Psychiatrists Often Fail to Diagnose Bipolar Disorder in Children
> 10/9/2006 9:46:38 AM

When testing children and adolescents for bipolar and manic tendencies, clinicians rely on the same standard measurements used for adults. Because of this, the disorders often go undiagnosed at a time when appropriate treatment can greatly benefit the developmentment of affected children, according to a new study published by the University of Pittsburgh School of Medicine. The main qualifier for a bipolar diagnosis is a history of emotional extremes alongside periods of relative stability, and the manic or "high" episodes displayed by some children are shorter and less severe than those of long-suffering adolescents and adults. Because the length of such episodes often falls below offical standards for bipolar disorder, these children do not receive correct diagnoses, thereby failing to qualify for essential treatments.

In most cases, bipolar patients experience stretches of mania or subsequent depression that last for several days. This generally applies to children and adolescents as well as adults. In the cases highlighted by this study, children display all the symptoms of bipolar disorder, yet their episodes are brief and do not result in traditional diagnosis. The condition has two general subtypes under its diagnostic definition: BP-I, characterized by full-blown manic episodes with or without major depression, and BP-II, involving less severe manias and heavier depression. A third diagnosis forms the basis of this study: BP-NOS, or Bipolar Disorder Not Otherwise Specified. Cases falling under this banner include significant manic symptoms without a history of major depression as well as the aforementioned episodes that fulfill the clinical criteria for mania in all aspects but length of duration. This third, nebulous definition is of great interest to researchers, as thirty five percent of the study's participants were diagnosed with BP-NOS.

BP-I, the most frequently diagnosed of these three conditions, has many of the same characteristics as BP-NOS: intensity, age of onset, family history, etc. Lead researcher David Axelson, M.D. believes that the distinction is slight and often detrimental to patients not included under either of the disorder's original subtypes:

"The results from this study suggest that some of these kids likely have bipolar disorder. We need more research to figure out which kids go on to become bipolar adults, so it is too early to say that every child with brief periods of manic symptoms is bipolar. However, it is reasonable for clinicians to consider the possibility of bipolar disorder in youth who present with mania that does not reach the duration criteria for adult bipolar disorder."

With so many patients suffering from an alternate version of this common affliction, a revised definition is clearly neccessary to determine whether they should receive the same treatment, but doctors cannot make such decided changes without further research to confrim these intital findings. This study is the second in a series of publications called the Course and Outcome of Bipolar Illness in Youth and funded by the National Institute for Mental Health. As these studies track their patients through adolescence and into adulthood, they can hopefully develop a fuller portrait of early-onset bipolar disorder that will make for more effective treatments in the future.

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