I thought the action was in the cases I saw. Obviously, the treatment of either is tricky and hardly formulaic, but it’s a lot more likely to address the central problems than atypical antipsychotics in my opinion. We were able to send one such child to a residential treatment program, a kid who had been taken in and adopted by a devoted Aunt after an absurdly chaotic childhood. It’s a token economy behavioral set-up. There are several weekly therapy sessions with the child and her Aunt together. It’s a big intervention, but so far it looks as if it’s heading towards being a success story.<\/p>\n

I don’t know what to say about the Bipolar Child story and how it will play out over time, but I feel confident that the epidemic I call Biedermania was being used to justify overmedicating kids for behavior control – whether that was the intent of Dr. Biederman and his group or not. As I’ve said before, if you’re going to use an antipsychotic drug for behavior control, and I accept that there are some situations where that is all that can be done, I don’t want people to have the excuse that they’re treating some disease with the appropriate medication. I just don’t think that’s close to proven. I want them to have to worry like the rest of us that they’re operating in a risk\/benefit grey·<\/font><\/strong><\/font><\/strong>zone and to be very careful and too vigilant.<\/p>\n

I’m not going to the APA meeting, but if I were, I’d hit this session for sure. This is an area of psychopathology that we only really understand in the broadest of strokes. Some of the patients have had a globally abnormal childhood with unstable or no primary attachment figures, general neglect, and associated traumatic experiences so it’s hard to parse out what goes with what. A few others have the signs and symptoms, but the story doesn’t have the expected problems that might explain things. Thi is an important area for some really careful sleuthing and needs all the sessions it can muster. Enough already with the elephant guns…<\/div>\n","protected":false},"excerpt":{"rendered":"

Among the misadventures of alliances between the pharmaceutical industry and academic psychiatry, the saga of Dr. Biederman’s group at Harvard and their Pediatric Bipolar Disorder craze is in the running as the paradigm of the genre. I recently looked back on it [the sound and the fury…] when I ran across some latter day ripples […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-35493","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/35493","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=35493"}],"version-history":[{"count":25,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/35493\/revisions"}],"predecessor-version":[{"id":35518,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/35493\/revisions\/35518"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=35493"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=35493"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=35493"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}