ACAMH is delighted to have the privilege of introducing world-renowned researchers and clinicians, working in the field of mood disorders, for the 2024 Emanuel Miller International Conference.

About the Conference

Following seminal studies and the publication of clinical guidelines, recognising and treating mood disorders in children and young people continues to improve. However both depressive disorders and bipolar early onset disorders often go unrecognised with current and long-term adverse consequences in interpersonal, social, educational and occupational functioning. Even when treated, 30-40 percent of young people do not respond to clinically recommended first line treatments for depression. Equally, Bipolar Disorders are still not timely diagnosed and evidence from long term studies points to the importance of early recognition and treatment.

This conference will address the recognition and diagnosis of mood disorders in children and young people, revisit postulated mechanisms and risk factors, refer to major treatment trials and treatment guidelines, address the complexity of treating co-morbid conditions, offer treatment algorithms and provide an update on our understanding of the early onset, and the often resistant to treatment, of the chronic and recurring nature of mood disorders.

Who should attend

This meeting will be of interest to practicing mental health workers from a range of professions, researchers, and neuroscientists. As always we welcome those with lived experience and members of the public.

Confirmed Speakers

Professor Boris Birmaher, Professor Bernadka Dubicka, Professor Argyris Stringaris, Professor Valeria Mondelli, Dr. Matthew Hodes, Professor Andrea Cipriani, Dr. Rasim Somer Diler, Associate Professor Meredith Gunlicks-Stoessel, and Dr. Victoria Pile.

About the talks

Professor Boris Birmaher ‘The Challenging of Diagnosing Pediatric Bipolar Disorder’

Bipolar Spectrum disorders (BD) is a recurrent illness that often onsets during adolescence but can also be present in prepubertal children. The symptoms of BD in youth are like those in adults but given the psychosocial developmental stage of the child which affects how the mood symptoms are manifested and expressed by the child, the presence of comorbid disorders, and the high prevalence of subsyndromal and mixed and rapid cycling presentations, the differential diagnosis of BD among youth can be very challenging. Early onset BD is associated with poor prognosis and high risk for suicidality, substance abuse, poor psychosocial functioning (e.g., academic, work, relationships with family and friends), physical/sexual abuse, legal problems, and medical complications. Thus, given the deleterious effects of this illness, it is crucial to correctly identify BD in youth and appropriately treat it. However, unfortunately it can take 5-10 years from the onset of mood symptoms until the correct diagnosis of BD is made.

During this presentation the phenomenology, differential diagnosis, inheritance, and course of pediatric bipolar will be presented. Diagnostic “pearls” for the early identification of this disorder in youth will be discussed.

Learning objectives

1. To understand the prevalence and importance of correctly diagnosing and treating youth with bipolar spectrum disorders (BD)
2. To discuss the differential diagnosis of BD in youth
3. To discuss the course and outcome of BD in youth
4. To recognize the demographic, clinical, familial, and genetic risk factors associated with increased risk to develop BD.
5. To be aware of the clinical and treatment implications of the above findings

Professor Andrea Cipriani ‘Antidepressants in Children and Adolescents: Meta-Review of Efficacy, Tolerability and Suicidality in the Acute Treatment’

Antidepressants are prescribed for the treatment of a number of psychiatric disorders in children and adolescents, however there is still controversy about whether they should be used in this population. During this talk I will present and update the findings from a study we carried out in 2020 assessing the effects of antidepressants for the acute treatment of attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, autistic spectrum disorder, enuresis, major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD) in children and adolescents. Efficacy was measured as response to treatment (either as mean overall change in symptoms or as a dichotomous outcome) and tolerability was measured as the proportion of patients discontinuing treatment due to adverse events. Suicidality was measured as suicidal ideation, behavior (including suicide attempts) and completed suicide. The scientific literature was systematically searched for existing systematic reviews and/or meta-analyses of double-blind randomized controlled trials. The quality of the included reviews was appraised using AMSTAR-2. Compared to placebo, selected antidepressants can be efficacious in the acute treatment of some common psychiatric disorders, although statistically significant differences do not always translate into clinically significant results. Little information is available about tolerability of antidepressants and on suicidal ideation/behavior. Findings from existing literature must be considered in light of potential limitations, such as the lack of comparative information about many antidepressants, the short-term outcomes and the quality of the available evidence.

