mainly makes me give thanks for what I don't have to go through :) I can't imagine a kid trying to strangle me, or what I would do about it. But it is interesting academically, and that's the first time that I have seen that point made about suicide. They could be right. I was orginally reading it going so what; all of this is due to people prescribing SSRIs instead of Ritalin because they are not controlled drugs. But yeah, if a child were bipolar, I can see that ritalin would be the wrong wa to go.
Dana On 5/25/05, Gruss Gott <[EMAIL PROTECTED]> wrote: > This might be useful to some of you: > > > Treating Children For Bipolar Disorder > Doctors Try Powerful Drugs On Kids as Young as Age 4; > An Overlap With ADHD > > By LEILA ABBOUD > Staff Reporter of THE WALL STREET JOURNAL > May 25, 2005; Page D1 > > Child psychiatry, roiled last year by revelations that antidepressants > could increase children's risk of suicidal behavior, now is embroiled > in another controversy: How to treat troubled children who have > explosive rages and dramatic mood swings that defy conventional > diagnosis. > > Doctors increasingly agree that some of these children have bipolar > disorder. Once thought to be exceedingly rare among children, the > problem is being diagnosed more frequently and at younger ages than > ever before. A small but growing group of psychiatrists say they are > treating children as young as four for bipolar disorder, prescribing > mood-stabilizing drugs and antipsychotics that have rarely if ever > been used on patients so young. > > The number of children diagnosed as bipolar rose 26% from 2002 to > 2004, to 19,776 cases in a database of 113 million anonymous patient > records kept by health-care information company NDCHealth Corp. > Increased use of antipsychotic medicines, such as Seroquel and > Risperdal, was a big driver of pediatric drug costs last year, > according to pharmacy-benefit manager Medco Health Solutions Inc. > > A debate is brewing over how to diagnose and treat these children. In > its classic form, bipolar disorder causes people to cycle between > manic, euphoric highs and crushing, depressive lows that last a week > or more. The picture in children often is muddier. A bipolar child can > flip between a high and low several times a day. There also is > disagreement over what constitutes the highs, with some doctors saying > the manic phase in children often reveals itself as extreme rages, > violence and emotional outbursts, rather than the traditional > euphoria. > > Making diagnosis even harder is the great overlap between the symptoms > of bipolar and attention deficit hyperactivity disorder. Research has > shown that 50% to 80% of children with bipolar also have ADHD. > > "We all agree that kids with classic symptoms definitely have > bipolar," says Boris Birmaher, professor of psychiatry and director of > a pediatric bipolar clinic at the University of Pittsburgh. "The > controversy is over the kids with vaguer symptoms." > > The debate is a key topic at the annual meeting of the American > Psychiatric Association this week in Atlanta, where two camps are > airing theories about which children are actually bipolar and how to > treat them. One group, led by Joseph Biederman and Janet Wozniak of > Massachusetts General Hospital in Boston, argues that a child > displaying violent outbursts and rages is likely bipolar even without > classic weeklong manic symptoms that help define the disorder in > adults. The opposing group is led by Barbara Geller, at Washington > University in St. Louis, who believes children should display the > textbook grandiose feelings or elated moods. In their practices, many > pediatric doctors who treat bipolar disorder fall somewhere in between > and follow the treatment guidelines for adults. > > The difference between the two positions isn't just academic. Children > incorrectly diagnosed with bipolar would be given powerful > mood-stabilizing medications they may not need, such as lithium or > Depakote, or a so-called atypical antipsychotic such as Zyprexa or > Risperdal -- few of which have been tested in children and all of > which carry serious side effects. Lithium can cause thyroid problems > and increased thirst, while the atypical antipsychotics can cause > serious weight gain. > > If a bipolar diagnosis is missed, children are likely to be put on > antidepressants such as Zoloft, or ADHD drugs such as Adderall, both > of which can actually push bipolar children into a manic mode. Indeed, > some psychiatrists believe the whole flap linking antidepressants with > a heightened risk of suicide in children may be explained by the fact > that these children really were bipolar and not depressed. > > A number of studies are exploring the diagnosis and treatment of > bipolar children. Among the