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Daniel S Pine

Publications and source records attributed to Daniel S Pine.

At least 91 records · Page 5Linked to original sources
PubMed2003

Defining clinical phenotypes of juvenile mania.

OBJECTIVE: The authors suggest criteria for a range of narrow to broad phenotypes of bipolar disorder in children, differentiated according to the characteristics of the manic or hypomanic episodes, and present methods for validation of the criteria. METHOD: Relevant literature describing bipolar disorder in both children and adults was reviewed critically, and the input of experts was sought. RESULTS: Areas of controversy include whether the diagnosis of bipolar disorder should require clearly demarcated affective episodes and, if so, of what duration, and whether specific hallmark symptoms of mania should be required for the diagnosis. The authors suggest a phenotypic system of juvenile mania consisting of a narrow phenotype, two intermediate phenotypes, and a broad phenotype. The narrow phenotype is exhibited by patients who meet the full DSM-IV diagnostic criteria for hypomania or mania, including the duration criterion, and also have hallmark symptoms of elevated mood or grandiosity. The intermediate phenotypes include 1) hypomania or mania not otherwise specified, in which the patient has clear episodes and hallmark symptoms, but the episodes are between 1 and 3 days in duration, and 2) irritable hypomania or mania, in which the patient has demarcated episodes with irritable, but not elevated, mood. The broad phenotype is exhibited by patients who have a chronic, nonepisodic illness that does not include the hallmark symptoms of mania but shares with the narrower phenotypes the symptoms of severe irritability and hyperarousal. CONCLUSIONS: The presence of distinct episodes and hallmark symptoms can be used to differentiate clinical phenotypes of juvenile mania. The utility and validity of this system can be tested in subsequent research.

Adolescent↗
PubMed2003

Facial expression recognition in adolescents with mood and anxiety disorders.

OBJECTIVE: The authors examined facial expression recognition in adolescents with mood and anxiety disorders. METHOD: Standard facial emotion identification tests were given to youth with bipolar disorder (N=11) or DSM-IV anxiety disorders (N=10) and a group of healthy comparison subjects (N=25). RESULTS: Relative to the anxiety disorder and healthy comparison groups, the subjects with bipolar disorder made more emotion recognition errors when presented with faces of children. Unlike the anxious and comparison subjects, bipolar disorder youth were prone to misidentify faces as angry. No differences in emotion recognition errors were seen when the adolescents were presented with adult faces. CONCLUSIONS: A bias to misinterpret the facial expressions of peers as angry may characterize youth with bipolar disorder but not youth with anxiety disorders. This bias may relate to social impairment in youth with bipolar disorder.

Adolescent↗
PubMed2003

Irritability in pediatric mania and other childhood psychopathology.

Irritability is an important symptom in childhood psychopathology that has received relatively little research attention. Recent controversy concerning the diagnosis of mania in children has focused attention on how little is known about how to assess irritability in a systematic way, and about its diagnostic associations. For example, subtyping irritability according to course (chronic vs. episodic), precipitants, and family history may facilitate the identification of psychopathology and the study of pathophysiology. While normative and pathologic irritability can be differentiated reliably, the validity of the distinction is unclear. In addition, there is a need for scales designed to measure the severity of irritability in children with mood and anxiety disorders. In order to facilitate research, we propose a definition of irritability from the perspective of affective neuroscience. Because reactive aggression may be a helpful animal model for irritability, we review the neural circuitry mediating this behavior. Behavioral paradigms that evoke frustration, as well as those that assess the ability to inhibit a prepotent motor response, maintain attentional focus, execute response reversal, recognize angry faces, and regulate emotional responses, may be useful in the study of irritability. Examples of such paradigms are described, and the pharmacology of irritability is reviewed briefly.

Adolescent↗
PubMed2002

Development and natural history of mood disorders.