Learning objectives

1. To understand systematic reviews and meta-analyses
2. To appraise the quality of evidence from randomised trials and systematic reviews.
3. To critically interpret the findings about the use of antidepressants with children and adolescents

Dr. Rasim Somer Diler ‘Differential Diagnosis of Bipolar vs Unipolar Depression in Youth’

About 20% of youth develop functionally impairing depression that substantially increases the risk for suicidality and hampers normal development. However, depression is a heterogeneous condition with various degrees of severity and different etiological mechanisms. Furthermore, less than two-thirds of depressed youth respond to treatment interventions and still had high risk for relapses despite ongoing treatment. Recent findings have demonstrated substantial co-occurrence of cognitive difficulties and mixed manic features during depression that brings up significant diagnostic and treatment challenges. Furthermore, some depressed youth, especially those with family history of bipolar disorder, can develop manic episode in few years that complicates the treatment interventions. Youth with higher risk are those with mania, agitation, of baseline suicidal ideation, and they should be monitored closely with close parental guidance. In this symposium, Dr. Diler from the US will review diagnostic and treatment difficulties of mixed manic features of unipolar and bipolar depression in youth. This talk will allow enough time for questions and help improve understanding and practice of diagnosis and treatment of pediatric depression.

Learning objectives

1. Identify key clinical features of depression and mixed features for accurate mood disorder diagnosis
2. Differentiate mixed mood presentations in youth from other common psychiatric diagnoses
3. Identify appropriate instruments for monitoring youth for possible bipolar spectrum disorders

Professor Bernadka Dubicka ‘Coping with demand: brief interventions in adolescent depression and the UK BAY trial’

The prevalence of emotional disorders in young people has been increasing in the UK, and other countries, leading to an increased demand on services, together with workforce shortages. Depression is a serious condition in young people, and intervening early is important to prevent disabling consequences. There is evidence from previous UK adolescent depression trials that specialist psychological interventions are not always required and good quality clinial care can be as effective as a first-line treatment. Evidence from adult depression trials has also found that behavioural activation (BA) can be as effective as more complex cognitive behavioural therapy, and that this can be delivered equally effectively as a first-line treatment by non-specialist practitioners. In England, as in many other countries, there is a long wait for specialist therapies in Child and Adolescent Mental Health Services (CAMHS) due to a limited workforce, however, there is greater access to non-specialist practitioners, such as psychology graduates. The UK National Institute of Mental Health Research funded BAY trial (Behavioural Activation for depressed Young people, NIHR132808) is recruiting adolescents with depression who have been referred to CAMHS; participants are randomised to receiving blended BA as a first-line intervention by non-specialist practitioners or routine care. All young people are given information about depression. The trial commenced in June 2022 and is due to end in 2026. A website for our values-based BA program has been developed with animations in conjunction with young people. Participants choose whether to have the therapist-led intervention delivered in clincs or remotely. Our feasibility study found that the intervention was acceptable to young people and clinicians, and improved depressed mood and impairment; in addition, 36% of participants could be discharged from CAMHS, therefore, BA may potentially be a cost-effective first-line therapy in CAMHS.

Learning objectives

1. Understand the increase in prevalence and demand for CAMHS for adolescent depression.
2. Understand the evidence base for good clinical care and brief interventions for adolescent depression in CAMHS.
3. Understand the rationale for the BAY trial.

Associate Professor Meredith Gunlicks-Stoessel ‘Updates on Interpersonal Psychotherapy for Children and Adolescents’

Interpersonal psychotherapy (IPT) is a well-established evidence-based intervention for youth with depression that aims to decrease depressive symptoms by helping youth improve their relationships and interpersonal interactions. While decades of research have demonstrated the positive effects of IPT for youth, like all evidence-based programs (EBP), not all youth who receive IPT will respond. Additional challenges exist with regard to facilitating the availability of EBPs, including IPT, for all youth who need them, particularly in under-served and low-resource communities. To realize the potential of EBPs for addressing the increasingly prevalent mental health needs of youth, strategies are needed to enhance the effects of these interventions and facilitate their dissemination and implementation. The objectives of this presentation are to present research that describes new approaches for optimizing IPT outcomes for youth and increasing the reach of IPT in diverse communities. Recommendations and future directions will also be discussed.

Learning objectives

1. Understand the evidence-base for IPT adaptations for youth.
2. Understand new approaches for adapting and personalizing depression interventions for youth, including IPT.
3. Understand new approaches for implementing IPT with youth in diverse communities.

Professor Valeria Mondelli ‘Mechanisms underlying depression: immunopsychiatry’

Recent research suggests that inflammation and activation of the immune system contribute to the development of depression. However, the majority of studies have been conducted in adult populations and it remains still unclear whether inflammation is relevant biological mechanism for onset of depression in adolescence and whether it could be considered as a viable target for early intervention (prevention and treatment). In this talk, I will present work from the Identifying Depression Early in Adolescence (IDEA) project, first presenting the IDEA composite risk score for the development of depression in adolescence that we have generated using 11 sociodemographic variables. I will then move on to presenting evidence from our systematic review of the literature on role of inflammation in development of depression in adolescence and the importance of the interaction between biological and socioenvironmental risk factors for adolescent depression. I will then present novel findings from the IDEA study investigating inflammatory markers in a cohort of adolescents stratified for increased risk or presence of depression and discuss potential ways forward for early intervention.

