Magazine article Clinical Psychiatry News

More Studies on Bipolar Disorder Sorely Needed

Magazine article Clinical Psychiatry News

More Studies on Bipolar Disorder Sorely Needed

Article excerpt

CAMBRIDGE, MASS. -- Despite the presence of manic symptoms and evidence of mixed, rapid cycling, bipolar disorder was initially misdiagnosed in 12 out of 24 youths in a small outpatient study.

A chart review of 24 bipolar children and adolescents showed that attention-deficit hyperactivity disorder was the most common misdiagnosis, occurring in 10 of the 12 patients, reported Dr. Linda S. Zamvil at a meeting on bipolar disorder sponsored by Harvard Medical School.

Although mood symptoms and the first mental health professional contact for the children in the study occurred on average at 5.8 years of age and the first reported manic episode occurred on average at 6.8 years, accurate diagnosis of bipolar disorder did not occur until 9.7 years, said Dr. Zamvil, director of child and adolescent psychiatry at Advocates Inc. in Framingham, Mass. During the interval between initial presentation and accurate diagnosis, the children were seen on average by about 5 mental health professionals, including 2 psychiatrists and 2.9 non-M.D. mental health therapists per child.

In all of the children, bipolar diagnoses were based on DSM-IV criteria using the Kiddie Schedule for Affective Disorders and Schizophrenia interviews. Of the 24 children, 19 presented with mixed, rapid cycling.

In terms of treatment course and efficacy, drug therapy with antidepressants and/or stimulants in the absence of mood stabilizers often had no effect or exacerbated manic symptoms. Among the 20 children who received antidepressants and/or stimulants, 75% experienced no benefit and 80% experienced induction or worsening of rapid cycling. "Of the small number of kids who could tolerate stimulants or antidepressants, it was only after gradually introducing them after mood stabilization," Dr. Zamvil said.

"Not surprisingly, 83% of the study population had a relative diagnosed with bipolar disorder, and 12% had both parents affected by it. These numbers are 'not surprising' because family history is common in bipolar diagnoses. It is surprising that these numbers were not clues to getting the correct diagnosis sooner," Dr. Zamvil said. Also noteworthy is the fact that 8% of the patients had a first-degree relative with unipolar depression, 4% had a family member with a substance use disorder, and 4% had a first-degree relative with an anxiety disorder. …

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