Furious Seasons

September 05, 2007

Preventing Bipolar Disorder In Kids, Hold The Meds

David Miklowitz, a psychologist at the University of Colorado, has begun a study to determine if family-focused therapy, of which his is the father, can work to prevent bipolar disorder from developing in kids. While the evidence is mixed that bipolar disorder even exists in preadolescents and, if it does exist, whether alleged risk factors in kids would ever blossom into a full-grown case of bipolar, it's refreshing to see someone taking a non-meds approach. (At least from what I can determine, no meds are involved.) It'll be interesting to see what his research determines. The study focuses on youths aged 9 to 17, according to the above press release. It ought to be a hell of a lot less problematic for the bodies of the patients than was Yale University's PRIME study.

Or maybe not. Another Miklowtiz-led two-year study of family-focused therapy uses meds such as Seroquel in its treatment arms.

If I've accessed the correct study in the clinicaltrials.gov database, then I am troubled by the inclusion criteria for the study. For a kid to be admitted, then his or her parents must have a diagnosis of bipolar disorder 1 or 2 and their children must meet "at least one current mood symptom meeting DSM-IV Criterion A and at least one depression or mania symptom meeting DSM-IV Criterion B." Meaning a kid with bipolar parents simply needs to be agitated or to have low-grade episodic depression and so forth to be tossed into the great bipolar net.

That's simply too low of a bar for my tastes and how might you measure clinical improvement in the patients? Less agitation? Maybe, Mom took the Pop Tarts away and cut back on the kids' computer time. OK, perhaps I am being too much of a skeptic here, but I am less than convinced of the prevention paradigm in youth that seems to be an emerging focus of researchers. It seems to me to be part and parcel of this whole subthreshold bipolar disorder nonsenseand America's rush to dub as "crazy" and "impaired for life" people who barely tip the scales of abnormality.

Miklowitz is one of the PIs on the STEP-BD study and in April published an article showing that psychosocial treatments used as an adjunct to meds were somewhat successful in treating bipolar depression. I previously wrote about the study here.

BTW, I am also aware of recent groundbreaking studies in Australia and the US on psychotherapy in treating bipolar disorder. I'll get to those when I have some more time.

Posted by Philip Dawdy at September 5, 2007 12:03 AM

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Comments

I just saw this, and am excited by the prospect. While I agree with you that the looser inclusion criteria will make measuring improvement difficult, I think targeting statistically "at risk" kids with a non-medicated solution is a huge step forward. Even if the majority of the people never end up developing full blown bipolar disorder, increasing knowledge in at-risk families can do nothing but help.

Posted by: Jon Gregory at September 5, 2007 06:17 AM

People with bipolar diagnoses used to get psychotherapy as a standard of care and guess what?, people with bipolar disorder used to recover a lot better than they do now. Frieda Fromm-Reichmann wrote some time ago about the difference in outcomes for patients at Chestnut Lodge before the advent of universal use of psychotropics and after. When psychotherapy was universally used there but psychotropics were not, many more patients went on to full recovery, getting a job and getting married than after the drugs came into use.

Psychotherapy gets a bum rap these days, partly because there are so few folks who haven't bought into quick fix, non-humanistic therapy approaches left, but there was never any proof that it isn't the gold standard for care for someone with bipolar disorder.

Posted by: Alison Hymes at September 5, 2007 06:53 AM

Kiki Chang was/is on the Child and Adolescent Bipolar Foundation (CABF bp kids org)Professional Advisory council at the same time Joseph Biederman was/is/don't know the current status on that; here is a link in PDF format that CABF interviewed Kiki Chang [in 2003] re: childhood bipolar, etc. it's quite interesting, being he is part of this study.
Offspring Studies-Kiki Chang.

Posted by: Stephany at September 5, 2007 09:24 AM

Not about bipolar disorder specifically, but last night the comedy/satirical animated TV show "South Park" had an episode about all of the town's kids being turned into zombies by taking Ritalin. The town's pharmacist owned stock in the company that makes Ritalin, and he was so happy with his profits from the stock's rising value that at first he didn't care about the kids being turned into zombies. But when he learned of an unusually extreme side effect, he produced an antidote that reversed Ritalin's effects, something called "Ritalout".

Posted by: Kent at September 5, 2007 01:30 PM

You'll probably find this on your own, but just in case, there's a study out linking processed foods to hyperactivity in children:
http://www.msnbc.msn.com/id/20612862/

Posted by: Gabriel... at September 6, 2007 03:06 AM

Re: processed foods, and dyes in drinks etc. and kid's behaviors: totally correct. You should see what most elementary kids have in their lunchboxes. Blue "sports drinks", red and blue "fruit snacks", orange "cheese puffs"...not to worry, because Adderall and Ritalin take care of that right?

Posted by: Stephany at September 6, 2007 09:15 AM