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Diagnostic stability in pediatric bipolar disorder.

Lars Vedel Kessing1, Eleni Vradi2, Per Kragh Andersen2

  • 1Psychiatric Center Copenhagen, Department O, 6233 Blegdamsvej 9, 2100 Copenhagen, Denmark and University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark.

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The diagnostic stability of pediatric bipolar disorder is low, with over half of children diagnosed later. Clinicians should monitor for manic symptoms in those initially presenting with other disorders.

Keywords:
Bipolar disorderChildren and adolescentsDiagnostic stabilityICD-10Mania

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Area of Science:

  • Child and Adolescent Psychiatry
  • Mental Health Research
  • Diagnostic Stability Studies

Background:

  • The diagnostic stability of pediatric bipolar disorder remains understudied.
  • Previous research has not focused on the long-term diagnostic trajectory of mania/bipolar disorder in children and adolescents.

Purpose of the Study:

  • To investigate the diagnostic stability of the ICD-10 diagnosis of pediatric mania/bipolar disorder.
  • To understand the time course of diagnosis for pediatric bipolar disorder.

Main Methods:

  • A nationwide register in Denmark was used to identify patients under 19 diagnosed with mania/bipolar disorder between 1994 and 2012.
  • Inclusion criteria involved at least one diagnosis of mania/bipolar disorder in inpatient or outpatient psychiatric settings.

Main Results:

  • Out of 354 identified patients, only 40.7% received the diagnosis at their first contact; 59.3% were diagnosed later.
  • For those diagnosed later, the median time to diagnosis was nearly 1 year, with 25% taking over 2.5 years.
  • Initial diagnoses frequently included depressive disorder (21.4%), transient psychotic disorders (19.2%), and adjustment disorders (14.8%).

Conclusions:

  • The study highlights a significant delay in diagnosing pediatric bipolar disorder, with many cases identified after initial presentation with other conditions.
  • Clinicians should maintain a high index of suspicion for manic symptoms in children presenting with adjustment disorders, transient psychoses, or behavioral issues.
  • Close monitoring and early identification of hypomanic/manic symptoms are crucial for timely and accurate diagnosis in pediatric populations.