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López-Cuadrado T, Susser E, Martínez-Alés G. Recent trends in hospital admission due to bipolar disorder in 10-19-year-olds in Spain: A nationwide population-based study. Bipolar Disord 2024. [PMID: 39237479 DOI: 10.1111/bdi.13500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
INTRODUCTION Bipolar disorder (BD) hospitalization rates in children and adolescents vary greatly across place and over time. There are no population-based studies on youth BD hospitalizations in Spain. METHODS We identified all patients aged 10-19 hospitalized due to BD in Spain between 2000 and 2021, examined their demographic and clinical characteristics, and assessed temporal trends in hospitalizations - overall and stratified by age and presence of additional psychiatric comorbidity. We used Joinpoint regressions to identify inflection points and quantify whole-period and annual percentage changes (APCs) in trends. RESULTS Of 4770 BD hospitalizations in 10-19-year-olds between 2000 and 2021 (average annual rate: 4.8 per 100,000), over half indicated an additional psychiatric comorbidity, most frequently substance abuse (62.2%), mostly due to cannabis (72.4%). During the study period, admissions increased twofold with an inflection point: Rates increased annually only between 2000 and 2008, for APCs 34.0% (95% confidence interval: 20.0%, 71.1%) among 10-14-year-olds, 10.3% (6.4%, 14.3%) among 15-19-year-olds, and 15.5% (11.5%, 22.7%) among patients with additional psychiatric comorbidity. Between 2009 and 2021, rates decreased moderately among 10-14-year-olds - APC: -8.3% (-14.1%, -4.4%) and slightly among 15-19-year-olds without additional psychiatric comorbidity - APC: -2.6(-5.7, -1.0), remaining largely stable among 15-19-year-olds overall. CONCLUSIONS Recent trends in hospitalization due to BD in 10-19-year-olds in Spain indicate salient increases in the early 2000s - especially among (i) patients aged 10-14 (decreasing moderately after 2009 among 10-14-year-olds and plateauing among 15-19-year-olds) and (ii) patients with additional psychiatric comorbidity (i.e., cannabis use disorder). These findings suggest links with recent changes in clinical practices for children and recent trends in substance use among Spanish youth.
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Affiliation(s)
- Teresa López-Cuadrado
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Gonzalo Martínez-Alés
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- CAUSALab, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
- Hospital La Paz Institute for Health Research (IDIPaz), Madrid, Spain
- Mental Health Network Biomedical Research Center (CIBERSAM), Madrid, Spain
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2
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Findling RL, Zhou X, George P, Chappell PB. Diagnostic Trends and Prescription Patterns in Disruptive Mood Dysregulation Disorder and Bipolar Disorder. J Am Acad Child Adolesc Psychiatry 2022; 61:434-445. [PMID: 34091008 DOI: 10.1016/j.jaac.2021.05.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/05/2021] [Accepted: 05/27/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Disruptive mood dysregulation disorder (DMDD) was introduced in DSM-5 to distinguish a subset of chronically irritable youth who may be incorrectly diagnosed and/or treated for pediatric bipolar disorder (BPD). This study characterized the rate of new treatment episodes and treated prevalence of BPD and DMDD from a longitudinal electronic health record database and examined the impact of DMDD on prescription trends. METHOD A retrospective cohort study using 2008-2018 Optum electronic health record data was conducted. Youth aged 10 to < 18 years with ≥ 183 days of database enrollment before the study cohort entry were included. Annual new treatment episode rates per 1,000 patient-years and treated prevalence (%) were estimated. Prescriptions for medications, concomitant diagnoses, and acute mental health service use for 2016-2018 were evaluated. RESULTS There were 7,677 youths with DMDD and 6,480 youths with BPD identified. Mean age (13-15 years) and ethnicity were similar for both groups. A rise in new treatment episode rates (0.87-1.75 per 1,000 patient-years, p < .0001) and treated prevalence (0.08%-0.35%, p < .0001) of DMDD diagnoses (2016-2018) following diagnosis inception was paralleled by decreasing new treatment episode rates (1.22-1.14 per 1,000 patient-years, p < .01) and treated prevalence (0.42%-0.36%, p < .0001) of BPD diagnoses (2015-2018). More youth in the DMDD group were prescribed medications compared with the BPD group (81.9% vs 69.4%), including antipsychotics (58.9% vs 51.0%). Higher proportions of youth with DMDD vs youth with BPD had disruptive behavior disorders (eg, 35.9% vs 20.5% had oppositional defiant disorder), and required inpatient hospitalization related to their mental health disorder (45.0% vs 33.0%). CONCLUSION Diagnosis of DMDD has had rapid uptake in clinical practice but is associated with increased antipsychotic and polypharmacy prescriptions and higher rates of comorbidity and inpatient hospitalization in youth with a DMDD diagnosis compared with a BPD diagnosis.
