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Aktuelle Kontroverse

Früh beginnende bipolare Störungen, ADHS oder Störung der Affektregulation?

Published Online:June 25, 2010https://doi.org/10.1026/0942-5403/a000025

Abstract

Die Arbeit gibt einen Überblick über die Hintergründe der Kontroverse und leitet daraus konkrete Schlussfolgerungen für die klinische Praxis ab. Bei der Diagnostik früher bipolarer Störungen ist vorrangig auf das Auftreten von abgrenzbaren Episoden mit eindeutigen Stimmungsänderungen und Veränderungen von Verhalten und Kognition zu achten. Das Mischbild aus ADHS und begleitender affektiver Dysregulation sollte nicht im Sinne einer beginnenden bipolaren Störung interpretiert werden, bedarf aber stärkerer Beachtung, insbesondere bei der Entwicklung geeigneter psycho- und pharmakotherapeutischer Ansätze. Erläutert werden zudem Gemeinsamkeiten und Unterschiede von bipolaren Störungen mit Schizophrenie, Depression, ADHS, Borderline-Persönlichkeitsstörung und Substanzmissbrauch.


Early-onset bipolar disorder, ADHD, or emotional dysregulation?

This review gives an overview of the background to the controversy along with orientations for clinical practice. For diagnosing early-onset BD, special emphasis should be laid on the occurrence of clearly demarcated affective episodes, accompanied by changes in behavior and cognition. The mixed phenotype of ADHD and severe affective dysregulation is not a correlate of BD but deserves more attention regarding the development of psychotherapeutic and pharmacotherapeutic procedures. Differential diagnostic considerations are made on the disparities and the overlap of BD with schizophrenia, depression, ADHD, borderline personality disorder, and substance misuse.

Literatur

  • Achenbach, T. M. , Edelbrock, C. S. (1983). Manual for Child Behavior Checklist and revised Behavior Profile. Burlington, VT: University of Vermont. First citation in articleGoogle Scholar

  • Akiskal, H. S. , Maser, J. D. , Zeller, P. J. , Endicott, J. , Coryell, W. , Keller, M. , Warshaw, M. , Clayton, P. , Goodwin, F. (1995). Switching from “unipolar” to bipolar II. An 11-year prospective study of clinical and temperamental predictors in 559 patients. Archives of General Psychiatry, 52, 114 – 123. First citation in articleCrossref, Google Scholar

  • American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM IV (Text Revision). Washington: American Psychiatric Association. First citation in articleGoogle Scholar

  • American Psychiatric Association (2010). Proposed revisions for DSM-V. Temper Dysregulation Disorder with Dysphoria. Verfügbar unter: www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=397 [19. 02. 2010]. First citation in articleGoogle Scholar

  • Arbeitsgruppe Deutsche CBCL (1998). CBCL/4 – 18: Elternfragebogen über das Verhalten von Kindern und Jugendlichen (2. Aufl.). Köln: Arbeitsgruppe Kinder-, Jugend- und Familiendiagnostik. First citation in articleGoogle Scholar

  • Baroni, A. , Lunsford, J. R. , Luckenbaugh, D. A. , Towbin, K. E. , Leibenluft, E. (2009). Practitioner review: The assessment of bipolar disorder in children and adolescents. Journal of Child Psychology and Psychiatry, 50, 203 – 215. First citation in articleCrossref, Google Scholar

  • Biederman, J. , Faraone, S. V. , Wozniak, J. , Mick, E. , Kwon, A. , Cayton, G. A. , Clark, S. V. (2005). Clinical correlates of bipolar disorder in a large, referred sample of children and adolescents. Journal of Psychiatric Research, 39, 611 – 622. First citation in articleCrossref, Google Scholar

  • Biederman, J. , Klein, R. G. , Pine, D. S. , Klein, D. F. (1998). Resolved: Mania is mistaken for ADHD in prepubertal children. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 1091 – 1099. First citation in articleCrossref, Google Scholar

  • Birmaher, B. , Axelson, D. , Strober, M. , Gill, M. K. , Valeri, S. , Chiapetta, L. , Ryan, M. , Leonard, H. et al. (2006). Clinical course of children and adolescents with bipolar spectrum disorders. Archives of General Psychiatry, 63, 175 – 183. First citation in articleCrossref, Google Scholar

  • Blader, J. C. , Carlson, G. A. (2007). Increased rates of bipolar disorder diagnoses among U.S. child, adolescent, and adult inpatients, 1996 – 2004. Biological Psychiatry, 62, 107 – 114. First citation in articleCrossref, Google Scholar

