The Bipolar Spectrum: Myth or Reality?

Youngstrom, Eric A.; Meter, Anna Van; Algorta, Guillermo Pérez

doi:10.1007/s11920-010-0153-3

Cited by 20 publications

(11 citation statements)

References 51 publications

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“…Early onset is often associated with a treatment-resistant course of BD in adulthood, with a high prevalence of rapid cycling, mixed symptoms, comorbid disorders, suicidal behavior and functional impairment (2, 3). Misdiagnosing BD in children can have significant adverse consequences for the long-term management of the disorder (4).…”

mentioning

confidence: 99%

Diagnostic Profiles and Clinical Characteristics of Youth Referred to a Pediatric Mood Disorders Clinic

Weintraub

Youngstrom

Marvin

et al. 2014

Journal of Psychiatric Practice

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Objectives The current study examined the diagnostic profiles and clinical characteristics of youth (ages 6–18) referred for diagnostic evaluation to a pediatric mood disorders clinic that specialized in early-onset bipolar disorder. Method A total of 250 youth were prescreened in an initial telephone intake and 73 participated in a full diagnostic evaluation. Trained psychologists administered the Schedule for Affective Disorders for Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) to the child and at least one parent, and a child psychiatrist conducted a separate pharmacological evaluation. Evaluators then met with a larger clinical team for a consensus diagnostic conference. Results Based on consensus diagnoses, 13 of the 73 referred youth (18%) met lifetime DSM-IV-TR criteria for bipolar I, II or not otherwise specified (NOS) disorder. The most common Axis I diagnoses were attention deficit-hyperactivity disorder (31/73, 42.5%) and major depressive disorder (23/73, 32%). Of the 73 youth, 27 (37%) were referred to the speciality clinic with a community diagnosis of BSD, but only 7 of these (26%) met the DSM-IV-TR criteria for a bipolar spectrum diagnosis (BD I, II, cyclothymic disorder, or NOS) based on structured interview and consensus diagnoses. Conclusions When youth referred for evaluation of BSD are diagnosed using standardized interviews with multiple reporters and consensus conferences, the “true positive” rate for bipolar spectrum diagnoses is relatively low. Reasons for the discrepancy between community and research-based diagnoses of pediatric BSD – including the tendency to stretch the BSD criteria to include children with depressive episodes and only 1–2 manic symptoms - are discussed.

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confidence: 99%

Diagnostic Profiles and Clinical Characteristics of Youth Referred to a Pediatric Mood Disorders Clinic

Weintraub

Youngstrom

Marvin

et al. 2014

Journal of Psychiatric Practice

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“…mild subsyndromal manic symptoms have been shown to have important clinical implications, including a more severe clinical course and a poor response to antidepressants (9)(10)(11)(12)(13)(14). An important diagnostic question is the degree to which these presentations represent a spectrum of bipolarity, versus distinct disorders with unique clinical characteristics and trajectories (15,16).…”

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confidence: 99%

Phenomenology of bipolar disorder not otherwise specified in youth: a comparison of clinical characteristics across the spectrum of manic symptoms

et al. 2013

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Objectives Controversy surrounds the diagnostic categorization of children with episodic moods that cause impairment, but do not meet DSM-IV criteria for bipolar I (BD-I) or bipolar II (BD-II) disorder. This study aims to characterize the degree to which these children, who meet criteria for bipolar disorder not otherwise specified (BD-NOS), are similar to those with full syndromal BD, versus those with no bipolar spectrum diagnosis (no BSD). Methods Children ages 6–12 years old were recruited from nine outpatient clinics, preferentially selected for higher scores on a 10-item screen for manic symptoms. Interviews with the children and their primary caregivers assessed a wide array of clinical variables, as well as family history. Results A total of 707 children (9.4 ± 1.9 years old) were evaluated at baseline, and were diagnosed with BD-I (n = 71), BD-II (n = 3), BD-NOS (including cyclothymia; n = 88), or no BSD (n = 545). Compared to BD-I, the BD-NOS group had less severe past functional impairment. However, current symptom severity and functional impairment did not differ between BD-NOS and BD-I, even though both groups were significantly more symptomatic and impaired than the no BSD group. Parental psychiatric history was similar for BD-NOS and BD-I groups, and both were more likely than the no BSD group to have a parent with history of mania. Rates of elated mood did not differ between BD-NOS and BD-I youth. Conclusions Children with BD-NOS and BD-I are quite similar, but different from the no BSD group, on many phenomenological measures. These findings support the hypothesis that BD-NOS is on the same spectrum as BD-I.

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“…This has created a number of ‘boundary issues’ for bipolar disorder, for example, (i) partitioning unipolar and bipolar disorder, (ii) delineating bipolar disorder from schizophrenia , (iii) separating bipolar II disorder and borderline personality disorder , and (iv) drawing a distinction between hypomania and normalcy . An ongoing inability to develop meaningful categorical mood disorder diagnoses has encouraged the development of dimensional perspectives, including the bipolar spectrum alluded to by Kraepelin, and a complete conceptual reconstruction whereby research diagnostic criteria have been proposed for investigating psychiatric disorders without reliance on DSM‐5 . In sum, perhaps psychiatric disorders such as bipolar disorder cannot yet be classified as true illnesses , given the lack of consistently reproducible biomarkers and their, at times, ambiguous signs and symptoms.…”

Section: The Nature Of Bipolar Disordersmentioning

confidence: 99%