Bipolar children - is the US overdiagnosing? - New Scientist Article

[Micklemouse]

From the New Scientist

http://www.newscientist.com/channel/...mg19426043.900

Bipolar children - is the US overdiagnosing?

• 16 May 2007
• NewScientist.com news service
• Andy Coghlan

A growing epidemic?

Rebecca Riley seemed a normal, playful young child, if at times a little boisterous. Then, aged 2, she was diagnosed with attention deficit hyperactivity disorder, and at 3 as having a bipolar personality. By the age of 4, Rebecca was dead, killed by an overdose of the drug clonidine, which was being used to treat her condition. She was also taking the anti-convulsant Depakote (valproate) and the anti-psychotic Seroquel (quetiapine fumarate) to stabilise her mood.


Rebecca died next to her parents' bed in Hull, Massachusetts, on 13 December last year. This Wednesday a pre-trial hearing began that will be followed by a full trial to determine whether her parents, Carolyn and Michael Riley, intentionally gave Rebecca too much of the drug, or whether she died of an accidental overdose. Whatever the verdict, Rebecca's tragic story forms part of a wider narrative: the growing numbers of young children in the US being diagnosed with bipolar disorder and given drugs to treat it.


While the trend is clear, the reasons behind it are not. Psychiatrists also disagree over whether children are being helped or harmed by being diagnosed with the condition.


Bipolar disorder used to be called manic depression. People with it swing across an extreme spectrum of moods, usually from a state in which they feel euphoric and active, to one of depression and despondency, and back again.


In 1994, the official psychiatric manual, DSM-IV, widened the definition of bipolar disorder. The classic condition, characterised by the symptoms described above, was named bipolar disorder I, and was joined by three newly defined conditions: bipolar disorder II, which is a milder version of disorder I; cyclothymic disorder, in which mood swings manifest themselves more subtly; and bipolar disorder not otherwise specified, a catch-all category for people with bipolar-like symptoms who do not fit the other three diagnostic criteria.


Some specialists see this widening of the diagnostic criteria as the cause of the explosion in the numbers of children diagnosed with bipolar disorder. "When DSM expands its symptomology there's obviously a greater basis for diagnosis and prescription," says Lisa Cosgrove, a clinical psychologist at the University of Massachusetts, Boston, who studies the links between psychiatrists and the drug industry.


Child psychiatrist Gabrielle Carlson agrees. She and colleague Joseph Blader, both at Stony Brook University, New York, analysed data on people with bipolar disorders discharged from US hospitals. Between 1996 and 2004 the rate "went up minimally in adults, but rose astronomically in children", Carlson says.


In 1996, 13 out of every 100,000 children in the US were diagnosed as having bipolar disorder. In 2004, the figure was 73 in 100,000, a more than fivefold rise, they report in a paper to be published in Biological Psychiatry. Among children diagnosed with a psychiatric condition in 1996, 1 in 10 were deemed to have bipolar disorder. By 2004, 4 out of 10 children with a psychiatric condition were told they were bipolar (see Chart).


Some say this high prevalence of bipolar disorder in children in the US, which far exceeds that in most other countries, is genuine. "I think it's down to increased recognition that the condition exists in children, which wasn't accepted until a decade ago," says Susan Resko, executive director of the Child and Adolescent Bipolar Foundation, an advocacy group for families with a bipolar child based in Wilmette, Illinois.


According to a review of bipolar disorder published this month in the Harvard Mental Health Letter by Michael Miller, a psychiatrist at Harvard Medical School in Boston, the jury is still out. "We simply don't have all the information we need to connect the dots between behaviour, causes and symptoms. We don't know yet if kids are being under-medicated, over-medicated or mis-medicated," he told New Scientist. Any genetic basis for the condition is also proving elusive
“We simply don't yet have all the information to know if kids are being under-medicated, over-medicated or mis-medicated”
That uncertainty over both the cause and true prevalence of bipolar disorder raises concerns that children are being prescribed inappropriate drugs with damaging side effects. Lithium, for example, can cause excessive weight gain, thirst and acne in young children. It also makes children want to urinate more. Valproate can trigger excessive hair growth and, in adolescent girls, polycystic ovary syndrome, a leading cause of infertility.
Another worry is that drugs prescribed for other psychiatric conditions could be triggering bipolar disorder. Around 2 million children in the US are diagnosed as having attention deficit hyperactivity disorder (ADHD), which in children presents similar symptoms to bipolar disorder, and the antidepressants used to treat ADHD can make bipolar symptoms worse.


This possibility is backed by a review of worldwide rates of bipolar disorder in children published in 2005 by César Soutullo of the University of Navarra in Pamplona, Spain, and colleagues (Bipolar Disorders, vol 7, p 497). One study they cited found that children given antidepressants go on to develop a bipolar disorder at an earlier age (at 10, on average, rather than 14), and with greater severity, than those not prescribed such drugs. Resko, however, rejects the idea that prescribed drugs are causing more children to become bipolar.
There are also worries that over-diagnosis of bipolar disorder is leading to other psychiatric conditions being missed. In February, Ellen Leibenluft and her colleagues at the US National Institute of Mental Health in Bethesda, Maryland, suggested that brain imaging tests could help pick out children with a condition called "severe mood dysregulation", which is characterised by bipolar-like symptoms such as extreme irritability and hyperactivity. "We will end up with more clear-cut clinical tests that help avoid misdiagnosis," she says.
Meanwhile, debate continues over whether children such as Rebecca should be diagnosed as having bipolar disorder. Carlson says many parents and doctors would prefer to have a medical diagnosis rather than accept that a badly behaved child is psychologically normal, and she questions the validity of some diagnoses. "When children are only 2 to 4 years old, how can they be 'grandiose'?" she asks. Children of that age have mood swings every hour, she points out.


