Recent studies indicate the number of children and teens being treated for bipolar disorder has increased dramatically over the last decade. Although experts are unsure whether this surge is due to better awareness or over-diagnosis, they do agree that much is still unknown about the brain and behavior interactions that play a role in pediatric bipolar disorder.
Daniel Dickstein, MD
That's why Bradley Hospital and its research arm, the Bradley Hasbro Children's Research Center, developed the Pediatric Mood, Imaging and Neurodevelopment (Pedi-MIND) program. Led by Daniel Dickstein, MD, Pedi-MIND is only one of a handful of research programs across the country using cutting-edge techniquesincluding brain imaging, computerized behavioral tasks and genetic analysesto determine how children with psychiatric disorders, including bipolar disorder, differ from their healthy peers.
Dickstein says the group began their research focusing on bipolar disorder because it is the quintessential example of a psychiatric illness that is often debilitating but that researchers know very little about, especially in children.
Bipolar disorder is characterized by dramatic and frequent mood swings that alternate between the manic phase of the disordereuphoria, elation and irritabilityand severe depression. Although bipolar disorder often begins in late adolescence or early adulthood, it can develop as early as the preschool years. There is no laboratory test for bipolar disorder, or any other psychiatric illness. Instead, the diagnosis is based entirely on a detailed clinical history, which is often more difficult to obtain with children.
If we could identify a biological or behavioral marker of pediatric bipolar disorder, it could augment the child's clinical history to improve the accuracy of our diagnoses, the efficacy of our treatments, and possibly allow us to help children at an earlier age, thus reducing these families' suffering. says Dickstein. These markers could be anything from a child's performance on a behavioral task to a finding on a brain scan to a specific gene.
To accomplish this goal, Pedi-MIND researchers are using a state-of-the-art magnetic resonance imaging (MRI) facility at Brown University to better define the structural, functional, and neural network variations in children with bipolar disorder. These brain images are compared to scans from both healthy children as well as youngsters with generalized anxiety disorder and attention deficit hyperactivity disorder (ADHD), since these two illnesses commonly co-occur with bipolar disorder and often have overlapping symptoms.
Genetics will also play a role in this research. As a next step, researchers plan to analyze DNA samples collected from all children participating in the study to learn how genetics might predict brain dysfunction.
Dickstein is also leading a similar project, funded by a five-year, $1.87 million grant from the National Institute of Mental Health's Bio-behavioral Research Awards for Innovative New Scientists (BRAINS) program. This study will identify bio-behavioral markers that differentiate children with full-blown type I bipolar disorder, whose manic episodes last one week or longer, from children who experience significant symptoms of bipolar disorder, but not at the level of those with the full diagnosis. If successful, Dickstein says these markers could lead to more of a personalized medicine approach, where biobehavioral markers are paired with clinical information to guide diagnosis, treatment, and prognosis. Only seven BRAINS grants were awarded nationwide in 2009, the program's inaugural year, and Dickstein was the only physician selected.
However, Dickstein's research interests extend beyond bipolar and mood disorders. He is also collaborating with Eric Morrow, MD, PhD, a developmental disorders genetics researcher, and Rowland Barrett, PhD, director of the Center for Autism and Developmental Disabilities (CADD) program at Bradley Hospital, to zero in on possible genetic and bio-behavioral markers of autism and cognitive delays. Although still in its infancy, this research programwhich will be based onsite at Bradley and will involve children in the CADD programwill use MRI imaging to better understand how these children handle reward-based decision making. Genetic samples will also be collected.
In addition, Dickstein is working with Anthony Spirito, PhD, whose research interests include adolescent depression and suicidal behavior, to study teens on Bradley Hospital's adolescent inpatient unit who intentionally cut themselves to determine how they differ emotionally and biologically from teens who attempt suicide.
We believe that research conducted by the Pedi-MIND programin collaboration with others at Lifespan, Brown and nationwidewill move the field of pediatric mental health beyond symptom- based diagnosis towards a time when clinical history and biology are united, resulting in better care for children and families with these disorders, says Dickstein.