  • Brotman, M. A. , Kassem, L. , Reising, M. M. , Guyer, A. E. , Dickstein, D. P. , Rich, B. A. , Towbin, K. E. , Pine, D. S. et al. (2007). Parental diagnoses in youth with narrow phenotype bipolar disorder or severe mood dysregulation. American Journal of Psychiatry, 164, 1238 – 1241. First citation in articleCrossref, Google Scholar

  • Carlson, G. A. (1998). Mania and ADHD: Comorbidity or confusion. Journal of Affective Disorders, 51, 177 – 187. First citation in articleCrossref, Google Scholar

  • Correll, C. U. , Penzner, J. B. , Frederickson, A. M. , Richter, J. J. , Auther, A. M. , Smith, C. W. , Kane, J. M. , Cornblatt, B. A. (2007). Differentiation in the preonset phases of schizophrenia and mood disorders: Evidence in support of a bipolar mania prodrome. Schizophrenia Bulletin, 33, 703 – 714. First citation in articleCrossref, Google Scholar

  • Desman, C. , Petermann, F. (2005). Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS): Wie valide sind die Subtypen? Kindheit und Entwicklung, 14, 244 – 254. First citation in articleLink, Google Scholar

  • Döpfner, M. , Schürmann, S. , Fröhlich, J. , Quast, C. , Wolff-Metternich, T. , Lehmkuhl, G. (1997). THOP–Das Therapieprogramm zur Behandlung von Kindern mit hyperkinetischem und oppositionellem Problemverhalten. Kindheit und Entwicklung, 6, 230 – 246. First citation in articleGoogle Scholar

  • Dubicka, B. , Carlson, G. A. , Vail, A. , Harrington, R. (2008). Prepubertal mania: Diagnostic differences between US and UK clinicians. European Child and Adolescent Psychiatry, 17, 153 – 161. First citation in articleCrossref, Google Scholar

  • Duffy, A. , Grof, C. , Robertson, C. , Alda, M. (2000). The implications of genetic studies of major mood disorders for clinical practice. Journal of Clinical Psychiatry, 61, 630 – 637. First citation in articleCrossref, Google Scholar

  • Duffy, A. (2006). Lithium treatment in children and adolescents: A selected review and integration of research findings. In M. Bauer, P. Grof , B. Müller-Oerlinghausen, (Eds.), Lithium in Neuropsychiatry: The Comprehensive Guide (pp. 193 – 206). London: Taylor & Francis. First citation in articleCrossref, Google Scholar

  • Duffy, A. , Alda, M. , Hajek, T. , Sherry, S. B. , Grof, P. (2010). Early stages in the development of bipolar disorder. Journal of Affective Disorders, 121, 127 – 135. First citation in articleCrossref, Google Scholar

  • Fleischhaker, C. , Munz, M. , Böhme, R. , Sixt, B. , Schulze, E. (2006). Dialektisch-Behaviorale Therapie für Adoleszente (DBT-A)–Eine Pilotstudie zur Therapie von Suizidalität, Parasuizidalität und selbstverletzenden Verhaltensweisen bei Patientinnen mit Symptomen einer Borderlinestörung. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 34, 15 – 25. First citation in articleLink, Google Scholar

  • Frank, E. , Swartz, H. A. , Boland, E. (2000). Interpersonal and social rhythm therapy: Managing the chaos of bipolar disorder. Biological Psychiatry, 48, 593 – 604. First citation in articleCrossref, Google Scholar

  • Galanter, C. A. , Carlson, G. A. , Jensen, P. S. , Greenhill, L. L. , Davies, M. , Li, W. , Chuang, S. Z. , Elliot, G. R. et al. (2003). Response to methylphenidate in children with attention deficit hyperactivity disorder and manic symptoms in the multimodal treatment study of children with attention deficit hyperactivity disorder titration trial. Journal of Child and Adolescent Psychopharmacology, 13, 123 – 136. First citation in articleCrossref, Google Scholar

  • Geller, B. , Tillman, R. , Craney, J. L. , Bolhofner, K. (2004). Four year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Archives of General Psychiatry, 61, 459 – 467. First citation in articleCrossref, Google Scholar

  • Geller, B. , Williams, M. , Zimerman, B. , Frazier, J. , Beringer, L. , Warner, K. L. (1998). Prepubertal and early adolescent bipolarity differentiate from ADHD by manic symptoms, grandiose delusions, ultra-rapid or ultradian cycling. Journal of Affective Disorders, 51, 81 – 91. First citation in articleCrossref, Google Scholar

