title: Pediatric bipolar disorder in a Spanish sample: features before and at the time of diagnosis.
abstract: BACKGROUND
  Bipolar disorder (BD) often starts in childhood or adolescence. Diagnostic delay is common and may have a negative impact on treatment response and outcome.
  
  
  OBJECTIVE
  To describe the clinical characteristics and symptoms of children with BD prior to their diagnosis and at the time of diagnosis in a sample in Spain.
  
  
  METHODS
  We retrospectively reviewed the medical records of all children and adolescents (N=38) with a DSM-IV diagnosis of BD evaluated in the Child & Adolescent Psychiatry Unit, University of Navarra, over a 6-year period. We collected the DSM-IV symptoms of BD prior and at the time of diagnosis using the K-SADS-PL interview template.
  
  
  RESULTS
  BD was diagnosed in close to 4% of clinic patients. Thirty (79%) were boys and 8 (21%) were girls; 17 (44.7%) had BD-1, 2 (5.3%) BD-2, and 19 (49.9%) BD-NOS. Median age at diagnosis was 13.9 (10.6;15.9). Delay of diagnosis was 1.5 (0.7;3.4) years. Symptoms of BD were similar to those reported in U.S. samples with high rates of severe irritability (94.6%) and psychiatric comorbidity: 92.1% of the BD children had at least one comorbid disorder and 18.4% had three comorbidities, most frequently ADHD (21%) and substance abuse (18.4%).
  
  
  CONCLUSIONS
  Clinical findings in this Spanish sample of children with BD closely resembles those described in U.S. clinics. Diagnostic delay, as in the U.S., and frequent misdiagnosis may explain low prevalence estimates found outside the U.S.
authors.affiliation: Child & Adolescent Psychiatry Unit, Department of Psychiatry & Medical Psychology, Clínica Universitaria, University of Navarra, Pamplona, Spain. csoutullo@unav.es
authors.forename: Cesar A
authors.initials: CA
authors.lastname: Soutullo
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Escamilla-Canales
authors.forename: Janet
authors.initials: J
authors.lastname: Wozniak
authors.forename: Pilar
authors.initials: P
authors.lastname: Gamazo-Garrán
authors.forename: Ana
authors.initials: A
authors.lastname: Figueroa-Quintana
authors.forename: Joseph
authors.initials: J
authors.lastname: Biederman
mesh_terms: D000293:Adolescent; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology* / Q000235:genetics; D002648:Child; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology / Q000235:genetics; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012189:Retrospective Studies; D013030:Spain
chemical_list: D011619:Psychotropic Drugs