Publications by authors named "Anna Van Meter"

53 Publications

Associations of Social Capital with Mental Disorder Prevalence, Severity, and Comorbidity among U.S. Adolescents.

J Clin Child Adolesc Psychol 2021 Mar 3:1-12. Epub 2021 Mar 3.

Intramural Research Program, National Institute of Mental Health.

: To examine cross-sectional associations between social capital constructs and 1) adolescent lifetime mental disorders, 2) severity of functional impairment, and 3) psychiatric comorbidity.: Data were from the National Comorbidity Survey Adolescent Supplement, a nationally representative mental health survey of 6,483 U.S. adolescents aged 13-18 years. Information from fully-structured diagnostic interviews, including adolescent and caregiver reports, was used to measure seven social capital constructs and lifetime DSM-IV mental disorders (mood, anxiety, behavior, substance use and eating disorder classes). Disorder severity was divided into severe vs. mild/moderate. Comorbidity was measured as the number of different classes of lifetime mental disorders.: Adjusted for socio-demographics and caregivers' mental health, the most consistent associations with adolescent mental disorder were for supportive friendships (any disorder OR = 0.95, 95%CI = 0.91-0.99), family cohesion (OR = 0.81, 95%CI = 0.75-0.86), school bonding (OR = 0.76, 95%CI = 0.71-0.81), and extracurricular participation (OR = 0.90, 95%CI = 0.86-0.95), although results differed by disorder class. Caregiver-reported neighborhood trust and reciprocity and caregiver community involvement were less consistently associated with mental disorder. Medium levels of adolescent-reported affiliation with neighbors was associated with lower odds of mood (OR = 0.81, 95%CI = 0.66-0.98) and anxiety (OR = 0.78, 95%CI = 0.64-0.96) disorder, while high levels were associated with higher odds of behavior disorder (OR = 1.47, 95%CI = 1.16-1.87). Several associations were stronger for severe vs. mild/moderate disorder and with increasing comorbidity.: Although we cannot infer causality, our findings support the notion that improving actual and/or perceived social capital, especially regarding friendships, family, and school, (e.g., through multimodal interventions) could aid in the prevention and treatment of both individual adolescent mental disorders and psychiatric comorbidity.
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http://dx.doi.org/10.1080/15374416.2021.1875326DOI Listing
March 2021

Interpretation bias training for bipolar disorder: A randomized controlled trial.

J Affect Disord 2021 Mar 30;282:876-884. Epub 2020 Dec 30.

MRC Integrative Epidemiology Unit, School of Psychological Science, University of Bristol, Bristol, United Kingdom.

Background: Bipolar disorder (BD) is associated with emotion interpretation biases that can exacerbate depressed mood. Interpretation bias training (IBT) may help; according to the "virtuous cycle" hypothesis, interpreting others' emotions as positive can lead to interactions that improve mood. Our goals were to determine whether IBT can shift emotion interpretation biases and demonstrate clinical benefits (lower depressed mood, improved social function) in people with BD.

Method: Young adults with BD were recruited for three sessions of computer-based IBT. Active IBT targets negative emotion bias by training judgments of ambiguous face emotions towards happy judgments. Participants were randomized to active or sham IBT. Participants reported on mood and functioning at baseline, intervention end (week two), and week 10.

Results: Fifty participants (average age 22, 72% female) enrolled, 38 completed the week 10 follow-up. IBT shifted emotion interpretations (Hedges g = 1.63). There was a group-by-time effect (B = -13.88, p < .0001) on self-reported depression; the IBT group had a larger decrease in depressed mood. The IBT group also had a larger increase in perceived familial support (B = 3.88, p < .0001). Baseline learning rate (i.e., how quickly emotion judgments were updated) was associated with reduced clinician- (B = -54.70, p < 0.001) and self-reported depression (B = -58.20, p = 0.009).

Conclusion: Our results converge with prior work demonstrating that IBT may reduce depressed mood. Additionally, our results provide support for role of operant conditioning in the treatment of depression. People with BD spend more time depressed than manic; IBT, an easily disseminated intervention, could augment traditional forms of treatment without significant expense or side effects.
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http://dx.doi.org/10.1016/j.jad.2020.12.162DOI Listing
March 2021

Identifying signals associated with psychiatric illness utilizing language and images posted to Facebook.

NPJ Schizophr 2020 Dec 3;6(1):38. Epub 2020 Dec 3.

IBM Research, Thomas J. Watson Research Center, Yorktown Heights, NY, USA.

Prior research has identified associations between social media activity and psychiatric diagnoses; however, diagnoses are rarely clinically confirmed. Toward the goal of applying novel approaches to improve outcomes, research using real patient data is necessary. We collected 3,404,959 Facebook messages and 142,390 images across 223 participants (mean age = 23.7; 41.7% male) with schizophrenia spectrum disorders (SSD), mood disorders (MD), and healthy volunteers (HV). We analyzed features uploaded up to 18 months before the first hospitalization using machine learning and built classifiers that distinguished SSD and MD from HV, and SSD from MD. Classification achieved AUC of 0.77 (HV vs. MD), 0.76 (HV vs. SSD), and 0.72 (SSD vs. MD). SSD used more (P < 0.01) perception words (hear, see, feel) than MD or HV. SSD and MD used more (P < 0.01) swear words compared to HV. SSD were more likely to express negative emotions compared to HV (P < 0.01). MD used more words related to biological processes (blood/pain) compared to HV (P < 0.01). The height and width of photos posted by SSD and MD were smaller (P < 0.01) than HV. MD photos contained more blues and less yellows (P < 0.01). Closer to hospitalization, use of punctuation increased (SSD vs HV), use of negative emotion words increased (MD vs. HV), and use of swear words increased (P < 0.01) for SSD and MD compared to HV. Machine-learning algorithms are capable of differentiating SSD and MD using Facebook activity alone over a year in advance of hospitalization. Integrating Facebook data with clinical information could one day serve to inform clinical decision-making.
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http://dx.doi.org/10.1038/s41537-020-00125-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713057PMC
December 2020

DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders.

Front Psychiatry 2020 21;11:568982. Epub 2020 Oct 21.

Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.

