November 16, 2009

Researchers' New Pediatric Bipolar Disorder Symptoms Include Bed Wetting, Nightmares

The folks at the Juvenile Bipolar Research Foundation--that's the Papaloses of "The Bipolar Child" book fame's organization--have really gone an done it now. They've fully crossed the Rubicon and now claim that kids having nightmares, wetting the bed and who are interruptive have so-called pediatric bipolar disorder. This is all from a JBRF "news flash," which I cannot locate on the group's website yet, but which I have in email form (if you want it, send me an email and I'll pass it along). The news flash, which is also a solicitation for contributions to JBRF, is entitled "Characteristics of Juvenile Bipolar Disorder: A New Phenotype."

"What do the following have in common?

* suffers horrendous nightmares
* antagonizes siblings
* excessively craves sweets and carbohydrates
* wets the bed
* sleeps hot
* takes excessive risks
* hoards food
* has many ideas at once
* interrupts or intrudes on others
* experiences periods of self-doubt and poor self-esteem
* deflects blame

"Independently, each of these traits is a symptom of a myriad of different psychiatric disorders. Considered together, they are all symptoms of Pediatric Bipolar Disorder (PBD)."

Forget about alleged kiddie mania and kiddie depression (both of them extremely dubious) and forget about Biederman/MGH crowd who push irritability in kids as a proxy for mania. Forget about how psychiatrists elsewhere in the world find this whole kiddie bipolar disorder business hard to swallow. Forget about the recent Canadian study that shot down the existence of pre-adolescent mania. It's now about that list of alleged symptoms above. And a lot of biological and genetic determinism:

"This more complete list of symptoms is reflective of the research progress JBRF has made by adopting the dimensional approach of defining psychiatric disorders: symptoms overlap between psychiatric conditions and one condition is differentiated from the other by how those clusters of overlapping symptoms come together. "Proceeding down this path, researchers have arrived at a novel perspective of the illness. While traits like mania and depression remain important, this analysis finds that they are not the central behavioral dimensions of PBD. Other dimensions such as aggression, anxiety, sensory sensitivity, sleep/wake disturbance, attention/executive function deficit, and oppositional behavior also figure prominently. Of paramount interest is a dimension that establishes a link between obsessive fears and aggressive behavior. JBRF investigators have termed this correlation 'Fear-of-Harm' (FOH). This new characterization of PBD has been labeled the 'Core phenotype.' "The Core phenotype is a more complete and accurate description of what these children experience than what is offered by the Diagnostic and Statistical Manual for Mental Disorders (DSM). Investigators suggest that in the DSM, bits and pieces of this single disorder have been parceled out into numerous other diagnoses. It is likely that this fragmented perspective of the disorder has obscured a clear view of its actual presentation in children and stalled efforts to get at the underlying biology.

"Concentrated exploration of the FOH trait has lead investigators to define a clinically homogeneous subgroup of children who are the most severely impacted by this disorder. This subgroup is called the 'FOH phenotype.' These children are characterized by extreme anxiety and the hyper-perception of threat which causes them to respond in a defensively retaliatory manner. They are often hospitalized and face great challenges socially and academically.

"Not only have JBRF investigators been able to describe the symptom profile of the FOH phenotype, but under this new paradigm, they have also pieced together the likely underlying biology involved in the disorder. Certain brain areas, activities and development that had not previously been considered became obvious foci for their attention. The specific neural pathway that ties these activities together in a manner consistent with the profile has been identified. Investigation of this complex system is ongoing. The more the details fall into place, the greater its explanatory value grows.

"The definition of the FOH phenotype moves us further in our quest to uncover the genetic variations associated with PBD. The high heritability of the FOH trait, refinement of the dimensionally derived symptoms that associate with it, and the fact that the CBQ can identify with 96% accuracy children whose profiles fit the phenotype make us optimistic that we are on the right path for a meaningful genetic analysis."

