Skip to main content

The overlap of pervasive developmental disorders and bipolar disorder in young people

Author/s
Mai Uchida, Emily Gray, Gagan Joshi
Citation
Issue 3 Summer 2013
CEPiP.2013;1:283-287
Abstract

Recent research has proved the bidirectional relationship between pervasive developmental disorders (PDD) and bipolar disorder (BPD). Young people with BPD comorbid with PDD present with earlier onset and higher severity of mood disturbance, and young people with PDD with family history of BPD present with mood disturbance characterized by a severe cycling pattern and agitation along with neurovegetative disturbances. Treatment approaches include similar comprehensive psychosocial interventions targeting PDD symptomatology with the addition of psychopharmacological interventions to target comorbid mood symptoms. This population is more prone to adverse effects and can have an atypical response to psychoactive medications; it is recommended that medication be initiated at a low dose and titrated in small increments. Second-generation antipsychotics are effective with both the consequences of the PDD (aggression and irritability) and the comorbid mania but also carry the concerning adverse effects of weight gain and impaired glucose metabolism.

Keywords: pervasive developmental disorder, bipolar disorder, comorbidity, young people, clinical correlates

Cite as: Cutting Edge Psychiatry in Practice 2013, 3(1):283-287; https://doi.org/10.65031/lphv3705

