title: Phenomenology of bipolar disorder not otherwise specified in youth: a comparison of clinical characteristics across the spectrum of manic symptoms.
abstract: OBJECTIVE
  Controversy surrounds the diagnostic categorization of children with episodic moods that cause impairment, but do not meet DSM-IV criteria for bipolar I (BD-I) or bipolar II (BD-II) disorder. This study aimed to characterize the degree to which these children, who meet criteria for bipolar disorder not otherwise specified (BD-NOS), are similar to those with full syndromal BD, versus those with no bipolar spectrum diagnosis (no BSD).
  
  
  METHODS
  Children aged 6-12 years were recruited from nine outpatient clinics, preferentially selected for higher scores on a 10-item screen for manic symptoms. Interviews with the children and their primary caregivers assessed a wide array of clinical variables, as well as family history.
  
  
  RESULTS
  A total of 707 children [mean ± standard deviation (SD) 9.4 ± 1.9 years old] were evaluated at baseline, and were diagnosed with BD-I (n = 71), BD-II (n = 3), BD-NOS (including cyclothymia; n = 88), or no BSD (n = 545). Compared to BD-I, the BD-NOS group had less severe past functional impairment. However, current symptom severity and functional impairment did not differ between BD-NOS and BD-I, even though both groups were significantly more symptomatic and impaired than the no BSD group. Parental psychiatric history was similar for the BD-NOS and BD-I groups, and both were more likely than the no BSD group to have a parent with a history of mania. Rates of elated mood did not differ between BD-NOS and BD-I youth.
  
  
  CONCLUSIONS
  Children with BD-NOS and BD-I are quite similar, but different from the no BSD group, on many phenomenological measures. These findings support the hypothesis that BD-NOS is on the same spectrum as BD-I.
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA 15213, USA. hafemand@upmc.edu
authors.forename: Danella
authors.initials: D
authors.lastname: Hafeman
authors.forename: David
authors.initials: D
authors.lastname: Axelson
authors.forename: Christine
authors.initials: C
authors.lastname: Demeter
authors.forename: Robert L
authors.initials: RL
authors.lastname: Findling
authors.forename: Mary A
authors.initials: MA
authors.lastname: Fristad
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kowatch
authors.forename: Eric A
authors.initials: EA
authors.lastname: Youngstrom
authors.forename: Sarah McCue
authors.initials: SM
authors.lastname: Horwitz
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Arnold
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Frazier
authors.forename: Neal
authors.initials: N
authors.lastname: Ryan
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Gill
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Hauser-Harrington
authors.forename: Judith
authors.initials: J
authors.lastname: Depew
authors.forename: Brieana M
authors.initials: BM
authors.lastname: Rowles
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
mesh_terms: D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D002648:Child; D019955:Conduct Disorder / Q000175:diagnosis / Q000453:epidemiology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D010045:Outpatients; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric