Objective To examine the psychometrics of the Screen for Adult Anxiety Related Disorders (SCAARED). Methods The SCAARED was adapted from the Screen for Child Anxiety Related Emotional Disorders. Participants (N=336) ages 18–27 years old were evaluated using the Structured Clinical Interview for DSM-IV Disorders (SCID). The SCAARED was completed at or within two-weeks before the SCID. The psychometrics of the SCAARED were analyzed using standard statistical analyses including principal components, and Receiver Operant Curve analyses. A replication was performed in an age/sex matched independent sample (N=158). Results The SCAARED showed four factors: somatic/panic/agoraphobia, generalized anxiety, separation anxiety, and social anxiety. The total and each factor scores demonstrated good internal consistency (α= 0.86 – 0.97) and good discriminant validity between anxiety and other disorders and within anxiety disorders for generalized and social anxiety. Area Under the Curve for the total and each of the factor scores ranged between 0.72 and 0.84 (p< 0.0001). These results were replicated in the independent sample. Conclusions The SCAARED showed excellent psychometric properties supporting its use to screen adults for anxiety disorders, longitudinal studies following youth into adulthood and studies comparing child and adult populations. Further replication studies in larger community and clinical samples are indicated.

Objective: Lithium (LI) is the mainstay for bipolar disorder (BD) treatment in adults, but evidence in youth is limited. We used data from the Course and Outcome of Bipolar Youth (COBY) study to assess whether LI vs. other mood stabilizing medication (OMS) was associated with improved outcomes, including mood symptoms and suicidality.Method: COBY is a naturalistic, longitudinal study of 413 youth, 7-17.11 years old at intake, with BD. At each visit, medication exposure, psychiatric symptoms, and psychosocial function over the preceding follow-up period were assessed using the Adolescent Longitudinal Interval Follow-Up Evaluation. Using mixed models, we determined whether participants taking LI vs. OMS (but not LI) differed regarding mood symptoms, suicidality, psychosocial function, hospitalization, aggression, and substance use.Results: 340 participants contributed 2638 six-month follow-up periods (886 LI, 1752 OMS), over a mean follow-up of ten years. During LI (vs. OMS) follow-up periods, participants were older, less likely to have lifetime anxiety, and less likely to be on antidepressants (p-values<.005). After covariate adjustment, the LI group (vs. OMS) had half as many suicide attempts (p=.03), fewer depressive symptoms (p=.004), less psychosocial impairment (p=.003), and less aggression (p=.0004). Similar findings were observed in the subgroup of follow-up periods where participants were <18 years old.

Objective: Despite abundant literature demonstrating increased metabolic syndrome (MetS) prevalence and important clinical correlates of MetS among middle-age adults with bipolar disorder (BD), little is known about this topic among adolescents and young adults early in their course of BD. We therefore examined this topic in the Course and Outcome of Bipolar Youth (COBY) study.Methods: Cross-sectional, retrospective study of 162 adolescents and young adults (20.8 ± 3.7 years; range =13.6 to 28.3) with BD (I, II, or not otherwise specified, based on DSM-IV) enrolled in COBY between 2000 and 2006. MetS measures (blood pressure, glucose, high-density lipoproteins, triglycerides, and waist circumference), defined using the International Diabetes Federation (IDF) criteria, were obtained at a single time-point. Mood, comorbidity and treatment

Objective Sleep disturbance may be involved in symptom progression across multiple domains of psychopathology and could represent a target for treatment development in youth. Our objective was to identify sleep patterns that longitudinally change in conjunction with psychiatric symptom severity in at-risk youth. Method The study included 484 Pittsburgh Bipolar Offspring Study youth with at least two sleep assessments occurring between 10 and 18 years-old: 267 offspring of parents with bipolar I or II disorder and 217 community comparison offspring. Assessments occurred approximately every 2 years (mean number of assessments=2.8±0.8, mean follow-up duration= 3.8±1.6 years). Offspring had a range of psychiatric diagnoses at baseline. Multivariate lasso regression was implemented to select offspring-reported sleep patterns associated with changes in five psychiatric symptom measures from baseline through last follow-up (mania, depression, mood lability, anxiety, inattention/externalizing). Analyses accounted for parent psychiatric diagnoses and offspring demographics, psychiatric diagnoses, and medications. Results Follow-up duration, baseline socioeconomic status, parental history of bipolar disorder, offspring attention deficit hyperactivity disorder and disruptive behavior disorder, and five sleep patterns were identified as predictors of change in all five psychiatric symptom measures. Decreasing sleep duration, later sleep timing preference, longer sleep latency, increasing nighttime awakenings, and greater sleepiness over follow-up were associated with increasing severity the five psychiatric symptom outcomes over follow-up. These ten predictors explained 16% of the variance in longitudinal psychiatric symptom change, 33% of which was accounted for by sleep predictors. Conclusion A constellation of sleep features were associated with psychiatric symptom changes in youth, and may represent viable targets for future interventions.

