Respond to your colleagues who argued the opposite side as you by countering their argument with evidence. Identify at least two consequences to support your position.
NOTE( my position is against the issue of diagnosing pediatric bipolar depression disorder)
Please cite References
Main Post
Pediatric Bipolar Depression
The American Psychiatric Association (2013) requires one manic episode or one hypomanic episode along with one depressive episode for a diagnosis of Bipolar Disorder. There has been some controversy over using the diagnosis of Pediatric Bipolar Disorder (PBD) due to what some believe was over-diagnosis resulting in a higher prevalence of the disorder in the United States, showing up to a 40-fold increase in the diagnosis in the previous decade (Van Meter, Moreria & Younstrom, 2019).
Arguing FOR the Diagnosis
While there was some debate for a period of time regarding over-diagnosis of PBD, Van Meter et al. (2019) suggest that rates of pediatric bipolar disorder are not increasing and the rate is not higher in the United States once meta-analysis is utilized to critically evaluate previous data. Some previous criticism of PBD resulted in the APA (2013) establishing the newer diagnosis of Disruptive Mood Disregulation Disorder which addressed the primary issue of children presenting for treatment with significant and pervasive irritability. An important distinction that must be made is the difference between PBD and DMDD: PBD has discrete episodes of irritability (mania) whereas in DMDD the irritability is chronic and nonepisodic (Findling & Chang, 2018).
With no other diagnosis available in the past, it is possible that some of these kids ended up with a PBD diagnosis for what was likely DMDD; still, this fact does not negate the necessity for a PBD diagnosis to be available. In fact, between 50-66% of adults with well-documented bipolar disorder report having had symptoms prior to age 19 (Findling & Chang, 2018). As has been well-established, earlier treatment and intervention result in better outcomes (McGorry & Mei, 2018).
The International Society for Bipolar Disorders Task Force (Goldstein et al., 2017) found that the previous studies which resulted in much of the debate appeared to be more influenced by training, conceptualization, and insurance as opposed to true differences in prevalence. While the Task Force acknowledges the need for more studies to more accurately assess for hypomania and differentiation of PBD from non-mood psychopathology, a need to recognize and diagnose PBD still remains. McGorry and Mei (2018) make the case for earlier intervention for PBD due to the fact that (1) earlier treatment is more effective, and (2) recurrence is often associated with structural changes in the brain. Considering this fact, and the new understanding that previous “over-diagnosis” was probably not actually over-diagnosis, recognizing and treating PBD remains a critical piece of pediatric psychiatry.
My Takeaway
When I began reading about pediatric bipolar disorder, I was initially inclined to think that it would be difficult to differentiate PBD from normal childhood mood swings. However, the more I read, the more clear it became that by accurately diagnosing PBD, the better the outcomes. Also, one thing that I noticed in several studies was the necessity for a “structured interview” in the diagnostic process. I have not seen that done in real life, but it inspired me enough that I found a handbook and manual, the Structured Clinical Interview for DSM-V, from the American Psychiatric Association Publishing arm that I purchased for my own resources (https://www.appi.org/Products/Interviewing/SET-of-SCID-5-CV-and-SCID-5-CV-Users-Guide). The bottom-line, for me, is to make sure that I remain open to what new research shows and to remember that I will never know everything and that I can always learn something new.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
Findling, R.L. & Chang, K.D. (2018). Improving the Diagnosis and Treatment of Pediatric Bipolar
Disorder. Journal of Clinical Psychiatry, 79(2), 62-69.
Goldstein, B.I., Birmaher, B., Carlson, G.A., DelBello, M.P., Findling, R.L., Fristad, M.,
Kowatch, R.A., Miklowitz, D.J., Nery, F.G., Perez-Algorta, G., Van Meter, A., Zeni, C.P.,
Correll, C.U., Kim, H.W., Wozniak, J., Chang, K.D., Hillegers, M. & Youngstrom, E.A.
(2017). The International Society for Bipolar Disorders Task Force report on pediatric
bipolar disorder: Knowledge to date and directions for future research. Bipolar Disorders,
19, 524-543. Doi: 10.111/bdi.12556.
Van Meter, A., Moreira, A.L., & Youngstrom, E. (2019). Updated Meta-Analysis of
Epidemiologic Studies of Pediatric Bipolar Disorder. Journal of Clinical Psychiatry, 80(3),
e1-e11. doi: 10.4088/JCP.18r12180.
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