Bipolar Disorder Diagnosed Late in Children and Adolescents

SEPTEMBER 28, 2009

A majority of children and adolescents with bipolar disorder receive the diagnosis late, and many receive other diagnoses—such as behavioral disorder and depression—before bipolar disorder is correctly identified, according to new research from the University Hospital of Navarra and Massachusetts General Hospital (MGH).

This new study was based on research from 2005 that examined the perspectives of bipolar disorder in children outside of the United States. According to Dr. Inmaculada Escamilla Canales, who conducted both the earlier and current research as the focus of her PhD thesis, the new research showed that 75% of the cases of pediatric bipolar disorder were diagnosed late, up to 18 months after symptoms first presented, and that the remaining 25% of patients received a diagnosis up to three years and four months late. As many as four other diagnoses were given to 14% of patients before the correct diagnosis of bipolar disorder was made.

According to Dr. Canales, the patients who were diagnosed with other disorders received medications to treat those illnesses, one-third of them having received three different drugs; the researchers are currently studying how those medications may influence the course of bipolar disorder, as some may have acted as stimulants.

The researchers, who worked in the Department of Psychiatry and Medical Psychology at Navarra and the Pediatric Psychopharmacology Unit at MGH, examined 38 boys and girls diagnosed with bipolar disorder over six years. Symptoms that manifested before and after diagnosis were recorded, as well as family psychiatric history, any treatment received, and progress in school.

The reason for this delay in a correct diagnosis may be that the symptoms of bipolar disorder can be symptomatic of other disorders, such as irritability, which is common in both bipolar disorder and depression. In addition, “unlike the progress of the illness amongst adults, the episodes in children are not clearly defined,” the researchers added; symptoms that are common in children and adolescents, such as outbursts and/or tantrums, are hard to distinguish as being symptoms of bipolar disorder or typical adolescent behavior.

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