To expand and accelerate research on mood disorders, the National Institute of Mental Health (NIMH) developed a project to formulate a strategic research plan for mood disorder research. One of the areas selected for review concerns the development and natural history of these disorders. The NIMH convened a multidisciplinary Workgroup of scientists to review the field and the NIMH portfolio and to generate specific recommendations. To encourage a balanced and creative set of proposals, experts were included within and outside this area of research, as well as public stakeholders. The Workgroup identified the need for expanded knowledge of mood disorders in children and adolescents, noting important gaps in understanding the onset, course, and recurrence of early-onset unipolar and bipolar disorder. Recommendations included the need for a multidisciplinary research initiative on the pathogenesis of unipolar depression encompassing genetic and environmental risk and protective factors. Specifically, we encourage the NIMH to convene a panel of experts and advocates to review the findings concerning children at high risk for unipolar depression. Joint analyses of existing data sets should examine specific risk factors to refine models of pathogenesis in preparation for the next era of multidisciplinary research. Other priority areas include the need to assess the long-term impact of successful treatment of juvenile depression and known precursors of depression, in particular, childhood anxiety disorders. Expanded knowledge of pediatric-onset bipolar disorder was identified as a particularly pressing issue because of the severity of the disorder, the controversies surrounding its diagnosis and treatment, and the possibility that widespread use of psychotropic medications in vulnerable children may precipitate the condition. The Workgroup recommends that the NIMH establish a collaborative multisite multidisciplinary Network of Research Programs on Pediatric-Onset Bipolar Disorder to achieve a better understanding of its causes, course, treatment, and prevention. The NIMH should develop a capacity-building plan to ensure the availability of trained investigators in the child and adolescent field. Mood disorders are among the most prevalent, recurrent, and disabling of all illnesses. They are often disorders of early onset. Although the NIMH has made important strides in mood disorders research, more data, beginning with at-risk infants, children, and adolescents, are needed concerning the etiology and developmental course of these disorders. A diverse program of multidisciplinary research is recommended to reduce the burden on children and families affected with these conditions.

Adolescent↗
PubMed2002

Trauma in children and adolescents: risk and treatment of psychiatric sequelae.

The recent wave of terrorism affecting the United States and other countries raises concerns about the welfare of children and adolescents. This review is designed to address such concerns by summarizing data from two scientific areas. First, a series of recent studies examine psychiatric outcomes over time in children exposed to various forms of trauma. This review summarizes data on the various psychiatric consequences of childhood exposure to trauma, with specific emphasis on identifying factors that predict psychiatric outcome. Prior studies suggest that level of exposure, evidence of psychopathology before trauma exposure, and disruption in social support networks consistently emerge as strong predictors of psychopathology following exposure to trauma. Hence, clinicians might monitor children exposed to trauma most closely when they present with these risk factors. Second, a series of randomized controlled trials documents the beneficial effects of cognitive behavioral therapy (CBT) in children exposed to sexual abuse. When combined with other data from open studies and controlled trials in nontraumatized children, these studies suggest that CBT represents a logical therapeutic option for children developing anxiety symptoms following the recent wave of terrorism. In terms of psychopharmacological treatments, data from randomized controlled trials in traumatized children have not been generated, but recent studies in other groups of children exhibiting symptoms of anxiety or depression suggest the utility of selective serotonin reuptake inhibitors.

Child↗
PubMed2002

Salivary cortisol concentrations before and after carbon-dioxide inhalations in children.

BACKGROUND: Considerable research implicates over-activity of the hypothalamic-pituitary adrenal axis in the pathophysiology of adult mood and anxiety disorders. The current study evaluates the association between salivary cortisol concentrations and response to carbon-dioxide inhalation in children and adolescents with anxiety disorders, mood disorders, or no psychiatric illness. The central question was whether response to carbon-dioxide inhalation is associated with levels of hypothalamic-pituitary adrenal axis activation. If confirmed, this would relate hypothalamic-pituitary adrenal axis activation in juveniles, as in adults, and response to a well-studied respiratory procedure. METHODS: Serial salivary cortisol samples were examined in 98 subjects (ages 9-17 years), including 62 subjects with an anxiety and/or mood disorder and 36 nonpsychiatrically ill comparisons. Samples were obtained upon arrival at the laboratory, following a tilt test, then before and immediately after a standard 5% carbon dioxide inhalation procedure. RESULTS: Salivary cortisol levels pre-carbon-dioxide inhalation were significantly higher in patients sensitive to the anxiogenic effects of carbon dioxide (n = 20) than in patients who did not respond to carbon dioxide (n = 42) and in healthy subjects, none of whom were sensitive to carbon dioxide (n = 36); cortisol concentrations in the latter two groups were indistinguishable. Salivary cortisol did not increase during carbon-dioxide inhalation, irrespective of diagnostic group or degree of reactivity to the procedure. CONCLUSIONS: The current data resemble data from studies of laboratory-induced panic among adult patients. In both groups, activation of the hypothalamic-pituitary adrenal axis is associated with the response to a standardized stressor. Similarly, as in adults, carbon-dioxide inhalation in juveniles does not produce a significant change in hypothalamic-pituitary adrenal axis activation.

Administration, Inhalation↗
PubMed2002

Consequences and correlates of adolescent depression.

