Faculty Bibliography

OBJECTIVES: To describe and compare the relative merits of different identification strategies for individuals at risk for bipolar disorder (BPD). METHODS: Selective review of data that support early identification in BPD, with a particular focus on emerging clinical high-risk strategies. RESULTS: Early detection of individuals at risk for BPD can utilize genetic, endophenotypic and clinical methods. Most published work focuses on genetic familial endophenotypic risk markers for BPD. However, despite encouraging results, problems with specificity and sensitivity limit the application of these data to early prevention programs. In addition, offspring studies of BPD patients systematically exclude the majority of subjects without a first-degree bipolar relative. On the other hand, emerging work in the clinical-high-risk arena has already produced encouraging results. Although still preliminary, the identification of individuals in subsyndromal or attenuated symptom 'prodromal' stages of BPD seems to be an under-researched area that holds considerable promise deserving increased attention. Required next steps include the development of rating tools for attenuated and subsyndromal manic and depressive symptoms and of prodromal criteria that will allow prodromal symptomatology to be systematically studied in patients with recent-onset bipolar, as well as in prospective population-based phenomenology trials and attenuated symptom-based high-risk studies. CONCLUSIONS: Given the current limitations of each early identification method, combining clinical, endophenotypic and genetic strategies will increase prediction accuracy. Since reliable biological markers for BPD have not been established and since most patients with BPD lack a first-degree relative with this disorder, clinical high-risk approaches have great potential to inform early identification and intervention programs.

OBJECTIVE: Research has found low concordance of personality disorder diagnoses made during depression versus after remission and made using patient versus collateral informants, but little is known about the reliability of personality disorder (PD) diagnoses made during depression using patient and collateral reports. METHOD: A total of 168 patients were evaluated for PDs during depression and following response using patient and close informant reports. kappa coefficients of inter-informant and test-retest reliability were calculated. RESULTS: After depression response, the proportion diagnosed with cluster A and C PDs fell by both patient and close informant report, and overall inter-informant reliability declined. Overall test-retest reliability did not differ between patients and informants. CONCLUSION: Collateral informants do not improve the reliability of PD diagnoses made during depressive episodes

OBJECTIVES: Studies of sex differences in methylphenidate response by children with attention-deficit/hyperactivity disorder have lacked methodological rigor and statistical power. This paper reports an examination of sex differences based on further analysis of data from a comparison of two once-daily methylphenidate formulations (the COMACS study), which addresses these shortcomings. METHOD: Children (184: 48 females; mean [SD] age, 9.58 [1.83] years) entered a double-blind, crossover trial of Concerta, MetadateCD/Equasym XL, or placebo. Attention-deficit/hyperactivity disorder symptoms were recorded at seven time points across the school day on the seventh day of treatment, using a laboratory classroom setting. RESULTS: More females had comorbid anxiety disorder. Males and females did not differ with regard to other characteristics. Observed sex differences in pharmacodynamic symptom profiles persisted after controlling for placebo and time 0 hours attention-deficit/hyperactivity disorder scores and the presence of an anxiety disorder. Females had a statistically superior response at 1.5 hours post-dosing and an inferior response at the 12-hour time point relative to their male counterparts, no matter which methylphenidate formulation was being assessed. CONCLUSIONS: Dose titration of once-daily formulations of methylphenidate should ideally be based on systematic evidence of response at different periods across the day. The responses of female patients may require additional assessments later in the day to determine the optimal dose

AIMS AND METHODS: Using a birth cohort, these secondary analyses document the prevalence and correlates of depressive symptoms in mothers of young children, as well as the rates and predictors of persistent and incident elevated depressive symptoms at a 1-year follow-up. RESULTS: At the initial survey, approximately 17% of women with young children had elevated depressive symptoms. Forty-six percent of women with initial elevated depressive symptoms continued to have elevated depressive symptoms at the 1-year follow-up. Results of adjusted regression models indicated that elevated initial symptoms were associated with such factors as comorbid anxiety symptoms, parenting distress, poor physical health, financial strain, stressful life events, low social support, low family expressiveness, and younger child age. For the subset of women with partners (n = 860), quality of the relationship with the partner and partner involvement were significant correlates of initial elevated depressive symptoms. Persistent elevated depressive symptoms were significantly associated with high anxiety symptoms, high family conflict, and low maternal education. Predictors of incident cases of elevated depressive symptoms indicated that in addition to sociodemographic correlates, education and maternal race/ethnicity, physical health, parenting distress, and parent and child life events are related to the development of elevated symptoms. CONCLUSIONS: Elevated depressive symptoms are common, and almost one half of the women in our sample with elevated depressive symptoms at the initial assessment also had elevated symptoms at the 1-year follow-up. Persistent and incident elevated depressive symptoms had different predictors, suggesting that identification and treatment of maternal depression must continue beyond the immediate postpartum period to prevent negative consequences of depression for mothers and their young children.

This study explored the factor structure and developmental trajectory of effortful control (EC), its relations with child adjustment, and the moderating role of age and gender in 75 4- to 6-year-old children at risk for psychopathology. Confirmatory factor analyses revealed two subcomponents of effortful control: Suppress/Initiate (the ability to inhibit a dominant response while initiating a new response) and Motor Control (inhibiting fine and gross motor activity). EC performance improved with age, and both subcomponents were associated with greater social competence at all ages. Associations with internalizing problems were moderated by child age such that greater EC was linked to fewer problems at age 4 but did not relate to problems at ages 5 or 6

PURPOSE: Autism spectrum disorders (ASD) are characterized by early impairments in language and related social communication skills. This investigation explored whether scores on the MacArthur-Bates Communicative Development Inventory (CDI) at ages 2 and 3 years predict outcome at age 9 years in children with ASD and developmental delay (DD). METHOD: Sixty-two children referred for possible autism at age 2 years, and 19 children with DD, were followed to age 9 years. Vocabulary, prespeech, and gestures scores on CDIs administered at ages 2 and 3 years were used to predict follow-up IQ, language, adaptive skills, and scores on diagnostic measures. RESULTS: CDI scores at ages 2 and 3 did not predict outcome for the DD group. For the ASD sample, CDI receptive and expressive language and late gestures at ages 2 and 3 years predicted a number of follow-up variables, although scores at age 3 years were generally more predictive than scores at age 2 years. CONCLUSIONS: The CDI yielded scores that were predictive of outcome, suggesting that this parent report measure may be a quick and informative assessment of early verbal and nonverbal skills in children with ASD