Resko maintains that a correct diagnosis of bipolar disorder can be helpful for children more than 5 or 6 years old, and says intervention may be required even for younger children if they have a history of the condition in the family. "These kids are suffering and committing suicide," she says. "It's a difficult call."

From issue 2604 of New Scientist magazine, 16 May 2007, page 6-7


Easy to confuse

Hyperactivity
Irritability (not getting your own way)
Psychosis (grandiosity/inflated self-esteem)
Elation (expansive mood)
Rapid speech
Sleep (lack of)
ATTENTION DEFICIT HYPERACTIVITY DISORDER
Hyperactivity
Impulsiveness
Distractability
Emotional lability (short temper)

...Being a child! This makes me sick. Truly, amazingly, furiously sick. I cannot find words to express quite how sick this makes me.

Reputation Comments on this post:

informative article, good find

[Micklemouse]

This from the New Scientist editorial comment

WHEN the prevalence of a medical condition leaps fivefold in eight years and it is not an infectious disease, something strange is going on. That is what has happened to childhood bipolar disorder in the US. The increase is not mirrored in other countries and there is no consensus among US doctors over the cause of the rise. Alarm bells are ringing.

I just find it so hard to believe that in the 21st Century a nation is medicalising childhood, & treating it with chemicals that are known to cause massive damage in adults, and about which there is little or no knowledge of effects on developing bodies & brains.

Just sick...

[Nagognog2]

Yep:

Being a child now has been compartmentalized into a psychiatric-syndrome in need of powerful drugs to stop the child's disorder of childhood.

I know the case in Hull, Mass. well. The parents will end up in prison. The doctor will get away to cause more harm. And the drug companies will reap the rewards.

If a doctor told me my 5 year old needed treatment because he was psychotic and believed in imaginary people (Santa Claus?), and handed me a prescription to give the kid, I'd break his arms.

It's not just OFS (Old Fart's Syndrome) that leads me to conclude that each subsequent generation is getting more fucked-up and dumber - it's the drugs being shoved down their throats with ever greater emphasis.

[stoneinfocus]

:P the earlier called "way of life", earlier called manic-depression, now called bipolar disorder... is now treated to treat the lack of getting money out of children adn adults with highly addictive drugs in combination with the most unpleasant drugs, that were used to be sold to adults, but now not anymore, cause, somehow these scripts and combimations suck and no adult would take them and pleasure inducing drugs, that were best selling, now forbidden had disappeared, because feeling good and getting good money for it, is not so cool, as giving your money to otherwise obsolete institutes and churches.

[stoneinfocus]

Beside all these symptoms might reflect a lack of a vitamine or a short episode of infection with bacetria, virus or bugs or whatsoever and dude, how often do 5 year old children plan and commit suicide... why dont we put this misery to an end and shoot all psychiatr... eeehhrg -children?

[enquirewithin]

Prescribing drugs for a condition is obviously easier than looking for the causes, which could be physiological, psychological or social. If a child spends years on anti depressants, they will soon develop disorders if they didn't have any beforehand! And, of course, there is the financial aspect-- drugs companies and doctors making profits.

[~lostgurl~]

Early intervention and treatment offer the best chance for children with emerging bipolar disorder to achieve stability, gain the best possible level of wellness, and grow up to enjoy their gifts and build upon their strengths.

Studies show that after symptoms first appear, typically there is a 10-year lag until treatment begins. Untreated bipolar disorder has a fatality rate of 18 percent or more (from suicide), equal to or greater than that for many serious physical illnesses. The untreated disorder carries the risk of drug and alcohol addiction, damaged relationships, school failure, and difficulty finding and holding jobs.

A good treatment plan can include medication, close monitoring of symptoms, education about the illness, counselling or psychotherapy for the individual and family, stress reduction, good nutrition, regular sleep and exercise, and participation in a network of support.

The risks of not treating bipolar disorder are substantial and must be measured against the unknown risks of using medications whose safety and efficacy have been established in adults, but not yet in children.

SWIM believes that the most effective tool for treating bipolar in children is for the individual and family to have a sound knowledge and understanding of the disease.

SWIM has bipolar with the onset occuring in early childhood. SWIM was not diagnosed until she was 26 and she feels her life would have been very different if she had been diagnosed in childhood. She is however happy that she was not medicated for bipolar while still a child, but believes medication in her mid to late teens would have been life changing for SWIM.

[stoneinfocus]

I think this medication plan is a fascist paln in rteating something, that in no way can be diagnosed with certenity and thus fucking up many many lifes not to say that it´s in most if not all cases a social problem, which,. again is medicated to death within the "patient".

One could as well curb the rebels and free-thinkers this way, which are easily identified as the rotten and disturbing and ill-precieved children, whie the ass lickers getting the grades and the jobs, and the power to prescribe lobotomising drugs. Oh, yes, swim is bipolar because he was mobbed and cut his whole life by his fascist sadiostic family of teacxhers and sick as fuck brothers as well as by his friends who were easily influenced by the authorities.

One should make an end to psychiatry, for good, I really can´t stand it any more for swim´s sake and all the others, ths scum spreading their sadistic, brain-dead bullshit.. bring back the age, and coke to the shops and psychiatry can go quit.

[Nacumen]

Overdiagnosing? Who's to say we don't have more lunies over here?