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With the American Academy of Child and Adolescent Psychiatry<\/font> meeting in San Diego right now, I’m having something of a remembrance of things past<\/em> period. Of course there’s Paxil Study 329 which stands in my mind as a paradigm for an infamous era, along with a other less well known Clinical Trials suggesting that the SSRIs are effective and safe in the treatment of adolescent depression [ie more Wagner et al<\/em>…<\/a>]. It remains a major unresolved question in my mind why the Journal of the American Academy of Child and Adolescent Psychiatry<\/font> is still unwilling to retract Paxil® Study 329, or for that matter, why the American Journal of Psychiatry<\/font> didn’t [and still doesn’t] retract Wagner et al’s ghost written Citalopram [Celexa®] paper [collusion with fiction…<\/a>]. And I continue to wonder why journals still publish the stream of papers attempting to discredit the Black Box Warning on these drugs about the uncommon but potentially fatal suicidality that the drugs sometimes cause [a betrayal…<\/a>]. It’s like the ripples from that period when the pharmaceutical industry, complicit psychiatrists, and journals were publishing fiction-as-fact<\/em> under the cover of darkness won’t die out.<\/p>\n There was one issue from that period that remains very sticky<\/em> – Pediatric Bipolar Disorder. It’s sticky<\/em> because the patients in question really exist,<\/em> and the medications in question really work,<\/em> and the treatment questions are really tricky<\/em> for anyone who actually sees these cases<\/em>. And whether these cases<\/em> represent a distinct group or not is, itself, an open question in my mind. To use Dr. Joseph Biederman’s term, they are children with super angry, grouchy, cranky, irritability<\/em>. They drive parents, teachers, siblings, psychiatrists, therapists, and themselves crazy. They usually have the clinical findings of ADHD [with a capital H] but there’s no cure<\/em> with stimulants, and if you give them antipsychotics, they do become more manageable – <\/em>but..<\/em>. These are among the kids that get drugged<\/em>, often in response to pleas by parents, caretakers, psychologists, social workers, teachers, etc. – the exasperated people who deal with them. I’ll skip the many diagnoses invented for this maybe-group<\/em>, except for one – Pediatric Bipolar Disorder.<\/p>\n When Risperda® was introduced, it came with a study of behavioral treatment for retarded children that was, of course, positive [genuinely positive] [see trial 93: a bad penny…<\/a>]. Janssen’s application for FDA Approval was turned down. When Dr. Biederman began to say that these kids with super angry, grouchy, cranky, irritability <\/em>had Pediatric Bipolar Disorder, this study was republished and repurposed under Dr. Biederman’s name [Risperidone for the treatment of affective symptoms in children with disruptive behavior disorder: a post hoc analysis of data from a 6-week, multicenter, randomized, double-blind, parallel-arm study<\/a>] and the rest is history. Pediatric Bipolar Disorder took off like wildfire and the papers flowed from everywhere [I called it Biedermania<\/em>].<\/p>\n I’ve reviewed all of this ad nauseum. And I ended up wondering if Pediatric Bipolar Disorder even exists, or if it does, thinking it’s uncommon. In my opinion, the reason Pediatric Bipolar Disorder caught on was that Child Psychiatrists and Pediatricians who were seeing these extremely difficult kids were previously guiltily<\/em> treating them with antipsychotics for behavior control [unable to place them in the tough love token economy environments of the past], and that the diagnosis of a disease<\/em> treated with a medicine for that disease <\/em>took away the guilt. I was volunteering in a child clinic for a time, and I ultimately quit working there because of this very issue. The pressure to medicate with antipsychotics was overwhelming because there were no rational alternatives, and that’s just not my cup of tea. It’s simply a do no harm<\/em> thing for me. But I felt some empathy for my colleagues who were and are in that double bind, and couldn’t just say, "No thanks<\/em>." <\/p>\nSo back to the ripples. Looking over the faculty at AACAP, Drs. Biederman and Wozniak who were the Pediatric Bipolar Disorder gurus are not listed at all on the faculty<\/a> of the American<\/font> Academy of Child and Adolescent Psychiatry<\/font> meeting today in San Diego, though they’re still publishing<\/a> regularly about the condition they popularized. And the ripples are still reverberating in the halls of the AACAP: <\/div>\n <\/p>\n
Institute 1: An Update in Advanced Psychopharmacology for Practitioners <\/a><\/div>\n<\/li>\nInstitute 6: Early Recognition and Intervention for Youth at High Risk for Bipolar Disorder<\/a><\/div>\n<\/li>\nInstitute 9: Fundamentals of Practical Pediatric Psychopharmacology for the Primary Care Clinician <\/a><\/div>\n<\/li>\nSymposium 9: Prodromal Symptoms in Bipolar Offspring: Cross-National Comparisons<\/a><\/div>\n<\/li>\nSymposium 15: Psychosocial Treatment for Youth With Bipolar Disorder: Research Updates to Inform Clinical Practice <\/a><\/div>\n<\/li>\n
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