Striking Increase Of Bipolar Diagnosis In Youth, According To New Columbia-Led Study

NEW YORK - In a study published in today’s Archives of General Psychiatry, researchers found a striking increase in the rates of bipolar diagnosis in children who visited outpatient clinics between 1994 and 2003.

Dr. Mark Olfson, professor of clinical psychiatry, at Columbia University Medical Center and the New York State Psychiatric Institute, and colleagues analyzed data from a nationally representative sample of over 1,000 visits from the National Ambulatory Medical Care Survey. Between 1994-1995 and 2002-2003, the number of outpatient visits by children and adolescents that included a bipolar diagnosis increased approximately forty-fold while the number of such visits by adults nearly doubled.

The rise in clinician’s diagnoses of bipolar disorder in youth, the authors write, suggest the need for reliability studies to assess the accuracy of diagnoses and the degree of misdiagnoses among children, who may have other psychiatric disorders. According to Dr. Olfson, “These trends likely reflect a recent tendency to over diagnose bipolar disorder in young people, a correction of historical under recognition, or a combination of both trends.”

“One factor that may have contributed to this increase,” said Dr. Olfson, “is a revision in the diagnostic criteria of bipolar disorder in the Diagnostic and Statistical Manual (DSM).” The DSM provides official definitions of psychiatric illnesses. The fourth edition, first published in 1994, broadened the criteria for bipolar disorders, added Dr. Olfson, to include the less severe, bipolar II disorder. Children and adults who would not have been identified as bipolar previously would be captured by this broader criteria of the DSM-IV. A recent analysis carried out by other investigators of trends in inpatient treatment has shown a substantial, though less dramatic, increase in the inpatient treatment of child and adolescent bipolar disorder.

Dr. Olfson and colleagues found that most of the youth and adults diagnosed with bipolar were treated with psychotropic medications. Roughly similar proportions of youth and adult visits for bipolar disorder included prescription of mood stabilizers, antipsychotic medications, and antidepressants. During 1999-2003, mood stabilizers were prescribed in 60.3 percent of youth visits and in 64.1 percent of adult visits with a bipolar diagnosis. Comparable percentages were 47.7 percent (youth) and 33.7 percent (adult) for antipsychotic medications and 34 percent (youth) and 46.5 percent (adult) for antidepressants.

There are some limitations to the findings. Olfson notes that because the diagnoses are based on physicians’ judgment rather than an “independent objective assessment,” it not possible to separate changes in diagnostic practices from underlying changes in the rate of bipolar disorder. In addition, no data were available on the dosage of the psychotropic medications prescribed.

People with bipolar disorder experience extreme changes in mood. A manic phase may include risky behavior and increased restlessness and irritability. A depressive phase may include persistent sad mood with feelings of hopelessness. Retrospective studies of adults with bipolar disorder have indicated age 18 as the average age of onset, though some youth exhibit symptoms before age 12. - ### -

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