Reliability of the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) Mania and Rapid Cycling Sections

BARBARA GELLER, M.D., BETSY ZIMERMAN, M.A., MARLENE WILLIAMS, R.N., KRISTINE BOLHOFNER, B.S., JAMES L. CRANEY, M.P.H., MELISSA P. DELBELLO, M.D., AND CESAR SOUTULLO, M.D.

Reprinted with permission from J Am Acad Child Adolesc Psychiatry, Volume 40, p. 450-455 (2001).

Objective: To investigate the reliability of the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) mania and rapid cycling sections. Method: The 1986 version of the KSADS was modified and expanded to include onset and offset of each symptom for both current and lifetime episodes, expanded prepubertal mania and rapid cycling sections, and categories for attention-deficit/hyperactivity disorder and other DSM-IV diagnoses. To optimize diagnostic research, skip-outs were minimized. Subjects participated in the ongoing “Phenomenology and Course of Pediatric Bipolar Disorder” study. Mothers and children were interviewed separately by research nurses who were blind to diagnostic group status. In addition, ratings of off-site child psychiatrists, made from the narrative documentation given for each WASH-U-KSADS item, were compared with research nurse ratings. This work was performed between 1995 and 2000.

by Kowatch, Robert A. M.D.; Suppes, Trisha M.D., Ph.D.; Carmody, Thomas J. Ph.D.; Bucci, John P. M.A.; Hume, Judith H. M.S.; Kromelis, Michelle R.PH.; Emslie, Graham J. M.D.; Weinberg, Warren A. M.D.; Rush, A. John M.D.

Journal of the American Academy of Child & Adolescent Psychiatry Copyright 2000 © American Academy of Child and Adolescent Psychiatry, Volume 39(6), June 2000, pp. 713-720

Objective: To develop effect sizes for 3 mood stabilizers-lithium, divalproex sodium, and carbamazepine-for the acute-phase treatment of bipolar I or II disorder, mixed or manic episode, in children and adolescents aged 8 to 18 years.
Method: Forty-two outpatients with a mean age of 11.4 years (20 with bipolar I disorder and 22 with bipolar II disorder) were randomly assigned to 6 weeks of open treatment with either lithium, divalproex sodium, or carbamazepine. The primary efficacy measures were the weekly Clinical Global Impression Improvement scores and the Young Mania Rating Scale (Y-MRS).

Siggurdsson, Engilbert; Eric Fombonne, Kapil Sayal, Stuart Checkley
British Journal of Psychiatry, 1999, 174, l2l-l27

38 cases of hospitalized adolescent mania, bipolar disorder, or depression with psychotic features (ages 11-18 at first hospitalization) were compared with 41 controls with unipolar depression. Cases were significantly more likely than controls to have lower IQ scores, a difference between verbal (higher) and performance (lower) subtest IQ scores, to have experienced childhood developmental impairments such as language delay, social delay, and motor skills delay, have a family history of bipolar disorder or a family history of psychosis. About 14% of kids in both groups had experienced "perinatal insults."

The article summaries other articles which found an association between neurodevelopmental delays and mood disorders, such as van Os, J., Jones, P.,Lewis, G., et al (l997), "Developmental precursors of affective illness in a general population birth cohort," Archives of General Psychiatry, 54,625-631. This study looked at 5,362 individuals born in the UK during the same week in 1946. Subjects with mood disorders by ages 13 and 15 years "attained motor milestones significantly later in early childhood than controls, and had double the risk of speech abnormalities." The authors concluded that "affective disturbances, especially the early-onset forms, are preceded by impaired neurodevelopment." The authors summarize several other studies with similar findings, including studies that found obstetric complications (birth difficulties) to be associated with early onset of mood disorders, and conclude that "our findings add to the increasing evidence that neurodevelopmental impairments act as vulnerability factors for early-onset affective disturbances, particularly the more severe ones."

(Abstract by Martha Hellander, The Balanced Mind Foundation Executive Director)