Symptoms and Characteristics of Youth Hospitalized for Depression: Subthreshold Manic Symptoms Can Help Differentiate Bipolar from Unipolar Depression

A Systematic Review of Misdiagnosis of Pediatric Bipolar Disorder: Assessments and Recommendations

Bipolar disorders (BP) are a class of psychiatric disorders with a complex symptom presentation. This systematic review aims to summarize literature pertaining to the misdiagnosis of pediatric BP using the DSM-IV and DSM-5 criteria, while emphasizing the negative impact that untreated BP has on life outcomes. This paper also attempts to outline and summarize available recommendations which may aid in improving diagnostic accuracy of pediatric BP. Scholars Portal Journals, PsychINFO, and MEDLINE databases were used to search articles until March 21, 2023. Inclusion criteria limited this review to articles published between 1995 and 2022 using a pediatric (age < 18) sample. Exclusion criteria omitted articles containing samples with self-reported diagnoses. A total of 15 articles are included in this review; study results were synthesized using a narrative summary. Youth with BP are most frequently misdiagnosed with attention-deficit hyperactive disorder (ADHD), schizophrenia, and major depressive disorder (MDD). Misdiagnosis can lead to inappropriate intervention plans and a delay in proper treatment, negatively impacting a child's quality of life by contributing to social, occupational, and economic adversity. Finally, this review addresses the need for future quantitative research on the implications of false negative diagnoses of pediatric BP.

Decreased dynamic variability of the cerebellum in the euthymic patients with bipolar disorder

BACKGROUND

Bipolar disorder (BD) is a complex mental illness characterized by different mood states, including depression, mania/hypomania, and euthymia. This study aimed to comprehensively evaluate dynamic changes in intrinsic brain activity by using dynamic fractional amplitude of low-frequency fluctuations (dfALFF) and dynamic degree centrality (dDC) in patients with BD euthymia or depression and healthy individuals.

METHODS

The resting-state functional magnetic resonance imaging data were analyzed from 37 euthymic and 28 depressed patients with BD, as well as 85 healthy individuals. Using the sliding-window method, the dfALFF and dDC were calculated for each participant. These values were compared between the 3 groups using one-way analysis of variance (ANOVA). Additional analyses were conducted using different window lengths, step width, and window type to ensure the reliability of the results.

RESULTS

The euthymic group showed significantly lower dfALFF and dDC values of the left and right cerebellum posterior lobe compared with the depressed and control groups (cluster level PFWE < 0.05), while the latter two groups were comparable. Brain regions showing significant group differences in the dfALFF analysis overlapped with those with significant differences in the dDC analysis. These results were consistent across different window lengths, step width, and window type.

CONCLUSIONS

These findings suggested that patients with euthymic BD exhibit less flexibility of temporal functional activities in the cerebellum posterior lobes compared to either depressed patients or healthy individuals. These results could contribute to the development of neuropathological models of BD, ultimately leading to improved diagnosis and treatment of this complex illness.

Bipolar disorder and sexuality: a preliminary qualitative pilot study

BACKGROUND

Individuals with mental health disorders have a higher risk of sexual problems impacting intimate relations and quality of life. For individuals with bipolar disorder (BD) the mood shifts might to a particular degree affect their sexual function with possible hypersexual interest during manic episodes and low sexual interest during depressive episodes. The diagnosis is often given in late adolescence, which may impact sexual identity and development. Only a few studies have looked at BD and sexual life, with no qualitative research on the topic. We conducted a qualitative pilot study exploring sexuality in connection to mood swings in five participants with BD.

RESULTS

Thematic content analysis revealed five themes: (1) sexual drive and impulses, (2) sexual behavior, (3) thoughts and feelings in relation to sexual issues, (4) intimate relationships, and (5) sexuality and identity. During manic episodes the participants described having a higher sexual drive, leading for some to more sexual interactions. During depressed episodes, the sexual drive in the three female participants was low, however, in the two men, rather than a reduced sexual drive, a more self-destructive way of engaging in sex prevailed. The sexual outgoing behavior during manic phases was described as joyful, with no feelings of shame connected to it. However, the shifts in sexual drive connected to mood shifts affected the participants' relationships negatively. Further, all the participants described having outgoing sexual behavior in their youth.

CONCLUSIONS

Overall, changes in sexual drive may act as a trigger or early warning symptoms of new episodes, pinpointing the clinical relevance of addressing sexuality in individuals with BD. In general, sexual drive followed affective episodes. However, during depressive episodes sex could be, instead of reduced drive, associated with negative feelings. All participants described having an outgoing sexual behavior in their youth before the onset of BD, which might be essential to consider if there is a clinical suspension of BD in an individual.

Comparison of Hypomanic Symptoms Between Bipolar I and Bipolar II Disorders: A Network Perspective

BACKGROUND

Hypomanic symptoms between bipolar-I disorder (BD-I) and bipolar-II disorder (BD-II) are often indistinguishable in clinical practice. This study compared the network structure of hypomanic symptoms between patients with BD-I and BD-II.

METHODS

The 32-item Hypomania Checklist (HCL-32) was used to assess hypomanic symptoms. Network model was generated in BD-I and BD-II patients. Centrality index of strength was used to quantify the importance of each symptom in the network. The Network Comparison Test (NCT) was used to assess the differences in hypomanic symptoms between BD-I and BD-II patients.

RESULTS

Altogether, 423 patients with BD (BD-I: 191 and BD-II: 232) were included. The most central symptom was HCL17 "I am more flirtatious and/or am more sexually active" (strength _BD-I = 5.21) and HCL12 "I have more ideas, I am more creative" (strength _BD-II = 6.84) in BD-I and BD-II samples, respectively. The results of NCT showed that four nodes (HCL12 "I have more ideas, I am more creative," HCL17 "I am more flirtatious and/or am more sexually active," HCL23 "My thoughts jump from topic to topic," and HCL31 "I drink more alcohol") were significantly different between the BD-I and BD-II samples. Two edges (HCL3 "I am more self-confident"-HCL17 "I am more flirtatious and/or am more sexually active," and HCL10 "I am physically more active (sport, etc.)"-HCL24 "I do things more quickly and/or more easily") were significantly stronger in BD-I compared to BD-II patients.

CONCLUSION

The network structure of hypomanic symptoms is different between BD-I and BD-II patients. Interventions targeting the respective central symptoms and edges should be developed for BD-I and BD-II separately.