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Journal Articles Course: J004: Phenotypes of ADHD, Bipolar & Severe Mood Dysregulation (SMD)

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This is a course based on reading freely available, peer-reviewed journal articles

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Read three journal articles and receive one CE credit for just $7. The full text of the journal articles can be obtained for free online via PubMed.com. The articles have been field tested and it should take approximately one hour total to read all 3 articles. They are titled "Parental Diagnoses in Youth with Narrow Phenotype Bipolar Disorder or Severe Mood Dysregulation"
"Defining Clinical Phenotypes of Juvenile Mania"
"Executive Function in Pediatric Bipolar Disorder and Attention-Deficit Hyperactivity Disorder: In Search of Distinct Phenotypic Profiles."

Todd Finnerty, Psy.D. is the instructor for the course. Contact Dr. Finnerty with any questions via toddfinnerty@toddfinnerty.com or (330)495-8809.

Course objective #1: You will be able to describe ways to differentiate Pediatric Bipolar Disorder from other childhood problems

Course Objective #2: You will be able to compare children with manic episodes to those with severe mood dysregulation (SMD)

The articles can be obtained for free here:

Parental Diagnoses in Youth with Narrow Phenotype Bipolar Disorder or Severe Mood Dysregulation

Full text on the web
Full text PDF file
Authors: Brotman MA, Kassem L, Reising MM, Guyer AE, Dickstein DP, Rich BA, Towbin KE, Pine DS, McMahon FJ, Leibenluft E.
Abstract: "OBJECTIVE: Controversy exists regarding whether nonepisodic irritability and hyperarousal (severe mood dysregulation) is a phenotype of pediatric bipolar disorder. The authors compared axis I diagnoses in parents of children with narrow phenotype bipolar disorder and parents of youth with severe mood dysregulation. METHOD: Parents of youth with narrow phenotype bipolar disorder (proband N=33, parent N=42) and youth with severe mood dysregulation (proband N=30, parent N=37) were interviewed by clinicians who were blind to the child's diagnostic status using the Diagnostic Interview for Genetic Studies. RESULTS: Compared to parents of youth with severe mood dysregulation, parents of youth with narrow phenotype bipolar disorder were significantly more likely to be diagnosed with bipolar disorder. There were no other diagnostic differences between the two groups. CONCLUSIONS: These data suggest that narrow phenotype bipolar disorder may be distinct from severe mood dysregulation in terms of familial aggregation. Additionally, the familiality of narrow phenotype bipolar disorder and adult DSM-IV bipolar disorder is high."
American Journal of Psychiatry; 2007 Aug;164(8):1238-41

Defining Clinical Phenotypes of Juvenile Mania

Full text on the web
Full text PDF file
Authors: Leibenluft E, Charney DS, Towbin KE, Bhangoo RK, Pine DS.
Abstract: "OBJECTIVE: The authors suggest criteria for a range of narrow to broad phenotypes of bipolar disorder in children, differentiated according to the characteristics of the manic or hypomanic episodes, and present methods for validation of the criteria. METHOD: Relevant literature describing bipolar disorder in both children and adults was reviewed critically, and the input of experts was sought. RESULTS: Areas of controversy include whether the diagnosis of bipolar disorder should require clearly demarcated affective episodes and, if so, of what duration, and whether specific hallmark symptoms of mania should be required for the diagnosis. The authors suggest a phenotypic system of juvenile mania consisting of a narrow phenotype, two intermediate phenotypes, and a broad phenotype. The narrow phenotype is exhibited by patients who meet the full DSM-IV diagnostic criteria for hypomania or mania, including the duration criterion, and also have hallmark symptoms of elevated mood or grandiosity. The intermediate phenotypes include 1) hypomania or mania not otherwise specified, in which the patient has clear episodes and hallmark symptoms, but the episodes are between 1 and 3 days in duration, and 2) irritable hypomania or mania, in which the patient has demarcated episodes with irritable, but not elevated, mood. The broad phenotype is exhibited by patients who have a chronic, nonepisodic illness that does not include the hallmark symptoms of mania but shares with the narrower phenotypes the symptoms of severe irritability and hyperarousal. CONCLUSIONS: The presence of distinct episodes and hallmark symptoms can be used to differentiate clinical phenotypes of juvenile mania. The utility and validity of this system can be tested in subsequent research."
American Journal of Psychiatry; 2003 Mar;160(3):430-7.

Executive Function in Pediatric Bipolar Disorder and Attention-Deficit Hyperactivity Disorder: In Search of Distinct Phenotypic Profiles

Full text on the web
Full text PDF file
Authors: Walshaw PD, Alloy LB, Sabb FW.
Abstract: "Often, there is diagnostic confusion between bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD) in youth due to similar behavioral presentations. Both disorders have been implicated as having abnormal functioning in the prefrontal cortex; however, there may be subtle differences in the manner in which the prefrontal cortex functions in each disorder that could assist in their differentiation. Executive function is a construct thought to be a behavioral analogy to prefrontal cortex functioning. We provide a qualitative review of the literature on performance on executive function tasks for BD and ADHD in order to determine differences in task performance and neurocognitive profile. Our review found primary differences in executive function in the areas of interference control, working memory, planning, cognitive flexibility, and fluency. These differences may begin to establish a pediatric BD profile that provides a more objective means of differential diagnosis between BD and ADHD when they are not reliably distinguished by clinical diagnostic methods."
Neuropsychology Review; 2010 Mar;20(1):103-20. Epub 2010 Feb 18.

CE Quiz Questions

The quiz questions that you will be asked are:

Question #1(True/False) The person taking this quiz is the one registered for the course and has reviewed the materials (you must answer "True").
Question #2Children with "Severe Mood Dysregulation"
a. have nonepisodic impairing irritability and hyperarousal
b. demonstrate a history of classic manic episodes
c. meet the strict DSM-IV criteria for Bipolar I disorder
d. never meet criteria for ODD
Question #3(True/False) According to the authors, children with Severe Mood Dysregulation have an earlier age of onset and higher rates of ADHD & ODD than those with "narrow phenotype" Bipolar Disorder.
Question #4(True/False) Children with "narrow phenotype" Bipolar were much more likely to have a parent with bipolar disorder than children with severe mood dysregulation.
Question #5The authors note that the most problematic issues in the diagnosis of juvenile mania involve questions about
a. The presence and duration of manic episodes
b. The identification of hallmark symptoms of mania
c. both a & b
d. none of the above
Question #6(True/False) Based on the evidence reviewed, elated mood and grandiosity were best able to differentiate youth with ADHD from those with bipolar.
Question #7(True/False) The authors proposed a "broad phenotype" characterized by individuals with increased reactivity to emotional stimuli in the form of severe "rages" as well as chronic hyperarousal.
Question #8(True/False) Five factors that may make up executive functioning are (1) inhibition (2) working memory (3) planning (4) set-shifting (5) fluency
Question #9(True/False) According to the authors, there is support for deficits in both verbal and spatial working memory in ADHD but not in bipolar disorder
Question #10(True/False) According to the article, there are no behavioral or physiological differences in executive functioning between people with ADHD and Bipolar Disorder.
Question #11(True/False) The authors note that the neurocognitive profile of ADHD may tend to remain stable while the neurocognitive profile of bipolar disorder may be more impacted by mood state.

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