I searched through the medical literature and the only mention I can find anywhere of this alleged FOH phenotype is in a 2007 Journal of Affective Disorders article by none other than Dimitri Papolos of the JBRF. I cannot find another reference to it anywhere, so this is clearly novel thinking.

Bed wetting as a symptom of child bipolar disorder? We live in strange times.

Thanks to the reader who made me aware of the above JBRF news flash.

Posted by Philip Dawdy at November 16, 2009 12:03 AM
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Comments

Here's a scary scenario. Bed wetting is usually normal in the course of toilet training but excessive bed wetting can indicate serious medical problems. So with the advent of articles like this, a pediatrician asks in the normal course of an exam if the child ever wets the bed. The parent says yes. The pediatrician with this misinformation you mention skips all inquiry into toilet training, activity level, diet, fluid intake, even frequency of bed wetting and moves straight to the prescription pad and the kid gets a major tranquilizer like zyprexa (I know they're marketed as "anti-psychotics" but lets not forget they're pharmacologically major tranquilizers). This causes the kid not just to be too heavily sedated to wake up to go to the bathroom (much like that dreadful group of adult incontinents - severe alcoholics) but also causes excessive thirst as all of these drugs do. So the "bipolar child's" bed wetting gets worse with drugs. Oops, he must also have a personality disorder. Increase the dosage and buy bigger diapers.

Horrifying.

Posted by: Sally at November 16, 2009 03:08 AM

It astonishing what despicable levels these truly evil people will stoop too in selling a pill, a book, and in making a buck.

What is really even more disturbing with organizations and people like this; is that the main stream media is actually giving this horrible and dangerous rubbish some validity.

CBS News used this Dimitri Papolos in one of their child bipolar propaganda news broadcast.

http://www.cbsnews.com/stories/2003/11/11/eveningnews/main582957.shtml

Posted by: MsPiggy at November 16, 2009 04:33 AM

* suffers horrendous nightmares
* antagonizes siblings
* excessively craves sweets and carbohydrates
* wets the bed
* sleeps hot
* takes excessive risks
* hoards food
* has many ideas at once
* interrupts or intrudes on others
* experiences periods of self-doubt and poor self-esteem
* deflects blame

WTF, this description of symptoms is being called a child, that is what a child IS, because they are not adults yet.

And adults experience-still do the following, it is not a disease , sorry.
* suffers horrendous nightmares
* excessively craves sweets and carbohydrates
* takes excessive risks
* experiences periods of self-doubt and poor self-esteem
* deflects blame

Posted by: mark p.s.2 at November 16, 2009 04:57 AM

Any chance you can post your email or send me the flash?

Thanks

My email is on this site on the top left.

Posted by: peter ryan at November 16, 2009 06:24 AM

Oh gosh, so now I find out I was really a BK--Bipolar Kid. I guess I can forget about healing from the effects of that maternal and other incest, the murder attempts, starvation, confinement abuse, etc., etc. Turns out all I needed was a pill.

Hell, if they'd just have doubled the dose we could have invited a few more adults to our little parties. After all, my problems were all biochemical, right? Right?

Grrrrr...

Posted by: Sherry at November 16, 2009 08:05 AM

Well a decade later, after being diagnosed Early Onset Childhood Bipolar at age 11 in 1999 after a psychotic reaction to the anti depressantImipramine for BED WETTTING PREVENTION (given by a PCP)the psychiatrists dismissed her bipolar diagnosis years ago, now she is "complex", "Chronic psychosis" and PDD.

Good luck to those who buy into that crap, I hope they don't see a child suffer HALF their lifetime on psych meds as I have, and I hope they don't find themselves in living hell as a result, where life and a nightmare of permanent damage outweighs the risk of medicating their children.

That book author was tight with CABF until they had a falling out, internal politics, pharma money, et al.