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Affiliation(s)
| | - Xiaofeng Zhou
- Epidemiology, Worldwide Safety and Regulatory, Pfizer Inc, New York
| | - Prethibha George
- Epidemiology, Worldwide Safety and Regulatory, Pfizer Inc, New York
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3
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Sherwood SN, Carlson GA, Freeman AJ. Decreasing rate of inpatient pediatric bipolar disorder diagnosis in the US between 2004 and 2010. Bipolar Disord 2022; 24:149-160. [PMID: 34664344 DOI: 10.1111/bdi.13145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Diagnosis of bipolar disorder (BD) increased substantially among youth between the mid-1990s and mid-2000s in the United States. This dramatic increase in diagnosis resulted in concern regarding the potential for misdiagnosis of BD among youth. However, the rate of BD diagnosis in the United States had not been evaluated nationally since the mid-2000s. It was unclear whether changes in diagnostic rates continued to occur. Therefore, the present study aimed to assess the pattern of longitudinal trends in the rate of national inpatient BD diagnosis subsequent to 2004. METHODS Data included a nationally representative dataset of inpatient hospitalizations between 1996 and 2010. De-identified data were obtained from the National Hospital Discharge Survey (NHDS) conducted annually by the National Center for Health Statistics. RESULTS The proportion of BD diagnoses relative to all psychiatric diagnoses increased between 1996 and 2004 among children and adolescents. The proportion of BD diagnoses then decreased between 2004 and 2010 among children but continued to increase for adolescents. However, population-adjusted rates of BD diagnosis per 10,000 individuals in the general population initially increased until the mid-2000s and then decreased until 2010 for both children and adolescents. CONCLUSIONS Rates of BD diagnosis substantially decreased for youth between the mid-2000s and 2010. This decline coincided with recommendations for more conservative diagnostic practices due to concerns about overdiagnosis and increasing awareness of the side effects of front-line medications used to treat BD in youth. Findings provide insight into changing trends in inpatient service utilization for BD in the United States.