Although attenuated psychotic symptoms often occur for the first time during adolescence, studies focusing on adolescents are scarce. Attenuated psychotic symptoms form the criteria to identify individuals at increased clinical risk of developing psychosis. The study of individuals with these symptoms has led to the release of the DSM-5 diagnosis of Attenuated Psychosis Syndrome (APS) as a condition for further research. We aimed to characterize and compare hospitalized adolescents with DSM-5-APS diagnosis vs. hospitalized adolescents without a DSM-5-APS diagnosis. Interviewing help-seeking, hospitalized adolescents (aged 12-18 years) and their caregivers independently with established research instruments, we (1) evaluated the presence of APS among non-psychotic adolescents, (2) characterized and compared APS and non-APS individuals regarding sociodemographic, illness and intervention characteristics, (3) correlated psychopathology with levels of functioning and severity of illness and (4) investigated the influence of individual clinical, functional and comorbidity variables on the likelihood of participants to be diagnosed with APS. Among 248 consecutively recruited adolescents (age=15.4 ± 1.5 years, females = 69.6%) with non-psychotic psychiatric disorders, 65 (26.2%) fulfilled APS criteria and 183 (73.8%) did not fulfill them. Adolescents with APS had higher number of psychiatric disorders than non-APS adolescents (3.5 vs. 2.4, < 0.001; Cohen's d = 0.77), particularly, disruptive behavior disorders (Cramer's V = 0.16), personality disorder traits (Cramer's V = 0.26), anxiety disorders (Cramer's V = 0.15), and eating disorders (Cramer's V = 0.16). Adolescents with APS scored higher on positive (Cohen's d = 1.5), negative (Cohen's d = 0.55), disorganized (Cohen's d = 0.51), and general symptoms (Cohen's d = 0.84), and were more severely ill (Cohen's d = 1.0) and functionally impaired (Cohen's d = 0.31). Negative symptoms were associated with lower functional levels (Pearson ρ = -0.17 to -0.20; = 0.014 to 0.031). Global illness severity was associated with higher positive, negative, and general symptoms (Pearson ρ = 0.22 to 0.46; = 0.04 to < 0.001). APS status was independently associated with perceptual abnormalities (OR = 2.0; 95% CI = 1.6-2.5, < 0.001), number of psychiatric diagnoses (OR = 1.5; 95% CI = 1.2-2.0, = 0.002), and impaired stress tolerance (OR = 1.4; 95% CI = 1.1-1.7, = 0.002) ( = 0.315, < 0.001). A considerable number of adolescents hospitalized with non-psychotic psychiatric disorders meet DSM-5-APS criteria. These help-seeking adolescents have more comorbid disorders and more severe symptoms, functional impairment, and severity of illness than non-APS adolescents. Thus, they warrant high intensity clinical care.
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http://dx.doi.org/10.3389/fpsyt.2020.568982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609900PMC
October 2020

Evidence Base Update on Assessing Sleep in Youth.

J Clin Child Adolesc Psychol 2020 Nov-Dec;49(6):701-736. Epub 2020 Nov 4.

Department of Psychiatry, Zucker Hillside Hospital.

Background: Sleep is vital to youth well-being and when it becomes disturbed - whether due to environmental or individual factors - mental and physical health suffer. Sleep problems can also be a symptom of underlying mental health disorders. Assessing different components of sleep, including quality and hygiene, can be useful both for identifying mental health problems and for measuring changes in well-being over time. However, there are dozens of sleep-related measures for youth and it can be difficult to determine which to select for a specific research or clinical purpose. The goal of this review was to identify sleep-related measures for clinical and/or research use in youth mental health settings, and to update the evidence base on this topic.

Method: We generated a list of candidate measures based on other reviews and searched in PubMed and PsycINFO using the terms "sleep" AND (measure OR assessment OR questionnaire) AND (psychometric OR reliability OR validity). Search results were limited to studies about children and adolescents (aged 2-17) published in English. Additional criteria for inclusion were that there had to be at least three publications reporting on the measure psychometrics in community or mental health populations. Sleep measures meeting these criteria were evaluated using the criteria set by De Los Reyes and Langer (2018).

Results: Twenty-six measures, across four domains of sleep - insomnia, sleep hygiene, sleepiness, sleep quality - met inclusion criteria. Each measure had at least adequate clinical utility. No measure(s) emerged as superior across psychometric domains.

Conclusion: Clinicians and researchers must evaluate sleep measures for each use case, as the intended purpose will dictate which measure is best. Future research is necessary to evaluate measure performance in transdiagnostic mental health populations, including youth with serious mental illness.
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http://dx.doi.org/10.1080/15374416.2020.1802735DOI Listing
February 2021

Identifying emerging mental illness utilizing search engine activity: A feasibility study.

PLoS One 2020 16;15(10):e0240820. Epub 2020 Oct 16.

The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States of America.

Mental illness often emerges during the formative years of adolescence and young adult development and interferes with the establishment of healthy educational, vocational, and social foundations. Despite the severity of symptoms and decline in functioning, the time between illness onset and receiving appropriate care can be lengthy. A method by which to objectively identify early signs of emerging psychiatric symptoms could improve early intervention strategies. We analyzed a total of 405,523 search queries from 105 individuals with schizophrenia spectrum disorders (SSD, N = 36), non-psychotic mood disorders (MD, N = 38) and healthy volunteers (HV, N = 31) utilizing one year's worth of data prior to the first psychiatric hospitalization. Across 52 weeks, we found significant differences in the timing (p<0.05) and frequency (p<0.001) of searches between individuals with SSD and MD compared to HV up to a year in advance of the first psychiatric hospitalization. We additionally identified significant linguistic differences in search content among the three groups including use of words related to sadness and perception, use of first and second person pronouns, and use of punctuation (all p<0.05). In the weeks before hospitalization, both participants with SSD and MD displayed significant shifts in search timing (p<0.05), and participants with SSD displayed significant shifts in search content (p<0.05). Our findings demonstrate promise for utilizing personal patterns of online search activity to inform clinical care.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240820PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567375PMC
December 2020

Generalizing the Prediction of Bipolar Disorder Onset Across High-Risk Populations.

J Am Acad Child Adolesc Psychiatry 2020 Oct 8. Epub 2020 Oct 8.

Virginia Commonwealth University, Richmond, Virginia.

Objective: Risk calculators (RC) to predict clinical outcomes are gaining interest. An RC to estimate risk of bipolar spectrum disorders (BPSD) could help reduce the duration of undiagnosed BPSD and improve outcomes. Our objective was to adapt an RC previously validated in the Pittsburgh Bipolar Offspring Study (BIOS) sample to achieve adequate predictive ability in both familial high-risk and clinical high-risk youths.

Method: Participants (aged 6-12 years at baseline) from the Longitudinal Assessment of Manic Symptoms (LAMS) study (N = 473) were evaluated semi-annually. Evaluations included a Kiddie Schedule for Affective Disorders (K-SADS) interview. After testing an RC that closely approximated the original, we made modifications to improve model prediction. Models were trained in the BIOS data, which included biennial K-SADS assessments, and tested in LAMS. The final model was then trained in LAMS participants, including family history of BPSD as a predictor, and tested in the familial high-risk sample.

Results: Over follow-up, 65 youths newly met criteria for BPSD. The original RC identified youths who developed BPSD only moderately well (area under the curve [AUC] = 0.67). Eliminating predictors other than the K-SADS screening items for mania and depression improved accuracy (AUC = 0.73) and generalizability. The model trained in LAMS, including family history as a predictor, performed well in the BIOS sample (AUC = 0.74).

Conclusion: The clinical circumstances under which the assessment of symptoms occurs affects RC accuracy; focusing on symptoms related to the onset of BPSD improved generalizability. Validation of the RC under clinically realistic circumstances will be an important next step.
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http://dx.doi.org/10.1016/j.jaac.2020.09.017DOI Listing
October 2020

Comorbidity and patterns of familial aggregation in attention-deficit/hyperactivity disorder and bipolar disorder in a family study of affective and anxiety spectrum disorders.