OBJECTIVE: To examine the correlates and consequences of high levels of depressive symptoms among adolescents. DESIGN: Secondary analysis of the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, a survey of a nationally representative sample of 4648 adolescent boys and girls between the ages of 10 and 18 years, inclusive, conducted in school settings. The self-administered questionnaire contains a screening instrument for depression based on the Children's Depression Inventory. OUTCOME: Days of school missed, performance at grade level, alcohol use, drug use, smoking, and bingeing. RESULTS: After controlling for sociodemographics, life events, sexual abuse, physical abuse, and exposure to violence, relative to other children, children and adolescents with high degrees of depressive symptoms missed about 1 day more of school in the month preceding the survey (P<.05) and had higher odds of smoking (odds ratio, 1.84; P<.001), bingeing (odds ratio, 2.02; P<.001), and suicidal ideation (odds ratio, 16.59; P<.001). CONCLUSION: High levels of depressive symptoms are correlated with serious and significant consequences, even after controlling for life circumstances.

Absenteeism↗
PubMed2002

Generalizability and correlates of clinically derived panic subtypes in the population.

To determine the generalizability and population-based correlates of clinically derived panic attack subtypes among adults in the community. Data were drawn from the National Comorbidity Survey (n = 8,098), a representative sample of adults of age 18-54 years in the United States. Sociodemographic characteristics, psychiatric comorbidity, and panic symptomotology associated with three clinically derived panic subtypes (early-onset, agoraphobia, and dyspnea) were compared using two-way ANOVA and multivariate logistic regression analyses. Among those with panic attacks in the community, 51.2% had early-onset, 32.6% had agoraphobia, and 64.4% had dysthymia. Significant differences in sociodemographic characteristics, psychiatric comorbidity, and panic symptomotology emerged between the three groups. Early-onset panic was associated with significantly increased likelihood of bipolar disorder and substance dependence but was not distinguished from the other two subtypes by panic symptoms. Panic attack with agoraphobia was associated with significantly higher odds of several comorbid anxiety disorders, and panic with dyspnea was more common among married females with less education and high levels of comorbid alcohol and depressive disorders. These data suggest that clinically derived panic subtypes are generalizable and may be associated with several unique sociodemographic and psychiatric correlates in the general population. Observed differences between these subtypes may influence results from clinical samples.

Adolescent↗
PubMed2002

Neurodevelopmental aspects of spatial navigation: a virtual reality fMRI study.

Navigation in spatial contexts has been studied in diverse species, yielding insights into underlying neural mechanisms and their phylogenetic progression. Spatial navigation in humans is marked by age-related changes that may carry important implications for understanding cortical development. The emergence of "allocentric" processing, reflecting that ability to use viewer-independent spatial abstractions, represents an important developmental change. We used fMRI to map brain regions engaged during memory-guided navigation in a virtual reality environment in adolescents and adults. Blood oxygen level-dependent (BOLD) signal was monitored in eight adolescents and eight adults in a 1.5-T MRI scanner during three conditions: (1) memory-guided navigation (NAV); (2) arrow-guided navigation (ARROW); and (3) fixation (FIX). We quantified navigation ability during scanning and allocentric memory after scanning, based on subjects' ability to label a previously unseen, aerial view of the town. Adolescents and adults exhibited similar memory-guided navigation ability, but adults exhibited superior allocentric memory ability. Memory-guided navigation ability during scanning correlated with BOLD change between NAV/ARROWS in various regions, including a right frontal and right-anterior medial temporal lobe region. Age group and allocentric memory together explained significant variance in BOLD change in temporoparietal association cortex and the cerebellum, particularly in the left hemisphere. Consistent with developmental models, these findings relate maturation in the coding of spatial information to functional changes in a distributed, left-lateralized neural network.

Adolescent↗
PubMed2002

Adolescent life events as predictors of adult depression.

BACKGROUND: Among adults, life events predict future episodes of major depression as well as a range of anxiety disorders. While studies have begun to examine this issue in adolescents, few studies rely upon prospective epidemiological designs to document relationships between adolescent life events and adult major depression. METHOD: An epidemiologically-selected sample of 776 young people living in Upstate New York received DSM-based psychiatric assessments and an assessment of life events in 1986. Psychopathology was again assessed in 1992. The current study examined the predictive relationship between life events in 1986 and depression as well as anxiety in 1992, controlling for depression/anxiety in 1986. RESULTS: Adolescent life events predicted an increased risk for major depression diagnosis in adulthood. When analyzed continuously, an association emerged with symptoms of major depression as well as with symptoms of generalized anxiety disorder. However, this association with generalized anxiety disorder was limited to females. CONCLUSIONS: Life events in adolescence predict risk for major depression during early adulthood.

Adolescent↗
PubMed2002

A developmental and neurobiological approach to early trauma research.

