Diagnostic Profiles and Clinical Characteristics of Youth Referred to a Pediatric Mood Disorders Clinic

Abstract

Objectives The current study examined the diagnostic profiles and clinical characteristics of youth (ages 6–18) referred for diagnostic evaluation to a pediatric mood disorders clinic that specialized in early-onset bipolar disorder. Method A total of 250 youth were prescreened in an initial telephone intake and 73 participated in a full diagnostic evaluation. Trained psychologists administered the Schedule for Affective Disorders for Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) to the child and at least one parent, and a child psychiatrist conducted a separate pharmacological evaluation. Evaluators then met with a larger clinical team for a consensus diagnostic conference. Results Based on consensus diagnoses, 13 of the 73 referred youth (18%) met lifetime DSM-IV-TR criteria for bipolar I, II or not otherwise specified (NOS) disorder. The most common Axis I diagnoses were attention deficit-hyperactivity disorder (31/73, 42.5%) and major depressive disorder (23/73, 32%). Of the 73 youth, 27 (37%) were referred to the speciality clinic with a community diagnosis of BSD, but only 7 of these (26%) met the DSM-IV-TR criteria for a bipolar spectrum diagnosis (BD I, II, cyclothymic disorder, or NOS) based on structured interview and consensus diagnoses. Conclusions When youth referred for evaluation of BSD are diagnosed using standardized interviews with multiple reporters and consensus conferences, the “true positive” rate for bipolar spectrum diagnoses is relatively low. Reasons for the discrepancy between community and research-based diagnoses of pediatric BSD – including the tendency to stretch the BSD criteria to include children with depressive episodes and only 1–2 manic symptoms - are discussed.

Comparing the CASI-4R and the PGBI-10 M for Differentiating Bipolar Spectrum Disorders from Other Outpatient Diagnoses in Youth

“…Using a probability nomogram (see Figure 2), we begin with a base rate for pediatric BPSD of 10%, which is consistent with the referral pattern at outpatient mood clinics (DelBello & Geller, 2001; Weintraub et al, 2014). Next, we incorporate the knowledge that Timothy’s father has a diagnosis of bipolar disorder, which increases Timothy’s risk of BPSD by about 5 times (Youngstrom et al, 2009).…”