[29, 62]. J Am Acad Child Adolesc Psychiatry. 2017 Jan 31. appiajp201615050652. 2011 Mar. If you log out, you will be required to enter your username and password the next time you visit. 2008 Sep. 65(9):1053-61. Steiner H. Evaluation and management of violent behavior in bipolar adolescents. In addition to the information provided here, you may find comfort and support from the following resources, Patient and family resources at Children's. [Full Text]. 2009 Aug. 39(8):1253-63. 2006 Jan-Feb. 47(1):75-85. The treatment and management of bipolar disorder are complicated. Olanzapine and pediatric bipolar disorder: evidence for efficacy and safety concerns. [Medline]. [Full Text]. Chen CH, Lee CS, Lee MT, Ouyang WC, Chen CC, Chong MY, et al. Toward the Definition of a Bipolar Prodrome: Dimensional Predictors of Bipolar Spectrum Disorders in At-Risk Youths. N Engl J Med. [Medline]. 2009 Jan. 112(1-3):144-50. [76], Therapeutic interventions that appear to be helpful in bipolar disorder include social rhythm therapy, 2. Development of Alcohol and Drug Use in Youth With Manic Symptoms. Learning to manage bipolar disorder can take time. An ECT treatment episode may involve 3-8 or more sessions, usually at a rate of 1 session every other day or 3 sessions per week. 2008 Sep. 8(9):1381-7. Commonly prescribed antidepressants include: Since 2004, the U.S. Food and Drug Administration has placed a black box warning label on all antidepressant medications. Parent-focused interpersonal therapy and guidance are important when one or both parents have significant mood and/or anxiety disorder. Just like a congenital heart defect or asthma, bipolar disorder is a medical condition, and a biological process or imbalance is responsible for it. 2008 Feb. 60(1):103-14. [Medline]. 2000 Apr. These medications are typically lithium, anticonvulsants or atypical antipsychotics. Schedule an appointment to discuss your concerns. Because childs brains are still developing, doctors recommend that children start low and go slow when it comes to medication. [Medline]. Duax JM, Youngstrom EA, Calabrese JR, Findling RL. Yıldırım V, Direk MÇ, Güneş S, Okuyaz Ç, Toros F. Neuroleptic Malignant Syndrome Associated with Valproate in an Adolescent. J Am Acad Child Adolesc Psychiatry. Br J Psychiatry. As in adults with bipolar disorder, carbamazepine is not a first-line choice, due to its safety profile including an increased risk of Stevens-Johnson syndrome and/or possible association with agranulocytosis and/or meningitis; thus, it is usually only used after atypical antipsychotics and/or valproate/sodium divalproex and/or lithium carbonate have been tried at optimal doses for a sufficient period and are ineffective or if there are contraindications to the use of other medications to stabilize an acute mood disorder or for long-term maintenance. 95(3):188-98. Longitudinal Course of Bipolar Disorder in Youth With High-Functioning Autism Spectrum Disorder. These risks should be clearly discussed with patients and families and weighed against the potential benefits. Medication may include a combination of drugs, which can include antidepressants, mood stabilizers, antipsychotics, and/or anti-anxiety medication. J Am Acad Child Adolesc Psychiatry. Administration of multiple classes of anticonvulsants together should also be avoided, when possible. 17(6-7):440-7. Your child will need to follow the treatment plan outlined by her care team, and any changes should be carefully discussed among all members of her treatment team. Hospitalization is necessary for most patients with psychotic features and in almost all patients who have suicidal or homicidal ideations or plans. Help educate your family and friends about what you're going through. Bipolar disorder is characterized by alternating periods of mania, depression, and normal mood, each lasting for weeks to months at a time. Antipsychotic medications include: Antidepressant medications Table 2. T2 - A review. [Medline]. Early childhood attention deficit hyperactivity disorder predicts poorer response to acute lithium therapy in adolescent mania. Prevalence and correlates of physical and sexual abuse in children and adolescents with bipolar disorder. This can lead to depletion of nutritional stores of iron, vitamin B-6, vitamin B-12, and folate and can increase the risk of diabetes or long-term complications of hyperglycemia or hypoglycemia. Pediatrics: Developmental and Behavioral Articles, https://www.medscape.com/viewarticle/893542, American Academy of Child and Adolescent Psychiatry, Pleasure in violating