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Affiliation(s)
| | - Gabrielle A Carlson
- Psychiatry and Pediatrics, State University of New York at Stony Brook, East Setauket, New York, USA
| | - Andrew J Freeman
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA.,Division of Child and Family Services, Nevada Department of Health and Human Services, Las Vegas, Nevada, USA
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Bipolar Disorder in pediatric patients: A nationwide retrospective study from 2000 to 2015. J Affect Disord 2022; 298:277-283. [PMID: 34715176 DOI: 10.1016/j.jad.2021.10.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pediatric Bipolar Disorder (BD) has been the focus of increased attention. To date, in Portugal, there is no evidence available for pediatricBD-related hospitalization rates. This study aimed to describe and characterize all pediatric hospitalizations with a primary diagnosis of BD registered in Portugal from 2000 to 2015. METHODS A retrospective observational study was conducted. Pediatric (< 18 years) inpatient episodes with a primary diagnosis of BD were selected from a national administrative database. The ICD-9-CM codes 296.x (excluding 296.2x, 296.3x and 296.9x) identified the diagnosis of interest. Additionally, age at discharge, sex, psychiatric comorbidities, length of stay (LoS), admission type and date, in-hospital mortality and hospital charges were analyzed. RESULTS A total of 348 hospitalizations, representing 258 patients, were identified. The overall population-based rate of hospitalizations was 1.18/100 000 youths. A non-linear increase throughout the study period was found. Patients were mostly female (60.6%), with a median age of 16 years (Q1-Q3:14-17). Admissions were mostly emergent (81%), and the median LoS was 14 days (Q1-Q3:7-24). Moreover, about 26% of all episodes were readmissions. Mean estimated charges per episode were 3503.10€, totalizing 1.20M€. LIMITATIONS Limitations include the use of secondary data and the retrospective nature of the study. CONCLUSIONS Annual rates of pediatric BD hospitalizations showed a non-linear increase. These findings may contribute to better understand the pediatric BD burden. Nevertheless, more research is warranted, to better characterize sociodemographic and clinical trends in pediatric BD to prevent the high number of acute hospitalizations and readmissions of these patients.
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Parry P, Allison S, Bastiampillai T. 'Pediatric Bipolar Disorder' rates are still lower than claimed: a re-examination of eight epidemiological surveys used by an updated meta-analysis. Int J Bipolar Disord 2021; 9:21. [PMID: 34170440 PMCID: PMC8233426 DOI: 10.1186/s40345-021-00225-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/15/2021] [Indexed: 01/20/2023] Open
Abstract
Background ‘Pediatric bipolar disorder’ (PBD) is a controversial diagnosis with varying rates of clinical diagnosis. A highly cited meta-analysis (Van Meter et al. 2011) of a dozen epidemiological surveys suggested a global community prevalence of PBD of 1.8%. This was updated to 3.9% with eight additional surveys (Van Meter et al. 2019a). In terms of the Cochrane Handbook for Systematic Reviews of Interventions, the heterogenous community surveys were arguably unsuitable for statistical meta-analysis and warranted a narrative analysis. A narrative analysis (Parry et al. 2018) of the original 12 surveys concluded rates of PBD were substantially lower than 1.8% and led to a nine-article debate on the validity, arguable overdiagnosis and iatrogenic aspects of the PBD diagnosis (e.g. Carlson and Dubicka Child Adolesc Mental Health 21:86–87, 2019). This article extends the narrative analysis to include the eight newer community surveys. Methods A narrative analysis of the methodologies and the prevalence rates reported by the epidemiological surveys. Results Across all twenty surveys there was significant variation in methodologies and reported prevalence rates. Of the eight newer surveys, five (two Brazilian, one English, one Turkish, one United States) provided information of pre-adolescent prevalence rates of bipolar spectrum disorder. These pre-adolescent rates were zero or close to zero. Rates of adolescent hypomania and mania were higher, but follow-up data in two studies suggested hypomania might sometimes achieve prolonged remission or not lead to adult bipolar disorder. Limitations Methods in the original surveys vary and criteria used for various bipolar diagnoses were not always fully described. This limitation applies to a narrative analysis but also to a statistical meta-analysis. Conclusion Bipolar disorder is very rare in childhood and rare in adolescence. PBD as a diagnostic construct fails to correlate with adult bipolar disorder and the term should be abandoned. Hypomanic syndromes in adolescence may not always progress to adult bipolar disorder. Early diagnosis of bipolar disorder is important, but over-diagnosis risks adverse iatrogenic consequences.
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Affiliation(s)
- Peter Parry
- College of Medicine and Public Health, Flinders University, Adelaide, Australia. .,Children's Health Queensland Clinical Unit, School of Clinical Medicine, University of Queensland, Brisbane, Australia.
