title: Children with a prepubertal and early adolescent bipolar disorder phenotype from pediatric versus psychiatric facilities.
abstract: OBJECTIVE
  To examine characteristics between subjects with a prepubertal and early adolescent bipolar disorder phenotype from pediatric versus psychiatric venues.
  
  
  METHODS
  Subjects (N = 93) with a prepubertal and early adolescent bipolar disorder phenotype were obtained through consecutive new case ascertainment from designated pediatric and psychiatric sites from 1995 to 1998. Children needed DSM-IV bipolar I disorder (manic or mixed phase) with elation and/or grandiosity as one criterion to avoid diagnosing mania only by symptoms that overlapped with those of attention-deficit/hyperactivity disorder. Comprehensive assessment included the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia, given separately to parents about their children and to children about themselves by experienced research nurses blinded to subjects' diagnostic status.
  
  
  RESULTS
  Rates of mixed mania (chi = 7.1, p = .008) and suicidality (chi = 7.2, p = .007) were significantly higher at psychiatric versus pediatric venues. Subjects from pediatric sites were significantly more likely to be living with their intact biological family (chi = 5.3, p = .022). Significantly more subjects with a prepubertal and early adolescent bipolar disorder phenotype ascertained at psychiatric sites versus pediatric sites were taking an antimanic medication (chi = 9.5, p = .002), while stimulant medication was significantly more common among subjects ascertained at pediatric sites (chi = 19.0, p < .0001).
  
  
  CONCLUSIONS
  These pediatric versus psychiatric site differences suggest that pediatricians may under-recognize mania and thus do not prescribe antimanic mood-stabilizing medications. Moreover, pediatricians may be more likely to refer children to psychiatrists when depression or suicidality is evident.
authors: Department of Psychiatry, Washington University, St. Louis, MO 63110, USA.
authors: Rebecca
authors: R
authors: Tillman
authors: Barbara
authors: B
authors: Geller
authors: Jeanne
authors: J
authors: Frazier
authors: Linda
authors: L
authors: Beringer
authors: Betsy
authors: B
authors: Zimerman
authors: Tricia
authors: T
authors: Klages
authors: Kristine
authors: K
authors: Bolhofner
mesh_terms: D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D002648:Child; D005260:Female; D006776:Hospitals, Pediatric; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D008923:Missouri / Q000453:epidemiology; D015588:Observer Variation; D010641:Phenotype; D010821:Physicians, Family; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011627:Puberty