Elsevier

Biological Psychiatry

Volume 58, Issue 7, 1 October 2005, Pages 583-588
Biological Psychiatry

Advances in the neurobiology of pediatric bipolar disorder
How Cardinal are Cardinal Symptoms in Pediatric Bipolar Disorder? An Examination of Clinical Correlates

https://doi.org/10.1016/j.biopsych.2005.08.014Get rights and content

Background

The main goal of this study was to test whether the hypothesized cardinal symptom of euphoria results in differences in clinical correlates in bipolar youth ascertained with no a priori assumptions about cardinal symptoms.

Methods

Subjects (n = 86) satisfying DSM-IV criteria for bipolar disorder with and without the proposed cardinal symptom of euphoria were compared in their bipolar symptom pattern, functioning and patterns of comorbidity.

Results

Among Criterion A (abnormal mood), we found that severe irritability was the predominant abnormal mood rather than euphoria (94% vs. 51%). We also found that among Criterion B items, grandiosity was not uniquely overrepresented in youth with mania, nor did the rate of grandiosity differ whether irritability or irritability and euphoria were the Criterion A mood symptom. Neither symptom profile, patterns of comorbidity nor measures of functioning differed related to the presence or absence of euphoria.

Conclusions

These findings challenge the notion that euphoria represents a cardinal symptom of mania in children. Instead they support the clinical relevance of severe irritability as the most common presentation of mania in the young. They also support the use of unmodified DSM-IV criteria in establishing the diagnosis of mania in pediatric populations.

Section snippets

Methods and Materials

Subjects were youth (≤18 years) with DSM-IV BPD on structured diagnostic interview and confirmed by clinical interview, who had been consecutively referred to a family study of pediatric bipolar disorder from ascertained outpatients from our Pediatric Psychopharmacology Clinic at Massachusetts General Hospital (MGH). Thus, parents calling for a psychiatric evaluation of their child were told about the family genetic study of pediatric bipolar disorder. Those interested who also met inclusion

Results

Subjects were 86 subjects with structured diagnostic interview diagnosis of DSM-IV bipolar disorder ascertained from a family genetic study of pediatric bipolar disorder endorsing either euphoria or irritability or both. Euphoria was reported by 44 (51%) of these subjects and irritability by 81 (94%) of subjects. Of the subjects with irritability, 48% (n = 39) also reported euphoria. Because the number of subjects without irritability was small (n = 5; 6%), we compared children with

Discussion

The main goal of this study was to test whether the hypothesized cardinal symptom of euphoria resulted in differences in clinical correlates in bipolar youth ascertained with no a priori assumptions about cardinal symptoms. Among Criterion A (abnormal mood), we found that severe irritability was the predominant abnormal mood rather than euphoria (94% vs. 51%). We also found that among Criterion B items, grandiosity was not uniquely overrepresented in youth with mania, nor did the rate of

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