Learning objectives

1. To understand the role of inflammation in the development of depression.
2. To understand the importance of the interaction between socioenvironmental and biological risk factors for adolescent depression.
3. To understand the potential use of inflammation as a target for development of future prevention and early intervention strategies.

Professor Argyris Stringaris ‘Fundamental Problems with the Evidence Base for Adolescent Depression Treatments’

A key clinical question asked by patients and their parents is: medication or psychotherapy (or both) for me/my child? Answering this question is far from straightforward. Guidelines for the treatment of adolescent depression and clinician decision making rely on indirect comparisons between medication and psychotherapy. IO will show that they are based on highly-problematic assumptions about comparability of a) the populations in question; b) the control groups used as comparators. I will describe the problems in clinical/conceptual and statistical terms.

Learning objectives

1. To understand the concept of indirect comaprisons
2. To recognise the flaws of current comparisons
3. To equip clinicians with making comparisons themselves

Dr. Matthew Hodes ‘The ongoing importance of social disadvantage in depression in young people’

This talk will address selectively some of the ways social disadvantage is related to depression in young people, and the implications for policies that promote better mental health. Firstly I discuss the link between poverty and depression, and consider whether depression prevalence can reduced by increasing family incomes. Secondly I discuss some extreme consequences of poverty such as homelessness. Thirdly I discuss depression and mental health issues in asylum seekers and refugees many of whom experience financial hardship, and are a vulnerable group in resettlement countries. Finally I comment on the public health policies that would most likely go some way to prevent depression.

Learning objectives

1. To understand the complex link between depression and poverty in young people
2. To understand how refugee experiences and financial hardship may be associated with depression.
3. To be aware of evidence-based policies that could prevent depression

Dr. Victoria Pile ‘Harnessing Mental Imagery to Develop Early Interventions for Adolescent Depression’

When depression begins in adolescence, rather than adulthood, it is associated with more recurrences and an increased risk of chronicity. The long-lasting and severe outcomes associated with adolescent depression might be prevented through intervening earlier. However, current psychological interventions can be difficult to access and suboptimal. One promising approach could be to harness emotional mental imagery. Young people tell us that their emotional imagery is an important part of their mental landscape but is not often targeted in therapies. Using psychological techniques to work with mental imagery – including distressing past images or a lack of positive future imagery – could be a novel and effective approach to reduce depression. Using co-design methodology, we have developed novel imagery-based interventions to target these mechanisms in different age groups. In this presentation, I will describe the evidence-base for imagery-based interventions in young people, the co-development of two interventions, and their evaluation in feasibility randomised controlled trials.

Learning objectives

1. To define emotional mental imagery and consider the importance of addressing mental imagery in treatments.
2. To understand the range of imagery-based intervention techniques available and the relative promise of these techniques.
3. To learn about the co-develop of an imagery-based protocols for adolescent depression and their initial evaluation.

 

About the Speakers

Professor Bernadka Dubicka is the editor in chief of the Child and Adolescent Mental Health journal, a professor at the University of York, and a consultant psychiatrist in the Greater Manchester Mental Health Trust. She is a past chair of the Royal College of Psychiatrists Child and Adolescent faculty, which involved national policy and media work, including the impact of the ecological crisis and technology on mental health. Her research interests include mood disorders with expertise in brief interventions and large depression trials. She is currently the chief investigator of an NIHR trial of Behavioural Activation, the BAY trial.

Professor Argyris Stringaris is the head of the Mood in Neurodevelopment (MIND) Unit at UCL. As a Clinician Scientist, he studies mood and the mechanisms that lead to depression, particularly in adolescents. His clinical interest is in depression and severe irritability (emotion dysregulation). He was, until recently, Senior Investigator and Chief of the Section of Clinical and Computational Psychiatry at NIMH/NIH in the USA and before that a Senior Lecturer and a Wellcome Trust Fellow at the Institute of Psychiatry Psychology and Neuroscience, King’s College London. He trained in Child and Adolescent Psychiatry at the Maudsley Hospital. He is the President of the International Society for Research in Child and Adolescent Psychiatry.

