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American Academy of Child & Adolescent Psychiatry, Oct. 28-Nov. 2, 2008

American Academy of Child & Adolescent Psychiatry Annual Meeting

The American Academy of Child & Adolescent Psychiatry's 55th Annual Meeting took place Oct. 28 to Nov. 2 in Chicago, featured more than 42 symposia and 300 abstracts, and attracted more than 4,000 child and adolescent psychiatrists and allied experts on child and adolescent mental illnesses from the United States and over 100 other countries. Key themes included the benefits of combining medication and psychotherapy in children with mental disorders, and advances in the understanding of how bipolar disorder develops in young people and continues into adulthood.

"The issue of medication versus psychotherapy versus a combination was a recurrent theme across several meetings that addressed multiple disorders," said program chair Neal Ryan, M.D., of the University of Pittsburgh. "Many clinicians may use medications first. But if patients don't get better, or only get partially better, it may be better to add psychotherapy instead of trying another medication. That's a pattern we're seeing in treatment with kids, and it's important to the field."

Several studies presented at the meeting addressed the issue of bipolar disorder in children and adolescents. "Some patients clearly have completely typical adult-type bipolar disorder, with exactly the same signs and symptoms," Ryan said. "But some don't experience the same cycles. They don't go from clearly manic to euthymic to depressed, and the cycles don't have the same duration. There's been a confluence of data about how kids with a variety of symptoms look over time and if they develop full bipolar disorder or not. Because treatment depends on solid diagnosis, a lack of such information has been limiting to the field before now. But we've made good progress on that over the past year."

Barbara Geller, M.D., of Washington University in St. Louis, moderated a session entitled "Latest Advances in Child Bipolar Disorder" and presented data from an eight-year study at another session entitled "Children at Risk for Bipolar Disorder: From Clinical Phenotypes to Neurobiology." "This is a seminal study," Ryan said.

Published in the October 2008 issue of the Archives of General Psychiatry, the study by Geller and colleagues investigated the continuity of child and adult bipolar disorder in 115 children (mean age 11.1 years) who were followed for eight years. She and her colleagues found that the frequency of manic episodes in the grown-up subjects -- 44.3 percent -- was 13 to 44 times higher than among the general population, which strongly supported continuity. They also found that the subjects' rate of substance use disorders mirrored that of adults with bipolar disorder.

"Mounting data support the existence of child bipolar disorder-1, and the severity and chronicity of this disorder argue strongly for large efforts toward understanding the neurobiology and for developing prevention and intervention strategies," Geller and colleagues concluded.

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"Although there's still not complete convergence, it does look like the broader phenotype than just the adult picture will turn out to be part of the same syndrome in children," Ryan said. "So even though children may have less cycling or less clear cycling than adults, they will still be part of this phenotype."

Another theme of the meeting was the relationship between the academy and the pharmaceutical industry, Ryan said. During a plenary address, Catherine D. DeAngelis, M.D., editor of the Journal of the American Medical Association and recipient of the academy's annual "Catcher in the Rye Humanitarian of the Year Award," delivered a speech entitled "Conflict of Interest in Medical Research: Facts or Fiction." "She addressed the importance of ensuring that studies are well-reported with correct statistical analysis and talked about some of the things that have gone astray in some publications," Ryan said.

"Dr. DeAngelis has demanded that the medical community re-examine and reflect on conflicts of interest to assure transparency and she continues to raise the bar on behalf of quality research being delivered to families," AACAP president Robert Hendren, D.O., said in a statement.

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