Is Bipolar Disorder the Most Common Diagnostic Entity in Hospitalized Adolescents and Children?
Isaac, Goerge, Adolescence
Several studies have brought attention to the fact that bipolar disorder is often unrecognized or misdiagnosed in children and adolescents as attention deficit hyperactivity disorder (A.D.H.D.), Conduct disorder, adolescent turmoil, and other disorders (Akiskal et al., 1985; Akiskal & Weller, 1989; Carlson, 1990; Davis, 1979; Delong & Aldershof, 1987; Gammon, John, & Rothblum, 1983; Isaac, 1991; Isaac, 1992; Neiman & Delong, 1987). In two previous studies conducted by the author (Isaac 1991, 1992) it was observed that bipolar disorder is very common but often unrecognized in the most problematic children and adolescents in a day school and treatment program for severely emotionally disturbed youngsters. As a result, a comprehensive evaluation of all children and adolescents admitted to a 14-bed child and adolescent psychiatry unit of a county general hospital in New York State was undertaken to determine the presence of this disorder. This paper reports the findings of that evaluation.
All children and adolescents admitted to the unit during a three-month period (March-May 1992) were evaluated with special attention paid to the possibility that Bipolar disorder would be the primary diagnosis in some or many of these patients. Measures found to be useful in identifying this disorder in this age group as summarized in the author's previous papers on the subject (Isaac 1991, 1992) and pointed out by others (Akiskal et al., 1985; Akiskal & Weller 1989; Carlson 1990; Davis, 1979; Delong & Aldershof, 1987) were applied. These included repeated semi-structured interviews by the author, as clinically warranted, to elicit present or past experiences and symptoms which would be indicative of bipolar disorder, careful observation of the patients throughout their hospital stay, gathering information from other staff members, obtaining a history of patients' lifetime symptomatology with special attention to episodes suggestive of mania, hypomania, and depression, especially in those previously diagnosed as suffering from A.D.H.D and conduct disorder. In addition, gathering of family history data either by interviewing immediate family members or eliciting data on family history suggestive of the disorder through a reliable close relative was also undertaken. These efforts were part of a comprehensive clinical evaluation and not performed primarily for research purposes.
Fifty-seven patients (age range 7-17 years; 32 males, 25 females; 29 white, 24 black, 4 others) were admitted to the unit during this period. Of these patients, 13 were prepubertal (below 13 years of age). Seventeen admissions had been court remanded for psychiatric evaluation. All except one of these youngsters were postpubertal.
Fourteen youngsters (including five prepubertal children) met the DSM III R criteria for bipolar disorder fully (referred to hereafter as the "definitely bipolar" group). Fifteen other children appeared to have features and a history highly suggestive of bipolar disorder (referred to hereafter as "very likely bipolar" group) but not meeting the DSM III R criteria fully at present. Fourteen children seemed to warrant prolonged observation and study to rule out the possibility of bipolar disorder (which was not possible at the time because of their very short stay, mostly for administrative reasons).
Thirteen of the 17 court-remanded youngsters were in the definitely or very likely bipolar groups. Eight of the ten (including four prepubertal) who showed psychotic phenomena (hallucinations and/or delusions) were in the definitely bipolar group. Ten of the 13 prepubertal children were in the definitely or very likely bipolar group.
Until the evaluation took place, most of the youngsters considered as belonging to the definitely or very likely groups had had a diagnosis of conduct disorder, attention deficit hyperactivity disorder or adjustment disorder. …