I'm not here for any retort conversation, I am here because it is my moral duty as a parent who has seen the worst case of over-medication gone bad in the last decade based on this paradigm, and who now is a parent of a severely disabled 21 year old.

I have bad news on the hospital front:

In the last year I have unfortunately seen an increase of peers my daughter's age inpatient, and they are all girls.

It was just 3 years ago the adult unit was predominently older men, and now it looks like a paradigm product, for once my daughter has people her age in a psych ward.

How does this apply to this> because we are beginning to see the fall out from these medicated bipolar/ADHD children, and let me tell you several are going (they told me)to the state institution.

I'm pretty sure Philip remembers a little over 3 years ago when my daughter was there for 21 days and it was full of very old, very violent patients. She was the youngest person there, and now it looks like things are changing.

What a way to make friends.

Posted by: Stephany at November 16, 2009 08:11 AM

Haven't we figured out by now that we're all bipolar and need meds? Every man, woman, and child. Pets will be next.

Posted by: Sara at November 16, 2009 08:31 AM

I had assumed at the onset of this entry that there would be a disclaimer pointing out the difference between clinical symptoms and normal experiences. Instead, their disclaimer was this:

"Independently, each of these traits is a symptom of a myriad of different psychiatric disorders."

Each trait is a symptom of a myriad of other psychiatric disorders. It's bad enough to be passively complicit in the forced drugging of children with some of the most dangerous chemicals available today short of blatantly lethal poisons. To get to the point where you're trying to get obviously universal or near universal childhood traits like "deflecting blame" viewed as symptoms of illnesses in need of such forced drugging is ridiculous Hollywood villain grade evil.

Maybe the psychiatric mainstream will retire the old "it's just like Diabetes" routine and try their luck with "it's just like getting your wisdom teeth removed-- pretty much everyone should." And they already got those 8 week long-acting antipsychotic injections; they could start giving them out as mental health vaccines in school. If only they could finally overcome that unfortunate stigma towards frivolous neurological druggings once and for all. Why are there still folks out there who don't understand these are brain diseases because they're widely established as brain diseases by lots of brain disease drug manufacturers?

Posted by: Bryan at November 16, 2009 09:36 AM

My daughter was diagnosed with bipolar at age 8 mainly based on having mood swings and family history. I recently got a second opinion from a different psychiatrist who doesn't think she presents as having bipolar. So, we took her off her medicine, lamictal, and are just going with therapy and she is doing well. But, she did have a period of nightly bed-wetting which stopped when we changed the time of day she took the lamictal.

Posted by: Lori at November 16, 2009 09:39 AM

They already give prozac to dogs who have anxiety over their owners leaving for the day. Pretty soon they will give the major tranqs to the yappy little dogs as "chemical balancers". And we will see pet psychiatrists.

Posted by: kimbriel at November 16, 2009 09:46 AM

What do the following have in common?
* suffers horrendous nightmares
* antagonizes siblings
* excessively craves sweets and carbohydrates
* wets the bed
* sleeps hot
* takes excessive risks
* hoards food
* has many ideas at once
* interrupts or intrudes on others
* experiences periods of self-doubt and poor self-esteem
* deflects blame

I must add here something VERY significant.

ALL of those "Symptoms" happened to my daughter AFTER TAKING THOSE MEDS.

Zyprexa, Depakote and Zoloft to start--she raged for hours on end, became an aggressive bully, read the list, it became the reason why I kept asking the doctor :

What is wrong with her? is it the meds? YES it was the meds! she never acted that way before those drugs and I mean how about attempting to jump from a moving vehicle on 15mg of Zyprexa, 1500mg of Depakote and 150mg of Zoloft at age 13?

Do these drugs change people, you bet they do.

