Criteria for childhood bipolar disorder diagnosis questioned
MedWire News: The incidence of DSM-IV-defined bipolar disorder is very low in children and adolescents, according to the results of an epidemiological study.
However, the study found a relatively high level of short mood episodes where symptom and impairment criteria were met, but DSM-IV duration criteria were not.
“Using the term not otherwise specified (NOS) to describe short episodes of manic symptoms implies that the condition is on a spectrum with bipolar I disorder and bipolar II disorder,” Argyris Stringaris (King’s College London, Institute of Psychiatry, London, UK) and colleagues comment.
The rate of diagnosis of bipolar disorder in children and adolescents has increased dramatically over the past decade, becoming a matter of intense debate, especially in the USA.
Some clinicians have questioned whether the duration criteria required by DSM-IV definitions of mania or hypomania (i.e., episodes of at least 7 and 4 days’ duration, respectively) are developmentally inappropriate for children.
Meanwhile, epidemiological studies suggest that hypomanic episodes lasting 1–3 days may be on a continuum with classical bipolar disorder.
To address the issue, the researchers performed a cross-sectional national survey of 5326 of 8–19-year-olds from the general population using self report measures and information from parents.
Outcome measures were prevalence rates and morbid associations assessed by the Developmental and Well-Being Assessment, and social impairment assessed by the impact scale of the Strengths and Difficulties Questionnaire.
In all, seven individuals met DSM-IV criteria for definite or probable bipolar I disorder or bipolar II disorder, giving a prevalence rate of 0.1%.
By contrast, the prevalence of bipolar disorder-NOS was 10-fold higher – at 1.1% by parent report and 1.5% by youth self report.
In addition, bipolar disorder-NOS showed strong associations with externalizing disorders. After adjusting for a dimensional measure of general psychopathology, self-reported (but not parent-reported) bipolar disorder-NOS remained associated with overall social impairment.
“Our findings call into question the extent to which bipolar disorder - NOS in youth is a variant of DSM-IV bipolar disorder – superficially similar symptoms may not necessarily imply deeper similarities in etiology or treatment response,” Stringaris and colleagues conclude.
The research is published in the Journal of Child Psychology and Psychiatry.
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By Andrew Czyzewski