Dr. Demitri Papolos, M.D. is an associate professor of psychiatry at the Albert Einstein College of Medicine in New York City, where he is the co-director of the Program in Behavioral Genetics. He has been a recipient of an NIMH Physician/ Scientist Award as well as a NARSAD Independent Investigator Award, and his research findings have been published in the American Journal of Psychiatry, the American Journal of Human Genetics, Molecular Psychiatry, and the Journal of Affective Disorders, among others.

In 2001, Dr. Papolos became the director of research of the Juvenile Bipolar Research Foundation (JBRF) where he established a consortium of clinical and basic researchers from medical centers across the country in order to focus on the root causes of childhood-onset bipolar disorder. These investigators are currently conducting studies in the fields of phenomenology, neuroimaging, neuropsychological testing, and molecular genetics. ) Recent work published by Demitri Papolos, M.D. and his JBRF colleagues may be viewed here

Because thousands of families have completed the online screening instruments developed by Dr. Papolos, JBRF has been able to assemble the largest clinical database in the world of children with, or at risk for, bipolar disorder. Moreover, these diagnostic instruments are available in multiple languages and are being used by clinics in this country and abroad.
The Child Bipolar Questionnaire
The Jeannie and Jeffrey Interview for Children

Dr. Papolos is the co-author of Overcoming Depression, Third Edition (HarperCollins, 1997) the most comprehensive book written for the lay person on depression and manic-depression, and which is also published in Italy and Poland. He is co-editor of the book, Genetic Studies in Affective Disorders (Wiley-Interscience, 1994) and was formerly associate editor of the Einstein Publication Series in Experimental and Clinical Psychiatry.

Demitri F. Papolos, M.D. is one of a handful of psychiatrists in the world who began to see and to speak out about the possible deleterious effects of antidepressants and stimulants in the population of children within the bipolar spectrum. His extensive work with youngsters with the condition and their families, led him to team with his author wife, Janice Papolos, to write the first book ever published on the subject of early-onset bipolar disorder, The Bipolar Child. In its first and second editions, the book returned to press 23 times and third edition was published in 2006.

Dr. Papolos has been featured on ABC News’s 20/20, the Oprah Winfrey Show, and National Public Radio’s “All Things Considered” and The Infinite Mind,” as well as CBS’ “Early Show” and The Evening News With Dan Rather.

Dr. Papolos earned his undergraduate degree at Harvard and completed his medical training at New York Medical College and the New York State Psychiatric Institute at Columbia Presbyterian. He is in private practice in New York City and Westport, Connecticut.

We have been honored to have four outstanding interviews with Dr. Papolos discussing his Fear Of Harm Phenotype and Ketamine study.  Listen any time by clicking on the Blog Talk Radio player box

First Interview:

Alissa Bronsteen Director of the Juvenile Bipolar Research Foundation and Dr. Demitri Papolos author of The Bipolar Child join us to announce the latest in research and breakthroughs in treating childhood bipolar disorder


Second Interview

What is the Fear Of Harm Phenotype – Dr Demitri Papolos author of The Bipolar Child and Executive Director of Research at the Juvenile Bipolar Foundation joins us again with Executive Director Inger Sjogren to discuss the latest in child bipolar research and the Fear Of Harm phenotype. The FOH phenotype will change the way clinicians and researchers look at this complex disorder and redirect the focus on this disorder. Dr Papolos was our guest previously and was one of our most listened to and applauded interviews.

Third Interview

A novel phenotype, cutting edge research and the passion and dedication of Dr Papolos and his team have given children with bipolar disorder and their families hope and promise with their findings and pilot study.

Listen to Dr Papolos and Inger Sjogren, executive director on their third appearance with updates and an exciting announcement.

Fourth Interview

Dr Papolos author of The Bipolar Child and Research Director of the Juvenile Bipolar Foundation and Alyssa Bronstein returns to discuss The Fear of Harm Phenotype. The Fear Of Harm phenotype is not a new definition of bipolar disorder but a distinct, neurologically-based disorder which can explain the symptom profile of many who are “bipolar” and some, but not all, who have other conceptual diagnoses such as ADHD, depression, anxiety.

