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Biomedical subjects

Gabrielle A Carlson

Publications and source records attributed to Gabrielle A Carlson.

At least 19 recordsLinked to original sources
PubMed2006

Clinical and neuropsychological characteristics of child and adolescent bipolar disorder.

BACKGROUND: The diagnosis of bipolar disorder in pre-pubertal populations remains difficult and often controversial. Consequently, the clinical and neuropsychological characteristics of mania in the child and adolescent years remain poorly defined. This review provides a clinical account of childhood and adolescent bipolar disorder and compares the neuropsychology and neuroanatomy of young BPD patients compared with adult BPD and childhood syndromes of attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD). METHOD: Literature review based on Pubmed searches. RESULTS: Early- and adult-onset mania and BPD may share a common pattern of neurobiological characteristics despite developmental variations in the clinical presentation. In contrast, important distinctions are apparent between the child-onset syndromes of BPD, ADHD and CD, specifically at the neural level. CONCLUSIONS: Disorders of affect dysregulation in childhood deserve closer neuroscientific and phenotypic scrutiny than given hitherto.

Adolescent↗
PubMed2006

A prospective high-risk study of the association among maternal negativity, apparent frontal lobe dysfunction, and the development of bipolar disorder.

In a previous paper, the authors found that impairment on the Wisconsin Card Sorting Test (WCST) in adolescence was predictive of bipolar disorder in young adulthood among offspring of mothers with bipolar illness. In the present study, the authors explore the contribution of maternal characteristics, beyond maternal mood disorder, to the prediction of offspring dysfunction on the WCST. Results showed that maternal bipolar disorder and maternal negativity were both predictive of impaired performance on the WCST during adolescence. The contribution of maternal negativity to offspring WCST impairment was not better explained by maternal personality disorder, mother's functional impairment, family loading for bipolar disorder, or offspring disruptive behavioral disturbance. Findings did not support a moderator model. However, support was found for a mediation model in which maternal negativity contributed to risk for offspring bipolar disorder through its negative association with apparent frontal lobe functioning, as measured by the WCST. Findings are discussed from the perspective of a vulnerability-stress model. In addition, the authors consider the possibility that maternal negativity and offspring impairment on the WCST may be reflective of a common heritable trait.

Adult↗
PubMed2006

Phenomenology and diagnosis of bipolar disorder in children, adolescents, and adults: complexities and developmental issues.

This review addresses the phenomenology of mania/bipolar disorder from a developmental psychopathology perspective and uses cases with longitudinal information to illustrate major points. Beginning with a summary of the phenomenology of bipolar illness as it occurs in adults, the authors identify diagnostic complexities unique to children and adolescents. These include the challenges of characterizing elation and grandiosity; differentiating mania from comorbid symptoms, rages, sequelae of maltreatment, and typical developmental phenomena; and the unique manifestations of psychosis. We conclude with the observation that a significant difference between early and later onset bipolar disorder is that, in the former, there appears to be a global delay or arrest in the development of appropriate affect regulation; whereas in adult-onset bipolar illness, emotion dysregulation generally presents as an intermittent phenomenon. At this juncture, the study of childhood bipolar illness would benefit from a developmental psychopathology perspective to move beyond the level of cross-sectional symptom description to begin to study individuals over time, focusing on developmental, environmental, genetic, and neurobiological influences on manifest behavior.

Adolescent↗
PubMed2006

Risk factors for conduct problems and depressive symptoms in a cohort of Ukrainian children.

Potential risk factors for conduct problems and depressive symptoms were tested in a cohort of 10- to 12-year-old Ukrainian children (N = 544, 47.6% male). Risk factors examined were child emotional lability, child attention problems, poor mother-child communication, coercive maternal discipline, maternal depression, and low marital satisfaction. Results indicated that poor mother-child communication was related to conduct problems and depressive symptoms for both boys and girls. In addition, conduct problems and depression were associated with attention problems for boys and with low marital satisfaction for girls. Emotional lability was related specifically to conduct problems, and maternal punishment was related specifically to depressive symptoms.

Attention↗
PubMed2006

Juvenile maladaptive aggression: a review of prevention, treatment, and service configuration and a proposed research agenda.