Background Sleep disturbances are a prominent feature of bipolar disorder (BP). However, it remains unclear how sleep phenotypes may evolve among at-risk youth, and their relevance to BP onset. Methods Pittsburgh Bipolar Offspring Study (BIOS) offspring (ages 10-18) and their parents completed assessments approximately every two years pertaining to current psychopathology and offspring sleep habits. A latent transition analysis (LTA) identified latent sleep groups within offspring based on their ratings of six sleep domains using the School Sleep Habits Survey. Demographic and clinical characteristics were compared between sleep groups. Logistic regression tested links between sleep group and BP onset at the subsequent assessment. Results The LTA model identified latent groups of good, poor, and variable sleepers. We observed an overall trend of good sleep becoming variable, and then poor, as youth age. Offspring in the poor sleep group were more likely to have psychopathology. Adjusting for age and depression, poor sleepers had nearly twice the odds of developing BP relative to good (OR=1.99, CI=0.45-8.91) or variable (OR=2.03, CI=0.72-5.72) sleepers. Limitations include the use of proximal sleep phenotypes to predict BP onset, and a self-report measure of sleep. Conclusions We found three non-overlapping sleep phenotype groups in a large sample of offspring of bipolar probands and offspring of demographically-matched community control parents. Clinicians should consider that youth will likely experience variable and/or poor sleep as they age, and that at-risk youth with poor sleep may be at increased risk of developing MDD and BP at their next assessment.

Objectives Having a parent with bipolar disorder (BP) is a very strong risk factor to develop BP. Similarly, depression among youth is a clinical risk factor for subsequent BP. We evaluated whether mood symptomatology in depressed youth is different between those at high versus low familial risk to develop BP. Methods The most severe major depressive episode in BP offspring (N=61) and community control offspring (N=20) was evaluated using expanded depression and mania rating scales derived from the Schedule for Affective Disorders and Schizophrenia for Children Present Version. The results were adjusted for any between-group significant demographic differences and for multiple comparisons. Results The severity of depressive symptoms and percentage of offspring with severe depressive symptoms, especially atypical depressive features, were significantly higher in the depressed offspring of BP parents compared to the depressed controls (ps<0.05). The depressive symptoms were helpful to identify high risk group (e.g., odds ratio (OR) for hypersomnia: 22.4, Confidence Interval (CI): 1.3–404, p=0.04). In addition, there were significantly more depressed offspring of BP parents with subsyndromal manic symptoms than the controls (52.5% vs. 20%, OR: 4.2, CI: 1.2–14.7, p<0.01). Conclusions Depressed BP offspring had more severe depression including atypical depressive symptoms, and were more likely to have subsyndromal mixed manic symptoms than depressed control offspring. Prospective studies to evaluate whether these youths are at high risk to develop BP are warranted. If replicated, the results of this study have important clinical (e.g., treatment of depression in depressed offspring of BP parents) and research implications.

Background Previous studies have explored the role of stressful life events in the development of mood disorders. We examined the frequency and nature of stressful life events as measured by the Stressful Life Events Scale(SLES) among three groups of adolescent offspring of probands: with bipolar(BD), with non-BD psychiatric disorders, and healthy control(HC). Furthermore, we examined the relationship between stressful life events and presence of DSM-IV Axis I disorders in these offspring. Stressful life events were characterized as dependent, independent, or uncertain (neither dependent or independent), and positive, negative, and neutral (neither positive or negative). Method Offspring of probands with BD aged 13–18 years(N=269), demographically-matched offspring of probands with non-BD Axis I disorders(N=88), and HC probands(N=81) from the Pittsburgh Bipolar Offspring Study were assessed from 2002–2007 with standardized instruments at intake. Probands completed the SLES for their offspring for life events within the prior year. Life events were evaluated with regard to current offspring Axis I diagnoses after adjusting for confounds. Results After adjusting for demographic and clinical between-group differences(in probands and offspring), offspring of BD probands had greater independent and neutral life events compared with HC offspring and greater number of more severe stressful life events than HC offspring, but not non-BD offspring. Offspring of BD probands with comorbid substance use disorder reported more independent stressful life events. Greater frequency and severity of stressful life events were associated with current Axis I disorder in offspring of both BD and non-BD affected probands regardless of dependency or valence. Greater frequency and severity of stressful life events were associated with greater current Axis I disorder in all offspring. Conclusions Offspring of BD probands have greater exposure to independent and neutral life events than HC offspring. Greater frequency and severity of stressful life events was associated with Axis I disorder in offspring of both BD and non-BD affected probands.

Objective To provide the first longitudinal characterization of mood and psychosocial functioning in youth with comorbid bipolar (BD) and autism spectrum (ASD) disorders. Method The Course and Outcome of Bipolar Youth study followed 368 youth (7–17 years) with DSM-IV bipolar I (BP-I), -II, or Not Otherwise Specified (NOS) for, on average, 9 years using the Longitudinal Interval Follow-up Evaluation. This subgroup analysis compared youth with and without ASD on clinical presentation, percentage of time with mood symptomatology, and psychosocial functioning. Results Thirty youth (~8%) met DSM-IV criteria for Asperger disorder or pervasive developmental disorder-NOS (referred to here as ASD). Lifetime worst episode severity was similar in both groups, but youth with both BD and ASD (BD+ASD) had elevated rates of comorbid attention-deficit/hyperactivity and obsessive-compulsive disorders, were younger at intake, and had an earlier onset of mood symptoms. Over time, in both groups, the proportion of predominantly euthymic youth increased, and episode recurrence decreased. Compared to youth with BD, the clinical presentation of youth with BD+ASD more frequently involved distractibility, racing thoughts, depressed mood, social withdrawal, and low reactivity of negative mood states. ASD-related symptomatic differences were generally strongest early and decreased over time. Youth with BD+ASD had significantly greater impairment in friendships throughout follow-up. Conclusion Youth with BD+ASD exhibit typical BD mood symptoms but with earlier onset, mixed symptom presentation, and additive functional impairments. Significant amelioration of clinical symptoms occurred over time, suggesting that early recognition and treatment of mood disorders in youth with ASD may improve clinical outcomes.