Thank you for the great article. I questioned out psychiatrist about smd after smallworld mentioned the studies on it, and he gave me the pp slideshow that went along with the study. It appears that he knows the researcher well.
What I find interesting in this article is that they consider SMD different than bipolar, but recommend treatment with mood stabilzers....however, at the end of the article they say stimulants should be given to smd and not bipolar? I wonder why they would give stimulants to smd children.
SMD children are generally hyperactive, which is why stimulants are sometimes prescribed. My own children are not hyperactive but do have attention problems. My son takes stimulants with no effect on mood.
I find this very intresting!!
Oceans I wondered the same thing. I will print this article and give it to Kate's psychiatrist, maybe this could be why mood stab. has not worked in the past for her. With the exception of the Lamictal, but it soon fizzles out too.
I guess the future will hold hope for diagnosis BiPolar (BP) with test. By the Kate will be an adult and will not comply with anymore testing!! Ha Thanks for this , Kathy
I don't see a difference between mood dysregulation disorder and bipolar II. I'd be leery of trying stims if there is any sort of mood problem, even if the kid is hyper. At least watch the child like a hawk. I'm not sure this disorder is widely accepted within the medical community.
MWM, SMD is not widely accepted within the medical community, but it is being studied extensively at the National Institute of Mental Health in Bethesda, Maryland. It is different from BPII because there is rarely an elevated mood but rather chronic irritability in the child, which according to the NIMH researchers is indicative of chronic depression.
Some kids with mood disorders can take stimulants. My son is one of them. He takes a low dose, and we watch him like a hawk for mood changes. He took a medication vacation a few weeks ago and begged us to put him back on Focalin XR because he couldn't concentrate in school.
Actually I just did a google search to see what I can find. Seems like there is a trial at NIH looking at lithium for these cases. Does anyone know what the preliminary results have been?
I am kind of suprised they are looking at lithium, since I would have thought it is drug that would be used for major cycling, not for the more chronic kind of irritability they describe SMD kids to have.
NIMH is looking at Lithium because it addresses the depressive end of BiPolar (BP) (and SMD is really a disorder of chronic irritability/depression with ADHD symptoms, but the kids have trialed lots of medications with little improvement -- like my son!). When I heard Dr. Leibenluft speak a year ago in Difficult Child, she did not indicate the results of the Lithium trials, but she did say that these kids grow up to have depression rather than BiPolar (BP).
I'm going to add the content of the article. I think this may be a thread we want to hold onto. I remember smallworld discussing this diagnosis a while back and it garnered much interest.
Extreme Irritability: Is It Childhood Bipolar Disorder?Brain's Electrical Signals Provide Clues
Results of a new study may help improve the diagnosis and treatment of two debilitating childhood mental disorders pediatric bipolar disorder (BD) and a syndrome called severe mood dysregulation (SMD). When the brain's electrical signals were measured during mildly frustrating situations, researchers from the National Institute of Mental Health (NIMH), of the National Institutes of Health, found a very different pattern in children with SMD, compared with children who had BD. The results indicate that different brain mechanisms may lead to irritability in children with SMD, suggesting that they may have an illness other than BD and may require different treatments.
"These aren't children with the occasional bad moods you see in most kids. They're typically very ill, with symptoms that interfere with their lives in major ways. Establishing clear diagnostic criteria is an essential step toward making sure they get the help they need," said NIMH Director Thomas R. Insel, M.D.
Children have a comparatively low rate of BD, but the rate increases with age, to approximately 1 percent among adolescents. About 3 percent of pre-adolescent and adolescent youth are estimated to have SMD. Mood-stabilizing and antipsychotic medications are used to treat children with BD, although the data on their effectiveness are limited and several studies are underway. Since SMD was only recently defined, there are no systematic studies on its treatment, and children with SMD are often treated as if they have BD.
Defining pediatric BD is a major issue in child psychiatry, because the disorder tends to be severe in this age group and the rate of diagnosed cases is rising. Until recent years, most studies of BD were conducted in adults. Some researchers maintain that pediatric BD should be defined more broadly to include children with SMD, an assertion countered by the new finding. Results of the study were published in the February 2007 issue of the American Journal of Psychiatry.
The classic definition of BD includes extreme, sustained mood swings that range from over-excited, elated moods and irritability the manic phase of the disorder to depression. In contrast, children with SMD are extremely irritable and hyperactive, but do not have clear-cut manic episodes.