OBJECTIVE: To review prevention programs, psychosocial and psychopharmacologic treatments, and service delivery configurations for children and adolescents with maladaptive aggression. To propose a research agenda for disorders of aggression in child and adolescent psychiatry. DATA SOURCES: Recent empirical studies were reviewed using searches of MEDLINE and PsycINFO (text terms: aggression, antisocial, violence, conduct, oppositional, psychosocial treatment, psychopharmacology, and prevention), relevant books, review articles, and bibliographies. DATA EXTRACTION: Articles met the following criteria: published in an English-language, peer-reviewed journal between 1980 and 2005, included a focus on individuals < 18 years old, and included an outcome measure of relevant significance. STUDY SELECTION: Results of 154 randomized, controlled psychosocial treatment trials, 20 controlled psychopharmacology studies, 4 open-label medication studies, and 2 psychopharmacology meta-analyses were reviewed. RESULTS: Prevention programs show promise for reducing future aggression in at-risk populations. Empirical support is available for the effectiveness of multifocused psychosocial treatments in reducing aggression in children and adolescents. Atypical antipsychotics, lithium, divalproex sodium, and stimulants for conduct problems associated with attention-deficit/hyperactivity disorder have empirical support for reducing aggression in selected patient populations. CONCLUSIONS: Therapeutic nihilism in the treatment of aggressive children and adolescents with conduct problems is no longer warranted. Multifocused psychosocial interventions given early in life to at-risk children have the most support for effectiveness. However, treatments for children who routinely present to the child psychiatrist with already well-established disorders of aggression are neither robust nor well-established. Further research into maladaptive aggression in referred children and adolescents within and across psychiatric diagnoses is important for the field of child and adolescent psychiatry.

Adolescent↗
PubMed2005

Long-term diagnostic stability and outcome in recent first-episode cohort studies of schizophrenia.

Knowing the long-term outcomes of schizophrenia and stability of a schizophrenia diagnosis are important from a clinical standpoint as well as essential to future research on diagnostic classifications and outcome. As in prior research on schizophrenia, prospectively designed long-term studies over the past 30 years find that the predominant course of illness includes chronically poor functioning, with little evidence of long-term improvement. Mortality due to suicide is significant at about 10% over 10-year periods of follow-up. Within studies, outcome domains are interrelated, and the relatively consistent predictors of poorer outcome include family history of schizophrenia, insidious onset, poor premorbid functioning, severity of negative symptoms, and severity and duration of untreated psychosis. Residing in a developed rather than a developing country is also associated with a poorer long-term course. The diagnostic stability of schizophrenia is less well studied. The positive predictive value exceeds 90%, and preliminary findings from the 10-year follow-up of the Suffolk County Mental Health Project cohort have found that the agreement across time increased from k = .52 (baseline to 10 years) to k = .76 (6 or 24 months to 10 years). After discussing several limitations of the existing body of research, we suggest that future studies incorporate more "modifiable" risk factors into the assessment battery that could potentially be used as building blocks in experimental intervention designs.

Adult↗
PubMed2005

Time to remission and relapse after the first hospital admission in severe bipolar disorder.

BACKGROUND: Few studies of the time to remission and first relapse in severe bipolar disorder have been based on epidemiologically defined samples or have examined patient characteristics and time-varying indicators of medication use simultaneously. Using a cohort from the Suffolk County Mental Health Project, we describe these temporal patterns and their relationships with childhood, illness, and treatment characteristics. METHOD: A multi-facility cohort of 123 first-admission inpatients with DSM-IV bipolar disorder with psychotic features was followed for 4 years. Dates of the first complete remission (lasting at least 2 months), subsequent relapses, and use of antimanic (AM),antipsychotic (AP), and antidepressant (AD) medications were recorded. Childhood and illness characteristics were ascertained at baseline using standard instruments. RESULTS: By the 4-year point, 83.7% had achieved a full remission, with 42.3% remitting within 3 months, 63.4% within 6 months, and 74.8% within 1 year. Overall, younger age of onset, history of childhood psychopathology, and higher Brief Psychiatric Rating Scale (BPRS) anxiety/depression scores were significantly associated with longer time to remission. Discontinuing AM, AP and AD (compared to never using) and taking AP and AD (compared to never using) were significantly associated with remission in the multivariate analysis. Of the 103 participants with complete remission, 61.2% suffered a relapse; 24.3 % relapsed within 6 months of remission, and 35.9% within a year. Overall, 32.5% of the 123 participants had a single episode followed by full remission. Childhood internalizing-type problems, higher BPRS anxiety/depression and Hamilton depression scores, and an admission episode not involving mania, but not patterns of medication use, were associated with shorter time to relapse. CONCLUSION: By 4-year follow-up, the majority of severely ill bipolar patients had remitted from their initial episode, but more than half subsequently relapsed. Illness characteristics, especially depressive symptoms, and medication treatment were associated with the early course, although medication use after remission was not associated with relapse.

Adult↗
PubMed2005

Longitudinal course of schizophrenia spectrum symptoms in offspring of psychiatrically hospitalized mothers.