J Psychiatr Res 2020 11 23;130:355-361. Epub 2020 Aug 23.

Genetic Epidemiology Research Branch, National Institute of Mental Health, Intramural Research Program, Building 35A, Room 2E410, MSC 3720, Bethesda, MD, 20892, USA. Electronic address:

The aim of this study is to examine the familial aggregation of Attention-deficit/hyperactivity disorder (ADHD) and its cross-transmission with bipolar disorder (BD) in a community-based family study of mood spectrum disorders. A clinically-enriched community sample of 562 probands recruited from the greater Washington, DC metropolitan area and their 698 directly interviewed relatives were included in analyses. Inclusion criteria were English speaking and consent to contact at least two first-degree relatives. Standard family study methodology was used and DSM-IV classified mental disorders were ascertained through a best-estimate procedure based on direct semi-structured interviews and multiple family history reports. There was specificity of familial aggregation of both bipolar I disorder (BD I) and bipolar II disorder (BD II) (i.e., BD I OR = 6.08 [1.66, 22.3]; BD II OR = 2.98 [1.11, 7.96]) and ADHD (ADHD OR = 2.13 [1.16, 3.95]). However, there was no evidence for cross-transmission of BD and ADHD in first degree relatives (i.e., did not observe increased rates of BD in relatives of those with ADHD and vice versa; all ps > 0.05). The specificity of familial aggregation of ADHD and BD alongside the absence of shared familial risk are consistent with the notion that the comorbidity between ADHD and BD may be attributable to diagnostic artifact, could represent a distinct BD suptype characterized by childhood-onset symptoms, or the possibility that attention problems serve as a precursor or consequence of BD.
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http://dx.doi.org/10.1016/j.jpsychires.2020.08.017DOI Listing
November 2020

Utilizing Machine Learning on Internet Search Activity to Support the Diagnostic Process and Relapse Detection in Young Individuals With Early Psychosis: Feasibility Study.

JMIR Ment Health 2020 Sep 1;7(9):e19348. Epub 2020 Sep 1.

The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.

Background: Psychiatry is nearly entirely reliant on patient self-reporting, and there are few objective and reliable tests or sources of collateral information available to help diagnostic and assessment procedures. Technology offers opportunities to collect objective digital data to complement patient experience and facilitate more informed treatment decisions.

Objective: We aimed to develop computational algorithms based on internet search activity designed to support diagnostic procedures and relapse identification in individuals with schizophrenia spectrum disorders.

Methods: We extracted 32,733 time-stamped search queries across 42 participants with schizophrenia spectrum disorders and 74 healthy volunteers between the ages of 15 and 35 (mean 24.4 years, 44.0% male), and built machine-learning diagnostic and relapse classifiers utilizing the timing, frequency, and content of online search activity.

Results: Classifiers predicted a diagnosis of schizophrenia spectrum disorders with an area under the curve value of 0.74 and predicted a psychotic relapse in individuals with schizophrenia spectrum disorders with an area under the curve of 0.71. Compared with healthy participants, those with schizophrenia spectrum disorders made fewer searches and their searches consisted of fewer words. Prior to a relapse hospitalization, participants with schizophrenia spectrum disorders were more likely to use words related to hearing, perception, and anger, and were less likely to use words related to health.

Conclusions: Online search activity holds promise for gathering objective and easily accessed indicators of psychiatric symptoms. Utilizing search activity as collateral behavioral health information would represent a major advancement in efforts to capitalize on objective digital data to improve mental health monitoring.
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http://dx.doi.org/10.2196/19348DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492982PMC
September 2020

Designing a Clinician-Facing Tool for Using Insights From Patients' Social Media Activity: Iterative Co-Design Approach.

JMIR Ment Health 2020 Aug 12;7(8):e16969. Epub 2020 Aug 12.

School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States.

Background: Recent research has emphasized the need for accessing information about patients to augment mental health patients' verbal reports in clinical settings. Although it has not been introduced in clinical settings, computational linguistic analysis on social media has proved it can infer mental health attributes, implying a potential use as collateral information at the point of care. To realize this potential and make social media insights actionable to clinical decision making, the gaps between computational linguistic analysis on social media and the current work practices of mental health clinicians must be bridged.

Objective: This study aimed to identify information derived from patients' social media data that can benefit clinicians and to develop a set of design implications, via a series of low-fidelity (lo-fi) prototypes, on how to deliver the information at the point of care.

Methods: A team of clinical researchers and human-computer interaction (HCI) researchers conducted a long-term co-design activity for over 6 months. The needs-affordances analysis framework was used to refine the clinicians' potential needs, which can be supported by patients' social media data. On the basis of those identified needs, the HCI researchers iteratively created 3 different lo-fi prototypes. The prototypes were shared with both groups of researchers via a videoconferencing software for discussion and feedback. During the remote meetings, potential clinical utility, potential use of the different prototypes in a treatment setting, and areas of improvement were discussed.

Results: Our first prototype was a card-type interface that supported treatment goal tracking. Each card included attribute levels: depression, anxiety, social activities, alcohol, and drug use. This version confirmed what types of information are helpful but revealed the need for a glanceable dashboard that highlights the trends of these information. As a result, we then developed the second prototype, an interface that shows the clinical state and trend. We found that focusing more on the changes since the last visit without visual representation can be more compatible with clinicians' work practices. In addition, the second phase of needs-affordances analysis identified 3 categories of information relevant to patients with schizophrenia: symptoms related to psychosis, symptoms related to mood and anxiety, and social functioning. Finally, we developed the third prototype, a clinical summary dashboard that showed changes from the last visit in plain texts and contrasting colors.

Conclusions: This exploratory co-design research confirmed that mental health attributes inferred from patients' social media data can be useful for clinicians, although it also revealed a gap between computational social media analyses and clinicians' expectations and conceptualizations of patients' mental health states. In summary, the iterative co-design process crystallized design directions for the future interface, including how we can organize and provide symptom-related information in a way that minimizes the clinicians' workloads.
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http://dx.doi.org/10.2196/16969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450381PMC
August 2020

Emotional body language: Social cognition deficits in bipolar disorder.

J Affect Disord 2020 07 30;272:231-238. Epub 2020 Apr 30.

Ferkauf Graduate School of Psychology, Yeshiva University, United States; Feinstein Institutes for Medical Research, Behavior Science, United States; Department of Psychiatry Research, The Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States. Electronic address:

Background: Research suggests that people with bipolar disorder (BD), like individuals with autism spectrum disorders or schizophrenia (among other forms of psychopathology), often have social cognition deficits that negatively impact relationships and quality of life. Studies of social cognition largely focus on face emotion recognition. However, relying solely on faces is not ecologically valid - other cues are available outside of a lab environment. If the ability to correctly interpret other emotion cues is intact, people with face emotion recognition deficits could learn to rely on other cues in order to make inferences about peoples' emotional states. This study explored whether both facial emotion and emotional body language (EBL) recognition are impaired in people with BD.

