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Ricardo J. Fermo, MD Diplomate of the American Board of Psychiatry and Neurology Diplomate of American Board of Child and Adolescent Psychiatry East Cooper Psychiatric Solutions, LLC 887 Johnnie Dodds Blvd. , Suite 100 Mount Pleasant, South Carolina 29464 ECPSLLC.COM
ADHD = attention deficit hyperactivity disorder
CD = conduct disorders
ODD = oppositional defiant disorder
Pliszka SR. Pediatr Drugs. 2003;5:741-750.
APA DSM IV
Pavuluri MN et al. J Am Acad Chld and Adolecnet Psychiatry 1005: 44:849-871
Biederman J et al. Biol Psychiatry. 2000;48:458-466.
State RC et al. Am J Psychiatry. 2002;159;918-925.
related neurodevelopmental disorder
Kowatch et al. JCAAP. 2006; 15:73108
Geller et al. J Affect Disord 1998
Irritability (98% vs. 72%)
Accelerated Speech (97% vs. 82%)
Distractability (94% vs. 96%)
Unusual Energy (100% vs. 95%)
Geller et al. J Child and Adol Psychophar m.2002
Has there ever been a period of time when you were not your usual self and…
… you felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble?
… you were so irritable that you shouted at people or started fights or arguments?
… you felt much more self-confident than usual?
… you got much less sleep than usual and found you didn’t really miss it?
… you were much more talkative or spoke much faster than usual?
… thoughts raced through your head or you couldn’t slowyour mind down?
Hirschfeld. Prim Care Companion J Clin Psychiatry. 2002;4:9-11.
12.8-year prospective NIMH natural history study (N = 146)
Judd LL et al. Arch Gen Psychiatry. 2002;59:530–537.
Patients currentlyor recently manic/hypomanic
Patients currentlyor recently depressedMaintenance Treatment to Help Maintain Stability Against Depressive Episodes Is Particularly Important
Depression: A Dominant Next Episode Among Patients Receiving Placebo During Two 18-Month Maintenance Trials
Mood Polarity of Events in Bipolar I Disorder
Bowden C et al. Arch Gen Psychiatry. 2003;60:392–400.
Data on file, GlaxoSmithKline.
1. Calabrese et al. J Clin Psychiatry. 2002;63(suppl 10):18-22.
2. Hirschfeld et al. Am J Psychiatry. 2002;159(4 suppl):1-50.
Duffy et al., 2002
Achieve rapid control of manic symptoms
Achieve remission of depressive symptoms
Return to normal levels of psychosocial functioning
Delay or prevent recurrence of manic or depressive episodes
Minimize subthreshold symptoms
Hirschfeld RM et al. Am J Psychiatry. 2002;159(Suppl):1–50.
Individual/Family/School diagnostic evaluation, intervention, education
Strong genetic component in Adults –four- to six fold increase risk of disorder in first degree relatives of affected individuals 1
Degree of familiality appears even higher in early onset, highly comorbid cases 2
Premorbid psychiatric problems are common in early-onset bipolar disorder, especially difficulties with disruptive behavior disorders, irritability, and behavioral dyscontrol 3
Most childhood cases are associated with Attention Deficit Hyperactivity Disorder 4
In those whose first mood episode is a depressive disorder. Approximately 20% of youths withmajor depression go on to experience manic episodes by adulthood 5
Based on the 12.8-year NIMH natural history study (n = 146), of the 47% of time spent symptomatically ill, patients experienced depressive symptoms 3 times more than manic symptoms1
Time spent symptomatically ill (%)
*76% of patient cohort were patients with bipolar I disorder.
1. Judd LL et al. Arch Gen Psychiatry. 2002;59:530–537.
2. Post RM et al. Clin Neurosci Res. 2002;2:142–157.
Emslie GJ, Mayes TL. Biol Psychiatry. 2001;49:1082-1090.
Thousands of dollars, 1998
Begleyet al. Pharmacoeconomics. 2001;19(5 pt 1):483-495.
Source: Datamonitor, Stakeholder Insight: MDD, Q1.2; Adult population figures from www.census.gov and MDD prevalence rates applied.