Paediatric bipolar disorder and its controversy.

Area of Science:

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

Background:

• Paediatric bipolar disorder (PBD) is controversial, with differing views on its prevalence and presentation in prepubertal children.
• Recent decades have seen arguments for PBD being more common than previously thought, challenging historical perspectives.
• Concerns exist regarding the validity of proposed PBD phenotypes and the risk of iatrogenic harm from misdiagnosis.

Purpose of the Study:

• To critically evaluate the construct of paediatric bipolar disorder.
• To assess the validity of PBD diagnoses using established criteria for psychiatric diagnoses.
• To review evidence across multiple domains to determine the scientific basis for PBD.

Main Methods:

• Application of Robins and Guze's criteria for psychiatric diagnosis validity.
• Systematic review of evidence concerning clinical description and delimitation from other disorders.
• Examination of follow-up, family, laboratory, and treatment response studies.

Main Results:

• Significant challenges exist in establishing PBD diagnoses, including heterogeneous criteria and poor reliability.
• Distinguishing PBD from other conditions is difficult, with notable international variations in diagnosis rates.
• Limited evidence supports continuity with adult bipolar disorder or proposed paediatric phenotypes in high-risk children.

Conclusions:

• The scientific evidence supporting the widespread existence of paediatric bipolar disorder and its phenotypes is currently weak.
• The diagnosis's popularity, particularly in the USA, may be influenced by social factors and limitations in psychiatric classification.
• The diagnostic uncertainty underscores the necessity for meticulous longitudinal assessments in affected children.