bipolar may be over diagnosed in youth | ADHD Information

I thought many of you would be interested in the following article from
today's Los Angeles Times.

Bipolar disorder in children and adolescents may be over-diagnosed.

A new study says a fortyfold increase can be partly attributed to doctors
mislabeling children and teens with the illness.

By Denise Gellene, Los Angeles Times Staff Writer
September 4, 2007

The diagnosis of bipolar disorder in children and adolescents has risen
fortyfold since 1994, according to a study released Monday. But
researchers partly attributed the dramatic rise to doctors over-diagnosing
the serious psychiatric disorder.

The report in the journal Archives of General Psychiatry said bipolar
disorder was found in 1,003 of every 100,000 office visits from children
and adolescents in 2002-03, compared with 25 of 100,000 office visits in
1994-95.

The diagnosis of bipolar disorder among adults increased twofold during
the same period, researchers said.

The study didn't investigate the reasons for the sudden rise in bipolar
cases among children and adolescents. A book published in 2000, "The
Bipolar Child," made the controversial assertion that one-third to one-
half of children with depression had bipolar disorder.

Dr. Mark Olfson, a psychiatrist at Columbia University's College of
Physicians and Surgeons and senior author of the latest study, said part
of the increase was attributable to an under-diagnosis of bipolar disorder
in the past.

But Olfson said another reason was the mislabeling of children and
adolescents with aggressive or irritable behaviors as bipolar, an illness
that is treated with powerful psychotropic medications, many of which
have not been tested in children.

Dr. Thomas R. Insel, director of the National Institute of Mental Health,
which funded the study, called the increase in bipolar diagnoses
worrisome.

"The way the label is being used is probably a little exuberant -- not
fitting with the strict definition of the illness," Insel said. The disorder "is
probably not as common as the very high rates we're seeing."

Bipolar disorder is marked by severe mood swings between depression
and mania, which is characterized by an excess of energy and
restlessness. For most patients, depressive episodes are three times more
common and longer lasting than those of mania. Symptoms of the
disorder can interfere with daily activities, and severe cases carry a risk of
suicide.

Until recently, the illness, which appears to run in families, was seldom
diagnosed in children. It was believed to begin in late adolescence or
early adulthood. About 2% of American adults are believed to have bipolar
disorder, although not all of them have been diagnosed.

In the latest study, researchers analyzed data from an annual national
survey that collected information from doctors about the nature of patient
visits.

Researchers found striking differences between adults and the young.
Among children and adolescents, boys were more likely to be diagnosed
with bipolar disorder. Among adults, it is more common in women.

Olfson said the gender difference between the groups suggested that
some boys with behavior problems or conduct disorders were being
misdiagnosed as bipolar. Irritability is a characteristic of bipolar disorder,
he said, but it is also a normal part of adolescence.

"The definition of bipolar disorder tells us what it looks like in adults but
not in children," Olfson said.

Young people were 10 times more likely to also receive a diagnosis of
attention defici
t hyperactivity disorder than bipolar adults, the report
noted. Olfson said it was likely that some children with ADHD received
the additional diagnosis of bipolar disorder because the symptoms of the
two illnesses overlapped. For example, he said, some children and
adolescents with ADHD have a "volatile, aggressive subtype" that is easily
confused with bipolar disorder.

The report found that children and adolescents diagnosed with bipolar
disorder received the same medication as adults with the illness. Sixty
percent of children and adolescents received a mood stabilizer, and about
33% of them received an antidepressant or antipsychotic medication,
which can cause weight gain.

Dr. Gabrielle A. Carlson, a psychiatrist at Stony Brook University in New
York, said 1 of every 5 children referred to her with a diagnosis of bipolar
disorder actually had it. The rest had autism, depression, anxiety or
another psychological disorder. All these conditions involve different
treatments, with drugs, behavioral therapy or both.

Carlson, who has studied the increase in bipolar diagnoses, said some
parents seemed to prefer a diagnosis of the disorder because the illness,
which is thought to be largely genetic, absolves them of blame.

"They don't have to deal with their chaos, their psychiatric disorder, their
marital troubles or abuse," she said.

She said that in some cases, providers would diagnose psychological
problems in children as bipolar disorder to obtain insurance
reimbursement for hospitalizations, a practice called upcoding.

Insel said his institute was conducting research that might lead to more
accurate diagnoses of bipolar disorder in young people. The agency said
recent imaging studies had detected differences between the brains of
normal children and those with bipolar disorder.

A large study looking for the genes responsible for the disorder is
nearing completion and may yield some additional clues, Insel said.

The agency is also tracking children with bipolar disorder to see how their
symptoms change over time. Only a small fraction of children referred for
the study actually had bipolar disorder, Insel said, another indication that
the label is misused.

"We urgently need to improve diagnosis and treatment for these kids with
severe emotional problems," he said.
Bi-Polar Disorder May be Over-Diagnosed in Youthkeelime39329.8077893518

I know three people with bipolar and they were ALL cranky irritable difficult children. One is my sister who should have been diagnosed in her teens and her outcome in life may have been better.  Her life could only have gone up because she couldn't go much further down.  She has had a miserable difficult life and most but not all is due to her irrational risky behavior.  Two others I know (sister in law and very good friend) also very irritable, difficult children and teenagers.  If most of you look at the people you know with bipolar you will find a difficult childhood. Most likely a childhood filled with truancy, drug use, pregnancy, promiscuous etc,. This may be over diagnosed but don't think that bipolar adults had rosy childhoods.  The better the outcome for these children probably lies in the hands of the parents.  The better the overall home life the better the outcome and less chance of the destructive behavior.  But, I read one expert who believes that your born with bipolar and how and when it surfaces is anyone’s guess.  And yes, it can surface is childhood.