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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Fructose and Uric Acid as Drivers of a Hyperactive Foraging Response: A Clue to Behavioral Disorders Associated with Impulsivity or Mania? EVOL HUM BEHAV 2021; 42:194-203. [PMID: 33994772 DOI: 10.1016/j.evolhumbehav.2020.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Several behavioral disorders, including attention deficit hyperactivity disorder (ADHD), bipolar disorder, and aggressive behaviors are linked with sugar intake and obesity. The reason(s) for this association has been unclear. Here we present a hypothesis supporting a role for fructose, a component of sugar and high fructose corn syrup (HFCS), and uric acid (a fructose metabolite), in increasing the risk for these behavioral disorders. Recent studies have shown that the reason fructose intake is strongly associated with development of metabolic syndrome is that fructose intake activates an evolutionary-based survival pathway that stimulates foraging behavior and the storage of energy as fat. While modest intake may aid animals that would like to store fat as a protective response from food shortage or starvation, we propose that high intake of sugar and HFCS causes a hyperactive foraging response that stimulates craving, impulsivity, risk taking and aggression that increases the risk for ADHD, bipolar disease and aggressive behavior. High glycemic carbohydrates and salty foods may also contribute as they can be converted to fructose in the body. Some studies suggest uric acid produced during fructose metabolism may mediate some of these effects. Chronic stimulation of the pathway could lead to desensitization of hedonic responses and induce depression. In conclusion, a hyperactive foraging response driven by high glycemic carbohydrates and sugars may contribute to affective disorders.
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Alghamdi WA. Disruptive Mood Dysregulation Disorder and its Impact on Rates of Bipolar Disorder among Children and Adolescents. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2021. [DOI: 10.2174/2666082216999200909113835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
In 2013, Disruptive Mood Dysregulation Disorder (DMDD) was introduced
in the DSM-5 in part to curb the rapid rise in the rates of bipolar diagnosis among children
and adolescents during the decade before the DSM-5 publication. DMDD proved to be a controversial
diagnosis for many reasons.
Objective:
This brief review aims to provide an overview of the DMDD diagnosis and its origins
and summarize available data on the impact of the introduction of the DMDD diagnosis on the rates
of bipolar disorder among children and adolescents.
Methods:
Multiple scientific databases were searched using the related terms “DMDD”, “Disruptive
Mood Dysregulation”, and “pediatric bipolar disorder” in combination with the terms “diagnosis”
and “impact”. The retrieved articles were reviewed carefully.
Results:
The DMDD diagnosis rates have steadily increased since its introduction. Furthermore,
available data show a decrease in the rates of bipolar disorder diagnosis among children and adolescents
over the past few years.
Conclusion:
The very limited available data since 2013 show a decline in the diagnosis of bipolar
disorder among children and adolescents. More time and further research are needed to more accurately
determine the impact of the DMDD diagnosis on the rates of bipolar disorder in this population.
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Affiliation(s)
- Waleed A. Alghamdi
- Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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8
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Sherwood SN, Greenway J, Freeman AJ. Decreasing rate of inpatient pediatric bipolar disorder diagnosis between 2005 and 2015. J Affect Disord 2020; 274:859-863. [PMID: 32664026 DOI: 10.1016/j.jad.2020.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/22/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The rate of bipolar disorder (BD) diagnosis in youth increased between the mid-1990s and mid-2000s in the U.S. and remained low in other countries. The discrepancy resulted in concerns regarding misdiagnosis of BD. However, the longitudinal trajectory of BD diagnosis subsequent to the mid-2000s was unclear. Therefore, the current study assessed longitudinal changes in the rate of inpatient BD diagnosis in the state of Nevada between 2005 and 2015. METHODS Data included Medicaid administrative billing claims (n = 48,108 unique admissions) for youth 5-17 hospitalized at one of five psychiatric inpatient hospitals in Nevada. Regressions assessed changes in the rate of diagnosis over time for BD and compared to depressive disorders (DD). RESULTS The rate of BD diagnosis declined between 2005 and 2015. The rate of DD diagnosis remained stable for boys and increased substantially for girls during the same time period. LIMITATIONS Some individuals may have been repeatedly hospitalized throughout the study period and contribute more than one unique admission. Findings from this study were limited to a sample of Medicaid-insured youth in a single state. CONCLUSIONS The rate of mood disorder diagnosis in inpatient units is changing. The use of BD as a diagnosis is decreasing in Nevada which may reflect US trends nationally, though still high by international comparison. In contrast, DD increased for girls but not boys. Awareness of the current diagnostic trends for BD may assist inpatient administrators and clinicians in preparing for anticipated service utilization and planning allocation of resources.