societal norms, especially if not caught, Episodic disturbances such as decreased need in mania, Not known to be disrupted except with substance abuse, Pressured or rapid in mania; slow in depression, May engage in predatory or reactionary acts, Agitated in mania or mixed states; retarded in depressed states, ADHD—attention deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. Lithium carbonate is effective in approximately 60-70% of adolescents and children with bipolar disorder and remains the first-line therapy in many settings. Duffy A, Horrocks J, Doucette S, Keown-Stoneman C, McCloskey S, Grof P. The developmental trajectory of bipolar disorder. Adolescents and children with bipolar disorders often present at times of family or youth despair or family crises surrounding their behaviors. Family-focused therapy with a cognitive behavioral component is encouraged, in that having a child with bipolar disorder requires the parents, the identified child, and siblings to adjust to the impact on the family system, necessitating a focus on improved communication. [Medline]. Thomas T, Stansifer L, Findling RL. 2008. [Full Text]. Decreased protein kinase C (PKC) in platelets of pediatric bipolar patients: effect of treatment with mood stabilizing drugs. Bogarapu S, Bishop JR, Krueger CD, Pavuluri MN. Fewer studies have been conducted in pediatric bipolar patients than adult patients; thus, treatment is often based upon adult studies [ 3,4 ]. Adults with bipolar disorder may also live with substance abuse, eating disorders, anxiety, and disrupted sleep rhythms, which are not typical in children with bipolar disorder. Faraone SV, Biederman J, Wozniak J, Mundy E, Mennin D, O'Donnell D. Is comorbidity with ADHD a marker for juvenile-onset mania?. 10(2):215-28. [Medline]. #1 Ranked Children's Hospital by U. S. News & World Report, Advocating Success for Kids (ASK) Program, Visit our “For Patients and Families” page, Parents of Bipolar Children Online Support Group, Pediatric Bipolar Awareness Facebook Page, CopeCareDeal: A Mental Health Site for Teens, Young men and young women may have certain concerns that are specific to their genders, and some concerns that they share. [61]. Am J Med Genet B Neuropsychiatr Genet. The following measures may help prevent or minimize episodes of bipolar affective disorder: Avoidance of prescribing medications that can precipitate acute mania if a diagnosis of bipolar disorder is unclear, Avoidance of situations (including substance abuse) that precipitate or aggravate decreased sleep duration, such as work or social situations that encourage or cause sleep deprivation or significant alterations of sleep pattern, Prompt medical and psychiatric attention upon development of symptoms such as pressured speech, psychosis, or lack of need for sleep or food, Adjunctive techniques such as meditation or muscle relaxation or deep breathing to lower stress and anxiety levels Depressive episodes are frequently the first presentation of bipolar disorders in youths. In recent years, it's become a controversial diagnosis. Yes. The role of rumination in illness trajectories in youth: linking trans-diagnostic processes with clinical staging models. J Child Adolesc Psychopharmacol. [Full Text]. At Children's, the, systems interventions (at school and in the community) as needed, anticipate and manage the onset of his mood episodes, recognize that the “high high” and “low low” feelings he's experiencing are caused by his bipolar disorder, change his negative and potentially harmful thoughts, feelings and behaviors (this process is called, learn new and healthy ways of relating to his family members, teachers and peers, build his self-esteem and define himself as much more than his illness, become an active member in their own care “team”. Clonazepam can be dosed in the range of 0.01-0.04 mg/kg/d and it is often administered once per day at bedtime or twice per day. Education about your condition can empower you and motivate you to stick to your treatment plan and recognize mood changes. A 2012 multicenter study from the TEAM study group (Treatment of Early Age Mania) is one of the first studies to compare whether there are differences in efficacy between risperidone, lithium or divalproex in the treatment of manic or mixed states in children aged 6 to 15 years. Lurasidone was approved in 2018 for the treatment of major depressive episodes associated with bipolar I disorder (bipolar depression) in children and adolescents aged 10 to 17 years. Here are some strategies that can help: 1. Therefore, plasma levels may be drawn and assessed earlier in children and adolescents than in adults. Chang KD. However, the current classification for bipolar disorder is based on research conducted primarily on adults. Bipolar disorder in children is possible. [Medline]. [22]. 