Mania in prepubertal children: has it been underdiagnosed?

Area of Science:

• Child and Adolescent Psychiatry
• Psychiatric Diagnostics
• Mental Health Research

Background:

• Prior to lithium's introduction, mania was frequently underdiagnosed in adults, with nearly 50% misdiagnosed as schizophrenia.
• This underdiagnosis pattern in adults suggested potential similar issues in diagnosing mania in prepubertal children.

Purpose of the Study:

• To investigate the extent of mania underdiagnosis in prepubertal children.
• To assess if prepubertal children meeting diagnostic criteria for mania were often initially given other diagnoses.

Main Methods:

• A review of 157 cases of 'severely disturbed' children from existing literature.
• Analysis of original diagnoses versus DSM-III (Diagnostic and Statistical Manual of Mental Disorders, Third Edition) criteria for mania.

Main Results:

• Approximately half (16 out of 33) of children diagnosed with mania according to DSM-III criteria had initially received different diagnoses.
• This finding mirrors the underdiagnosis rates observed in adults prior to lithium treatment.

Conclusions:

• Mania should be a key consideration in the differential diagnosis of children presenting with psychotic symptoms.
• Particular attention should be paid to prepubertal children with affective symptoms who may be misdiagnosed.
• The study underscores the importance of accurate diagnostic criteria for childhood mania.