The article describes ‘The Course and Outcome of Bipolar Youth (COBY)’ study on children and adolescents with Bipolar- I (BP-I), Bipolar- II(BP-II) and Bipolar disorder not otherwise specified (BP-NOS).It was aimed at studying the similarities and differences of various manic symptoms among BP-subtypes and adding further data to the related previous findings. Much interest was centered on the BP-I disorder and the reasons for the ineligibility of subjects to meet the DSM-IV criteria for BP-I. The article also suggests a follow-up study to determine, whether or not, BP-NOS subjects transform to DSM-IV BP-I.
BP-I subjects are well represented with psychological illness history and manic symptoms for a prolonged period in contrast to BP- NOS subjects. However, BP-NOS subjects share some of the pathogenic complications characteristic of BP-I. Hence, it seems right that the conclusion has made a positive link between BP-NOS subjects and youth with BP-I.
Similarly, although the association of BP-II subjects with that of BP-I was clear, there is no projection for a future study. This may be because the majority of subjects with BP spectrum of illness, particularly BP-NOS are failing to be grouped under DSM-IV category for BP-I. Therefore it makes sense that the conclusion has reflected on what kind of upcoming projects have to be undertaken.
Further, only mood elevation seems to be common in all the three BP-subtypes. It indicates that other symptoms might show a variation. It can be concluded from the results that subjects with BP-NOS can be grouped or identified as BP-I, provided if they meet the criteria of DSM-IV. High anxiety disorders were very particular to BP-II. Psychiatric hospitalization is another key parameter unique to BP-I. Hence a wide spectrum of illness factors need to be considered for BP –disorders.
We can also conclude that research methodologies adapted in the study need to be refined. It raises a question that why the general or mass sampling was not taken into consideration while selecting the subjects. AS BP-I seems to be a major health problem in the society, vigorous epidemiological surveys might be required to identify the victims with BP-spectrum illness and subsequently include them under BP-I category.
BP-I subjects meeting the DSM –IV criteria need to be regularly monitored by a child psychiatrist. This could assist in better understanding the longevity of the manic symptoms.
Subjects with disorders related to depression, conduct, suicide attempt etc, are common in the society and could be easily identified for BP-spectrum illness.
As more number of young children is susceptible to BP, prior importance should be given to the age factor and strictly followed. It could be better if the study throws some light on the current therapies in progress at the clinical centers.
Because the conventional method of sampling and diagnosing is a cumbersome and laborious, more advanced strategies need to be implemented. It would be an added advantage if a concomitant future research was undertaken to identify potential serological or molecular markers for rapid diagnosis.
Blood brain barrier or Blood-CSF (Cerebrospinal fluid) barrier is a vital component of the central nervous system. Understanding its structural and functional integrity might furnish better insights on the pathophysiology of psychic disorders. Similarly, an analysis of cerebrospinal fluid components such as albumin, immunoglobulin levels and some metabolites, could be an added advantage because they might exhibit some alterations.
Neuroimmunolgy should also become another research interest for today’s psychiatrsts to resolve the mysteries associated with BP-disorders.
From the above description it was learnt in sequence that diseases especially, BP-I, are causing serious health concern and should be given due importance while undertaking a research project. BP-I is a kind of psychiatric disorder characterized by good number of manic symptoms and their long term duration.
If a particular disease has more than one subtype, comparative studies are required largely to know about the uniqueness and the degree of variation of a particular symptom, say elated mood, in the present case.
For a compelling evidence, there may be a need for huge data from a large number of studies. Therefore projects have to written with the objective of obtaining further data and strengthening the previous studies. Studies requiring large number of subjects need to prefer mass sampling as they may give better results than that of clinical programs. Similarly, such studies also require the help of good statistical analysis. It is imperative that the selection of subjects done under the supervision of an experienced clinician.
It is very essential for the investigator to strictly follow diagnostic criteria set by an authorized international committee during selection procedure.
This is not only the case in the present study. For example to diagnose type 1 and type 2 diabetes mellitus, a severe metabolic disorder, the researchers need to abide by the criterion set by the expert committee on the diagnosis and classification of diabetes mellitus, during the selection procedure. There is a need for clinical studies to get confined to single reliable research methodology.
Further, follow up studies are necessary while considering the long duration symptomology. In addition, whenever there is ambiguity in understanding a particular disease, confirmation studies may be required in order to add further data The more complicated a study the more would be complexity involved in a research methodology.
Reference
David Axelson, Boris Birmaher, Michael Strober, Mary Kay Gill, MSN, Sylvia Valeri, Laurel Chiappetta, Neal Ryan, Henrietta Leonard, Jeffrey Hunt, Satish Iyengar, Jeffrey Bridge, Martin Keller. (2006).Phenomenology of Children and Adolescents With Bipolar Spectrum Disorders.Arch Gen Psychiatry, 63, 1139-1148. Web.