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Affiliation(s)
- Samantha N Sherwood
- Department of Psychology, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, Nevada, USA
| | - Joseph Greenway
- Center for Health Information Analysis at the University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, Nevada, USA
| | - Andrew J Freeman
- Department of Psychology, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, Nevada, USA.
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9
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Sher L. Early-onset bipolar disorder and suicide. Asian J Psychiatr 2020; 47:101854. [PMID: 31726423 DOI: 10.1016/j.ajp.2019.101854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Leo Sher
- James J. Peters Veterans' Administration Medical Center, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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10
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Frahm Laursen M, Valentin JB, Licht RW, Correll CU, Nielsen RE. Longitudinal outcomes in pediatric- and adult-onset bipolar patients compared to healthy and schizophrenia controls. Bipolar Disord 2019; 21:514-524. [PMID: 31069923 DOI: 10.1111/bdi.12793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Comparing outcomes of bipolar disorder (BD) with schizophrenia (SCZ) and psychiatrically healthy controls (PHC), contrasting pediatric-onset with adult-onset disorders. METHODS A nationwide cohort study, including patients with an incident diagnosis of BD or SCZ registered in the Danish National Patient Registry and corresponding PHCs. Outcomes were (a) duration of hospitalization, (b) psychiatric admissions, (c) psychiatric outpatient contacts, (d) bone-fracture-related healthcare contacts, (e) self-harm-related healthcare contacts (including suicide and non-suicidal self-injuries), and (f) criminal charges. Incidence rate ratios (IRRs), adjusted for age at first psychiatric contact, substance abuse and parental psychiatric illness, were calculated, comparing pediatric-onset BD (5-17 years) and adult-onset BD (18-39 years) with age- and sex-matched SCZ patients and PHC. RESULTS Pediatric-onset BD (n = 349) performed better than 1:1-matched pediatric-onset SCZ (n = 349) on all six outcomes (IRR = 0.30 for self-harm-related contacts (P < 0.001) to IRR = 0.86 for criminal charges (P = 0.05). Similar, but less pronounced results were observed comparing 1:1-matched adult-onset BD (n = 5515) with adult-onset SCZ (n = 5515) IRR = 0.58 for psychiatric outpatient contact (P < 0.001) to IRR = 0.93 for criminal charges (P < 0.001), except for more bone-fracture-related contacts in adult-onset BD (IRR = 1.13, P < 0.01). Comparing pediatric-onset BD (n = 365) to 1:3-matched PHC (n = 1095), only self-harm-related contacts differed significantly (IRR = 2.80, P < 0.001). Conversely, comparing adult-onset BD (n = 6005) with 1:3-matched PHC (n = 18 015), self-harm-related contacts (IRR = 16.68, P < 0.001), bone fractures (IRR = 1.74, P < 0.001), and criminal charges (IRR = 2.03, P < 0.001) were more common in BD. CONCLUSION BD was associated with poorer outcomes than PHC, but better outcomes than SCZ. Furthermore, outcomes were more favorable in pediatric-onset BD when indirectly contrasted to adult-onset BD.