OBJECTIVE: The aim of this study was to describe schizophrenia spectrum symptoms (SZSD) in children and adolescents with schizotypal personality disorder (SPD) as adults. INTRODUCTION: There are no descriptive studies of children who develop into adults with SPD. METHOD: Twelve offspring of psychiatrically hospitalized mothers (6 mothers with schizophrenia), were compared with 11 socioeconomic status (SES)-matched offspring of control, non-ill mothers. Offspring were evaluated clinically and psychometrically between infancy and 2, 10, 15 years of age, and adulthood. Adult Axis I and II diagnoses were made blind to infant and parent status. RESULTS: Six hospitalized mothers were diagnosed with schizophrenia, 6 with other severe psychopathology. Offspring with SZSD more likely had schizophrenic mothers, and childhood deteriorating IQs, symptoms of social isolation, constricted affect, digressive speech, suspiciousness, and excessive social anxiety. Global assessment scores in SZSD offspring were lower in childhood and adulthood than comparison offspring. DISCUSSION: Children with SZSD met currently accepted criteria for schizotypy; 3 by 10 years of age, and 2 by 19 years of age. Differential diagnosis is discussed. An appendix of case histories is presented.

Adolescent↗
PubMed2005

Validation of three dimensions of childhood psychopathology in young clinic-referred boys.

Short measures of child inattention-overactivity (IO), aggression-defiance (AG), and anxiety-depression or emotionality (EM) derived through a double validation procedure are administered to mothers of 243 clinic-referred suburban New York boys between 6 and 10 years of age. Mother-rated IO is uniquely related to poor performance on cognitive and achievement tests; observed inattentive, hyperactive, and impulsive behaviors in a restricted academic setting; less father education and lower family income; and most mother-reported impairments and treatment use. Mothers of high-IO boys describe themselves and their sons as having similar childhood symptoms. AG is uniquely related to child-reported disruptive behavior and sensation seeking, many measures of family conflict and negative parenting styles, and mother-reported symptom pervasiveness and number of treatments. EM is uniquely related only to poorer cognitive and achievement test performance, living with one parent, parents who considered themselves too busy, and fewer friends. Each dimension also is associated with parallel teacher-rated factors.

Achievement↗
PubMed2005

Early onset bipolar disorder: clinical and research considerations.

This article examined some of the reasons for confusion and controversy surrounding the frequency of diagnosis of bipolar disorder, especially in prepubertal children. Four case vignettes are used to articulate questions surrounding manifestations of euphoria and grandiosity, informant variance, diagnostic implications of medication-induced behavioral toxicity, and treatment implications of family history. Although extant literature cited addresses some of the issues, specific research is needed for definitive answers.

Adolescent↗
PubMed2004

A prospective study of the association among impaired executive functioning, childhood attentional problems, and the development of bipolar disorder.

Studies of adults who have been diagnosed with, and treated for, bipolar disorder have shown that these patients exhibit impairment on measures of executive functioning. However, it is unclear whether executive dysfunction precedes the diagnosis of bipolar illness, or develops subsequent to its onset. Moreover, investigators have failed to control for the effects of premorbid attentional problems on cognitive performance in these patients. The present authors explored these questions using data from a longitudinal prospective study of individuals at risk for major mood disorder. Results revealed that 67% of participants who met criteria for bipolar disorder in young adulthood showed impairment on the Wisconsin Card Sorting Test (WCST) when they were assessed during adolescence, as compared with 17% of individuals with no major mood diagnosis, and 19% with unipolar depression. This association between performance on the WCST and bipolar illness was not accounted for by high rates of premorbid attentional disturbance. In fact, among participants with early attentional problems, only those who ultimately developed bipolar disorder exhibited impairment on the WCST. Early attentional problems that preceded unipolar depression or no mood disorder were not associated with executive dysfunction.

Adolescent↗
PubMed2004

ODD and ADHD symptoms in Ukrainian children: external validators and comorbidity.

OBJECTIVE: To examine potential external validators for oppositional defiant disorder (ODD) and attention-deficient/hyperactive disorder (ADHD) symptoms in a Ukrainian community-based sample of 600 children age 10 to 12 years old and evaluate the nature of co-occurring ODD and ADHD symptoms using mother- and teacher-defined groups. METHOD: In 1997, parents, children, and teachers participated in extensive clinical assessments using standard Western measures. Four areas of functioning were assessed: child mental health, parent-child interactions, parental well-being, and school/cognitive performance. RESULTS: Mother-defined ODD versus ADHD symptom groups were differentiated by a history of overactivity and tantrums, behavior in school, and maternal anxiety and hostility. Teacher-defined groups were differentiated by conduct problems, internalizing symptoms, mother-child interactions, and paternal alcohol use. The effects of co-occurring ODD and ADHD symptoms were greater than would be expected based on their separate effects for conduct problems, internalizing symptoms, social problems, academic performance, parent-child relations, and marital discord. CONCLUSIONS: Children with ODD versus ADHD symptoms were not significantly different from each other for the majority of variables examined, and group differences were dependent on the rater used to define symptom groups.

Analysis of Variance↗
PubMed2004

Medication use patterns and 2-year outcome in first-admission bipolar disorder with psychotic features.

