title: Relationship of persistent manic symptoms to the diagnosis of pediatric bipolar spectrum disorders.
abstract: OBJECTIVE
  The diagnosis of bipolar spectrum disorders (BPSDs [bipolar I and II disorders, cyclothymic disorder, and bipolar disorder not otherwise specified]) in youth remains controversial. The present study evaluated the possibility that the presence of persistent manic symptoms over a relatively short interval may increase the probability of a BPSD DSM diagnosis.
  
  
  METHODS
  Data were obtained from the screening and baseline assessments collected from 2005 through 2008 of an ongoing prospective, longitudinal study (Longitudinal Assessment of Manic Symptoms) examining the diagnosis and phenomenology of youth (N = 692) presenting to outpatient centers at ages 6-12 years. Youth were assessed for elevated symptoms of mania (ESM) with the Parent General Behavior Inventory-10-Item Mania Scale (PGBI-10M), the primary outcome measure. Screening and baseline scores separated individuals into those with ESM (ESM+; PGBI-10M score ≥ 12) and a control group of youth without ESM (ESM-; PGBI-10M score < 12). Youth were classified into 4 groups: persistent ESM+, remitted ESM+, persistent ESM-, and progressed to ESM+.
  
  
  RESULTS
  Individuals with persistent ESM+ were more likely to have a BPSD (relative risk = 3.04; 95% CI, 2.15-4.30). Using 2 administrations of the PGBI-10M spaced over a relatively brief interval (median = 4.0, mean = 6.1, SD = 5.9 weeks) improved the prediction of BPSD over using only the first administration (ΔR(2) = 0.10, Δχ(2)(1) = 50.06, P < .001). Likelihood ratios indicated that persistent ESM- substantially decreased the probability of BPSD. While high levels of persistent ESM+ increased the probability of a BPSD diagnosis, the final positive predictive value was only sufficient to signify the need for more thorough clinical evaluation.
  
  
  CONCLUSIONS
  In many cases, obtaining repeated parent report of mania symptoms substantially altered the probability of a BPSD diagnosis and may be a useful adjunct to a careful clinical evaluation. Future waves of data collection from this longitudinal study will be crucial for devising clinically useful methods for identifying or ruling out pediatric BPSD.
authors: Center for Pediatric Behavioral Health and Center for Autism, Cleveland Clinic, 2801 Martin Luther King Jr Drive, Cleveland, OH 44104, USA. FRAZIET2@ccf.org
authors: Thomas W
authors: TW
authors: Frazier
authors: Eric A
authors: EA
authors: Youngstrom
authors: Sarah McCue
authors: SM
authors: Horwitz
authors: Christine A
authors: CA
authors: Demeter
authors: Mary A
authors: MA
authors: Fristad
authors: L Eugene
authors: LE
authors: Arnold
authors: Boris
authors: B
authors: Birmaher
authors: Robert A
authors: RA
authors: Kowatch
authors: David
authors: D
authors: Axelson
authors: Neal
authors: N
authors: Ryan
authors: Mary Kay
authors: MK
authors: Gill
authors: Robert L
authors: RL
authors: Findling
mesh_terms: D000367:Age Factors; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology*; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016017:Odds Ratio; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D012306:Risk