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Affiliation(s)
- Mathilde Frahm Laursen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan B Valentin
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Rasmus W Licht
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christoph U Correll
- Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York City, New York, USA.,Hofstra Northwell School of Medicine, Hempstead, New York, USA.,The Feinstein Institute for Medical Research, Manhasset, New York, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - René E Nielsen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Research and Treatment Program for Bipolar Disorder, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
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Parry P, Allison S, Bastiampillai T. The geography of a controversial diagnosis: A bibliographic analysis of published academic perspectives on 'paediatric bipolar disorder'. Clin Child Psychol Psychiatry 2019; 24:529-545. [PMID: 30905170 DOI: 10.1177/1359104519836700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The hypothesis that bipolar disorder presents before puberty with atypical mania has proved to be controversial. Published academic perspectives on the validity of Paediatric Bipolar Disorder (PBD) appear to vary between the United States and the rest of the world. METHODS We examined the perspectives of articles citing four seminal articles. The citing articles were grouped as either supportive or non-supportive of the PBD hypothesis, and the perspectives of the articles by US authors were compared with those by non-US authors. RESULTS There were 787 citing articles commenting on PBD, mostly published in US-based journals. Most authors were affiliated with several US institutions. Among the 624 articles with US authorship, the majority (83%) supported PBD. Of the 163 articles by non-US authors, most (60%) supported the traditional view that bipolar disorders are rare before mid-adolescence. Published academic perspectives in favour of the PBD hypothesis are mostly concentrated in several US institutions. CONCLUSION There is majority support for PBD among citing articles from the United States, whereas the traditional perspective predominates in articles from most other countries.
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Affiliation(s)
- Peter Parry
- 1 School of Clinical Medicine - Children's Health Queensland Clinical Unit, University of Queensland, Australia.,2 College of Medicine and Public Health, Flinders University, Australia
| | - Stephen Allison
- 2 College of Medicine and Public Health, Flinders University, Australia
| | - Tarun Bastiampillai
- 2 College of Medicine and Public Health, Flinders University, Australia.,3 Mind and Brain Theme, South Australian Health and Medical Research Institute, Australia
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Parry P, Allison S, Bastiampillai T. Debate: Bipolar disorder: extremely rare before puberty and antipsychotics cause serious harms - a commentary on Van Meter et al. (2019). Child Adolesc Ment Health 2019; 24:92-94. [PMID: 32677224 DOI: 10.1111/camh.12306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 11/28/2022]
Abstract
'Paediatric bipolar disorder' (PBD) remains controversial; because it is based on the hypothesis that bipolar disorder (BD) often begins in childhood with atypical forms of mania. A meta-analysis of 12 epidemiological surveys found a high prevalence of PBD among children and adolescents worldwide (1.8%), however, our study of the measurement issues (Child and Adolescent Mental Health, 23, 2018, 14) found that PBD rates were lower than claimed. Our findings are consistent with the developmental trajectory of BD, as described by most longitudinal studies of high-risk offspring. BD is extremely rare in childhood with nearly all index manic/hypomanic episodes being in midadolescence or later. Treatment for BD should not commence until the first well-defined manic/hypomanic episode, because children and younger adolescents are extremely sensitive to the side effects of second-generation antipsychotics including weight gain, metabolic syndrome, extrapyramidal side effects and the risk of cerebral atrophy, as observed in studies of juvenile animals.
