Likelihood of childhood/adolescent bipolar diagnosis unaffected by age
MedWire News: The decision to diagnose mania in children and adolescents is influenced by symptoms such as a decreased need for sleep, along with elated mood and grandiosity, say UK and German scientists who found that age does not affect the diagnosis.
Rates of bipolar disorder diagnoses in childhood and early adolescence vary widely between countries, which has led to claims that conditions such as attention deficit/hyperactivity disorder may be diagnosed instead due to the presence of atypical symptoms.
To determine whether there is a bias against a bipolar disorder diagnosis in younger children, Thomas Meyer, from Newcastle University in the UK, and colleagues designed a study to determine whether age influences diagnostic decisions, and to test whether a previous finding that decreased need for sleep was a relevant symptom could be replicated.
The team therefore sent a randomly chosen vignette from a set of four that described a person with current mania to 368 child and adolescent psychiatrists in Southern Germany. The age of the patient in the vignette was systematically varied between 6 and 16 years, as was the presence or absence of decreased need for sleep. However, each vignette included enough information to diagnose mania.
In all, 63.8% of the 116 respondents diagnosed bipolar disorder in the patient described in the vignette. A diagnosis of schizophrenia was made by 16.4% of psychiatrists, the researchers note in the journal Comprehensive Psychiatry.
Age did not significantly affect the likelihood of a bipolar disorder diagnosis.
But ignoring the age of the patient, the presence of decreased need for sleep significantly affected the likelihood of a bipolar diagnosis, with 71.9% of psychiatrists diagnosing the disorder when this symptom was present versus 52.0% when it was absent.
Clinicians were also asked to nominate the three most important symptoms for a diagnosis of bipolar disorder. The most commonly chosen symptoms were decreased need for sleep, episodic course, increased energy or drive, elevated mood, and grandiose ideas.
The team concludes: "We think that there is sufficient evidence from our study to conclude that there are certain symptoms that influence diagnostic decisions more than others. The age of the patient, however, does not seem to matter with regard to a diagnosis of bipolar disorder."
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