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Children with mania do not always have bipolar

Mania in children more often linked to disruptive behaviour disorders

Jo Carlowe

Monday, 01 November 2010

Children with elevated symptoms of mania (ESM) are far more likely to meet criteria for disruptive behaviour disorders than for bipolar spectrum disorder.

This is according to new data from the Longitudinal Assessment of Manic Symptoms (LAMS) study.

But kids that do have bipolar disorder have lower overall functioning and more psychiatric hospitalisations than other children with ESM, said Dr Boris Birmaher, of the Western Psychiatric Institute and Clinic in Pittsburgh, Pennsylvania, in a presentation at the 57th annual meeting of the American Academy of Child and Adolescent Psychiatry in New York City.

Dr Birmaher’s study, published in the Journal of Clinical Psychiatry, involved 621 children with ESM, ages 6 to 12. Clinicians at 10 university-affiliated sites diagnosed 76% with attention deficit/hyperactivity disorder (ADHD), 53% with other disruptive behaviour disorders and 43% with mood disorders. Only 25% met criteria for bipolar spectrum disorder.

A control group of 86 paediatric psychiatric outpatients without ESM had a similar prevalence of ADHD (74%). They were less likely to be diagnosed with other disruptive behaviour disorders (36%), mood disorders (22%) and bipolar spectrum disorder (22%).

The ESM-positive group had more diagnoses than the ESM-negative group (mean 2.6 vs 2.0).

Considerable controversy surrounds the diagnosis of bipolar disorder before puberty, which has been made with increasing frequency in the last decade. Although a large number of children brought to psychiatric care have ESM, little is known about the phenomenology, course, or symptomatic evolution of these youngsters.

The LAMS study, funded by the National Institute of Mental Health, is screening a large sample of children who present for care with ESM, regardless of their clinical diagnoses, and carefully examining them both cross-sectionally and over the next five years. The study's goal is to provide the data necessary to develop valid, evidence-based criteria for a childhood-specific bipolar phenotype.

For the current work, Dr Birmaher and colleagues had parents or guardians of 2622 new outpatients complete the Parent General Behavior Inventory-10-Item Mania Scale (PGBI-10M), a 0-30 point scale for which higher scores indicate greater symptomatology. An ESM diagnosis required a minimum score of 12.

Overall, parents rated ESM-positive kids more highly on scales of depressive, ADHD, and anxiety symptoms, suggesting that ESM indicates a more symptomatic patient.

Dr Birmaher theorised that the presence of ESM may represent severe pathology rather than bipolar disorder.


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