Method: We measured the performance of individuals with BD relative to community controls on a computer-based emotion recognition task that isolated participants' ability to interpret emotions in faces, bodies without faces, and in bodies with faces.

Results: Results indicated that the BD group was significantly less accurate on face emotion recognition (Cohen's d = -0.87, p = .023), and was more likely to misidentify neutral stimuli as sad (Cohen's d = -0.58, p = .030). Emotion identification accuracy was equivalent across groups when the body (not just face) was visible.

Conclusion: People with BD experience deficits in face emotion recognition, and their emotional state may influence their interpretation of others' emotions. However, recognition of EBL seems largely intact in this population. Paying attention to EBL may help people with BD to compensate for face emotion processing deficits and improve social functioning.
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http://dx.doi.org/10.1016/j.jad.2020.03.114DOI Listing
July 2020

Demographic and Clinical Characteristics, Including Subsyndromal Symptoms Across Bipolar-Spectrum Disorders in Adolescents.

J Child Adolesc Psychopharmacol 2020 05 21;30(4):222-234. Epub 2020 Feb 21.

Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA.

Bipolar disorder (BD) is a debilitating illness that often starts at an early age. Prevention of first and subsequent mood episodes, which are usually preceded by a period characterized by subthreshold symptoms is important. We compared demographic and clinical characteristics including severity and duration of subsyndromal symptoms across adolescents with three different bipolar-spectrum disorders. Syndromal and subsyndromal psychopathology were assessed in adolescent inpatients (age = 12-18 years) with a clinical mood disorder diagnosis. Assessments included the validated Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P). We compared phenomenology across patients with a research consensus conference-confirmed DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnoses of BD-I, BD-not otherwise specified (NOS), or mood disorder (MD) NOS. Seventy-six adolescents (age = 15.6 ± 1.4 years, females = 59.2%) were included (BD-I = 24; BD-NOS = 29; MD-NOS = 23) in this study. Median baseline global assessment of functioning scale score was 21 (interquartile range = 17-40; between-group  = 0.31). Comorbidity was frequent, and similar across groups, including disruptive behavior disorders (55.5%,  = 0.27), anxiety disorders (40.8%,  = 0.98), and personality disorder traits (25.0%,  = 0.21). Mania symptoms (most frequent: irritability = 93.4%,  = 0.82) and depressive symptoms (most frequent: depressed mood = 81.6%,  = 0.14) were common in all three BD-spectrum groups. Manic and depressive symptoms were more severe in both BD-I and BD-NOS versus MD-NOS ( < 0.0001). Median duration of subthreshold manic symptoms was shorter in MD-NOS versus BD-NOS (11.7 vs. 20.4 weeks,  = 0.002) and substantial in both groups. The most used psychotropics upon discharge were antipsychotics (65.8%; BD-I = 79.2%; BD-NOS = 62.1%; MD-NOS = 56.5%,  = 0.227), followed by mood stabilizers (43.4%; BD-I = 66.7%; BD-NOS = 31.0%; MD-NOS = 34.8%,  = 0.02) and antidepressants (19.7%; BD-I = 20.8%; BD-NOS = 10.3%; MD-NOS = 30.4%). Youth with BD-I, BD-NOS, and MD-NOS experience considerable symptomatology and are functionally impaired, with few differences observed in psychiatric comorbidity and clinical severity. Moreover, youth with BD-NOS and MD-NOS undergo a period with subthreshold manic symptoms, enabling identification and, possibly, preventive intervention of those at risk for developing BD or other affective episodes requiring hospitalization.
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http://dx.doi.org/10.1089/cap.2019.0138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232658PMC
May 2020

Medication Use in Acute Care Adolescent Psychiatric Unit.

J Child Adolesc Psychopharmacol 2020 05 3;30(4):250-260. Epub 2019 Dec 3.

Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA.

Evidence to support the use of (PRN) medication is limited, and the details of PRN use (indication, frequency of administration, patient characteristics) are rarely reported, particularly in youth populations. The goal of this study was to report on the pattern of PRN use over 6 years in an acute care psychiatric unit for adolescents. A retrospective chart review of patients' records from November 2012 to October 2018 was conducted. Variables extracted from electronic medical records included age, gender, race/ethnicity, clinical rating scores at admission (on a subset of patients), length of stay, psychotropic and nonpsychotropic PRN medication administration, timing of administration, discharge diagnosis, and discharge medication. Records from 2961 individuals with a total 3937 admissions were analyzed. A total of 62% of admissions had at least one PRN medication administration. Severity of symptoms, as indicated by higher scores on clinical rating scales at admission, longer length of stay, and readmission were related to high PRN use. Patients with bipolar spectrum disorders received more psychotropic and nonpsychotropic PRN medications than other patients. Patients who were high psychotropic PRN users were also high nonpsychotropic PRN users. Despite the lack of clear evidence in support of the efficacy of PRN medications, they commonly used to control symptoms in acute care inpatient settings. Youth with severe symptoms utilized not only psychotropic PRN medication but also nonpsychotropic PRN more frequently, suggesting a possible role of systemic disorder among youth with serious mental illness. More research is necessary to examine the efficacy of PRN medications for managing targeted symptoms.
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http://dx.doi.org/10.1089/cap.2019.0131DOI Listing
May 2020

Feasibility and impact of a guided symptom exposure augmented cognitive behavior therapy protocol to prevent symptoms of pharmacologically induced depression: A pilot study.

Cognit Ther Res 2019 Aug 12;43(4):679-692. Epub 2019 Feb 12.

Mount Sinai Medical Center; 1468 Madison Avenue, New York, NY 10029, USA.

Depression is the leading cause of disability and a major cause of morbidity worldwide, with societal costs now upwards of 1 trillion dollars across the globe. Hence, extending current efforts to augment prevention outcomes is consistent with global public health interests. Although many prevention programs have been developed and have demonstrated efficacy, studies have yet to demonstrate that CBT is effective in preventing symptoms in populations at risk for developing depression induced by pharmacological substances. Using a randomized, controlled design, this pilot study reports on the feasibility and preliminary effects of a novel, guided symptom exposure augmented cognitive behavioral prevention intervention (GSE-CBT) in a sample diagnosed with Hepatitis C at risk for developing medication induced depression. Results demonstrated that the guided symptom exposure augmented CBT (GSE-CBT) was feasible in this population and was delivered with high integrity. Although not statistically different, we observed a pattern of lower depression levels in the GSE-CBT group versus those in the control group throughout. This pilot study demonstrates that a psychosocial prevention intervention is feasible for use in patients at risk for developing pharmacologically induced depression and that a guided symptom exposure augmented CBT protocol has the potential to prevent symptoms of depression that develop as a side effect to taking these medications. Results are preliminary and future studies should use larger samples and test the intervention in other populations.
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http://dx.doi.org/10.1007/s10608-018-09990-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880945PMC
August 2019

Feasibility and impact of a guided symptom exposure augmented cognitive behavior therapy protocol to prevent symptoms of pharmacologically induced depression: A pilot study.

Cognit Ther Res 2019 Aug 12;43(4):679-692. Epub 2019 Feb 12.

Mount Sinai Medical Center; 1468 Madison Avenue, New York, NY 10029, USA.

Depression is the leading cause of disability and a major cause of morbidity worldwide, with societal costs now upwards of 1 trillion dollars across the globe. Hence, extending current efforts to augment prevention outcomes is consistent with global public health interests. Although many prevention programs have been developed and have demonstrated efficacy, studies have yet to demonstrate that CBT is effective in preventing symptoms in populations at risk for developing depression induced by pharmacological substances. Using a randomized, controlled design, this pilot study reports on the feasibility and preliminary effects of a novel, guided symptom exposure augmented cognitive behavioral prevention intervention (GSE-CBT) in a sample diagnosed with Hepatitis C at risk for developing medication induced depression. Results demonstrated that the guided symptom exposure augmented CBT (GSE-CBT) was feasible in this population and was delivered with high integrity. Although not statistically different, we observed a pattern of lower depression levels in the GSE-CBT group versus those in the control group throughout. This pilot study demonstrates that a psychosocial prevention intervention is feasible for use in patients at risk for developing pharmacologically induced depression and that a guided symptom exposure augmented CBT protocol has the potential to prevent symptoms of depression that develop as a side effect to taking these medications. Results are preliminary and future studies should use larger samples and test the intervention in other populations.
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http://dx.doi.org/10.1007/s10608-018-09990-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880945PMC
August 2019

Development of bipolar disorder and other comorbidity among youth with attention-deficit/hyperactivity disorder.

J Child Psychol Psychiatry 2020 02 15;61(2):175-181. Epub 2019 Sep 15.

Department of Psychology, University of New Orleans, New Orleans, LA, USA.

Objective: To examine development of bipolar spectrum disorders (BPSD) and other disorders in prospectively followed children with attention-deficit/hyperactivity disorder (ADHD).

Method: In the Longitudinal Assessment of Manic Symptoms (LAMS) study, 531 of 685 children age 6-12 (most selected for scores > 12 on General Behavior Inventory 10-item Mania scale) had ADHD, 112 with BPSD, and 419 without. With annual assessments for 8 years, retention averaged 6.2 years. Chi-square analyses compared rate of new BPSD and other comorbidity between those with versus without baseline ADHD and between retained versus resolved ADHD diagnosis. Cox regression tested factors influencing speed of BPSD onset.

Results: Of 419 with baseline ADHD but not BPSD, 52 (12.4%) developed BPSD, compared with 16 of 110 (14.5%) without either baseline diagnosis. Those who developed BPSD had more nonmood comorbidity over the follow-up than those who did not develop BPSD (p = .0001). Of 170 who still had ADHD at eight-year follow-up (and not baseline BPSD), 26 (15.3%) had developed BPSD, compared with 16 of 186 (8.6%) who had ADHD without BPSD at baseline but lost the ADHD diagnosis (χ  = 3.82, p = .051). There was no statistical difference in whether ADHD persisted or not across new BPSD subtypes (χ  = 1.62, p = .446). Of those who developed BPSD, speed of onset was not significantly related to baseline ADHD (p = .566), baseline anxiety (p = .121), baseline depression (p = .185), baseline disruptive behavior disorder (p = .184), age (B = -.11 p = .092), maternal mania (p = .389), or paternal mania (B = .73, p = .056). Those who started with both diagnoses had more severe symptoms/impairment than those with later developed BPSD and reported having ADHD first.

Conclusions: In a cohort selected for symptoms of mania at age 6-12, baseline ADHD was not a significant prospective risk factor for developing BPSD. However, persistence of ADHD may marginally mediate risk of BPSD, and early comorbidity of both diagnoses increases severity/impairment.
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http://dx.doi.org/10.1111/jcpp.13122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980179PMC
February 2020

An International Society of Bipolar Disorders task force report: Precursors and prodromes of bipolar disorder.

Bipolar Disord 2019 12 18;21(8):720-740. Epub 2019 Sep 18.

Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA.

Objectives: To clarify the clinical features preceding the onset of bipolar disorder (BD) has become a public health priority for the prevention of high morbidity and mortality. BD remains frequently under- or misdiagnosed, and under- or mistreated, often for years.

Methods: We assessed the predictive value of precursors and prodromes of BD. We assessed precursors of first-lifetime manic or hypomanic episodes with/without mixed features in retrospective and prospective studies. The task force evaluated and summarized separately assessments of familial risk, premorbid personality traits, retrospective, and prospective studies.

Results: Cyclothymic features, a family history of BD, retrospectively reported attenuated manic symptoms, prospectively identified subthreshold symptoms of hypomania, recurrence of depression, panic anxiety and psychotic features, have been identified as clinical precursors of BD. The prodromal symptoms like [hypo]mania often appears to be long enough to encourage early identification and timely intervention.

Conclusions: The predictive value of any risk factor identified remains largely unknown. Prospective controlled studies are urgently needed for prevention and effective treatment.
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http://dx.doi.org/10.1111/bdi.12831DOI Listing
December 2019

Childhood factors associated with increased risk for mood episode recurrences in bipolar disorder-A systematic review.

Bipolar Disord 2019 09 15;21(6):483-502. Epub 2019 May 15.

Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Background: Bipolar Disorder (BD) is a recurrent illness associated with high morbidity and mortality. The frequency of mood episode recurrence in BD is highly heterogeneous and significantly impacts the person's psychosocial functioning and well-being. Understanding the factors associated with mood recurrences could inform the prognosis and treatment. The objective of this review is to summarize the literature on factors, present during childhood, that influence recurrence.

Methodology: A systematic review of PubMed (1946-2017) and PsycINFO (1884-2017) databases was conducted to identify candidate studies. Search terms included bipolar disorder, episodes, predictors, recurrences, and course. Study characteristics, risk for bias, and factors associated with recurrence were coded by two raters according to predetermined criteria.

Results: Twenty child studies and 28 adult studies that retrospectively evaluated childhood variables associated with mood recurrences were included. Early age of onset, low socioeconomic status, comorbid disorders, inter-episode subsyndromal mood symptoms, BD-I/II subtypes, presence of stressors, and family history of BD were associated with higher number of recurrences.

Limitations: Risk factors and mood recurrences were assessed and defined in different ways, limiting generalizability.

Conclusion: Multiple factors are associated with increased risk of mood episode recurrence in BD. Interventions targeting modifiable factors could reduce the impact of BD. For example, treatment of comorbid disorders and subsyndromal mood symptoms, coupled with appropriate cognitive behavioral and family-focused therapies could ameliorate risk related to many clinical factors. When coupled with social services to address environmental factors, the number of episodes could be reduced and the course of BD significantly improved.
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http://dx.doi.org/10.1111/bdi.12785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6768757PMC
September 2019

Online help-seeking prior to diagnosis: Can web-based resources reduce the duration of untreated mood disorders in young people?