Basic and clinical research documents associations between stress and a set of related psychobiologic perturbations, including dysfunction of the hypothalamic-pituitary-adrenal axis, alterations in the structure and function of the medial temporal lobe, and impairments in explicit memory. Although these associations are thought to emerge developmentally, insufficient clinical research elucidates the manner in which early trauma relates to these abnormalities. To gain a better understanding of relevant processes, we propose the use of a developmental and neurobiological approach, where data in animal models are used to inform studies in traumatized children who will be followed longitudinally. This approach will help clarify how early traumatic events have the capacity to lead to psychopathology or a healthy outcome.

Adult↗
PubMed2002

Brain development and the onset of mood disorders.

Research in mood disorder pathophysiology has stimulated considerable interest in clinical and biologic aspects of mood disorders among children and adolescents. From the clinical perspective, developmental aspects of psychiatric disorders have crystallized in the relatively new theoretical school known as developmental psychopathology. This school attempts to understand the nature of developmental changes in behavior, with the goal of differentiating normal from abnormal stage-related behavior. This perspective has exerted major impact on conceptualizations of psychiatric disorders. From the basic science perspective, biologic findings in emotion have stimulated an integration of basic and clinical approaches to mood disorders. The term emotion is often used to refer to brain states elicited by stimuli for which an organism will extend effort to obtain (rewards) or avoid (punishments). Imaging studies suggest that brain regions engaged by rewarding and punishing stimuli in lower mammals are also implicated in mood disorders. Other studies suggest that environmental factors exert profound effects on the development of these brain regions. The impact of 4 areas of research on our understanding of depression pathophysiology is reviewed: (1) mood disorder onset, (2) structural magnetic resonance imaging (MRI), (3) behavioral or cognitive correlates of major depression, and (4) functional MRI of brain regions engaged across development. This is a US government work. There are no restrictions on its use.

Adolescent↗
PubMed2002

Treatment of pediatric anxiety disorders: an open-label extension of the research units on pediatric psychopharmacology anxiety study.

BACKGROUND: An 8-week placebo-controlled study, the Research Units on Pediatric Psychopharmacology Anxiety Study, documented beneficial effects of fluvoxamine in the treatment of pediatric social anxiety, separation anxiety, or generalized anxiety disorders. Following completion of this study, participants were invited to enter a 6-month open-label treatment phase designed to examine three issues: (a) long-term maintenance of response in fluvoxamine responders, (b) acute response to fluoxetine in fluvoxamine nonresponders, and (c) acute response to fluvoxamine in placebo nonresponders. METHODS: Participants aged 6-17 years meeting criteria for social anxiety, separation anxiety, or generalized anxiety disorders previously treated in an 8-week placebo-controlled trial (n = 128) were offered open treatment. Changes in symptoms of anxiety during open treatment were assessed in three groups: (a) fluvoxamine responders maintained on fluvoxamine, (b) fluvoxamine nonresponders changed to fluoxetine, and (c) placebo nonresponders changed to fluvoxamine. Response was defined based on Clinical Global Impression criteria. RESULTS: During 6 months of continued open treatment, anxiety symptoms remained low in 33 of 35 (94%) subjects who initially responded to fluvoxamine. Among 14 fluvoxamine nonresponders switched to fluoxetine, anxiety symptoms appeared significantly improved in 10 (71%) subjects. Finally, among 48 placebo nonresponders, 27 (56%) showed clinically significant improvement in anxiety on fluvoxamine. CONCLUSION: The current findings concerning extended treatment of pediatric anxiety disorders are only preliminary, because treatment was uncontrolled. Results suggest that an initial fluvoxamine response is likely to be retained with continued treatment, that some fluvoxamine nonresponders may respond to fluoxetine, and that some placebo nonresponders may respond to fluvoxamine.

Adolescent↗
PubMed2002

Treating children and adolescents with selective serotonin reuptake inhibitors: how long is appropriate?

This article addresses a key question on the use of selective serotonin reuptake inhibitors (SSRIs) among children and adolescents. As briefly reviewed, recent randomized controlled trials have established the safety and efficacy of SSRIs in the acute treatment of major depression and anxiety disorders among children and adolescents. Major questions emerge in light of these data concerning the potential risks and benefits of long-term SSRI use among children and adolescents who receive significant short-term benefits from SSRI treatment. The current review summarizes research on longitudinal outcomes, neuroscience, and psychopharmacology to formulate a set of preliminary recommendations on long-term SSRI use. A review of data in these areas supports three conclusions. First, for children who achieve marked reduction in anxiety or depressive symptoms on an SSRI, clinicians should consider recommending a medication-free trial. Second, when indicated, this medication-free trial should coincide with the first low-stress period occurring after 1 year of continual SSRI treatment. Third, SSRI treatment should be reinitiated in children who exhibit signs of relapse during this medication-free trial.