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Affiliation(s)
- Peter Parry
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Children's Health Queensland Clinical Unit, School of Clinical Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Wesemann D. Decreasing Rates of Pediatric Bipolar Within an Outpatient Practice. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2017; 29:188-195. [PMID: 28093821 DOI: 10.1111/jcap.12162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 11/28/2022]
Abstract
PROBLEM Pediatric bipolar disorder (PBD) prevalence is estimated to be 1-3%. Nationally and internationally, rates of PBD have increased by over 400%. However, in Iowa and at one psychiatric clinic in Iowa, from 2008-2013, there was a decrease in PBD diagnosis of 33 and 51.2% respectively. This study examined the diagnosing practices of PBD by local providers in one outpatient mental health center. METHOD Parents completed a screening packet to differentiate between PBD and attention deficit hyperactivity disorder (ADHD) using three tools: Child Mania Rating Scale (CMRS), Child Behavior Checklist-Mania Scale (CBCL-MS), and the NICHQ Vanderbilt. Symptom agreement analysis between the screeners and the provider's clinical diagnoses was performed using ANOVA and Tukey HSD posthoc analysis. FINDINGS A 19.6% of the participants were positive for PBD on the CMRS and 55.9% were positive on the CBCL-MS. A total of 36.60% were positive for ADHD on the Vanderbilt. The screening data compared to the provider's clinical diagnosis showed no diagnostic agreement for PBD (p < .05). Providers' rates of diagnosing PBD did not match the rate of PBD symptoms identified by the screeners. CONCLUSION Further evidence to determine the criteria and use of current screening measures for PBD is needed to guide practice for distinguishing PBD from related disorders.
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Affiliation(s)
- Daniel Wesemann
- Daniel Wesemann, DNP, PMHNP-BC, APRN, is Project Leader, 2917, 28th Ave. A Moline, Illinois
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Rao P, Moore JK, Stewart R, Runions K, Bear N, Wong JWY, Holtmann M, Zepf FD. Bipolar disorder in children and adolescents: diagnostic inpatient rates from 2000 to 2013 in Germany. Int J Bipolar Disord 2016; 4:23. [PMID: 27837521 PMCID: PMC5106426 DOI: 10.1186/s40345-016-0064-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 10/23/2016] [Indexed: 11/14/2022] Open
Abstract
Background Despite growing consensus on nosology and epidemiology of bipolar disorder (BD) in minors, differences remain. We contribute to this discussion by measuring long-term trends in the inpatient discharge rates of BD in minors. Methods Nationwide German inpatient discharge diagnoses of BD and other related psychiatric disorders were mapped between 2008 and 2013 using registry data from the German Federal Health Monitoring System. This was compared with previously published data, 2000–2007, to assess long-term trends in diagnosis of BD at discharge. Long-term trends (2000–2013) were also computed. Results Discharge diagnosis of BD increased by 18% (2.02–2.46 per 100,000) in minors. There was a significant increase of 24.1% in adolescents 15–19 years old (6.56–8.14 per 100,000). BD, at discharge, as a proportion of all psychiatric disorders, increased from 0.26% in 2008 to 0.27% in 2013. When analysing long-term trends (2000–2013), the rates for BD increased significantly as did trends for all mental disorders, except for psychotic disorders, which fell by almost 14%. Between 2000 and 2013, the rate for depression in minors increased by 730%. Limitations The dataset consisted of cross-sectional administrative data points with diagnoses based on clinical criteria. Conclusions The rate of BD as a discharge diagnosis in German minors has increased significantly, consistently exceeding the general trend for a rise in rates for mental disorders. Overall, the rate of discharge diagnosis of BD from inpatient units in Germany remains a small proportion of all psychiatric diagnoses.
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Affiliation(s)
- Pradeep Rao
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia. .,Department of Health, Western Australia, Community Child and Adolescent Mental Health Services, Perth, WA, Australia.
| | - Julie K Moore
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia.,Paediatric Consultation-Liaison Program, Department of Health, Western Australia, Child and Adolescent Mental Health Services, Perth, WA, Australia
| | - Richard Stewart
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia
| | - Kevin Runions
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Natasha Bear
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Department of Clinical Research and Education, Child and Adolescent Health Service, Department of Health, Western Australia, Perth, WA, Australia
| | - Janice W Y Wong
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Martin Holtmann
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr University Bochum, Hamm, Germany
| | - Florian D Zepf
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Department of Health in Western Australia, Specialised Child and Adolescent Mental Health Services (CAMHS), Perth, Australia
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