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Manic symptoms in psychiatrically hospitalized children--what do they mean?
1Department of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook, 11794-8790, USA. gcarlson@mail.psychiatry.sunysb.edu
Insights
Manic symptoms in children aged 5-12 indicate severe psychopathology, including attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). These children often require longer hospital stays and show resistance to treatment.
Area of Science:
- Child and Adolescent Psychiatry
- Pediatric Psychology
- Behavioral Pediatrics
Background:
- Manic symptoms in children are increasingly recognized but their clinical implications require further elucidation.
- Understanding the comorbidities and treatment outcomes associated with pediatric mania is crucial for effective intervention.
Purpose of the Study:
- To investigate the clinical significance of manic symptoms in hospitalized children aged 5 to 12 years.
- To compare children with and without manic symptoms regarding other psychiatric disorders and treatment response.
Main Methods:
- Utilized the Child Symptom Inventory IIIR and Child Behavior Checklist (CBCL) for pre-hospitalization symptom assessment.
- Conducted structured interviews (K-SADS-E) and weekly rating scales during hospitalization.
- Compared children with and without manic symptoms, including analysis of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and depression severity, and examined stimulant treatment effects in a subgroup.
Main Results:
- Children with manic symptoms exhibited more severe ADHD, ODD, and depression.
- Higher scores on aggression, social, and thought problems were observed in children with manic symptoms, corroborated by staff observations.
- Hospitalization duration was longer for children with manic symptoms, and stimulant treatment yielded modest overall psychopathology reduction in both groups.
Conclusions:
- Manic symptoms in children, irrespective of a formal bipolar disorder diagnosis, signify serious underlying psychopathology.
- These symptoms are associated with greater treatment resistance and more complex clinical presentations.
Objective:
To examine the clinical implications of manic symptoms in psychiatrically hospitalized children aged 5-12.
Methods:
DSMIIIR manic symptoms, along with symptoms of other psychiatric disorders, were rated by parents and teachers on the Child Symptom Inventory IIIR prior to hospitalization. The Child Behavior Checklist (CBCL; was also completed. During hospitalization children were evaluated by structured interview (K-SADS-E), and numerous rating scales weekly. Children with symptoms of mania (mania criteria with/without episodes) were compared to those without mania. Severity of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), depression, CBCL factors, and comparable factors from teacher and parent inpatient rating scales were examined. Finally, a subgroup of both groups of children treated with stimulants were compared at baseline and at least two weeks of treatment.
Results:
Children with manic symptoms had more severe ADHD, ODD and depression symptoms. CBCL scores on aggression, social and thought problems were higher. Teachers and nursing staff made similar observations. Time in hospital was greater for children with manic symptoms. Both groups improved significantly on stimulant medication though reduction in overall psychopathology was often modest.
Conclusions:
Manic symptoms, regardless of whether or not they represent bipolar disorder, are a marker of serious psychopathology and treatment resistance.