Adolescent↗
PubMed2002

Relationship between separation anxiety disorder, parental panic disorder, and atopic disorders in children: a controlled high-risk study.

OBJECTIVE: To test the hypotheses that rates of atopic disorders are elevated in offspring of parents with panic disorder (PD) and in children with separation anxiety disorder (SAD). METHOD: Rates of atopic disorders were assessed in 343 offspring (aged 6-17 years) of parents with PD, nonpanic psychiatric disorders, and no psychiatric disorder. Lifetime history of atopic disorders was determined by parental responses to a clinician-administered questionnaire assessing medical treatment for asthma and allergies. Logistic regression analyses assessed the association between atopic disorders and parental PD, and between atopic disorders and probable or definite childhood SAD. Analyses controlled for age, sex, socioeconomic status, and treatment for other medical illnesses. RESULTS: Increased rates of atopic disorders were found in offspring of parents with PD (odds ratio [OR] = 2.56, 95% confidence interval [CI] = 1.27-5.16, p = .009) and in children with SAD (OR = 2.71, 95% Cl = 1.22-6.03, p = .015). Associations remained significant when both parental PD and SAD were included in the model, suggesting that each contributed independently to increased rates of atopy. The interaction of parental PD and child SAD was not significant. CONCLUSIONS: Atopic disorders in children are associated with parental PD and with childhood SAD. Results do not appear to support that having both childhood SAD and a parent with PD confers increased risk for atopic disorders above and beyond either condition alone.

Adolescent↗
PubMed2002

Respiratory disease and panic attacks among adults in the United States.

OBJECTIVE: To determine the association between respiratory disease and panic attacks among adults in the US population. METHOD: Data were drawn from the Midlife Development in the United States Survey (n = 3,032), a representative sample of adults aged 25 to 74 years. Multivariate logistic regression analyses were used to determine the relationship between self-reported respiratory and other lung disease and panic attacks, major depression, generalized anxiety disorder, and alcohol/substance use disorders. RESULTS: After adjusting for demographic characteristics, comorbid mental disorders, and comorbid physical disorders, self-reported respiratory disease (ie, asthma, chronic bronchitis, or emphysema) was associated with a significantly increased likelihood of panic attacks (odds ratio, 1.7; confidence interval, 1.2 to 2.4). Other self-reported lung disease was also associated with a significantly increased odds of panic attacks (odds ratio, 2.3; confidence interval, 1.2 to 4.2), and having both self-reported respiratory disease and another lung disease was associated with increased likelihood of panic attacks (odds ratio, 4.1; confidence interval, 1.7, 9.9). These associations also persisted after adjusting for demographic characteristics, comorbid mental disorders, and physical comorbidity. CONCLUSION: These findings are consistent with and extend previous clinical and epidemiologic data by showing a specific association between self-reported respiratory disease and panic attacks among adults. Future studies that investigate the relationship between respiratory disease and panic attacks, and other mental disorders, using prospectively collected data on respiratory functioning, may help to improve our understanding of the mechanism of this association.

Adult↗
PubMedDate not supplied

Blindness of clinical evaluators, parents, and children in a placebo-controlled trial of fluvoxamine.

OBJECTIVE: Few of the increasing number of pediatric clinical trials of selective serotonin reuptake inhibitors (SSRIs) in children have been evaluated for level of blindness of investigators, children, and parents. The success of the masking procedures used in a double-blind, pediatric trial of fluvoxamine in children was examined. METHOD: Clinical evaluators, parents, and children were asked to guess individual treatment assignment at the end of an 8-week, placebo-controlled trial of fluvoxamine conducted in 128 outpatients (6-17 years of age) with anxiety disorders. The relationship between treatment attribution and improvement status or presence of adverse events was examined. RESULTS: The rate of correct guesses was significantly greater than chance among clinical evaluators (78%), parents (81%), and children (67%) (for all, p < 0.001). Attribution to fluvoxamine was associated with presence of clinical improvement, and attribution to placebo with lack of improvement (p < 0.001) in both the fluvoxamine and placebo group. There was no association between presence of adverse events and direction of the guess. Accuracy of the guess did not improve with time. CONCLUSIONS: The tendency to attribute improvement to active treatment and lack of improvement to placebo was consistent across investigators, parents, and children and was applied regardless of actual treatment received by the patient. Adverse events did not influence treatment attribution.

Adolescent↗