title: Symptoms leading to a bipolar diagnosis: a phone survey of child and adolescent psychiatrists.
abstract: OBJECTIVE
  We surveyed child and adolescent psychiatrists (CAPs) to characterize how they diagnose bipolar disorder (BPD) in children.
  
  
  METHODS
  We approached by mail and then telephone 100 CAPs randomly sampled from five regions of the main professional organization of American CAPs; 53 CAPs were reached and agreed to participate. We asked about their training and practice setting, and asked them to name 10 symptoms indicative of BPD. We conducted descriptive analyses to determine how CAPs ranked symptoms, whether reports were consistent with Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) criteria, and whether alternative symptom models might guide their decision making.
  
  
  RESULTS
  CAPs considered lability, grandiosity, family history of BPD, aggression, and expansive or euphoric mood as the most important factors in diagnosing BPD. Only 21 (39.6%) CAPs reported sufficient symptoms to meet DSM criteria for BPD (DSM-Yes status). DSM-Yes status was associated with participants' region, less expertise (< or =10 years practicing child and adolescent psychiatry), and lower levels of self-reported confidence in their ability to diagnose BPD.
  
  
  CONCLUSIONS
  CAPs vary in the symptoms they use to diagnose BPD, with most using a mixture of DSM and non-DSM symptoms. Expertise and confidence may lessen one's reliance on DSM criteria. Further studies are needed to understand CAPs' diagnostic decisions about BD and to develop interventions to support accurate diagnostic decision making and improve patient care.
authors.affiliation: Division of Child and Adolescent Psychiatry, Columbia University, New York, New York 10032, USA. cg168@columbia.edu
authors.forename: Cathryn A
authors.initials: CA
authors.lastname: Galanter
authors.forename: Dana L
authors.initials: DL
authors.lastname: Pagar
authors.forename: Peter P
authors.initials: PP
authors.lastname: Oberg
authors.forename: Carrie
authors.initials: C
authors.lastname: Wong
authors.forename: Mark
authors.initials: M
authors.lastname: Davies
authors.forename: Peter S
authors.initials: PS
authors.lastname: Jensen
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis*; D002648:Child; D003657:Decision Making; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*