Help for mood disorders in children

OSU researchers seek better treatments for children with bipolar and other conditions

As devastating as bipolar disorder is for adults, mental health professionals have learned much about how to treat this severe mood disorder.

But when bipolar disorder strikes in childhood, doctors are less sure about effective therapies.

Researchers at Ohio State are trying to rectify that situation with two new studies, one funded by the National Institute of Mental Health (NIMH) and the other by the Ohio Department of Mental Health.

Mary Fristad, professor of psychiatry and psychology is leading a study of a promising new treatment that could help children with early-onset bipolar disorder.   By Kevin Fitzsimons

The researchers are studying a promising new treatment called psychoeducation that they believe can help children with early-onset bipolar disorder -- also known as manic-depression -- and their families.

While there have been a few studies evaluating medication use in children, none have examined psychosocial treatments, said Mary Fristad, leader of the studies and a professor of psychiatry and psychology.

"Medications are vital for helping children with bipolar disorders, but they can't do everything," Fristad said. "We need to develop other interventions that can help children and their parents become more effective managers of this chronic illness."

The larger study, funded with a $1.7 million grant from the NIMH, is called the Multifamily Psychoeducation Group (MFPG) study. The researchers are recruiting 165 families to participate. This study will involve families with a child between 8 and 11 years old who has bipolar disorder or another major mood disorder such as depression.

The psychoeducation program involves teaching parents and children about mood disorders and skills they can use to cope, Fristad said. The program includes eight 90-minute sessions in a group setting, where children can interact with others who have their disorder, and parents can meet to discuss their common issues and problems.

Parents will learn about mood disorders, medications that are often prescribed, how to get services in school and through the mental health system, and family problems they are likely to face. They also learn skills to deal with their child's symptoms and the problems it may cause within the family.

Children learn about their condition and are taught skills to cope with symptoms such as anger and poor concentration. They also learn how to improve relations with peers and family.

"If you have your first mood disorder as an adult, you have already learned a lot of coping skills that can help you, such as how to hold a conversation and how to treat friends," Fristad said. "But when you get a mood disorder as a child, you often have never had a chance to develop these interpersonal skills. We help kids'catch up' with these skills, which in turn helps them manage their symptoms."

The group setting seems to be particularly effective, she said. In a small pilot project, Fristad and her colleagues found that children with mood disorders did extremely well together, encouraging each other and providing help and understanding.

"These are kids who often don't get along well with others at school, so it was great to see the support they give each other. And to see 8 to 11 year olds get very enthusiastic about therapy -- well, that's something that doesn't happen a lot."

One unique aspect to this study is that participants don't have to abandon or change any other treatments they currently are undergoing such as medication or special school placements, Fristad said. The psychoeducation program will simply be added to their standard therapy.

"We hope this will make the parents better consumers of care," she said. "They will be able to work better with their doctors and school officials because they'll know more about their medications and other treatments they are receiving."

Fristad said all families enrolled in the study will eventually receive the psychoeducation treatment. Half will participate shortly after enrollment. The other half will serve as a control for a year, but will then participate in the full program. Participating families will receive six assessments during an 18-month period.

The second study, funded by a $100,000 grant from the Ohio Department of Mental Health, is called the Individual Family Psychoeducation study. The treatment is similar to that in the NIMH study, but will not be done in a group setting. Fristad said this study will include 20 families -- 10 who will receive immediate treatment and 10 who will serve as controls for a year before joining the psychoeducation program. In this study, the treatment will be spread out over 16 weeks, rather than the eight weeks in the NIMH-funded study.

Another difference is this study will only accept families with a child who has bipolar disorder -- other mood disorders will not be part of this study.

Fristad said the end result of both studies should be a better understanding of how to help children with bipolar disorders and their families.

"Childhood mood disorders are a major health concern," she said. "But effective treatments, especially for early-onset bipolar disorder, have been underdeveloped and understudied. We hope to begin changing that."

Families who want to volunteer for the studies can receive a free screening evaluation to see if they qualify. Potential volunteers for the Multifamily Psychoeducation Group study should call 293-3292. Those interested in the Individual Family Psychoeducation study should call 293-9197.

Cyber security

Computer Incident Response Team is here to help

"Don't panic."

This calming message greets visitors to the Web page for the Computer Incident Response Team (OSU-IRT), the group to call if University faculty or staff members become the victims of a computer attack.

Most people don't think of OSU-IRT until an incident drives them to the aforementioned state of panic, but this division of the Office of Information Technology (OIT) is always ready to deal with security problems -- and prevent them from happening in the first place.

An attack can take many different forms, said Steve Romig, OSU-IRT manager. Criminals can use the Internet to view or steal files, or hijack University computers to commit other crimes by remote control.

Although the Sept. 11 attacks have heightened awareness about cyber terrorism, most incidents at Ohio State aren't as serious, Romig said. In the typical case, someone has stolen space on a University Web server to distribute illegal software, copyrighted music, or pornography, or has subverted University computers to attack other computers on the Internet.

"Everybody occasionally has security problems," Romig said. "It goes with the territory of having computers."