  • Geller, B. , Zimerman, B. , Williams, M. , Delbello, M. P. , Bolhofner, K. , Craney, J. L. , Frazier, J. , Beringer, L. et al. (2002). DSM-IV mania symptoms in a prepubertal and early adolescent bipolar disorder phenotype compared to attention-deficit hyperactive and normal controls. Journal of Child and Adolescent Psychopharmacology, 12, 11 – 25. First citation in articleCrossref, Google Scholar

  • Gerber-von Müller, G. , Petermann, U. , Petermann, F. , Niederberger, U. , Stephani, U. , Siniatchkin, M. , Gerber, W.-D. (2009). Das ADHS-Summercamp–Entwicklung und Evaluation eines multimodalen Programms. Kindheit und Entwicklung, 18, 162 – 172. First citation in articleLink, Google Scholar

  • Gracious, B. L. , Youngstrom, E. A. , Findling, R. L. , Calabrese, J. R. (2002). Discriminative validity of a parent version of the Young Mania Rating Scale. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1350 – 1359. First citation in articleCrossref, Google Scholar

  • Hlastala, S. A. , Frank E., (2006). Adapting interpersonal and social rhythm therapy to the developmental needs of adolescents with bipolar disorder. Development and Psychopathology, 18, 1267 – 1288. First citation in articleCrossref, Google Scholar

  • Holtmann, M. (2009). Früh beginnende bipolare Störungen: Unterdiagnostiziert oder überbewertet? Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 37, 159 – 161. First citation in articleLink, Google Scholar

  • Holtmann, M. , Grasmann, D. , Cionek-Szpak, E. , Hager, V. , Panzner, N. , Beyer, A. , Poustka, F. , Stadler, C. (2009a). Spezifische Wirksamkeit von Neurofeedback auf die Impulsivität bei ADHS. Kindheit und Entwicklung, 18, 95 – 104. First citation in articleLink, Google Scholar

  • Holtmann, M. , Duketis, E. , Poustka, L. , Zepf, F. D. , Poustka, F. , Bölte, S. (2010). Bipolar Disorder in children and adolescents in Germany: National trends in the rates of inpatients 2000 – 2007. Bipolar Disorders, 12, 155 – 163. First citation in articleCrossref, Google Scholar

  • Holtmann, M. , Pörtner, F. , Duketis, E. , Flechtner, H. H. , Angst, J. , Lehmkuhl, G. (2009b). Validation of the Hypomania Checklist (HCL-32) in a nonclinical sample of German adolescents. Journal of Adolescence, 32, 1075 – 1088. First citation in articleCrossref, Google Scholar

  • Holtmann, M. , Bölte, S. , Goth, K. , Döpfner, M. , Plück, J , Huss, M. , Fergert, J. M. , Lehmkuhl, G. et al. (2007). Prevalence of the Child Behavior Checklist-pediatric bipolar disorder phenotype in a German general population sample. Bipolar Disorders, 9, 895 – 900. First citation in articleCrossref, Google Scholar

  • Holtmann, M. , Bölte, S. , Poustka, F. (2008a). Rapid increase in rates of bipolar diagnosis in youth: “True” bipolarity or misdiagnosed severe disruptive behavior disorders? Archives of General Psychiatry, 65, 477 – 477. First citation in articleCrossref, Google Scholar

  • Holtmann, M. , Goth, K. , Wöckel, L. , Poustka, F. , Bölte, S. (2008b). CBCL-pediatric bipolar disorder phenotype: Severe ADHD or bipolar disorder? Journal of Neural Transmission, 115, 155 – 161. First citation in articleCrossref, Google Scholar

  • Kaufman, J. , Birmaher, B. , Brent, D. , Rao, U. , Flynn, C. , Moreci, P. , Williamson, D. , Ryan, M. (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980 – 988. First citation in articleCrossref, Google Scholar

  • Kyte, Z. A. , Carlson, G. A. , Goodyer, I. M. (2006). Clinical and neuropsychological characteristics of child and adolescent bipolar disorder. Psychological Medicine, 36, 1197 – 1211. First citation in articleCrossref, Google Scholar

  • Leibenluft, E. , Charney, D. S. , Towbin, K. E. , Bhangoo, R. K. , Pine, D. S. (2003). Defining clinical phenotypes of juvenile mania. American Journal of Psychiatry, 160, 430 – 437. First citation in articleCrossref, Google Scholar

  • Masi, G. , Perugi, G. , Millepiedi, S. , Mucci, M. , Toni, C. , Bertini, N. , Pfanner, C. , Berloffa, S. , Pari, C. (2006). Developmental differences according to age at onset in juvenile bipolar disorder. Journal of Child and Adolescent Psychopharmacology, 16, 679 – 685. First citation in articleCrossref, Google Scholar