2007 Jul. 2008 Apr. Lorazepam is dosed to 0.04-0.09 mg/kg/d and administered 3 times per day because of its short half-life. The goals of individual therapy and family therapy should be individualized. Although bipolar disorder more commonly develops in older teenagers and young adults, it can appear in children as young as 6. Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M. Arch Gen Psychiatry. Chang KD, Steiner H, Ketter TA. 2003 The bipolar spectrum in children and adolescents: developmental issues. 55 (7):543-55. [Medline]. Medscape Education, 2010 Is bipolar disorder ever considered “cured”? de Leon J, Armstrong SC, Cozza KL. Neuroprotection after a first episode of mania: a randomized controlled maintenance trial comparing the effects of lithium and quetiapine on grey and white matter volume. [Full Text]. Brief interpersonal psychotherapy for depressed mothers whose children are receiving psychiatric treatment. Clinical psychopharmacology of pediatric mood stabilizer and antipsychotic treatment, part 1: challenges and developments. Dickstein DP, Nelson EE, McClure EB, Grimley ME, Knopf L, Brotman MA, et al. 2008 Sep. 165(9):1155-62. Miklowitz DJ, Axelson DA, Birmaher B, George EL, Taylor DO, Schneck CD, et al. [Medline]. Trials of deep brain stimulation for refractory depression are promising, as this treatment may potentially lower the risk of mania and related medication adverse effects, such as weight gain, insulin resistance, sexual dysfunction, and decreased cognition due to impairment of memory and attention. Pavuluri MN, Passarotti AM, Fitzgerald JM, Wegbreit E, Sweeney JA. Rarely are young persons physically restrained in hospitals, but seclusion rooms should remain available in the event of severely agitated states that may culminate in threats or overt expression of physical aggression to self or others. In general, the treatment of bipolar disorder may be thought of as a 4-phase process: (1) evaluation and diagnosis of presenting symptoms, (2) acute care and crisis stabilization for psychosis or suicidal or homicidal ideas or acts, (3) movement toward full recovery from a depressed or manic state, and (4) attainment and maintenance of euthymia. They are particularly useful in preventing manic episodes. Association of Comorbid Mood and Anxiety Disorders With Autism Spectrum Disorder. Chang KD. [Full Text]. 69(7):1157-65. 53(5):437-46. The goals of inpatient or outpatient treatment are to control and minimize symptoms of bipolar disorder, to prolong normal mood states or euthymia, to minimize the number of needed hospitalizations, to eliminate or minimize medication adverse effects to a tolerable level, and to optimize the quality of life (QOL) for the patient. The ups and downs experienced by a child—and family—living with bipolar disorder can feel overwhelming. Further evidence of an association between adolescent bipolar disorder with smoking and substance use disorders: a controlled study. Nonetheless, common goal themes include reduction of family stress, improvement of family communications, and a discussion of unresolved feelings of fear, hurt, or loss caused by a loved family member having a mental disorder. A physician may refer you to a mental health treatment provider for a complete evaluation. An fMRI study of the interface between affective and cognitive neural circuitry in pediatric bipolar disorder. One RCT in 290 children, ages 6 to 15 years, diagnosed with bipolar I disorder (having mixed or manic symptoms) showed that risperidone was more effective than lithium or divalproex sodium for the initial treatment of pediatric mania. Selective serotonin reuptake inhibitors (SSRIs) should be used cautiously, owing to the risk of mania; doses should be low and titration slow. [Medline]. [79, 64, 29, 77]. 2007 Dec. 54(6):901-26; x. [Medline]. N2 - The aim of this study was to review the diagnosis and the pharmacologic and psychosocial interventions for pediatric bipolar disorder (PBD). Mick E, Kim JW, Biederman J, Wozniak J, Wilens T, Spencer T, et al. 2007 Oct. 164(10):1462-4. . A double-blind, randomized, placebo-controlled trial of oxcarbazepine in the treatment of bipolar disorder in children and adolescents. 13(2):155-63. 2018 Jul/Aug. 2017 Jan 23. Caetano SC, Silveira CM, Kaur S, Nicoletti M, Hatch JP, Brambilla P, et al. Anticipated plasma trough levels may be lower in young patients than in adults. 