Bipolar diagnosis jumps in young children: study

Ros Krasny
(Reuters)
BOSTON

Fri Jan 15, 2010

BOSTON (Reuters) - The number of children aged 2 to 5 who have been diagnosed with bipolar disorder and prescribed powerful antipsychotic drugs has doubled over the past decade, according to research released on Friday.

Health

The research suggests that while it is still rare to prescribe powerful psychiatric drugs to 2-year-olds, the practice is becoming more frequent.

The data, compiled from 2000 to 2007, and published in the Journal of the American Academy of Child & Adolescent Psychiatry, could inform testimony at the upcoming Boston-area murder trials of the parents of 4-year-old Rebecca Riley. The girl died of an overdose of mood-stabilizing medication in 2006.

A Boston child psychiatrist, Kayoko Kifuji, diagnosed Riley with bipolar disorder and attention deficit hyperactivity disorder when she was 30 months old, and placed her on several powerful drugs: Depakote, an antiseizure medication also used for bipolar disorder, and clonidine, a blood pressure medication.

Kifuji's testimony may be crucial to the fate of Michael and Carolyn Riley, who face first-degree murder charges. A grand jury and a review by the state's medical licensing board cleared the doctor of wrongdoing.

Prosecutors claim the Rileys deliberately overmedicated their daughter to subdue her. The couple say they were following Kifuji's instructions and their daughter died of pneumonia.

The case has shone the spotlight again on a debate within the psychiatric profession about whether bipolar disorder can be diagnosed in very young children and whether it is wise to prescribe powerful medications.

BIPOLAR TODDLERS?

Bipolar disorder, characterized by severe mood swings, was once thought to emerge only during adolescence or later. But Dr. Joseph Biederman, a child psychiatrist at Harvard University, transformed views on the subject by arguing that children could have the disorder at extremely young ages.

He is credited with spearheading a more than 40-fold increase in the number of children diagnosed with bipolar disorder over the past decade.

Biederman was accused in 2008 by Republican U.S. Senator Charles Grassley of failing to fully disclose payments by drug companies, including some that produced medication for bipolar disorder. Biederman declined to be interviewed about the latest study.

"The psychiatric diagnosis of very young children is anything but an exact science," said Harry Tracy, a psychologist and publisher of NeuroInvestment, a monthly publication specializing in central nervous system disorders.

"Such disparate causes as ADHD, depression, bipolar disorder, sexual abuse, and family dysfunction can produce very similar symptoms in a toddler."

The report's author, Mark Olfson, professor of clinical psychiatry at Columbia University, said about 1.5 percent of all privately insured children between the ages of 2 and 5, or one in 70 children, received some sort of psychotropic drug -- whether an antipsychotic, a mood stabilizer, a stimulant or an antidepressant -- in 2007.

If a child is diagnosed with bipolar disorder between the ages of 2 and 5, about half are prescribed an antipsychotic, such as Eli Lilly & Co's Zyprexa, AstraZeneca Plc's Seroquel, and Johnson & Johnson's Risperdal. They are prescribed to about one in 3,000 2-year-olds, according to his report.

"There might be a role for these drugs but only after you've tried other interventions, with the parents, or with the parents and child together, but that is not happening when you examine the billing records," Olfson said.

(Additional reporting by Toni Clarke; Editing by Peter Cooney)

Doc Who Urged Antipsychotics for 3-Year-Olds Funded by J&J, AZ and Shire

BNET
By Jim Edwards | Aug 28, 2009

A doctor who wrote in an academic journal that preschoolers may suffer from depression and could be good candidates for atypical antipsychotics received funding from three drug companies that make mental health medicines.

Dr. Joan Luby, a professor of child psychiatry at the Washington University School of Medicine in St. Louis, wrote that children as young as three years old may suffer from bipolar disorder, and that there are “promising findings for the use of atypical antipsychotic agents and mood stabilizers, both singly and in combination” in the very young. Atypical antipsychotics are not FDA-approved for such use.

Her article, in a 2009 journal titled Child and Adolescent Psychiatric Clinics of North America, does not disclose that in the past Luby’s work has been funded by Janssen (the unit of Johnson & Johnson that markets Risperdal), or that she has given talks sponsored by AstraZeneca (maker of Seroquel), and has been a consultant for Shire (maker of Adderall XR and Vyvanse).

Luby (pictured) disclosed her relationships with drug companies in a 2006 article in the Journal of the American Academy of Child & Adolescent Psychiatry, which was also about depression in preschoolers. Her disclosure said:

Disclosure: Dr. Luby has received grant/research support from Janssen, has given occasional talks sponsored by AstraZeneca, and has served as a consultant for Shire Pharmaceuticals.

Luby did not return an email or two phone calls requesting comment. It is not clear whether academic journal rules at the time required her disclosures. AZ said:

AstraZeneca records show that Dr. Luby participated in our speakers program from 2003-2004. It is AstraZeneca policy to compensate speakers according to the fair market value of their services.

After checking its records, Shire said it paid $2,000 to Luby in 2004, plus a $19 in travel expenses.* J&J did not respond to a message requesting comment.

Luby is not the only academic researcher whose disclosure of Big Pharma funding has been spotty. Sen. Chuck Grassley, R-Iowa, is pushing for transparency legislation that would force all university researchers to disclose their ties to drug companies.

A selection of Luby’s published papers on childhood depression shows that while in 2006 she did disclose her payments from drug companies, in 2007 she did not. In an article titled “Psychotropic Prescriptions in a Sample Including Both Healthy and Mood and Disruptive Disordered Preschoolers,” in the Journal of Child and Adolesent Psychopharmacology, Luby’s disclosure statement said:

The authors do not have any corporate, commercial, or financial relationships that pose conflicts of interest.

Also in 2007, Luby signed as an author to a “Special Communication” in the same journal written by a group of child psychiatrists called The Preschool Psychopharmacology Working Group. The purpose of their group, Luby and her colleagues wrote, was:

… to promote responsible treatment of young children, recognizing that this will sometimes involve the use of medications.

The other authors of that paper disclosed a wealth of company ties, including Eli Lilly, Organon, Forest Labs, GlaxoSmithKline, Wyeth-Ayerst, McNeil, Novartis, Pfizer, Bristol-Myers Squibb, Abbott, AstraZeneca, Sepracor, Cephalon, Sanofi-Aventis, Boehringer-Ingelheim, and Janssen. Regarding Luby, the paper said:

The other authors have no financial relationships to disclose.

In Luby’s 2009 editorial, she wrote:

The need for large-scale and focused studies of this issue is underscored by the high and increasing rates of prescriptions of atypical antipsychotics and other mood stabilizing agents for preschool children with presumptive clinical diagnosis of bipolar disorder.

She cited a paper by Harvard’s Dr. Joseph Biederman, who was subpoenaed by federal prosecutors investigating J&J’s promotion of Risperdal, much of which was allegedly off-label to children. Separately, hundreds of lawsuits have been filed alleging that Seroquel has dangerous side effects such as weight gain and diabetes.

*Correction: Shire originally said it had no contact with Luby in the prior two years.

* Related:
* Biederman’s Finances: He Names His Own Price, and It’s $550 an Hour
* AstraZeneca Q2: $593M Seroquel Legal Bill Taps Out Insurance; Income Charges Expected