One component of irritability is the tendency to get acutely frustrated when a goal is not met. Thus, through electroencephalograms (EEGs), the researchers could observe the brain's electrical signals that occurred during frustration while children with either disorder performed simple tasks.
The new study shows that clinicians some day could use biological measurements, such as EEGs, to help make psychiatric diagnoses, in combination with clinical symptoms. Currently, clinicians diagnose mental illnesses based on symptoms alone. The difficulty of diagnosing BD in children is compounded by the frequent co-occurrence of one or more other mental disorders.
"We're approaching the day when we'll be able to use neuroscience techniques to improve psychiatric diagnoses. Pediatric BD has some of the most pressing needs in this regard, because of its severity and because of questions about how to best make the diagnosis," said senior author Ellen Leibenluft, M.D., Chief of the Unit on Bipolar Spectrum Disorders in the Emotion and Development Branch of the NIMH Mood and Anxiety Disorders Research Program.
In this study, scientists obtained EEGs of 35 children with classic BD, 21 children with SMD, and 26 healthy children (average age 12 to 13) while they performed a task repeatedly; each time they did the task, they won or lost 10 cents. The task was frustrating because the children often lost money.
The researchers found that while both the children with BD and those with SMD became more frustrated than did healthy children performing the same task, the brain mechanisms associated with their frustration differed. Children with BD had an abnormality in the brain's P3 electrical signals, which measure ability to purposefully direct attention, but children with SMD had abnormalities in N1 signals, which occur when a stimulus grabs someone's attention. Both abnormalities suggest deficits in the brain's attention-related activity, but in different phases of that activity.
"If future research indicates that BD and SMD are two separate disorders, this could guide parents and physicians toward the right treatments," said first author Brendan Rich, Ph.D., of the NIMH Unit on Bipolar Spectrum Disorders. "A good example is that medication prescribed for symptoms seen in SMD, such as stimulant medication, might be inappropriate for a child with classically defined bipolar disorder," he said.
NIMH scientists Mariana Schmajuk, B.S., and Daniel Pine, M.D., also contributed to the research, as did University of Maryland scientists Koraly E. Perez-Edgar, Ph.D., (currently at George Mason University) and Nathan A. Fox, Ph.D.
Well, with bipolar II, you are certainly chronically irritable. Depression will do that. I'm still thinking that, at least for me, until this is more widely accepted, I'm very skeptical of this. Some BiPolar (BP) kids can handle low dose stims, but this is still a mood disorder and I'd be careful about adding any. What is bipolar, if not a mood dysregulation? I have it and that's what it is...
Why would you doubt some of the leading researchers in this country? Having lived with whatever disorder my kids have over the last several years, I think their research makes a lot of sense. And so do our psychiatrists.
I have pored over the The Bipolar child. SMD seems to fit my children so much better than the BiPolar (BP) diagnosis because they don't cycle in and out of depression and/or mania. They are always disregulated--always irritable, always with a low frustration tolerance that hits the boiling point every now and again. And stims do seem to help, but not enough. I am really glad that the researchers are looking at this, because hopefully we might even get some diagnostic tests --and some better recommendations on medications. What of course makes its hard is that all these mood disorders share overlapping symptoms. Just like backaches or whatever are all not the same, not all mood disorders are likely to be bipolar.
this describes my difficult child very well. He does not meet full BiPolar (BP) criteria, and that is why we have the cyclothymia diagnosis. difficult child is extremely hyper, and can be irritable, but never seems truly manic. He cannot tolerate mood stabilizers so far. Now we are trialing focalin xr 10mg along with Inderal la 80mg. This morning he is calm, he had the focalin about 1 hr ago. Before the focalin caused some Obsessive Compulsive Disorder (OCD) stuff, and we are hoping maybe the Inderal will be a good combo with the stimulant.
After I read the article I can see how smd and BiPolar (BP) differ, but just from the names they sound the same. So they do use mood stabilizers with smd?
Crazymama, they do use mood stabilizers with SMD. My kids are definitely depressed, but they flip out when they take SSRIs, the traditional treatment for depression. So we had to turn to mood stabilizers. My kids, and I know at least one of pepperidge's, have responded positively to Lamictal because it works on the depressive end of BiPolar (BP). But Lamictal didn't do enough to lift my kids' mood so we have added in small doses of SSRIs (Lexapro this time). My son also takes a low dose of Focalin XR (10 mg) to help with schoolwork. My daughter is in the process of being tested for ADD and may be taking a stimulant soon as well.