research is a large, six-year study at the > Washington University School of Medicine and five other sites, funded > by the National Institutes of Health, that is trying to determine > which medications work best in bipolar patients who are six to 15 > years old. The NIH is conducting another trial that will follow 700 > children ages 6 to 17 to try to map what bipolar looks like in > children. > > Dr. Biederman's group at Massachusetts General recently presented a > small study of 39 children ages 4 to 6, which showed that those with > bipolar benefited from treatment with antipsychotic drugs, though with > significant side effects including increased appetite and sedation. > The study was funded by the nonprofit Stanley Medical Research > Institute, the NIH and the hospital itself. Dr. Biederman's group has > received research funds from makers of atypical antipsychotics. He and > Dr. Wozniak also consult for some drug makers. > > Ann Elliott's daughter, Chloe, was given Prozac for depression when > she was six years old, after a two-year history of rages, giddy spells > and self-destructive behavior, including bashing her head against a > bathroom sink. Within a month of starting on the drug, she became mean > and manic, says Ms. Elliott, a computer programmer from Northern > California. Prozac was stopped. Chloe later was diagnosed as bipolar. > Now eight, she is doing well on Trileptal, a mood stabilizer, and > Abilify, an antipsychotic. > > Such extreme behavioral problems fall under an umbrella of symptoms > called "irritability" that Dr. Biederman and Dr. Wozniak think is > central to bipolar in kids. These children can have three-hour rages > touched off by something as routine as being told to brush their > teeth. The rest of their families walk on eggshells, never knowing > what could set the children off. Dr. Wozniak says these children are > bipolar, even though their symptoms differ from those seen in adults. > > Dr. Geller and other psychiatrists, however, point out that > "irritability" can be found in many illnesses, like depression, autism > and retardation. The scientific data aren't yet convincing, she says, > to show that children who have rages, but not the conventional manic > symptoms, actually have bipolar disorder. > > In a study funded by the NIH, Dr. Geller for four years followed 86 > children whom she identified as bipolar. She identified grandiosity > and elated mood as two key symptoms. Since the two symptoms aren't > present in ADHD, Dr. Geller says, grandiosity and elation can > distinguish the children with bipolar from those with ADHD. She > concedes that current science can't give clear answers. "We need > biological tests or markers," she says. However, genetic tests or > brain scans are probably decades away. > > Doctors say parents with such troubled children should consult with a > child psychiatrist who specializes in bipolar disorder at a large > academic medical center, where much of the research on bipolar > children is done. The Child and Adolescent Bipolar Foundation Web site > at www.bpkids.org also may be a helpful source. > > Making a diagnosis can take months. It can involve interviews with the > child, parents, teachers and siblings, and even observation of the > child at school or at home. > > It took more than eight years for doctors to diagnose Sue Cahalan's > daughter with bipolar disorder. The girl had tantrums and violent fits > going back to age 4. At age 8, she stole from family and neighbors. At > 10, she tried to choke her mother in an argument over the telephone. > At 12, Ms. Cahalan came home to find her daughter holding a butcher > knife outside the upstairs bathroom in which she had locked her two > younger siblings. "The psychiatrist said he was finally ready to call > it bipolar," says Ms. Cahalan, a lawyer from the Chicago area. > > Her daughter was put on lithium and her condition improved. For the > next few years, doctors had to tinker with her medication, but Ms. > Cahalan says her daughter slowly stabilized and was able to attend > high school at a residential facility and will head to college next > year. "I do wonder whether things would have been different had she > been diagnosed earlier," she says. > > Write to Leila Abboud at [EMAIL PROTECTED] > > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| Discover CFTicket - The leading ColdFusion Help Desk and Trouble Ticket application http://www.houseoffusion.com/banners/view.cfm?bannerid=48 Message: http://www.houseoffusion.com/lists.cfm/link=i:5:158781 Archives: http://www.houseoffusion.com/cf_lists/threads.cfm/5 Subscription: http://www.houseoffusion.com/lists.cfm/link=s:5 Unsubscribe: http://www.houseoffusion.com/cf_lists/unsubscribe.cfm?user=11502.10531.5 Donations & Support: http://www.houseoffusion.com/tiny.cfm/54