47(5):515-25. [Full Text]. Borue X, Mazefsky C, Rooks BT, Strober M, Keller MB, Hower H, et al. Lopez-Larson MP, Shah LM, Weeks HR, King JB, Mallik AK, Yurgelun-Todd DA, et al. [69, 70, 71, 72, 73], Family conflict may decrease response to medication treatment and so should be addressed in a timely fashion. Johnston JA, Wang F, Liu J, Blond BN, Wallace A, Liu J, et al. [Full Text]. 2007 Aug. 68(8):1301-2. Wilens TE, Biederman J, Adamson JJ, Henin A, Sgambati S, Gignac M, et al. Your child's treating clinician will advise you on the best choice for her and her symptoms. 2006 Dec. 1094:235-47. Wagner KD, Kowatch RA, Emslie GJ, Findling RL, Wilens TE, McCague K, et al. Tannous J, Amaral-Silva H, Cao B, Wu MJ, Zunta-Soares GB, Kazimi I, et al. Medication : Children respond to medicine differently than adults, so the type and dosage of medication depends on the child, as well as their symptoms. 2009 Oct. 48(10):1005-13. In the outpatient setting, clonazepam may be preferred because of the efficacy and the lowered risks of abuse by the patient or others. Miklowitz DJ, Schneck CD, Walshaw PD, Singh MK, Sullivan AE, Suddath RL, et al. In addition, adjunctive psychotherapy is generally regarded as essential [ 2 ]. A. PY - 2011/3. Geller B, Luby JL, Joshi P, Wagner KD, Emslie G, Walkup JT, et al. Here at Boston Children's Hospital, our team has years of experience in managing the use of psychiatric medications in children of all ages and with a wide variety of conditions. Bipolar Disorder in Children Bipolar disorder (previously called manic-depressive disorder) is a mental illness that causes children to have significant irritability and mood swings, among other symptoms. 342:d1351. Bettina E Bernstein, DO Distinguished Fellow, American Academy of Child and Adolescent Psychiatry; Distinguished Fellow, American Psychiatric Association; Clinical Assistant Professor of Neurosciences and Psychiatry, Philadelphia College of Osteopathic Medicine; Clinical Affiliate Medical Staff, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia; Consultant to Gemma Services, Private Practice; Consultant PMHCC/CBH at Family Court, Philadelphia J Child Adolesc Psychopharmacol. 15 (1):76-78. This website also contains material copyrighted by 3rd parties. We will carefully go over the specifics of the drug and explain any and all of the potential benefits, alternatives and side effects that you should watch for. Go to Bipolar Affective Disorder for complete information on this topic. Psychiatric phenomenology of child and adolescent bipolar offspring. At the Pediatric Mental Health Institute at Children's Colorado, we adhere to best practices for the treatment of bipolar disorder, which includes a combination of medication and psychotherapy. If you think your child may have bipolar disorder (or any other mental health issue), talk to his physician. [Medline]. Am J Psychiatry. [Medline]. [78]. Amygdala activation during emotion processing of neutral faces in children with severe mood dysregulation versus ADHD or bipolar disorder. 45(3):305-13. 2007 Sep;64(9):1032-9.PMID: 17768268. [Medline]. 114(1-3):174-83. J Psychiatr Res. Once a therapeutic level and response to the mood stabilizer are attained, an antidepressant may be considered as additional treatment needed for the current state of depression, with close monitoring for antidepressant-induced mania. [29, 9, 57] In family and individual sessions, medication issues and compliance should also be addressed so that optimal care can be attained in the outpatient setting. However, this agent should be used carefully in patients with bipolar disorder because of its long half-life and because of its potential to cause significant weight gain and/or to exacerbate manic symptoms. [Medline]. T1 - Treatment of pediatric bipolar disorder. Many people with bipolar disorder need to take medication for long periods (over several years) to best combat the illness. Effects of Family-Focused Therapy vs Enhanced Usual Care for Symptomatic Youths at High Risk for Bipolar Disorder: A Randomized Clinical Trial. Though this isn't always easy, the benefits of the medication far outweigh the inconvenience and possible side effects. [Full Text]. [Medline]. Youths with this disorder are at risk for poor long-term outcomes, but with careful screening, clinicians may be able to detect early signs or subthreshold symptoms and provide a timely diagnosis and effective treatment. Biederman J, Faraone S, Milberger S, Guite J, Mick E, Chen L, et al. Efficacy of aripiprazole adjunctive to lithium or valproate in the long-term treatment of patients with bipolar I disorder with an inadequate response to lithium or valproate monotherapy: a multicenter, double-blind, randomized study. Correll CU. Current research in child and adolescent bipolar disorder. 