Description

Traditionally bipolar disorder has been seen as extremely rare prior to puberty and very rare in early adolescence, with first onset usually being from mid adolescence into adulthood. Diagnosis is often made late and early detection is important. However since the mid 1990s in the USA the rate of bipolar disorder diagnoses with children and teens has soared (44 fold from 94/95 to 02/03), is not uncommonly diagnosed in children as young as 2 years of age, and is the most common diagnosis in pre-pubertal paediatric psychiatric inpatient units. There is intense controversy over the diagnosis including between proponents of different “paediatric bipolar disorder phenotypes” and from clinicians who hold to traditional views that discount the validity of “Paediatric Bipolar Disorder” (PBD). 

This rise in diagnosis appears to relate to multiple factors. This talk examines the changing diagnostic criteria, a neglect or disconnect from the attachment and traumatology literature, influences of the pharmaceutical industry within US academic psychiatry and "diagnostic upcoding" to access services rationed on a diagnosis basis by US health insurers. The rise in PBD diagnosis also correlates with increased polypharmacy for very young children.
 
More traditional views appear to hold sway in ANZ, the UK and Germany, though PBD is increasingly being diagnosed in some other countries.

Resources

This workshop includes a comprehensive PowerPoint presentation. Real-time reference to slides is available throughout the presentation.