References

  1. Autism and Developmental Disabilities Monitoring Network. Prevalence of Autism Spectrum Disorders. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report; March 30 2012. https://doi.org/10.15585/mmwr.mm6745a7
  2. Geller B, Fox L, Clark K. Rate and predictors of prepubertal bipolarity during follow-up of 6-to 12-year-old depressed children. J Am Acad Child Adolesc Psychiatry 1994; 33: 461-8. https://doi.org/10.1097/00004583-199405000-00003
  3. Joshi G, Wilens T. Comorbidity in pediatric bipolar disorder. Child Adolesc Psychiatr Clin N Am 2009; 18 (2): 291-319. https://doi.org/10.1016/j.chc.2008.12.005
  4. Kerbeshian J, Burd L. Case study: comorbidity among Tourette’s syndrome, autistic disorder, and bipolar disorder. J Am Acad Child Adolesc Psychiatry 1996; 35: 681-5. https://doi.org/10.1097/00004583-199605000-00024
  5. Komoto J, Seigo U, Hirata J. Infantile autism and affective disorder. J Autism Dev Disord 1984; 14: 81-4. https://doi.org/10.1007/bf02408557
  6. Sovner R, Hurley AD. Do the mentally retarded suffer from affective illness? Arch Gen Psychiatry 1983; 40: 61-7. https://doi.org/10.1001/archpsyc.1983.01790010063008
  7. Steingard R, Biederman J. Lithium responsive manic-like symptoms in two individuals with autism and mental retardation. J Am Acad Child Adolesc Psychiatry 1987; 26: 932-5. https://doi.org/10.1097/00004583-198726060-00021
  8. Wing L. Asperger’s syndrome: a clinical account. Psychol Med 1981; 11: 115-29.               
  9. Towbin KE, Pradella A, Gorrindo T et al. Autism spectrum traits in children with mood and anxiety disorders. J Child Adolesc Psychopharmacol 2005; 15: 452-64. https://doi.org/10.1089/cap.2005.15.452
  10. Wozniak J, Biederman J, Faraone S et al. Mania in children with pervasive developmental disorder revisited. J Am Acad Child Adolesc Psychiatry 1997; 36: 1552-60. https://doi.org/10.1097/00004583-199711000-00017
  11. Joshi G, Petty C, Wozniak J, Henin A, Fried R, Galdo M, Kotarski M, Walls S, Biederman J. The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: a large comparative study of a psychiatrically referred population. J Autism Dev Disord 2010 Nov; 40 (11): 1361-70. https://doi.org/10.1007/s10803-010-0996-9
  12. Joshi G, Biederman J, Wozniak J, Doyle R, Hammerness P, Galdo M, Sullivan N, Williams C, Brethel K, Woodworth KY, Mick E. Response to second generation antipsychotics in youth with comorbid bipolar disorder and autism spectrum disorder. CNS Neurosci Ther 2012 Jan; 18 (1): 28-33. https://doi.org/10.1111/j.1755-5949.2010.00219.x
  13. Joshi G, Biederman J, Petty C, Goldin R, Wozniak J. Examining the Comorbidity of Bipolar Disorder and Autism Spectrum Disorders: A Large Controlled Analysis of Phenotypic and Familial Correlates in Referred Population of Youth with Bipolar I Disorder with and without Autism Spectrum Disorders. J Clin Psych (accepted for publication). https://doi.org/10.4088/jcp.12m07392
  14. DeLong GR, Nohria C. Psychiatric family history and neurological disease in autistic spectrum disorders. Dev Med Child Neurol 1994; 36: 441-8. https://doi.org/10.1111/j.1469-8749.1994.tb11870.x
  15. DeLong GR, Dwyer JT. Correlation of family history with specific autistic subgroups: Asperger’s syndrome and bipolar affective disease. J Autism Dev Disord 1988; 18: 593-600. https://doi.org/10.1007/bf02211877
  16. Herzberg B. The families of autistic children. In: Coleman M (ed.) The autistic syndromes. Amsterdam: North Holland; 1976. p 151-72.
  17. Research Units on Pediatric Psychopharmacology Autism Network. Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Arch Gen Psychiatry 2005; 62: 1266. https://doi.org/10.1001/archpsyc.62.11.1266
  18. Aman MG, Arnold MDL, McDougle CJ et al. Acute and long-term safety and tolerability of risperidone in children with autism. J Child Adolesc Psychophar- macol 2005; 15: 869-84.                 
  19. Posey DJ, Wiegand RE, Wilkerson J et al. Open-label atomoxetine for attention- deficit/hyperactivity disorder symptoms associated with high-functioning pervasive developmental disorders. J Child Adolesc Psychopharmacol 2006; 16: 599-610. https://doi.org/10.1089/cap.2006.16.599
  20. Lainhart JE, Folstein SE. Affective disorders in people with autism: a review of published cases. J Autism Dev Disord 1994; 24: 587-601. https://doi.org/10.1007/bf02172140
  21. Research Units on Pediatric Psychopharmacology Autism Network. Risperidone in children with autism and serious behavioral problems. N Engl J Med 2002; 347: 314-21. https://doi.org/10.1056/nejm200212053472316
  22. Nagaraj R, Singhi P, Malhi P. Risperidone in children with autism: randomized, placebo controlled, double-blind study. J Child Neurol 2006; 21: 450-5. https://doi.org/10.1177/08830738060210060801
  23. Shea S, Turgay A, Carroll A et al. Risperidone in the treatment of disruptive behavioral symptoms in children with autistic and other pervasive developmental disorders. Pediatrics 2004; 114: e634-41. https://doi.org/10.1542/peds.2003-0264-f
  24. Malone RP, Delaney MA, Hyman SB et al. Ziprasidone in adolescents with autism: an open-label pilot study. J Child Adolesc Psychopharmacol 2007; 17: 779-90. https://doi.org/10.1089/cap.2006.0126
  25. Stigler KA, Diener JT, Kohn AE et al. A prospective open-label study of aripiprazole in youth with Asperger’s disorder and pervasive development disorder not otherwise specified. Neuropscyhopharmacology 2006; 31: S194. https://doi.org/10.1089/cap.2008.093
  26. Findling RL, McNamara NK, Gracious BL et al. Quetiapine in nine youths with autistic disorder. J Child Adolesc Psychopharmacol 2004; 14: 287-94. https://doi.org/10.1089/1044546041649129
  27. Hollander E, Wasserman S, Swanson EN et al. A double-blind placebo-controlled pilot study of olanzapine in childhood/adolescent pervasive developmental disorder. J Child Adolesc Psychopharmacol 2006; 16: 541-8. https://doi.org/10.1089/cap.2006.16.541
  28. Martin A, Koenig K, Scahill L et al. Open-label quetiapine in the treatment of children and adolescents with autistic disorder. J Child Adolesc Psychopharmacol 1999; 9: 99-107. https://doi.org/10.1089/cap.1999.9.99
  29. Klein DJ, Cottingham EM, Sorter M et al. A randomized, double-blind, placebo-controlled trial of metformin treatment of weight gain associated with initiation of atypical antipsychotic therapy in children and adolescents. Am J Psychiatry 2006; 163: 2072-2079. https://doi.org/10.1176/appi.ajp.163.12.2072
  30. Bapista T, Martinez J, Lacruz A et al. Metformin for prevention of weight gain and insulin resistance with olanzapine: A double-blind placebo-controlled trial. Can J Psychiatry-Revue Canadianne de Psychiatrie; 2006; 51: 192-196. https://doi.org/10.1177/070674370605100310
  31. Gutkovich ZA, Carlson GA, Carlson HE et al. Advanced Pediatric Psychopharmacology: Asperger’s disorder and co-morbid bipolar disorder: Diagnostic and treatment challenges. J Child Adolesc Psychopharmacol 2007; 17: 247-255. https://doi.org/10.1089/cap.2007.1723