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Bipolar Disorder in Children and Adolescents: New Data to Inform Classification » Meeting Agenda

Washington, DC

Day One: Thursday, February 26, 2009
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
9:00 – 10:30 Session I: Emerging Data to Inform Diagnostic Classification of Bipolar (I, II, NOS) Disorder

Questions to address:
  1. 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?
  2. What minimum duration should be required for an episode? Do we use DSM-IV time criteria?
  3. 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?
  4. Should euphoria be required for a manic episode?
  5. Is persistent, non-episodic irritability a developmental presentation of mania?
  6. 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?
  7. 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?
  8. Is there continuity across developmental stages? Is there continuity across Bipolar diagnoses (BP-I, II, and NOS)? (please be clear about WHAT shows continuity)
  9. How to define BP-NOS? Should BP-NOS include short episodes, absence of episodes, or both?
  10. 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)
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)
12:30 – 1:45 Lunch (on your own)
1:45 – 3:00 Session I Continued
Presentations (10 minutes each; focused on addressing specific questions above)
3:00 - 3:15 Break
3:15 – 5:00 Session II: Contribution of Biological Studies to Inform Diagnostic Classification

Points of discussion:
  1. 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?
  2. Defining functional neural circuits that probe specific affective and cognitive domains and correspond to behavior
  3. Disentangling comorbidity and defining boundaries across disorders:
Presentations (10 minutes each)

5:00 Adjourn for Day One
6:30 Optional Group Dinner
Day Two: Friday, February 27, 2008
8:30 – 9:00 Continental Breakfast
9:00 - 10:45 Session III: Enhancing Comparability across Research Studies

Goals to address:
  1. Work toward consensus on how to operationalize symptoms/criteria in research studies of BP-I, -II, and -NOS in children and adolescents
  2. 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?
  3. Define areas of classification or assessment that require further investigation
10:45 – 11:10 Break (and check-out)
11:10 - 1:30 Session IV: Future Research Directions

Define future directions:
  1. Peer review of papers on bipolar disorder among youth
  2. Integration of clinical science and neuroscience - which lines of research are most promising? What are the next steps?
  3. Phenomenology of the prodromal phase - does it start with chronic irritability, very brief episodes of euphoria, sleep disturbance, or is the prodrome variable?
1:30 Adjourn Meeting