In our first three intervies we discussed at length child bipolar, the fear of harm phenotype and the cutting edge research that is giving us answers to so many questions about these struggling children and teens.

In this final interview we also meet a parent involved in the Ketamine study and how it has transformed their child.


THE FEAR OF HARM PHENOTYPE

Description of the Condition

Sleep, Activity Patterns and Temperature Study
Physiological Marker for a Psychiatric Condition?
The findings of an NIMH funded study, Sleep, Activity Patterns, and Temperature Study conducted by JBRF researchers provides evidence for what may be the first physiological marker for a psychiatric syndrome. Why is this important to the JBRF community? Because it narrows the focus of our research to specific pathways in the brain, and may lead to novel treatment approaches.

Children who have the Fear of Harm type of bipolar disorder exhibit symptoms that reflect high levels of fear as well as defensive or reactive aggressive behaviors, and dramatic shifts in states of arousal: intense fear of harm coming to self or others, territorial aggression, carbohydrate craving/hoarding, disturbances in sleep onset and sleep offset, parasomnias (arousal disorders of sleep), as well overheating despite neutral ambient temperature.

The children who fit this phenotype share some common traits: they have difficulty settling at night and difficulty getting to sleep once in bed, they sleep fitfully and/or awaken throughout the night, and they have difficulty arising in the morning. A growing body of research has demonstrated that all of these sleep-related issues are associated with disruptions in thermoregulation. While the relationship between the ability to sleep well and body temperature has long been known, a robust series of recent research studies has shown that when temperature regulation is disrupted, problems with both sleep and arousal/wakefulness occur.

Now, for the first time, we have data showing that: thermoreguation is dysregulated in children with FOH, and sleep quality is disturbed as a result. In this study, children with the FOH phenotype were compared with healthy control children. The investigators found that an inability to dissipate heat at bedtime was strongly correlated with sleep onset latency. Skin temperature from the chest and from the lower leg were measured throughout the night, and the gradient, or difference, between these temperatures was calculated each minute. The childrens’ sleep was recorded using wrist-worn activity monitors. Typically, when a person lays down for bed, leg temperature will increase in parallel with decreases in chest temperature, as the thermoregulatory center in the brain sends a signal to the peripheral nervous system that results in vasodilation and heat dissipation. As the body’s core divests more heat, and the gradient between chest and leg temperatures approaches zero degrees, sleep onset occurs.

Researchers found in this study, however, that in children with FOH, chest temperature remained high, sometimes throughout the entire sleep period, and leg temperature changed slowly relative to the comparison group. Whereas, the skin temperature gradient reached zero degrees an average of 9 minutes after bedtime in the comparison children, it took longer than an hour for children the FOH group to reach this thermoregulatory balance. Importantly, higher temperature gradients were significantly and strongly associated with the time it took to fall asleep.

These initial findings provide objective evidence for the link between temperature dysregulation, sleep/arousal issues, and emotion dysregulation that JBRF investigators theorize underlie the primary behavioral features of the disorder. Follow-up studies of this research will continue to examine the role of thermoregulation in the biological basis of the FOH type of juvenile bipolar disorder.

Proposed Treatment
As suggested by the physiological marker (skin temperature gradient) described above, investigators are exploring thermoregulatory approaches to treatment: melatonin, fans to enhance heat dissipation during sleep, and hypothermic agents.

Next Steps
JBRF has filed an IND application which was approved by the FDA to conduct a pharmaceutical study in 6-12 year olds with an agent that has hypothermic properties, ketamine, and which in animal studies also has been found to reduce fear sensitization. Researchers will conduct a double blind placebo controlled study to determine the safety and efficacy of this agent in treating children with the FOH type of bipolar disorder.

The Sleep, Activity Patterns, and Temperature Study and its promising findings were made possible by JBRF, by the National Institutes of Health, and by you, our supportive community. We are so grateful for your support and we are thrilled to present to you evidenced-based research that is advancing knowledge in the field.

The Ketamine Study – Pilot Study Video