Diagnosing pediatric bipolar disorder

Lee T. Pediatric Bipolar Disorder. Pediatr Ann. 2016 Oct 1;45(10):e362-e366.

The diagnosis of bipolar disorder (BD) in youth is confusing and controversial. Controversy notwithstanding, youth diagnosed with BD have high behavioral health needs and are at elevated risk for problematic long-term psychosocial functioning and complex psychiatric medication regimens. Pediatricians and other primary care providers (PCPs) can play an important role in the assessment and treatment of youth diagnosed with BD and the recently created and also controversial diagnosis of disruptive mood dysregulation disorder (DMDD). This article provides information on the definitions, background, and presentation of pediatric bipolar disorder (PBD), how to differentiate PBD from other psychiatric disorders, effective psychiatric and psychosocial interventions for PBD, potential roles for PCPs, and what is known about DMDD.

Full-text for Children’s and Emory users.

Singh MK, et al. Distinguishing bipolar disorder from other psychiatric disorders in children. Curr Psychiatry Rep. 2014 Dec;16(12):516.

Pediatric onset bipolar disorder (BD) is a challenging diagnosis with potentially debilitating outcomes. This review aims to critically evaluate recently published literature relevant to the diagnosis of BD in youth, emphasizing interesting and important new findings characterizing pediatric BD and reporting updates in the diagnostic and statistical manual relevant to this disorder in youth. Challenges regarding the diagnosis of BD will be discussed, in addition to important distinctions with other childhood disorders, including other bipolar spectrum disorders; major depressive disorder; dysthymia; disruptive mood dysregulation disorder (DMDD); attention-deficit/ hyperactivity disorder (ADHD) and other disruptive behavioral disorders; anxiety disorders, including post-traumatic stress disorder (PTSD); psychotic disorders; autism spectrum disorders; substance use disorders; and borderline personality disorder. The review concludes with a comment on past research limitations and future directions in the field.

Full-text for Emory users.

Goldstein BI, Birmaher B. Prevalence, clinical presentation and differential diagnosis of pediatric bipolar disorder. Isr J Psychiatry Relat Sci. 2012;49(1):3-14.

“Pediatric BP diagnosis presents a challenging dialectic. Withholding of diagnoses and treatment of BP from patients who truly have BP presents substantial morbid risks, including suicidality and marked functional impairment.(13, 14) However, unnecessary diagnoses and unnecessary exposure to mood-stabilizing medications risk unduly invoking concerns about a life-long illness, pre-empting psychosocial treatments, delayed and/or suboptimal pharmacological treatment of other psychiatric conditions such as major depressive disorder (MDD) or attention-deficit hyperactivity disorder (ADHD), and significant physical risks.(15) As such, one focus of this review is on summarizing recent literature that can inform considerations regarding accurate diagnoses of individual children and adolescents with and without BP. Another focus of this review is on highlighting various demographic, clinical, and familial characteristics that are salient to the diagnosis, monitoring, and treatment of youth with BP.”

Free full-text.

Luby JL, Navsaria N. Pediatric bipolar disorder: evidence for prodromal states and early markers. J Child Psychol Psychiatry. 2010 Apr;51(4):459-71.

There has been very limited investigation of early prodromes of childhood bipolar disorder. Based on the promising findings of prodromes as well as high-risk states and possible endophenotypic markers, more controlled and targeted investigations into the early markers of bipolar disorder appear warranted and potentially fruitful. Until such longitudinal studies with appropriate controls are conducted, specific markers for bipolar prodromes will remain elusive, although evidence suggests they are manifest in at least some subgroups. The finding of promising psychotherapeutic prevention programs underscores the need to find specific and sensitive markers of bipolar prodromes in childhood.

Free full-text.

Youngstrom EA, et al. The assessment of children and adolescents with bipolar disorder. Child Adolesc Psychiatr Clin N Am. 2009 Apr;18(2):353-90, viii-ix.

The overarching goal of this article is to examine the current best evidence for assessing bipolar disorder (BPD) in children and adolescents and provide a comprehensive, evidence-based approach to diagnosis. Evidence- based assessment strategies are organized around the “3 Ps” of clinical assessment: Predict important criteria or developmental trajectories, Prescribe a change in treatment choice, and inform Process of treating the youth and his/her family. The review characterizes BPD in youths-specifically addressing bipolar diagnoses and clinical subtypes; it then provides an actuarial approach to assessment using prevalence of disorder, risk factors, and questionnaires; discusses treatment thresholds; and identifies practical measures of process and outcomes. The clinical tools and risk factors selected for inclusion in this review represent the best empirical evidence in the literature. By the end of the article, clinicians will have a framework and set of clinically useful tools with which to effectively make evidence-based decisions regarding the diagnosis of BPD in children and adolescents.

Free full-text.

More PubMed results on diagnosing PBD.

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