Mood disorders in adolescents: concepts and interrogations among Francophone psychiatrists

With the publication of DSM III, the nosology of children and adolescents' disorders has evolved differently in Francophone and Anglo-Saxon countries. We want to 1 / familiarize readers with the nosographic concepts of mood disorders and bipolar disorders in the Francophone world of Adolescent Psychiatry; 2/ highlight the major current issues of concern to both Francophone and Anglo-Saxon adolescents' psychiatrists.

A review of the literature in PubMed, PsycINFO and PsycARTICLES, but also of Francophone journals or textbooks not included in these databases nor distributed outside Francophone countries.

Although Francophone adolescents' psychiatrists still rely on the DSM II, particularly in reference to the transitory dimension of problems during adolescence, the DSM III led to a tightening of criteria for bipolar disorder in the Anglo-Saxon countries. These disorders have become rare in the 2000s while still common in Francophone countries. Nowadays the evolution of current criteria in Anglo-Saxon countries tends to bring the diagnostic criteria closer to the Francophone's one even though important differences still persist.

Despite differences between these two approaches in Psychiatry, there is agreement regarding the poor prognosis of type I bipolar disorder, particularly when psychotic traits are observed. Early diagnosis and treatment are therefore a challenge for both, but their limitations are inherent to their respective approaches. In Anglo-Saxon countries, if the criteria are met for bipolar disorder, treatment is decided at the risk of over-diagnosis and stigmatization of false positives. In Francophone countries, even if the criteria for bipolar disorder are met, it is still necessary that the psychopathological analysis of the disorder in the developmental framework of adolescence confirms that the disorder is stable, at the risk of later treatment and of increase of insufficiently treated false negatives. A reconciliation of these fields may limit the above side effects.