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Diagnosis of bipolar disorder among youth skyrockets

Diagnosis of bipolar disorder among U.S. youth jumped fortyfold during office visits between 1994 and 2003, according to a new study. Bipolar disorder is a mood disorder in which individuals suffer both depressive episodes and manic or hypomanic episodes. The number of visits in which youth were diagnosed with bipolar disorder rose from 25 to 1,003 visits per 100,000 population between 1994 and 2003. Similarly, the proportion of office visits with a bipolar diagnosis among youth rose from 0.01 percent in 1994 to 0.44 percent by 2003. The comparable rise in proportion of office visits with a bipolar diagnosis among adults was from 0.31 percent in 1994 to 0.50 percent by 2003.

The researchers analyzed annual data from the National Ambulatory Medical Care Survey to determine the differences in bipolar disorder diagnostic patterns between youth and adults. They examined 154 youth visits to physicians and 808 adult visits to physicians in which this diagnosis was received, which represented 763 visits per 100,000 population for youth and 1,602 visits per 100,000 population for adults. Two-thirds of youth visits were by males, while two-thirds of adult visits were by females.

Both youth and adults were equally likely to have coexisting mental disorders, but youth were 10 times as likely to be also diagnosed with attention deficit hyperactivity disorder (ADHD). Visit duration and frequency of psychotherapy were also similar for youth and adults. Nearly two-thirds of youth and adults were likely to receive a combination of drugs such as a mood stabilizer and antidepressant or a mood stabilizer and antipsychotic. Anticonvulsants were the most frequently prescribed mood stabilizer in both groups.

The increase in the diagnosis of bipolar diagnosis in youth indicates a shift in clinical diagnostic practices. This could be explained by either a historic underdiagnosis, which is now being rectified, or a current overdiagnosis in this group. The authors call for a consensus among researchers and clinicians concerning diagnostic criteria and assessment methods and for studies to examine the accuracy of bipolar disorder diagnoses in community practice. Diagnosis of bipolar disorder in youth can be more difficult due to the overlap of symptoms with other more prevalent psychiatric disorders. This research was supported in part by the Agency for Healthcare Research and Quality (HS16097).

See "National trends in the outpatient diagnosis and treatment of bipolar disorder in youth" by Carmen Moreno, M.D., Gonzalo Laje, M.D., Carlos Blanco, M.D., and others in the September 2007 Archives of General Psychiatry 64 (9), pp. 1032-1039.

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