7 (1):e1011. [Medline]. American Psychiatric Association. 99:50-61. [Medline]. /viewarticle/443970 Can J Psychiatry. [Medline]. 9(5):e96905. Learn more about psychiatric medications. [Medline]. [Medline]. 2006 Jul. Chicago, IL: The 153rd Annual Meeting of the American Psychiatric Association; May 14, 2000. There is no cure for bipolar disorder, but with effective treatment (therapy and medications) it is possible for children to live normal lives. J Am Acad Child Adolesc Psychiatry. [66, 32, 67], Therapy with atypical antipsychotics may predispose to neuroleptic malignant syndrome (NMS) in children and adolescents; patients should be closely observed for such effects. Evaluation and comparison of psychometric instruments for pediatric bipolar spectrum disorders in four age groups. Although electroconvulsive therapy (ECT) is well documented as an effective and safe treatment option in patients with depressive or psychotic states, most clinicians do not consider it a first-line intervention in children or adolescents. A pilot study of antidepressant-induced mania in pediatric bipolar disorder: Characteristics, risk factors, and the serotonin transporter gene. [Medline]. [Medline]. Chang K, DelBello M, Garrett A, Kelley R, Howe M, Adler C, et al. Neurofunctional Correlates of Response to Quetiapine in Adolescents with Bipolar Depression. J Clin Psychiatry. In the ideal situation, these professionals work together in a team approach so optimal care can be attained in the medical, educational, family, and social realms. Abnormal Functional Connectivity Between Default and Salience Networks in Pediatric Bipolar Disorder. Pavuluri MN, Passarotti A. Neural bases of emotional processing in pediatric bipolar disorder. Learn about bipolar disorder. 198(4):284-288. Goldstein TR, Birmaher B, Axelson D, Goldstein BI, Gill MK, Esposito-Smythers C, et al. During the last 10 years, there has been a significant increase in the number of children diagnosed with bipolar disorder. In those whose condition does not respond to lithium, sodium divalproex is generally the next agent of choice. Role of omega-3 Fatty acids in the treatment of depressive disorders: a comprehensive meta-analysis of randomized clinical trials. Hippocampal subfield volumes in children and adolescents with mood disorders. [Medline]. Wozniak J, Biederman J, Mick E, Waxmonsky J, Hantsoo L, Best C, et al. [Medline]. Special precautions must be taken when one doses psychiatric medications to treat adolescents and children to achieve therapeutic effect while staying safely below toxic levels. 112700. It is believed to provide protection against suicidality similar to that provided by lithium; however, it should not be a first-line medication, because of the significant risk for agranulocytosis and the resulting need for frequent hematologic monitoring. These links are provided as a resource. [Medline]. [Full Text]. [Medline]. We typically treat bipolar disorder through a combination of: Children's approach to mental health care is evidence-based—which means that our treatments have been tested and proven effective through scientific studies, both here at our hospital and by other leading institutions worldwide. Our experienced psychiatrists, psychologists, social workers and nurses understand the wide-reaching impact of a child's bipolar disorder, and we will give your child and family all of the tools you need to manage your unique situation. Goldberg JF, Harrow M. A 15-year prospective follow-up of bipolar affective disorders: comparisons with unipolar nonpsychotic depression. Arlington, VA: American Psychiatric Publishing. 2010 Mar 5. Am J Psychiatry. Medscape Medical News. Dickerson F, Gennusa JV 3rd, Stallings C, Origoni A, Katsafanas E, Sweeney K, et al. Consultations with a neurologist, nephrologist, cardiologist, or endocrinologist may be needed if the patient fails to respond to first-line treatment or develops complications or adverse reactions to medications. [Medline]. Pine DS, Guyer AE, Goldwin M, Towbin KA, Leibenluft E. Autism spectrum disorder scale scores in pediatric mood and anxiety disorders. BMJ. Psychiatry Res. [75], Family Focused care also appeared to delay episodes of bipolar depression as compared to regular enhanced care. [63]. 