title: Comparing the CASI-4R and the PGBI-10 M for Differentiating Bipolar Spectrum Disorders from Other Outpatient Diagnoses in Youth.
abstract: We compared 2 rating scales with different manic symptom items on diagnostic accuracy for detecting pediatric bipolar spectrum disorder (BPSDs) in outpatient mental health clinics. Participants were 681 parents/guardians of eligible children (465 male, mean age = 9.34) who completed the Parent General Behavior Inventory-10-item Mania (PGBI-10 M) and mania subscale of the Child and Adolescent Symptom Inventory-Revised (CASI-4R). Diagnoses were based on KSADS interviews with parent and youth. Receiver operating characteristic (ROC) analyses and diagnostic likelihood ratios (DLRs) determined discriminative validity and provided clinical utility, respectively. Logistic regressions tested for incremental validity in the CASI-4R mania subscale and PGBI-10 M in predicting youth BPSD status above and beyond demographic and common diagnostic comorbidities. Both CASI-4R and PGBI-10 M scales significantly distinguished BPSD (N = 160) from other disorders (CASI-4R: Area under curve (AUC) = .80, p < 0.0005; PGBI-10 M: AUC = 0.79, p < 0.0005) even though scale items differed. Both scales performed equally well in differentiating BPSDs (Venkatraman test p > 0.05). Diagnostic likelihood ratios indicated low scores on either scale (CASI: 0-5; PGBI-10 M: 0-6) cut BPSD odds to 1/5 of those with high scores (CASI DLR- = 0.17; PGBI-10 M DLR- = 0.18). High scores on either scale (CASI: 14+; PGBI-10 M: 20+) increased BPSD odds about fourfold (CASI DLR+ = 4.53; PGBI-10 M DLR+ = 3.97). Logistic regressions indicated the CASI-4R mania subscale and PGBI-10 M each provided incremental validity in predicting youth BPSD status. The CASI-4R is at least as valid as the PGBI-10 M to help identify BPSDs, and can be considered as part of an assessment battery to screen for pediatric BPSDs.
authors.affiliation: Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC, 27599-3270, USA.
authors.forename: Mian-Li
authors.initials: ML
authors.lastname: Ong
authors.affiliation: Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC, 27599-3270, USA. eay@unc.edu.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Youngstrom
authors.affiliation: Department of Psychology, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore.
authors.forename: Jesselyn Jia-Xin
authors.initials: JJ
authors.lastname: Chua
authors.affiliation: Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC, 27599-3270, USA.
authors.forename: Tate F
authors.initials: TF
authors.lastname: Halverson
authors.affiliation: Department of Child and Adolescent Psychiatry, New York University, New York, NY, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Horwitz
authors.affiliation: Statistical Research Consultants, LLC, Charlotte, NC, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Storfer-Isser
authors.affiliation: Cleveland Clinic Foundation, 2049 E 100th St, Cleveland, OH, 44195, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Frazier
authors.affiliation: Department of Psychology, Ohio State University, Columbus, OH, 43210, USA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Fristad
authors.affiliation: Research Unit on Pediatric Psychopharmacology, Ohio State University, Columbus, OH, 43210, USA.
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Arnold
authors.affiliation: Department of Psychiatry, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Phillips
authors.affiliation: Department of Psychiatry, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA.
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.affiliation: Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kowatch
authors.affiliation: Department of Psychiatry, Kennedy Krieger Institute, John Hopkins University, Baltimore, MD, 21218, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Findling
mesh_terms: D001008:Anxiety Disorders / Q000175:diagnosis*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis*; D001714:Bipolar Disorder / Q000175:diagnosis*; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000175:diagnosis; D012680:Sensitivity and Specificity
keywords: Adolescents; Assessment; Bipolar disorder; CASI; PGBI-10 M; Receiver operating characteristic, diagnostic likelihood ratio