J Affect Disord 2019 06 8;252:130-134. Epub 2019 Apr 8.

Department of Psychiatry Research, The Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, 11004 NY, USA; Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA.

Objective: Mood and anxiety disorders typically begin in adolescence or early adulthood, but those at the age of highest risk are among those least likely to access mental health services. However, they may be more likely than other demographic groups to seek help online. The goal of the present study was to investigate the online help- and information-seeking activity of young people newly diagnosed with mood and anxiety disorders in order to better understand how digital resources might serve this population.

Method: Participants, aged 15 to 35, with a diagnosis of a mood or anxiety disorder were eligible if they had received their first mental health diagnosis within 24 months. Participants were interviewed with the Pathways to Care Questionnaire, which inquires about online activity prior to one's first interaction with mental healthcare providers.

Results: Forty people participated (depression n = 30, bipolar disorder n = 5, generalized anxiety disorder n = 5); average age 21 years (SD=3.2), 60% female. Eighty-one percent reported seeking help and/or information about their symptoms online. The gap between symptom onset and in-person help seeking was 91.90 weeks (SD=133.7). Most participants (85%) reported they would be open to communicating with a mental health professional online.

Conclusion: A majority of young people experiencing clinically-significant symptoms seek help online. However, the gap between symptom onset and treatment initiation remains unacceptably long. Better strategies are needed to translate young people's interest in online resources into meaningful care, whether through web-based services or facilitated pathways to traditional treatment.
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http://dx.doi.org/10.1016/j.jad.2019.04.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6529208PMC
June 2019

Updated Meta-Analysis of Epidemiologic Studies of Pediatric Bipolar Disorder.

J Clin Psychiatry 2019 04 2;80(3). Epub 2019 Apr 2.

Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Objective: Research on pediatric bipolar disorder (PBD) has grown substantially in the past 7 years; updating a 2011 meta-analysis of PBD prevalence could improve understanding of factors that influence prevalence.

Data Sources: A literature review of papers published in English was updated in 2018 using PubMed and PsycINFO. Search terms included pediatric, child, "bipolar disorder," bipolar, mania, prevalence, epidemiology, community, adolescent, and youth.

Study Selection: Inclusion criteria were (1) youth epidemiologic sample, (2) number of youth with bipolar spectrum disorders reported, and (3) prevalence rates for youth differentiated from prevalence for those over age 21 years (if both included). Of 2,400 articles retrieved, 44 were evaluated and 8 new were included.

Data Extraction: Prevalence rates for each bipolar subtype were recorded as reported; hypothesized moderators (eg, study characteristics, environmental factors) were also coded.

Results: Eight additional studies resulted in a total sample of 19 studies, tripling the sample size to N = 56,103 and n = 1,383 with bipolar disorder. Seven studies were from the United States, and 12 were from South America, Central America, or Europe. Weighted average prevalence of bipolar spectrum disorders was 3.9% (95% CI, 2.6%-5.8%). There was significant heterogeneity across studies (Q = 759.82, df = 32, P < .0005). The pooled rate of bipolar I was 0.6% (95% CI, 0.3%-1.2%); these rates were also heterogeneous (Q = 154.27, df = 13, P < .0001). Predictors of higher bipolar spectrum disorder prevalence were the use of broad bipolar criteria (P < .0001), older minimum age (P = .005), and lifetime prevalence (P = .002). Newer studies were associated with lower rates (P < .0001).

Conclusions: The updated meta-analysis confirms that rates of bipolar spectrum disorders are not higher in the United States than in other Western countries, nor are rates increasing over time. Nonstandard diagnostic criteria result in highly variable prevalence rates, as does focusing on narrow definitions of PBD to the exclusion of the full spectrum. Consistent application of validated criteria could help to settle questions regarding PBD prevalence. Studies from non-Western countries are needed to refine understanding of international prevalence and risk factors.
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http://dx.doi.org/10.4088/JCP.18r12180DOI Listing
April 2019

Bipolar Prodrome Symptom Scale - Abbreviated Screen for Patients: Description and validation.

J Affect Disord 2019 Apr 12;249:357-365. Epub 2019 Feb 12.

The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany. Electronic address:

Objective: There is no standard method for assessing symptoms of the prodrome to bipolar disorder (BD), which has limited progress toward early identification and intervention. We aimed to validate the Bipolar Prodrome Symptom Scale-Abbreviated Screen for Patients (BPSS-AS-P), a brief self-report derived from the validated, clinician-rated Bipolar Prodrome Symptom Interview and Scale-Full Prospective (BPSS-FP), as a means to screen and identify people for whom further evaluation is indicated.

Method: Altogether, 134 participants (aged 12-18 years) were drawn from a study of the pre-syndromal stage of mood and psychotic disorders. All participants had chart diagnoses of a mood- or psychosis-spectrum disorder. Participants were interviewed with the BPSS-FP and completed measures of mania and non-mood psychopathology. Prior to being interviewed, patients completed the BPSS-AS-P. Scores on the BPSS-AS-P were determined by summing the severity and frequency ratings for each item.

Results: BPSS-AS-P scores were highly reliable (Cronbach's alpha = 0.94) and correlated with the interview-based BPSS-FP Mania Symptom Index (r = 0.55, p < .0001). BPSS-AS-P scores had good convergent validity, correlating with the General Behavior Inventory-10M (r = 0.65, p < .0001) and Young Mania Rating Scale; r = 0.48, p < .0001). The BPSS-AS-P had good discriminant validity, not being correlated with scales measuring positive and negative symptoms of psychotic disorders (p-values = 0.072-0.667).

Limitations: Findings are limited by the cross-sectional nature of the study by the fact that the participants were all treatment-seeking. Future studies need to evaluate the predictive validity of the BPSS-AS-P for identifying those who develop BD in a community sample.

Conclusion: BPSS-AS-P has promise as a screening tool for people at risk for BD. Adopting the BPSS-AS-P would support the goal of characterizing the prodrome systematically in order to facilitate research and clinical care.
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http://dx.doi.org/10.1016/j.jad.2019.02.040DOI Listing
April 2019

Debate: Looking forward: choose data over opinions to best serve youth with bipolar spectrum disorders - commentary on Parry et al. (2018).

Child Adolesc Ment Health 2019 Feb;24(1):88-91

Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, USA.

