Post- Jenny

 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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