Posted by: Stephany at November 16, 2009 10:18 AM

I agree that diagnosing any child based on those behaviors is ridiculous. The behaviors could have any number of causes. My son has been diagnosed as bipolar and I do think he most likely is bipolar (due to factors that go way beyond that list) but thanks to this site, the research and links it provides, and Stephany's input with her daughter's story we now have him off all meds. And we think his psychosis that we were medicating him for was the result of the Adderall he was given for a short time and has now been corrected. We will see what the future brings but as a growing teen even if he is bipolar we now believe he should be off all meds as long as possible as the meds have major issues in and of themselves. I'm really grateful for this site though and the information it provides. Thanks Philip and Stephany.

Posted by: Meg at November 16, 2009 12:17 PM

Meg, You've just brought tears to my eyes!!!!, God bless you and your son.

It is because of this blog's comment section, that I found Meg via her blog.

THANK YOU PHILIP and commenters, this comment from Meg makes my weary soul feel encouraged.

Posted by: Stephany at November 16, 2009 01:22 PM

Philip, this should be a boost to give you fuel to remain fired up writing about pharma, medicating kids and the Bipolar Child paradigm.

2 boys are now off of medications as a result of your work here, I find that to be an amazing thing, and I wish them all the best and continued long happy lives. Kudos to those mothers.

http://www.furiousseasons.com/archives/2008/04/mom_saves_her_child_with_adhd_from_antipsychotics.html

Posted by: Stephany at November 16, 2009 02:45 PM

Dear Meg:

I personally applaud you for the efforts you have undertaken researching and finding answers outside of the pill-box that's being narrowly presented to so many desperate parents in today's childhood mental health modality.

There are no easy one size fits all answers to many of the problems we face today. Yet, the growing consensus and body of evidence is telling us all that there has to be a better way.

Posted by: Just-One at November 16, 2009 02:51 PM

Meg, I would like to second others here in thanking you for sharing your story and for letting us know that this site has made a difference in your son's life. I kid you not that it really is important to hear this from time to time because frankly a lot of us here are very concerned about the drug induced epidemic of harm that is upon us and little rays of light and hope are needed every so often.

Posted by: Sara at November 16, 2009 04:32 PM

Bed wetting is also one of the legs of the McDonald Triad used to diagnose antisocial personality disorder. Fire starting and cruelty to animals are the other two. It sounds as though they want to round up all the problem children and lump them together as bipolar.

Posted by: Tony at November 16, 2009 07:38 PM

Philip, i appreciate the work you do, getting this information out, but there are some times -- like when i read stuff like this -- that i kind of wish i'd never discovered your blog. It's lovely to see the comments from Stephany and Meg; they "take the edge off"! Thanks, ladies!

I am just a teensy bit conflicted in my vehement condemnation of this "childhood bipolar" framework, because i know that there are some truly difficult kids that the most dedicated of parents would have trouble managing. I used to get calls from the frantic parents when i volunteered on a crisis line. So i do think we need to figure out strategies to help these kids and their parents (and then make this help _affordable_ and _accessible_), and i don't want to minimize their plight.

On the other hand, well, it's hard to even make coherent sentences... What better time to teach a person how to identify, work with, and manage emotions than in childhood?? (Good Lord, if only everybody could learn that. Nothing more annoying than a grownup throwing a tantrum.) How can you even assess where a child is at, with all their phases and developmental milestones, if the child is drugged? You don't have any baseline; you don't know how much of the behavior is due to emotional stresses, physical health issues, the drugs, and so on. It just kills me to think of how many unscrupulous psychiatrists will use this framework as a medically sanctioned justification for prescription. And anyway, thought it was well known that kids up to ten can have physical growth issues that cause periods of bed wetting. Bah!

So... Weed out all the unscrupulous psychiatrists (that is, 90% of them), then give all the mood stabilizers to the yappy dogs, then? Sound like a plan?

Posted by: Sarah at November 16, 2009 07:55 PM

Bedwetting in children is NOT uncommon. It's not a sign of mental illness. Christ. Pediatricians across the world are likely rolling their eyes at this nonsense.

Posted by: Lisa at November 17, 2009 05:36 PM
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