Diagnosis and classification of pediatric bipolar disorder.
BACKGROUND
Many children and adolescents with apparent bipolar disorder cannot be meaningfully diagnosed using the DSM-IV. The variety of pediatric bipolar phenotypes observed in clinical practice remains unclarified.


METHODS
130 consecutively evaluated bipolar children and adolescents were assessed using semistructured clinical interviews and operational criteria that abandoned adherence to the DSM-IV cardinal symptom, duration of symptom persistence, and episodicity requirements.


RESULTS
97.6% of the total sample manifested either all three, or two of the three symptoms elation, grandiosity, and racing thoughts, when manic. 96.9% of the total sample exhibited five or more of the eight DSM-IV criterion symptoms when manic. 52.3% of the subjects manifested ultradian cycling; 22.3% manifested chronic mania or chronic simultaneous manic mixed conditions. Only 21.5% could be classified within the Leibenluft et al. [Leibenluft, E., Charney, D.S., Towbin, K.E., Bhangoo, R.K., Pine, D.S., 2003. Defining clinical phenotypes of juvenile mania. Am. J. Psychiatry 160, 430-437.] system. Problematic distractibility-inattention was present in 89.9% and recurrent rage attacks in 48.5% of the total sample. Older subjects exhibited significantly more depressive symptoms, and nonsignificantly greater prevalences of major depression, severe depression, and ultradian cycling than did younger subjects. The number of depressive symptoms was significantly correlated with ultradian cycling.


CONCLUSIONS
This study relied upon retrospective as well as current reports of symptoms. The study results cannot be generalized to community samples.


CONCLUSIONS
We propose two testable hypotheses: (1) that the recurrent, or chronic, simultaneous presence of any two of the symptoms elation, grandiosity, and racing thoughts and a total of five DSM-IV manic symptoms (without specific cardinal symptom, duration, or episodicity requirements) will identify nearly all clinic-referred bipolar children and adolescents; and (2) that a comprehensive classification of pediatric bipolar phenotypes based upon pattern of manic symptom episodicity or chronicity and degree of depression will identify subtypes of pediatric bipolar disorder that have greater correspondence with treatment response than do those of the DSM-IV classification. Problematic distractibility-inattention and explosive irritability-rage are highly prevalent; their presences should be specified when indicated.
Staton
Dennis
D
Lakeland Mental Health Center, 1010 32nd Avenue South, Moorhead, Minnesota 56560, United States. dstaton@alum.mit.edu
Volness
Linda Jo
LJ
Beatty
William W
WW
D000204:Activity Cycles; D000293:Adolescent; D000367:Age Factors; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology; D001714:Bipolar Disorder / Q000145:classification* / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D010641:Phenotype; D015995:Prevalence; D011889:Rage; D012189:Retrospective Studies; D012720:Severity of Illness Index