Over the past two decades, research on pediatric bipolar disorder has grown geometrically. The diagnosis of pediatric bipolar disorder was met with enthusiasm, which in healthy doses catalyzed change, and skepticism, which in good measure pushes for rigor. Skepticism led to productive questions about the phenomenology of pediatric bipolar disorder and how best to diagnose and treat it. With regard to prevalence, key questions included whether it was increasing over time, and whether it was limited to the United States. In 2011, we published a meta-analysis addressing the prevalence questions; results indicated that bipolar disorder manifested at statistically indistinguishable rates in youth community samples across the world. In their recent paper, Parry et al. examine the studies included in the 2011 meta-analysis using a qualitative approach. Their opinion piece represents a step backwards; every study has shortcomings, but in focusing on a dozen individual studies, Parry et al. fail to take into account the preponderance of evidence - literally thousands of articles across countries, cohorts and methodologies - that support the existence of bipolar disorder in both prepubescent youth and adolescents. This commentary addresses misperceptions regarding the diagnosis of bipolar disorder in youth, particularly with regard to cross-informant agreement, to present converging data from international sources regarding the onset of bipolar disorder in childhood, and to correct the false claim that pediatric bipolar disorder is controversial. As clinicians and researchers, we have an obligation to do what we can to improve the lives of youth affected by mental illness. Denying the existence of a serious mood disorder will not serve the best interests of young people and will perpetuate the long delays many experience before getting an accurate diagnosis, appropriate treatment, and a fair chance at a good quality of life.
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http://dx.doi.org/10.1111/camh.12296DOI Listing
February 2019

Debate: Looking forward: choose data over opinions to best serve youth with bipolar spectrum disorders - commentary on Parry et al. (2018).

Child Adolesc Ment Health 2019 Feb;24(1):88-91

Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, USA.

Over the past two decades, research on pediatric bipolar disorder has grown geometrically. The diagnosis of pediatric bipolar disorder was met with enthusiasm, which in healthy doses catalyzed change, and skepticism, which in good measure pushes for rigor. Skepticism led to productive questions about the phenomenology of pediatric bipolar disorder and how best to diagnose and treat it. With regard to prevalence, key questions included whether it was increasing over time, and whether it was limited to the United States. In 2011, we published a meta-analysis addressing the prevalence questions; results indicated that bipolar disorder manifested at statistically indistinguishable rates in youth community samples across the world. In their recent paper, Parry et al. examine the studies included in the 2011 meta-analysis using a qualitative approach. Their opinion piece represents a step backwards; every study has shortcomings, but in focusing on a dozen individual studies, Parry et al. fail to take into account the preponderance of evidence - literally thousands of articles across countries, cohorts and methodologies - that support the existence of bipolar disorder in both prepubescent youth and adolescents. This commentary addresses misperceptions regarding the diagnosis of bipolar disorder in youth, particularly with regard to cross-informant agreement, to present converging data from international sources regarding the onset of bipolar disorder in childhood, and to correct the false claim that pediatric bipolar disorder is controversial. As clinicians and researchers, we have an obligation to do what we can to improve the lives of youth affected by mental illness. Denying the existence of a serious mood disorder will not serve the best interests of young people and will perpetuate the long delays many experience before getting an accurate diagnosis, appropriate treatment, and a fair chance at a good quality of life.
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http://dx.doi.org/10.1111/camh.12296DOI Listing
February 2019

Blue blocking glasses worn at night in first year higher education students with sleep complaints: a feasibility study.

Pilot Feasibility Stud 2018 1;4:166. Epub 2018 Nov 1.

1Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Furness Building C73, Lancaster, LA14YT UK.

Background: Late adolescence and early adulthood is a period of highest incidence for onset of mental health problems. Transition to college environment has been associated with many risk factors such as the initial disruption-and subsequent irregularity-of the student's sleep and activity schedule. We tested the feasibility of using blue blocking glasses (BBG) at night in first year higher education students with sleep complaints, to obtain preliminary evidence for the impact of BBG on sleep, activity, and mood.

Methods: Participants were 13 first year undergraduates (from 10 different academic courses) living on campus for the first time with sleep complaints/disorders confirmed at screening via the Duke Structured Interview Schedule for Sleep Disorders. We used a 2-week, balanced crossover design (BBG vs placebo glasses; participants were unaware which was the active intervention) with computer-generated random allocation. Exploratory analyses provided descriptive and frequency summaries to evaluate feasibility of the intervention.

Results: Preliminary evidence supports the feasibility and acceptability of the trial; almost all screened participants consented and completed the protocol with high adherence; missing data were negligible. Additionally, the effectiveness of BBGs to enhance sleep, mood, and activity levels in young adults was supported.

Conclusions: The results of this feasibility trial suggest that BBG have potential as an inexpensive and feasible intervention for reducing sleep and circadian dysregulation in young adult students. A larger trial, following this successfully implemented protocol, is necessary to fully test the efficacy of BBG.
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http://dx.doi.org/10.1186/s40814-018-0360-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6211454PMC
November 2018

Overhauling technology-based interventions for young people with bipolar disorder: Lessons learned from adults.

Bipolar Disord 2019 02 1;21(1):86-87. Epub 2018 Dec 1.

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.

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http://dx.doi.org/10.1111/bdi.12716DOI Listing
February 2019

Developing and Validating Short Forms of the Parent General Behavior Inventory Mania and Depression Scales for Rating Youth Mood Symptoms.

J Clin Child Adolesc Psychol 2020 Mar-Apr;49(2):162-177. Epub 2018 Jul 24.

Department of Psychiatry, Johns Hopkins University.

To develop short forms of parent-rated mania and depression scales, evaluating their reliability, content coverage, criterion validity, and diagnostic accuracy. Caregivers completed the Parent General Behavior Inventory about their youth 5-18 years of age seeking outpatient mental health services at either an academic medical clinic (= 617) or urban community mental health center (= 530), along with other rating scales. Families also completed a semistructured Kiddie Schedule for Affective Disorders and Schizophrenia interview, with the rating scales masked during diagnosis. Ten-item short forms and projections of their psychometrics (vs. the full-length 46-item Depression and 28-item Hypomanic/Biphasic scales) were built in the academic sample and then externally cross-validated in the community sample. The mania and two depression short forms maintained high reliability (αs > .87 across both samples); high correlations with the full-length scales (s> .93); excellent convergent and discriminant validity with mood, behavior, and demographic criteria; and diagnostic accuracy undiminished compared to using the full-length scales. Present analyses developed and externally cross-validated 10-item short forms that maintain high reliability and content coverage and show strong criterion validity and diagnostic accuracy-even when used in an independent sample with markedly different demographics and referral patterns. The short forms appear useful in clinical applications, including screening and initial evaluation, as well as in research settings, where they offer an inexpensive quantitative score. Future work should further evaluate sensitivity to treatment effects. The short forms are available in more than a dozen translations.
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http://dx.doi.org/10.1080/15374416.2018.1491006DOI Listing
September 2020

Symptom Dimensions and Trajectories of Functioning Among Bipolar Youth: A Cluster Analysis.

J Psychiatr Pract 2018 05;24(3):146-157

PETERS, WEINSTEIN, ISAIA, ZULAUF, and WEST: Department of Psychiatry, University of Illinois at Chicago, Chicago, IL VAN METER: Department of Psychology, Yeshiva University, New York, NY.

Background: Accurate assessment of pediatric bipolar disorder (BD) is important for allocating appropriate treatment, but it is complicated by significant heterogeneity in symptom presentation and high rates of comorbidity. Investigating clinical subtypes of the disorder may help to clarify diagnostic boundaries and inform targeted treatment. This study used a full diagnostic instrument to examine symptom patterns among youth with BD.

