Children With a Prepubertal and Early Adolescent Bipolar Disorder Phenotype From Pediatric Versus Psychiatric Facilities

• NCJ Number: 210945
• Journal: Journal of the American Academy of Child & Adolescent Psychiatry Volume: 44 Issue: 8 Dated: August 2005 Pages: 776-781
• Author(s): Rebecca Tillman M.S.; Barbara Gellar M.D.; Jeanne Frazier BSN; Linda Beringer R.N.; Betsy Zimerman M.A.; Tricia Klages M.S.; Kristine Bolhofner B.S.
• Date Published: August 2005
• Length: 6 pages
• Grant Number(s): R01MH-53063
• Sponsoring Agency: National Institute of Mental Health
• Publication Format: Article
• Publication Type: Report (Study/Research)
• Language: English
• Country: United States of America

Annotation

This study examined whether there were differences in the severity of and medication patterns for prepubertal and early adolescent bipolar disorder phenotype (PEA-BP) according to whether patients were treated in pediatric or psychiatric facilities.

Abstract

Criteria for inclusion in the study were being 7-16 years old, in good physical health, and having DSM-IV BP-I (manic or mixed phase) for at least 2 weeks. At least one of the two cardinal symptoms of mania (i.e., elation and/or grandiosity) was required to avoid diagnosing mania only by symptoms that overlapped with those for attention-deficit/hyperactivity disorder (ADHD). A total of 93 subjects from designated pediatric and psychiatric sites met these criteria and were recruited for this study from consecutive new cases over the period from 1995 to 1998. Assessment was conducted with the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia, administered separately to parents in providing information about their children and to children in providing information about themselves. Rates of mixed mania and suicidality were significantly higher for subjects treated at psychiatric compared to pediatric venues. Patients at pediatric sites were significantly more likely to be living in an intact biological family. Significantly more PEA-BP patients at psychiatric sites were taking an antimanic medication compared with pediatric patients; and stimulant medication was significantly more common among pediatric patients than among psychiatric patients. These findings suggest that pediatricians may underdiagnose mania and thus fail to prescribe antimanic mood-stabilizing medications. Also, pediatricians may be likely to refer children to psychiatrists when they diagnose depression or suicidality in a patient. 1 table, 1 figure, and 24 references