  • Meyer, T. D. , Koßmann-Böhm, S. , Schlottke, P. (2004). Do child psychiatrists in Germany diagnose bipolar disorders in children and adolescents? Results from a survey. Bipolar Disorders, 6, 426 – 431. First citation in articleCrossref, Google Scholar

  • Moreno, C. , Laje, G. , Blanco, C. , Jiang, H. , Schmidt, A. B. , Olfson, M. (2007). National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Archives of General Psychiatry, 64, 1032 – 1039. First citation in articleCrossref, Google Scholar

  • Özmen, S. K. (2009). Einzelfallstudien zu einem verhaltensorientierten Elterntraining bei ADHS. Kindheit und Entwicklung, 18, 254 – 259. First citation in articleLink, Google Scholar

  • Perlis, R. H. , Miyahara, S. , Marangell, L. B. , Wisniewski, S. R. , Ostacher, M. , DelBello, M. P. , Bowden, C. L. , Sachs, G. S. , Nierenberg, A. A. , for the STEP-BD Investigators, (2004). Long-term implications of early onset in bipolar disorder: Data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biological Psychiatry, 55, 875 – 881. First citation in articleCrossref, Google Scholar

  • Petermann, F. , Hampel, P. (2009). Aufmerksamkeitsdefizit- /Hyperaktivitätsstörung (ADHS). Kindheit und Entwicklung, 18, 135 – 136. First citation in articleLink, Google Scholar

  • Rademacher, C. , Walter, D. , Döpfner, M. (2002). SELBST–Ein Therapieprogramm zur Behandlung von Jugendlichen mit Selbstwert, Aktivitäts- und Affekt, Leistungs- und Beziehungsstörungen. Kindheit und Entwicklung, 11, 107 – 118. First citation in articleLink, Google Scholar

  • Schmidt, S. , Petermann, F. (2008). Entwicklungspsychopathologie der ADHS. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 56, 265 – 274. First citation in articleLink, Google Scholar

  • Schmidt, S. , Petermann, F. (2009). Developmental psychopathology: Attention Deficit Hyperactivity Disorder (ADHD). BMC Psychiatry, 9, Art. No. 58. First citation in articleCrossref, Google Scholar

  • Schubert, I. , Köster, I. , Lehmkuhl, G. (2009). Changes in the prescribing of antipsychotic drugs and methylphenidate to children and adolescents between 2000 and 2006. Data of the SHI sample AOK Hessen/KV Hessen. In M. Schulte-Markwort, (Hrsg.), XXXI. Kongress der Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik 2009 (S. 190). Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft. First citation in articleGoogle Scholar

  • Smarty, S. , Findling, R. L. (2007). Psychopharmacology of pediatric bipolar disorder: A review. Psychopharmacology, 191, 39 – 54. First citation in articleCrossref, Google Scholar

  • Soutullo, C. A. , DelBello, M. P. , Ochsner, J. E. (2002). Severity of bipolarity in hospitalized manic adolescents with history of stimulant or antidepressant treatment. Journal of Affective Disorders, 70, 323 – 327. First citation in articleCrossref, Google Scholar

  • Tillman, R. , Geller, B. (2006). Controlled study of switching from attention-deficit/hyperactivity disorder to a prepubertal and early adolescent bipolar I disorder phenotype during 6-year prospective follow-up: Rate, risk, and predictors. Development and Psychopathology, 18, 1037 – 1053. First citation in articleCrossref, Google Scholar

  • Vloet, J. A. , Hagenah, U. F. (2009). Pharmakotherapie bipolarer Störungen bei Kindern und Jugendlichen. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 37, 27 – 49. First citation in articleLink, Google Scholar

  • Waxmonsky, J. , Pelham, W. E. , Gnagy, E. , Cummings, M. R. , O′Connor, B. , Majundar, A. , Verley, J. , Hoffman, M. T. et al. (2008). The efficacy and tolerability of methylphenidate and behavior modification in children with attention-deficit/hyperactivity disorder and severe mood dysregulation. Journal of Child and Adolescent Psychopharmacology, 18, 573 – 588. First citation in articleCrossref, Google Scholar

  • Wiegand-Grefe, S , Peers, G. , Plaß, A. , Petermann F. & Riedesser P., (2009). Kinder psychisch kranker Eltern: Zusammenhänge zwischen subjektiver elterlicher Beeinträchtigung und psychischer Auffälligkeit der Kinder aus Elternsicht. Kindheit und Entwicklung, 18, 111 – 121. First citation in articleLink, Google Scholar

  • WHO (1992). The ICD-10 classification of mental and behavioural disorders. Clinical descriptions and guidelines. Genf: WHO. First citation in articleGoogle Scholar