Rachel A Vaughn-Coaxum1, John Merranko2, Boris Birmaher2, Daniel P Dickstein3, Danella Hafeman2, Jessica C Levenson4, Fangzi Liao2, Mary Kay Gill2, Heather Hower5, Benjamin I Goldstein6, Michael Strober7, Neal D Ryan2, Rasim Diler2, Martin B Keller8, Shirley Yen9, Lauren M Weinstock8, David Axelson10, Tina R Goldstein2. 1. Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Bellefield Towers, Pittsburgh, PA 15213, United States. Electronic address: coaxumra@upmc.edu. 2. Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Bellefield Towers, Pittsburgh, PA 15213, United States. 3. Simches Center of Excellence in Child and Adolescent Psychiatry, Harvard Medical School, McLean Hospital, United States; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, United States. 4. Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Bellefield Towers, Pittsburgh, PA 15213, United States; Department of Pediatrics, University of Pittsburgh School of Medicine, United States. 5. Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, United States; Department of Health Services, Policy, and Practice, Brown University School of Public Health, United States; Department of Psychiatry, School of Medicine, University of California at San Diego, United States. 6. Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, Canada. 7. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, United States. 8. Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, United States. 9. Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, United States; Massachusetts Mental Health Center and Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, United States. 10. Department of Psychiatry, Nationwide Children's Hospital and The Ohio State University, United States.
Abstract
BACKGROUND: Pediatric bipolar disorders are often characterized by disruptions in cognitive functioning, and exposure to child maltreatment (e.g., physical and sexual abuse) is associated with a significantly poorer course of illness. Although clinical and developmental research has shown maltreatment to be robustly associated with poorer cognitive functioning, it is unclear whether maltreatment and cognitive function jointly influence the clinical course of bipolar symptoms. METHODS: This secondary analysis examined moderating effects of lifetime childhood physical and sexual abuse, and cognitive disruptions (sustained attention, affective information processing), on longitudinal ratings of depression symptom severity in youths from the Course and Outcome of Bipolar Youth (COBY) study, examined from intake (M = 12.24 years) through age 22 (N = 198; 43.9% female; Mean age of bipolar onset = 8.85 years). RESULTS: A significant moderating effect was detected for sustained attention and maltreatment history. In the context of lower sustained attention, maltreatment exposure was associated with higher depression symptom severity during childhood, but not late adolescence. There was no association between maltreatment and symptom severity in the context of higher sustained attention, and no association between attention and depression symptom severity for non-maltreated youths. LIMITATIONS: Depression symptom ratings at each assessment were subject to retrospective recall bias despite the longitudinal design. Cognitive assessments were administered at different ages across youths. CONCLUSIONS: Depressive symptoms in pediatric bipolar may be jointly moderated by impairments in attention and exposure to maltreatment. Assessment of these risks, particularly in childhood, may be beneficial for considering risk of recurrence or chronicity of depressive symptoms.
BACKGROUND: Pediatric bipolar disorders are often characterized by disruptions in cognitive functioning, and exposure to child maltreatment (e.g., physical and sexual abuse) is associated with a significantly poorer course of illness. Although clinical and developmental research has shown maltreatment to be robustly associated with poorer cognitive functioning, it is unclear whether maltreatment and cognitive function jointly influence the clinical course of bipolar symptoms. METHODS: This secondary analysis examined moderating effects of lifetime childhood physical and sexual abuse, and cognitive disruptions (sustained attention, affective information processing), on longitudinal ratings of depression symptom severity in youths from the Course and Outcome of Bipolar Youth (COBY) study, examined from intake (M = 12.24 years) through age 22 (N = 198; 43.9% female; Mean age of bipolar onset = 8.85 years). RESULTS: A significant moderating effect was detected for sustained attention and maltreatment history. In the context of lower sustained attention, maltreatment exposure was associated with higher depression symptom severity during childhood, but not late adolescence. There was no association between maltreatment and symptom severity in the context of higher sustained attention, and no association between attention and depression symptom severity for non-maltreated youths. LIMITATIONS: Depression symptom ratings at each assessment were subject to retrospective recall bias despite the longitudinal design. Cognitive assessments were administered at different ages across youths. CONCLUSIONS: Depressive symptoms in pediatric bipolar may be jointly moderated by impairments in attention and exposure to maltreatment. Assessment of these risks, particularly in childhood, may be beneficial for considering risk of recurrence or chronicity of depressive symptoms.
Authors: J Kaufman; B Birmaher; D Brent; U Rao; C Flynn; P Moreci; D Williamson; N Ryan Journal: J Am Acad Child Adolesc Psychiatry Date: 1997-07 Impact factor: 8.829
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Authors: Alysa E Doyle; Timothy E Wilens; Anne Kwon; Larry J Seidman; Stephen V Faraone; Ronna Fried; Allison Swezey; Lindsey Snyder; Joseph Biederman Journal: Biol Psychiatry Date: 2005-09-30 Impact factor: 13.382
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