Behavior Inventory Aids Pediatric Bipolar Diagnosis. (Useful Adjunct to Clinical Assessment)
Sherman, Carl, Clinical Psychiatry News
CHICAGO -- The diagnosis of bipolar disorder in children and adolescents can be assisted by adding a specialized instrument such as the General Behavior Inventory to a thorough clinical evaluation, Eric A. Youngstrom, Ph.D., said at an industry-supported symposium at the American Psychiatric Association's Institute on Psychiatric Services.
Research using the General Behavior Inventory (GBI) suggests that parent ratings of young patients' behavior are most helpful, and teacher ratings are least helpful, said Dr. Youngstrom of Case Western Reserve University Cleveland.
The difficulty of diagnosing bipolar disorder in young patients is reflected in widely varying prevalence rates, which studies have placed at 0.4%-1% for bipolar I and roughly five times higher for other bipolar spectrum disorders.
Developmental constraints complicate diagnosis. Such classic manifestations of mania as overspending are inaccessible to young children, and bizarre appearance may simply reflect parental taste or adolescent fashion. Pronounced mood swings may be normal at certain ages, and rapid cycling and comorbidity are also highly prevalent. "Most bipolar children have other disorders superimposed," Dr. Youngstrom said.
Generally a reliable diagnosis requires assessment over time. "All you get in the office is a snapshot of behavior" that reflects the phase of the cycle, not the disorder, he said. Mania may be easily mistaken for attention-deficit hyperactivity disorder (ADHD) or conduct disorder; depression can look like "textbook" unipolar disorder, he noted.
Carefully fill in the history for evidence of cycling, paying particular attention to symptoms that are specific to mania, such as grandiosity, racing thoughts, and hypersexuality, Dr. Youngstrom suggested. The family history can add "hugely important" data: If one parent is bipolar, the risk increases ninefold for the child, although it is still just 10%. …