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New DSM-5 Category May Curb Youth Bipolar Overdiagnosis
By: MITCHEL L. ZOLER, Clinical Psychiatry News Digital Network
EXPERT ANALYSIS FROM THE ANNUAL CONGRESS OF THE EUROPEAN COLLEGE OF NEUROPSYCHO- PHARMACOLOGY
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PARIS – Many psychiatrists have overdiagnosed bipolar disorder in children and adolescents over the past decade, which has led to overly aggressive treatment with second-generation antipsychotic drugs, Dr. David Cohen said at a press briefing at the annual congress of the European College of Neuropsychopharmacology.
This issue might start to resolve with the scheduled publication in 2013 of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), because the current draft establishes a new diagnostic category that Dr. Cohen said is more appropriate for many of these children: temper dysregulation disorder with dysphoria (TDDD).
"I’m very pleased that the DSM 5 Working Group intends to improve the way these kids will be characterized by changing the label to TDDD. I think this labeling will help to better characterize this disease and not confuse [these patients] with bipolar disorder," Dr. Cohen said in an interview. Results from follow-up studies suggest that children and adolescents with the spectrum of symptoms included in TDDD, which could also be labeled today as severe mood dysregulation, "may be risk factors for [the diagnosis of] bipolar disorder in adulthood, in perhaps 20% of patients, but many do not develop bipolar disorder," said Dr. Cohen, professor of psychiatry at the University of Paris and head of the department of child and adolescent psychiatry at La Salpêtrière Hospital in Paris.
"I have [results from] long follow-up studies that do not show that manic symptoms in children lead to bipolar disorder" when they become adults. Certain children with symptoms that often characterize bipolar disorder "may be at risk for having bipolar disorder as adults, but not at high rates. Only after a child is 11 or 12 years old and you see these symptoms can you be confident that it is likely bipolar disorder. Adolescence is when" the diagnosis of bipolar can start to be made with any confidence, he said.
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(c) Mitchel L. Zoler/IMNG
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"Puberty is a good threshold for talking about bipolar disorder. TDDD is a better diagnosis for pre-pubertal children" because at that stage of life the manic symptoms of bipolar disease, such as irritability, mood change, hyperactivity, and sleep disturbance, can serve as risk markers for the eventual development of bipolar disease, but not at high rates. "Only once a child is at least 11 or 12 years old can you see these symptoms and be confident that it is likely bipolar disease of adolescence or beyond." Adolescence is when the diagnosis of bipolar disease can truly start. A reliable diagnosis of bipolar disorder in a younger child "is really exceptional."
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