OBJECTIVE: This study examined the patterns and predictors of medication use and 24-month course/outcome in first-admission patients with bipolar disorder (BD) with psychotic features. METHOD: An epidemiologic sample of 155 first-admission patients with research diagnoses of BD with psychotic features received intensive clinical assessments at baseline, 6- and 24-month follow-ups and telephone assessments at 3-month intervals. Use of antipsychotics, antimanic agents (lithium and anticonvulsants), and antidepressants was determined from self-reports corroborated by external sources where possible. Outcome was assessed with the Global Assessment of Functioning (GAF), consensus evaluations of illness course, and time in remission. RESULTS: More patients received antipsychotics (80.0%) than antimanics (52.3%) at discharge. At the 24-month point, 44.6% reported using no medications; 19.4 and 38.8% received antipsychotics and antimanics, respectively. Health insurance and early regular antimanic use were the strongest predictors of regular antimanic use during the 6-24-month follow-up. Early and later regular use of antimanics and less use of antipsychotics were associated with higher GAF scores and greater time in remission. Conversely, failure to use antimanics regularly was associated with the worst outcome on these two measures. Early functioning as measured by the GAF strongly predicted outcome for all three measures. Younger and non-White subjects were significantly less likely to attain complete remission during the 6-24-month follow-up. CONCLUSIONS: The findings confirm clinical trial data that for some outcome measures use of antimanics is associated with good outcome in bipolar populations while failure to use these medications regularly was common among subjects with the worst outcomes. In addition, our findings that higher educational attainment and having health insurance predicted regular antimanic use and (for the latter) better outcome underscore the effect of socioeconomic influences while achieving a complete remission seems unrelated to medication use but strongly predicted by age and ethnicity. Finally, the fact that early regular treatment and early high functioning strongly predicted better outcome supports the need for the early diagnosis and treatment of patients with this disorder.

Adolescent↗
PubMed2003

Clinical implications of pervasive manic symptoms in children.

BACKGROUND: Prior investigations of cross-informant agreement among parents, teachers, and clinicians about externalizing and internalizing problems have not directly addressed agreement about manic symptoms. METHODS: We identified three groups from a large cohort of youths, aged 8-12 years, treated on an inpatient unit. All 108 participants met criteria for an externalizing disorder, based on a semi-structured diagnostic interview. Of these, 49 did not have manic symptoms endorsed by either the parent or a teacher; 34 had manic symptoms reported by the parent only, and 25 had pervasive manic symptoms (i.e., corroborated by both sources). RESULTS: The "corroborated mania" group consistently showed the most disruptive behavior on the inpatient unit, the worst behavior problems on multiple scales, and the longest admission durations. The "parent-only" group scored in the midrange on all of these measures, with group differences typically representing small to medium effect sizes. The "externalizing only" group consistently scored lowest on all dependent measures, with the differences representing large to extremely large effects when compared with the corroborated mania group and medium effects as compared with the parent-only group. CONCLUSIONS: Youths for whom multiple informants report manic symptoms appear likely to have more severe symptom presentation and more complicated, refractory courses than do youths without manic symptoms.

Adolescent↗
PubMed2003

Methodological issues and controversies in clinical trials with child and adolescent patients with bipolar disorder: report of a consensus conference.

OBJECTIVE: To achieve consensus among researchers, pharmaceutical industry representatives, federal regulatory agency staff, and family advocates on a template for clinical trials of acute mania/bipolar disorder in children and adolescents. METHOD: The American Academy of Child and Adolescent Psychiatry, in collaboration with Best Practice, convened a group of experts from the key stakeholder communities (including adult psychiatrists with expertise in bipolar disorder) and assigned them to workgroups to examine core methodological issues surrounding the design of clinical trials and, ultimately, to generate a consensus statement encompassing: (1) inclusion/exclusion criteria, (2) investigator training needs and site selection, (3) assessment and outcome measures, (4) protocol design and ethical issues unique to trials involving children/adolescents, and (5) regulatory agency perspectives on these deliberations. RESULTS: Conference participants reached agreement on 18 broad methodological questions. Key points of consensus were to assign priority to placebo-controlled studies of acute manic episodes in children and adolescents aged 10-17 years, who may or may not be hospitalized, and who may or may not suffer from common comorbid psychiatric disorders; to require that specialist diagnostic "gatekeepers" screen youths' eligibility to participate in trials; to monitor interviewer and rater competency over the course of the trial using agreed upon standards; and to develop new tools for assessment, including scales to measure aggression/rage and cognitive function, while using the best available instruments (e.g., Young Mania Rating Scale) in the interim. CONCLUSIONS: Methodologically rigorous, large-scale clinical trials of treatment of acute mania are urgently needed to provide information regarding the safety and efficacy, in youth, of diverse agents with potential mood-stabilizing properties.

Adolescent↗