Early-Onset Bipolar Spectrum Disorders: Diagnostic Issues

Abstract

Since the mid 1990s, early-onset bipolar spectrum disorders (BPSDs) have received increased attention in both the popular press and scholarly press. Rates of diagnosis of BPSD in children and adolescents have increased in inpatient, outpatient, and primary care settings. BPSDs remain difficult to diagnose, particularly in youth. The current diagnostic system makes few modifications to accommodate children and adolescents. Researchers in this area have developed specific BPSD definitions that affect the generalizability of their findings to all youth with BPSD. Despite knowledge gains from the research, BPSDs are still difficult to diagnose because clinicians must: (1) consider the impact of the child’s developmental level on symptom presentation (e.g., normative behavior prevalence, environmental limitations on youth behavior, pubertal status, irritability, symptom duration); (2) weigh associated impairment and course of illness (e.g., neurocognitive functioning, failing to meet full DSM criteria, future impairment); and (3) make decisions about appropriate assessment (differentiating BPSD from medical illnesses, medications, drug use, or other psychiatric diagnoses that might better account for symptoms; comorbid disorders; informant characteristics and assessment measures to use). Research findings concerning these challenges and relevant recommendations are offered. Areas for further research to guide clinicians’ assessment of children with early-onset BPSD are highlighted.

Time Trends in Lifetime Incidence Rates of First-Time Diagnosed Bipolar and Depressive Disorders Across 16 Years in Danish Psychiatric Hospitals

“…Second, and related to this debate, the extension of the psychopathological features of early onset bipolar disorders [18][19][20][21][22][23][24] might have also directed the awareness of clinicians to the lesser known characteristic features of bipolar disorders in young people, such as irritability or less pronounced mood swings. In addition, given the fact that the psychopathological phenomena of early-onset bipolar disorder are somewhat different from those of classical adult-onset bipolar disorder, there is more room for clinical interpretation.…”

“…[14][15][16] Sex effects were found in 1 study, 14 but no sex differences were found in other studies. 12,13,17 More recently, the construct of prepubertal bipolar disorder has become an issue of major controversy, [18][19][20][21][22][23][24] especially because there are no internationally accepted criteria for bipolar disorders in children. 23 All studies have revealed rather low prevalence rates for bipolar disorders in children and youth.…”

Unfiltered Administration of the YMRS and CDRS-R in a Clinical Sample of Children

“…In particular, PPV becomes inflated as base rates increases, and NPV tends to be high when the target condition is rare. For the total sample, the BD base rate was .23, which may be similar to some inpatient settings but is probably higher than outpatient settings and is certainly higher than epidemiologic samples (Soutullo et al, 2005; Youngstrom & Duax, 2005; Danner et al, 2009; Merikangas & Pato, 2009; Van Meter, Moreira, & Youngstrom, 2011). The total sample DD base rate was .18, which may be similar or lower than some outpatient settings but higher than epidemiologic estimates (Costello, Erkanli, & Angold, 2006).…”

“…There has been a dramatic increase in the diagnosis of BD in youth since the mid-1990s (Danner et al 2009; Moreno et al 2007; Blader & Carlson, 2007). Rates at hospital discharge increased linearly from 1.3 to 7.3 per 10,000 from 1996 to 2004 (Blader & Carlson, 2007).…”

Is There Evidence for the Bipolar Spectrum and the Safety of Pharmaceutical Interventions?

“…Private insurance and some state Medicaid systems will only pay for the treatment of those with more severe diagnoses (Danner et al, 2009). With extreme diagnoses, children can receive Supplemental Security Income.…”