2007 Mar. A randomized controlled trial of risperidone, lithium, or divalproex sodium for initial treatment of bipolar I disorder, manic or mixed phase, in children and adolescents. 46(3):341-55. Medication should be started only after informed consent is obtained. [Medline]. Youth with bipolar disorder are most often treated in outpatient mental health clinics. Medication Treatment for the Treatment of Childhood Bipolar Disorder Most children with bipolar disorder are treated with medications, whether inpatient or outpatient (treatment while the child lives at home). J Affect Disord. Randomized controlled trials have recommended individual cognitive behavior therapy in children and adolescents to focus on suicide prevention, as well as to monitor and manage medication if family conflict and negative expressed emotions are absent. Correll CU, Olvet DM, Auther AM, et al. 163(7):1179-86. [Medline]. 2012 May. Dialogues Clin Neurosci. [Medline]. 2019 Nov 22. [Medline]. [Full Text]. 69(5):515-28. Pediatric treatment guidelines have evolved on the basis of empirically derived plans. 2008 Jun 1. He also provided an overview of bipolar disorder treatment for youth via a three-pronged approach: medications, educational interventions and psychotherapy. Coping with bipolar disorder can be challenging. Adequate protein intake may be protective of cognitive function in bipolar disorder. [64, 66, 62] An antidepressant with a potentially lowered risk of inducing mania is bupropion (Wellbutrin). Stay focused on your goals. [Full Text]. 2011 Mar. For almost 60 years, the Department of Psychiatry at Boston Children's Hospital has been a leader i in the mental health care of children, adolescents and their families, delivering leading-edge care, research and advocacy. Risperidone and divalproex differentially engage the fronto-striato-temporal circuitry in pediatric mania: a pharmacological functional magnetic resonance imaging study. 2009 Jul. [68], Caution should be used when anticonvulsants and atypical antipsychotics are administered together because of the increased risk of hematologic side effects. Benzodiazepines, such as clonazepam (Klonopin) and lorazepam (Ativan), are generally avoided in children because of the long-term risk of dependence, but they may be temporarily useful (< 2 wk maximum) in restoring sleep or in modulating irritability or agitation not caused by psychosis. An important consideration with atypical antipsychotics is the potential for weight gain and metabolic syndrome. 173 (7):695-704. Risk for bipolar disorder is associated with face-processing deficits across emotions. Psychol Med. [Medline]. FDA Drug Approvals, Psychiatry — 2019 Midyear Review, Billions of Years Old, Lithium Still Has a Promising Therapeutic Future, Launching From an Unstable Platform: Bipolar Depression in Adolescents and Young Adults, Global Experts Map the Latest in Bipolar Management, Seasonal Affective Disorder (SAD): Facts and Misconceptions, Repurposed Antidepressant Shows Early Promise in COVID-19, From Cradle to Grave, Alcohol Is Bad for the Brain, Psilocybin Delivers 'Remarkable' Relief in Severe Depression, The Secret Behind Cocoa's Brain-Boosting Ability, Simple Language Test May Predict Alzheimer's Years Before Symptoms, Lithium Resistance in Bipolar Tied to Deficient Gene Expression. Clin Psychopharmacol Neurosci. Eur Neuropsychopharmacol. J Clin Psychiatry. 2014 Jan 9. Y1 - 2011/3. Supportive psychotherapy or psychoanalysis should be reserved for individuals who are more likely to respond to those therapies. Doyle AE, Wozniak J, Wilens TE, Henin A, Seidman LJ, Petty C, et al. 164(4):537-9. Omega-3 fatty acid monotherapy for pediatric bipolar disorder: a prospective open-label trial. 2007 Dec. 46(12):1532-72. Hooley JM, Miklowitz DJ. J Psychiatr Res. 53 (4):408-16. 2017 Jan. 2 (1):85-93. Am J Psychiatry. Share cases and questions with Physicians on Medscape consult. Calcium channel blockers (Verapamil), angiotensin-converting enzyme (ACE) inhibitors, and phenytoin (Dilantin) may be helpful in some individuals but have not been proven effective and have not been tested in children or adolescents for use in bipolar disorder. Familial transmission of suicidal behavior: factors mediating the relationship between childhood abuse and offspring suicide attempts. Overview of studies of microbiome in schizophrenia and bipolar disorder.e glycoproteins with assembled cytoskeletal proteins in concanavalin A-activated rabbit platelets. PLoS One. , Yurgelun-Todd DA, Yu H, Cao B, Brent DA trans-diagnostic with... 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