Method: Trained interviewers completed the Washington University Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) with 71 children (7 to 13 y of age) and families as part of the baseline assessment for a randomized clinical trial of Child- and Family-focused Cognitive-Behavioral Therapy (CFF-CBT) compared with treatment as usual (TAU) for pediatric BD. All participants met DSM-IV-TR criteria for a bipolar spectrum disorder. Hierarchical and K-means cluster analyses were performed. Resultant clusters were compared on symptom severity and psychosocial functioning at baseline and across treatment.

Results: Two distinct symptom profiles emerged: "dysregulated/defiant" and "classic presentation." The dysregulated/defiant cluster was characterized by more externalizing and disruptive behaviors, whereas the classic cluster presented with more severe depression, hallmark manic symptoms, anxiety, and inattention. CFF-CBT consistently promoted psychosocial coping skills, such as problem solving and self-control, for the dysregulated/defiant cluster. TAU also promoted these skills among the individuals in the classic presentation group but not those with symptoms in the dysregulated/defiant cluster.

Discussion: Pediatric BD may be characterized by distinct phenotypes with unique etiologies and pathways to impairment. The use of a parametric approach to classify the diverse symptom presentations helped yield valuable insights into how to promote the best prognosis for improved functional outcomes in CFF-CBT versus TAU for youth with pediatric BD.
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http://dx.doi.org/10.1097/PRA.0000000000000307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050982PMC
May 2018

Parsing cyclothymic disorder and other specified bipolar spectrum disorders in youth.

J Affect Disord 2018 10 7;238:375-382. Epub 2018 Jun 7.

Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA.

Objective: Most studies of pediatric bipolar disorder (BP) combine youth who have manic symptoms, but do not meet criteria for BP I/II, into one "not otherwise specified" (NOS) group. Consequently, little is known about how youth with cyclothymic disorder (CycD) differ from youth with BP NOS. The objective of this study was to determine whether youth with a research diagnosis of CycD (RDCyc) differ from youth with operationalized BP NOS.

Method: Participants from the Course and Outcome of Bipolar Youth study were evaluated to determine whether they met RDCyc criteria. Characteristics of RDCyc youth and BP NOS youth were compared at baseline, and over eight-years follow-up.

Results: Of 154 youth (average age 11.96 (3.3), 42% female), 29 met RDCyc criteria. RDCyc youth were younger (p = .04) at baseline. Over follow-up, RDCyc youth were more likely to have a disruptive behavior disorder (p = .01), and were more likely to experience irritability (p = .03), mood reactivity (p = .02), and rejection sensitivity (p = .03). BP NOS youth were more likely to develop hypomania (p = .02), or depression (p = .02), and tended to have mood episodes earlier in the eight-year follow-up period.

Limitations: RDCyc diagnoses were made retrospectively and followed stringent criteria, which may highlight differences that, under typical clinical conditions and more vague criteria, would not be evident.

Conclusion: There were few differences between RDCyc and BP NOS youth. However, the ways in which the groups diverged could have implications; chronic subsyndromal mood symptoms may portend a severe, but ultimately non-bipolar, course. Longer follow-up is necessary to determine the trajectory and outcomes of CycD symptoms.
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http://dx.doi.org/10.1016/j.jad.2018.06.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322201PMC
October 2018

Factorial structure and familial aggregation of the Hypomania Checklist-32 (HCL-32): Results of the NIMH Family Study of Affective Spectrum Disorders.

Compr Psychiatry 2018 07 3;84:7-14. Epub 2018 Apr 3.

Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Bethesda, MD 20892, United States. Electronic address:

Background: There is substantial evidence that bipolar disorder (BD) manifests on a spectrum rather than as a categorical condition. Detection of people with subthreshold manifestations of BD is therefore important. The Hypomania Checklist-32 (HCL-32) was developed as a tool to identify such people.

Purpose: The aims of this paper were to: (1) investigate the factor structure of HCL-32; (2) determine whether the HCL-32 can discriminate between mood disorder subtypes; and (3) assess the familial aggregation and cross-aggregation of hypomanic symptoms assessed on the HCL with BD.

Procedures: Ninety-six probands recruited from the community and 154 of their adult first-degree relatives completed the HCL-32. Diagnosis was based on semi-structured interviews and family history reports. Explanatory factor analysis and mixed effects linear regression models were used.

Findings: A four-factor ("Activity/Increased energy," "Distractibility/Irritability", "Novelty seeking/Disinhibition, "Substance use") solution fit the HCL-32, explaining 11.1% of the total variance. The Distractibility/Irritability score was elevated among those with BP-I and BP-II, compared to those with depression and no mood disorders. Higher HCL-32 scores were associated with increased risk of BD-I (OR = 1.22, 95%CI 1.14-1.30). The "Distractibility/Irritability" score was transmitted within families (β = 0.15, p = 0.040). However, there was no familial cross-aggregation between mood disorders and the 4 HCL factors.

Conclusions: Our findings suggest that the HCL-32 discriminates the mood disorder subtypes, is familial and may provide a dimensional index of propensity to BD. Future studies should explore the heritability of symptoms, rather than focusing on diagnoses.
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http://dx.doi.org/10.1016/j.comppsych.2018.03.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002901PMC
July 2018

Improving the global identification of bipolar spectrum disorders: Meta-analysis of the diagnostic accuracy of checklists.

Psychol Bull 2018 03 1;144(3):315-342. Epub 2018 Feb 1.

Ferkauf Graduate School, Yeshiva University.

Shifting definitions and differences in the conceptualization of bipolar disorders have contributed to long diagnostic delays, poor reliability, and inconsistent findings. Rating scales are independent of clinical judgment and offer a reliable way to assess manic symptoms, making them good tools to improve both clinical and research diagnoses of bipolar disorder. However, there are dozens of candidates, with few obvious distinguishing characteristics, making it difficult to select one. Our goal was to metaanalyze the diagnostic accuracy of rating scales designed to identify [hypo]manic symptoms. Additionally, we explored potential moderator variables including global region, translation into a different language, and sample composition. Nearly 4000 articles were identified with searches in PubMed and PsycINFO, yielding 127 effect sizes from 103 studies that met the following inclusion criteria: (a) statistics reported by which a standardized effect size could be calculated, (b) participants age 18 + years, (c) reference diagnoses made by semistructured/structured diagnostic interview, (d) results published in English. Multivariate mixed regression models accounted for multiple effect sizes nested within sample. One hundred twenty-seven effect sizes across 14 rating scales were evaluated. There was significant heterogeneity across effect sizes; Cochran's Q(126 df) = 1622.08, p < .00005, and substantial variance components both within (σ2 = .057) and between samples (σ2 = .253). Four measures performed similarly well and significantly better than some competitors after controlling for design and reporting features. The best rating scales offer an inexpensive, efficient way to improve research and clinical diagnostic processes across diverse populations, and could also complement formal diagnoses for examining secular and cultural trends. (PsycINFO Database Record
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http://dx.doi.org/10.1037/bul0000137DOI Listing
March 2018