Now Romig is organizing a group of computer systems administrators from across the University to establish best practices for computer security. The group will formulate security standards tailored expressly for Ohio State. New members are welcome.

Creating standards won't be easy, however, in part because of the distributed nature of the University. Colleges, offices and academic departments create networks within networks, each with different security policies and system administrators. Even individual research groups can create their own networks.

Romig would like people to think of computer security the way they think of home security: "We don't think twice about locking our doors and windows or installing smoke alarms, because that's the safe thing to do."

But securing a computer is more complicated than locking a door, and most people don't have the expertise to handle computer security on their own. That's where OSU-IRT comes in.

Often staffers don't even know their computer has been broken into, until OSU-IRT alerts them to the problem. When that happens, Romig and his team must shut down the affected computer so it can't be used to attack the rest of the University.

For researchers, the real terror can come from the notion that an invader has viewed or altered their project data. If the research is medical, private patient data is at risk. If it's a project with a corporate partner, proprietary information may have been stolen. Shutting down the computer as soon as possible prevents further damage, and gives OSU-IRT a chance to repair the problem.

Until University-wide security standards can be established, Romig offers some advice on how to keep computers safe.

For systems administrators:

• Build a firewall around your networks. This security software can block access to unauthorized users. Someone could still try to break in, but with difficulty. "Most intruders are going after low hanging fruit," Romig said. "If they can't break in easily, they'll go elsewhere."

• Make people use passwords -- good passwords. All faculty members, staff and students with access to the network should have to use a password to sign on. Encourage them to change passwords often, and pick passwords that can't be guessed. Many criminals have software that will find accounts with passwords such as "password" or "1234."

• Patch software frequently. Once a software company discovers a security hole in one of their products, they often distribute a free patch to fix the problem.

• Turn off unnecessary network services. New computers can arrive from the manufacturer with all network services active. Each connection between the user's computer and the larger network constitutes a potential break-in point, especially if you don't know the connection is there.

"It's like someone breaking into your house through an unlocked window you never knew you had," Romig said.

All this security costs time and money. But as Romig noted, the alternative -- leaving a computer open to attack -- can prove expensive later.

Depending on the size and type of computer network, setting up a firewall can cost anywhere from $1,000 to tens of thousands of dollars for specialized hardware, plus the labor of a security expert, Romig said.

He stressed that any systems administrator can contact OSU-IRT for free advice. Extensive, hands-on assistance is available for a fee. He and his staff also can suggest commercial consultants. Individuals needing help with virus problems should either contact their local network administrator or the OIT help desk.

Individual users can help promote computer safety by following several basic rules:

• Install virus-scanning software on your computer, and update it frequently. Viruses contracted through e-mail or downloaded software can damage a computer network and open it to further attack. Anyone with an Ohio State e-mail account can obtain virus software for free from OIT's Software To Go Web site at htpp://softwaretogo.osu.edu/. Check back to download updates as they are made available.

• Don't download and run programs unless approved by your systems administrator. For instance, don't open e-mail attachments you didn't ask for. That cool new screensaver e-mailed to you by your friend may in fact be a virus, and your friend might not even have sent it. Return addresses can be faked.

• Use good passwords. Good passwords consist of a mix of upper and lower case letters, numbers and punctuation. Avoid names and common words since these are easily guessed.

• Personal firewall software is available for many systems. This can keep unauthorized people from accessing network services that are running on your computer, which they might then be able to use to gain access.

New urgent care sites open

Five new urgent care facilities in the Central Ohio area will be added to the University health plan network, beginning Oct. 1.

Having access to urgent care in the evenings and on weekends (when the primary care physician may not be available) has been a key priority for faculty and staff over the past year, according to Larry M. Lewellen, associate vice president for human resources. "The University Staff Advisory Committee recommended adding more urgent care sites to the network, and we are pleased to have been able to contract sites that will make urgent care more easily accessible in all areas of the city," Lewellen said.

The copayment for services at the new urgent care sites will be $30 per visit for members of in-network health plans (University Prime Care, OSU Health Plan, Regional University Prime Care). Out-of-network plans (OSU Health Plan, Buckeye Health Plan, Traditional Health Plan, OSU Extension Traditional Health Plan) pay applicable deductibles and coinsurance.

The new sites include:

• Northwest -- Dublin Medical Mall Urgent Care; 6350 Frantz Road, Dublin; 789-4444; 8 a.m.- 8 p.m. Mon.-Fri. and 8 a.m.-4 p.m. Sun.

• East -- U.S. HealthWorks; 5175 E. Main St.; 863-5188;8 a.m.-8 p.m. Mon.-Fri. and 8 a.m.-4 p.m. Sun.

• West Ñ U.S. HealthWorks; 85 Phillipi Road, Columbus; 274-7756; 8 a.m.-6 p.m. Mon.-Fri.

• South -- Urgent Care (Plus); 1430 S. High St., Columbus; 542-0940; 10 a.m.-8 p.m. Mon.-Sun.

• Pickerington -- America's Urgent Care of Pickerington; 475 Hill Road, North Pickerington; 833-6002; 11 a.m.-9 p.m. Mon.-Sun.