If it takes a village to raise a child, it might just take a village to kill one, too, which is what I believe happened to Rebecca Riley. Here are some facts about and testimony from some of Rebecca Riley’s “caregivers” as reported by Boston.com, The Patriot Ledger, and Carolyn Riley herself during her 60 Minutes interview with Katie Couric, along with some commentary.

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Patricia Wen of the Boston Globe posted an article today entitled “Psychiatrist admits she approved higher drug dosage in Riley trial. In it, she recounts the testimony given today by Dr. Kayoko Kifuji, the psychiatrist who had diagnosed and treated Rebecca Riley for bipolar disorder and attention deficit hyperactivity disorder (ADHD). I read the article cautiously, because there are so many facets to consider in watching this trial unfold, but the psychiatric testimony carries a lot of weight.

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Many people are shocked to hear that anyone as young as Rebecca Riley could be diagnosed as having bipolar disorder and prescribed powerful psychotropic medications. Following are several questions I have been hearing about the case recently that are related to early childhood diagnosis and treatment followed by my answers:

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The Patriot Ledger seems to be following Carolyn Riley’s murder trial closely. For Lane Lambert’s report on the second day of the trial (Wednesday), see “Teachers say Rebecca’s parents shed no tears.” On Patriot.com, you can also view a video of the prosecutor’s opening remarks delivered on Tuesday.

Rebecca Riley was four years old when she died three years ago. She had been diagnosed as having bipolar disorder and ADHD and was being treated with clonidine (a blood pressure medicine sometimes used as a sedative for ADHD) and Depakote (for bipolar). (See Department of Social Services (DSS) case file recounting the timeline of DSS involvement with the family of 4-year-old Rebecca Riley.)

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4-year old Rebecca Riley was diagnosed with ADHD and bipolar disorder and died allegedly due to an overdose of prescription meds. The parents are on trial for her death. The trial of Carolyn Riley (Rebecca’s mom) is scheduled to begin Tuesday in Brockton Superior Court. She is accused, with her husband, Michael, of abusing the drugs Rebecca Riley had been prescribed. See “Mom’s trial in Rebecca Riley’s drug death set to begin” where you can find links to additional information about the case.

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Mark Olfson, professor of clinical psychiatry at Columbia University, just published results of his study in the Journal of the American Academy of Child & Adolescent Psychiatry, in which he found that “the number of children aged 2 to 5 who have been diagnosed with bipolar disorder and prescribed powerful psychiatric medications has doubled over the past decade.” (To read more about the study, check out today’s story from Reuters reporter Ros Krasny entitled “Bipolar diagnosis jumps in young children: study.”)

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Bipolar disorder is notorious for leaving broken relationships in its wake – both intimate relationships and close friendships. Bipolar can be a double-edged sword – driving away the very people we rely on to maintain our mental health.

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When I was a medical student we used to have “Liver Rounds” at the hospital on Friday afternoons – a happy hour, keg, and pizza party, compliments of some pharmaceutical companies. Variations of this continued throughout my internship and residency. Later, as a practicing psychiatrist, I would see drug reps in the office and used their pens and pads and ate their lunches. Colleagues and I would often remind ourselves that we needed to see the reps because they gave us samples of medications we could give to our patients. We reassured ourselves that we wouldn’t change our prescribing habits based on the gifts we received.

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(This is Part IV in a five-part series on bipolar. To catch up, see Bipolar on the Job Part I: “Will I Be Able to Return to Work?” Part II: “To Tell or Not to Tell?” Part III, “How to Talk about Bipolar Disorder” and Part IV, “Requesting Reasonable Workplace Accommodations.”)

An “occupational hazard” of bipolar disorder is that it can trigger snap decisions, especially in the midst of a major manic or depressive episode. The illness can limit your foresight. You can’t work or foresee a time in the near future when you’ll be able to return to work, so you decide to quit, resign, or take early retirement.

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