Neuropsychological Testing in Juvenile-onset Bipolar Disorder

Update Forthcoming

Differentiating Childhood-onset Bipolar Disorder from Attention Deficit Disorder with Hyperactivity: Neuropsychological Testing Profiles and Frontal Lobe Function Deficits

Steven Mattis, Ph.D. Department of Neurology, New York - Presbyterian Hospital (Westchester Division) and Weill Medical College of New York University

Demitri F. Papolos M.D. Department of Psychiatry, Albert Einstein College of Medicine

Dana Luck, Ph.D, Mattis & Luck Center for Neuropsychological Services

The complexities wrought by the frequent overlap of symptoms with other disorders that are far more commonly diagnosed in childhood has had a confounding affect on clinical diagnostic practice for years. A leading source of diagnostic confusion in childhood mania is its symptomatic overlap with attention deficit hyperactivity disorder (ADHD). Therefore, it is imperative that additional clinical methods be employed to assist clinicians in arriving at appropriate diagnoses.

To date, cognitive deficits associated with mood disorders, especially bipolar disorder, have been the focus of limited systematic investigation. In one of the few reported adult studies, Sweeney et al. demonstrated robust deficits in episodic and working memory, spatial attention, and problem solving in a group of young adult bipolar patients. Our recent neuropsychological testing findings obtained from a pilot study of 45 children ages 7-15, diagnosed with bipolar disorder according to DSM-IV (revised) criteria, suggests that there exist a shared set of identifiable deficits that represent specific prefrontal lobe dysfunction. Recent neuroimaging studies by Blumberg et al. that investigated prefrontal cortex function in the manic state of bipolar disorder and found decreased right rostral and orbital prefrontal cortex activation during word generation, and decreased orbitofrontal activity during rest, support the presence of rostral and orbital prefrontal dysfunction in mania.

Neuropsychological test batteries that will include tests of intelligence and executive function will be administered to 50 children diagnosed with bipolar disorder and an equal number of children diagnosed with attention-deficit disorder with hyperactivity who have a negative family history of mood disorders.
The application of neuropsychological testing may have a role in providing information that would not only serve to distinguish between ADHD and COBPD clinically, but also provide information that could facilitate a synthesis of neuroimaging studies and
clinical concepts. This work would further the possibility of developing novel and testable hypotheses about the etiology and underlying pathophysiology of juvenile-onset bipolar disorder, including the identification of dysfunctional brain circuits that may underlie the condition.

• If a subject meets entry criteria for participation in this study, his/her parents will be asked to complete behavioral screening tools: Child Bipolar Questionnaire (CBQ), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Overt Aggression Scale (OAS).

• SADS P/L will be administered to establish DSM-IV diagnoses. Symptom severity will be measured by using the Young mania scale, the Global Assessment Scale (GAS), and the Brief Psychiatric Rating Scale (BPRS) at study onset.

• Subjects will be administered a battery of neuropsychological tests that will include tests of intelligence, executive function, attention, motor coordination and bilateral coordination of skills both in areas of motor planning, motor output, and rhythmical sequencing of movement.

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Neuropsychological Testing in Juvenile-onset Bipolar Disorder