Bipolar disorder in children and adolescents: Assessment and diagnosis
- Boris Birmaher, MD
Boris Birmaher, MD
- Endowed Chair in Early Onset Bipolar Disease, Professor of Psychiatry
- University of Pittsburgh, School of Medicine
Bipolar disorder in children and adolescents is characterized by recurrent episodes of elevated mood (mania or hypomania) that exceed what is expected for the child’s developmental stage and are not better accounted by other psychiatric and medical conditions. In addition, youth with bipolar disorder usually have recurrent episodes of major depression [1-3].
Bipolar disorder severely affects the normal development and psychosocial functioning of the youth and increases the risk for suicide, psychosis, substance abuse and behavioral, academic, social, and legal problems [1,2]. Pediatric bipolar disorder frequently has a variable course with rapid fluctuation in mood symptoms during acute episodes. These factors coupled with developmental issues influencing the clinical picture, the difficulties youth can have verbalizing their emotions, and high rates of comorbid disorders, account for the complexity and controversies in diagnosing children and adolescents with bipolar disorder.
The prevalence of pediatric bipolar disorder in epidemiologic studies is comparable across different countries, with average rates for bipolar I disorder plus bipolar II disorder of approximately 1 to 2 percent . However, there may be variability across countries for diagnosing bipolar disorder, particularly the other specified bipolar and related disorder (bipolar disorder not otherwise specified) subtype [4,5]. As an example, a study of hospital discharge rates for pediatric bipolar disorder in the United States and England found that after adjusting for length of stay, the discharge rate was more than 12 times higher in the United States . This discrepancy was much larger than for other psychiatric diagnoses.
This topic describes the assessment and diagnosis of bipolar disorder in children and adolescents. The epidemiology, clinical presentation, comorbidity, and treatment of pediatric bipolar disorder are discussed separately.
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- Assessment instruments
- - Diagnostic interviews
- - Clinician administered rating scales
- - Youth and parent administered rating scales
- - Mood timelines or diaries
- Mood episodes
- - Mania
- - Hypomania
- - Major depression
- - Mood episode specifiers
- Bipolar disorders
- - Bipolar I disorder
- - Bipolar II disorder
- - Cyclothymic disorder
- - Other specified bipolar and related disorder
- - Mood disorder specifiers
- Diagnostic challenges
- Differential diagnosis
- - ADHD, conduct disorder, oppositional defiant disorder, and DMDD
- - Unipolar major depression
- - Schizophrenia
- - Autism spectrum disorder
- - Substance abuse
- - Medication reactions
- - General medical conditions