How Does the Brain Differ in Pediatric Bipolar Disorder vs Severe Irritability and ADHD?

Marlene Busko

May 12, 2008

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Interview with Dr. Leibenluft

May 12, 2008 (Washington, DC) — In preliminary studies, new imaging techniques show differences in brain pathophysiology of children with bipolar disease vs those with severe irritability and attention deficit/hyperactivity disorder (ADHD) when they are playing a frustrating game.

"In many ways, my talk will be viewed as a bit of 'proof of principal' of how we ultimately might use brain-imaging techniques to sort groups of children who have what would appear to be somewhat similar symptoms," said Ellen Leibenluft, MD, from the National Institute of Mental Health (NIMH), in Bethesda, Maryland, in a press conference at the American Psychiatric Association 161st Annual Meeting.

"We're finding that these very irritable children with ADHD share some of the characteristics of children with bipolar disorder but also have significant differences," she said in a press release.

Severe Mood Dysregulation

"We were interested in the question of whether children with very severe irritability but without any clear manic episodes . . . should be considered to be bipolar, so we defined a syndrome . . . called severe mood dysregulation, or SMD," Dr. Leibenluft told Medscape Psychiatry.

These very irritable children do not have the distinct episodes of mania seen in classic bipolar disorder, she added. When they enter early adulthood, they are likely to have depression rather than bipolar disorder. In addition, compared with children with bipolar disorder, children with SMD tend to have less bipolar disorder in their families.

More Frustrated Children, Different Brain Responses

In a study that compared children with SMD vs children with bipolar disorder vs healthy children, they found that when the children played a frustrating game, compared with the controls, the children with bipolar disorder and those with SMD were more frustrated.

Using event-related potentials (ERPs) — which represent the brain's neural response to events and which are computed by electroencephalograph (EEG) recordings from the scalp — the researchers found that activity in the brains of the 2 groups of children differed when they were playing this frustrating game.

Dr. Leibenluft's team is now extending this work using magnetoencephalography (MEG), which can detect electrical activity deep within the brain with excellent resolution, the press release states.

Preliminary findings with MEG showed that in response to frustrating situations, compared with healthy children, children with bipolar disorder displayed different activity in the anterior cingulate, a brain region that directs attention to important signals in the environment.

The team is conducting a similar study to compare children with SMD vs those with bipolar disorder.

"It's important to note that at this time we can't use brain imaging to make diagnoses, and it's going to be awhile until we are able to do this; even then, it will complement clinical assessment and other brain-based measures," Dr. Leibenluft cautioned.

Dr. Leibenluft has indicated that she does not have any financial conflicts of interest to disclose.

American Psychiatric Association 161st Annual Meeting: Symposium 35. May 3-8, 2008.


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