| Day One: | Thursday, February 26, 2009 |
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| 8:00 – 8:30 | Continental Breakfast |
| 8:30 – 9:00 | Welcome and Introductions
Molly Oliveri, PhD, Director, Division of Developmental Translational Research
Shelli Avenevoli, PhD, Chief, Developmental Trajectories of Mental Disorders Branch
Moderators: Robert Freedman, MD, Editor-in-Chief, American Journal of Psychiatry
Andres Martin, MD, MPH, Editor-in-Chief, Journal of the American Academy of Child and Adolescent Psychiatry Participant |
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| 9:00 – 10:30 | Session I: Emerging Data to Inform Diagnostic Classification of Bipolar (I, II, NOS) Disorder
Questions to address:
- DSM-IV defines a manic episode as a "distinct period" of abnormal mood, accompanied by specific symptoms. How does one operationalize a "distinct period" or episode?
- What minimum duration should be required for an episode? Do we use DSM-IV time criteria?
- How does one operationalize grandiosity and elation? Must the symptom represent a distinct change from the child's baseline, or simply something that is developmentally abnormal? How does one differentiate grandiosity from oppositionality? How does one differentiate elation from silliness or giddiness?
- Should euphoria be required for a manic episode?
- Is persistent, non-episodic irritability a developmental presentation of mania?
- How to handle symptom overlap (e.g., hyperactivity) across disorders? If a child has ADHD, should the hyperactivity have to worsen at the same time as the mood change in order to be "counted" toward the diagnosis of mania?
- For investigators who have used or studied both, how do the WASH-U-KSADS and the KSAD-PL differ in how they address these issues? Do we double count symptoms?
- Is there continuity across developmental stages? Is there continuity across Bipolar diagnoses (BP-I, II, and NOS)? (please be clear about WHAT shows continuity)
- How to define BP-NOS? Should BP-NOS include short episodes, absence of episodes, or both?
- Is bipolar disorder more than a sum of the symptoms? What is the utility of a symptom-based versus syndrome-based approach?
Presentations (10 minutes each; focused on addressing specific questions above)
Discussion
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| 10:30 – 10:45 | Break |
| 10:45 – 12:30 | Session I Continued
Thomas Insel, MD, Director, National Institute of Mental Health
Presentations (10 minutes each; focused on addressing specific questions above)
Discussion |
| 12:30 – 1:45 | Lunch (on your own)
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| 1:45 – 3:00 | Session I Continued
Presentations (10 minutes each; focused on addressing specific questions above)
Discussion |
| 3:00 - 3:15 | Break |
| 3:15 – 5:00 | Session II: Contribution of Biological Studies to Inform Diagnostic Classification
Points of discussion:
- Identifying biomarkers of illness onset, type of episode, progression (e.g., severity), and treatment response. What are the best candidates for biomarkers? What findings are state- versus trait-related?
- Defining functional neural circuits that probe specific affective and cognitive domains and correspond to behavior
- Disentangling comorbidity and defining boundaries across disorders:
Presentations (10 minutes each)
Discussion
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| 5:00 | Adjourn for Day One |
| 6:30 | Optional Group Dinner |
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| Day Two: | Friday, February 27, 2008 |
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| 8:30 – 9:00 | Continental Breakfast |
| 9:00 - 10:45 | Session III: Enhancing Comparability across Research Studies
Goals to address:
- Work toward consensus on how to operationalize symptoms/criteria in research studies of BP-I, -II, and -NOS in children and adolescents
- Reach consensus on the primary assessment tools and research methods to be used to assess these symptoms/criteria in youth. To the extent that the WASH-U-KSADS and KSADS-PL differ, how can these approaches be reconciled?
- Define areas of classification or assessment that require further investigation
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| 10:45 – 11:10 | Break (and check-out) |
| 11:10 - 1:30 | Session IV: Future Research Directions
Define future directions:
- Peer review of papers on bipolar disorder among youth
- Integration of clinical science and neuroscience - which lines of research are most promising? What are the next steps?
- Phenomenology of the prodromal phase - does it start with chronic irritability, very brief episodes of euphoria, sleep disturbance, or is the prodrome variable?
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| 1:30 | Adjourn Meeting |
