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Can manic switches be predicted in pediatric major depression? A systematic literature review
Mai Uchida1, Giulia Serra2, Lazaro Zayas3
1Massachusetts General Hospital, Department of Pediatric Psychopharmacology, Boston, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA.
Insights
Predicting bipolar disorder switches in children with depression is crucial. Key risk factors include family history, emotional dysregulation, subthreshold mania, and psychosis, aiding early clinical detection.
Area of Science:
- Child and Adolescent Psychiatry
- Mood Disorders
- Clinical Psychology
Background:
- High rates of pediatric major depression transition to bipolar disorder.
- Predicting these switches is clinically significant but challenging.
- Identifying risk factors is essential for early intervention.
Purpose of the Study:
- To systematically review literature on clinical correlates predicting bipolar switches in children with initial depressive episodes.
- To synthesize evidence on risk factors for manic switches in pediatric depression.
Main Methods:
- Systematic literature search for studies on risk factors for bipolar switching in youth.
- Qualitative review of seven studies meeting a priori inclusion criteria.
Main Results:
- Several risk factors predict manic switches in pediatric depression.
- Identified predictors include positive family history of mood disorders.
- Other predictors are emotional/behavioral dysregulation, subthreshold mania, and psychosis.
Conclusions:
- Findings can alert clinicians to the risk of manic switches in pediatric depression.
- Limited number of studies (seven) reviewed.
- Majority of study samples were referred and Caucasian, potentially limiting generalizability.
Background:
The rate of switching from major depression to bipolar disorder is high in children. Predicting who is at risk for switching poses unique challenges and is of high clinical relevance. Our aim was to examine the existing scientific literature elucidating if certain clinical correlates predict ultimate bipolar switches in children initially presenting with a depressive episode.
Methods:
We conducted a systematic literature search of studies assessing the risk factors for bipolar switching in youth. In all, seven studies fit our a priori criteria and were thus included in our qualitative review.
Results:
Together, these papers found that manic switches in pediatric depression can be predicted by several risk factors, including positive family history of mood disorders, emotional and behavioral dysregulation, subthreshold mania, and psychosis.
Limitations:
We identified only seven prospective informative studies for our review. The majority of subjects included in these studies were referred and Caucasian. Thus, the results may not generalize to other community samples and other ethnicities.
Conclusions:
These findings can help alert clinicians of the risk of manic switches.
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