 

Professor Valeria Mondelli is a Clinical Professor of Psychoneuroimmunology at Professor Valeria Mondellithe Institute of Psychiatry Psychology and Neuroscience, King’s College London and Honorary Liaison Consultant Psychiatrist at King’s College Hospital. Prof Mondelli’s research interest focuses on the interplay between physical and mental health and on the role of biological systems involved in the stress response in the pathogenesis of psychiatric disorders, in particular psychosis and depression. She has led the Identifying Depression Early in Adolescence (IDEA) project, an international global mental health project aiming to identify adolescents at high risk of depression at an early stage with the ultimate goal of reducing the onset of depression in adolescence. She has particularly focused her research in understanding how the brain and body respond to traumatic events during childhood and how these responses may contribute to the onset of mental health problems later in life. She has received various awards, including the 2018 Emerging Leaders in Adolescent Mental Health Prize by the Medical Research Foundation. Prof Mondelli is currently the co-lead of the recently funded NIHR SLaM BRC Research Theme on Psychosis and Mood Disorders. She is currently Associate Editor of the journal Brain Behaviour and Immunity, the leading scientific journal in her area of research (psychoneuroimmunology). She has published over 200 scientific publications (Scopus H index: 54) and she is one the 2020, 2021, 2022 and 2023 Highly Cited Researchers (Clarivate, Web of Science).

Dr. Matthew Hodes is currently Consultant in Child and Adolescent Psychiatry at Westminster CAMHS, CNWL NHS Foundation Trust, in the Emotional Disorders and Paediatric Liaison Teams. Also Honorary Senior Lecturer in Child & Adolescent Psychiatry, Division of Psychiatry, Imperial College London and visiting researcher at the Department of Child Psychiatry, University of Turku, Finland. Recent research in young refugees’ mental health.

Dr. Rasim Somer Diler serves as a researcher, clinician and a teacher at the inpatient and outpatient Child and Adolescent Bipolar Services. Dr. Diler’s research has focused on the assessment, treatment, etiology (e.g., disease- and treatment-specific biomarkers) of depressive and bipolar disorders in youth. Dr. Diler has developed expertise in mood disorders and contributed to the field with over 100 peer-reviewed publications and over 90 presentations at national and international meetings, where I served on multiple advisory and scientific boards. Dr. Diler is currently serving as the Principal Investigator for two translational longitudinal imaging studies and site-PI for a multi-site study of machine learning approaches for school violence. Dr. Diler is committed to pursue his research interests in understanding neurodevelopmental trajectories of bipolar disorder and searching for neural markers that can differentiate bipolar disorder early in life.

Professor Andrea Cipriani is Professor of Psychiatry at the University of Oxford and honorary consultant psychiatrist in the NHS. As a clinical academic, his research focuses on the evaluation of treatments in mental health, mainly mood disorders and schizophrenia. His interest in evidence synthesis has now a specific focus on data science and precision mental health, trying to assess the validity and interpretation of innovative statistical and machine learning approaches to better inform the decision-making process between patients and clinicians to personalise treatment in routine clinical care. He is currently Director of GALENOS (Global Alliance for Living Evidence on Anxiety, Depression and Psychosis – funded by the Wellcome Trust), Director of the NIHR Oxford Health Clinical Research Facility, Lead of the Data Science Theme of the NIHR Oxford Health Biomedical Research Centre and Editor-in-Chief of BMJ Mental Health.

Dr. Victoria Pile is a Clinical Psychologist and Lecturer in Clinical Psychology. She currently holds an Advanced Fellowship from the National Institute for Health Research (NIHR). Victoria’s programme of clinical research focuses on addressing the need for effective early interventions for depression and anxiety in young people. She aims to co-design accessible psychological interventions with young people and practitioners. Her interests lie in identifying and then targeting key cognitive mechanisms implicated in depression and anxiety. For example, IMAGINE is a brief, school-based intervention that harnesses emotional mental imagery to reduce depression. Clinically, Victoria has primarily worked in CAMHS services, including national and specialist services and CYP-IAPT. Victoria has experience in both teaching and supervising CBT and third-wave therapies, as well as supervising PhD students and trainees on the doctorate in clinical psychology. In addition, Victoria co-leads a multi-disciplinary special interest group for adolescent depression, funded by Emerging Minds (UKRI).

Associate Professor Meredith Gunlicks-Stoessel, PhD, LP is a practicing clinical child psychologist and Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Minnesota. Her research focuses on the development of new methods of delivering more effective, personalized, and responsive care for youth with depression. Dr. Gunlicks-Stoessel is certified in interpersonal psychotherapy (IPT) as a therapist, supervisor, and trainer. She has conducted clinical trials that have included IPT, and she has written numerous publications on IPT and interpersonal mechanisms of risk and treatment response.