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Thursday, December 28, 2017 by Finn

"From a developmental point of view, we simply don't know how accurately we can diagnose bipolar disorder, or whether those diagnosed at age 5 or 6 or 7 will grow up to be adults with the illness," he said. "The label may or may not reflect reality."

Most children who qualify for the diagnosis do not go on to develop the classic features of adult bipolar disorder, like mania, researchers have found. They are far more likely to become depressed.

But Dr. Mani Pavuluri, director of the pediatric mood disorders program at the University of Illinois, Chicago, said that that label was often better than any of the other diagnoses that difficult children often receive. "These are kids that have rage, anger, bubbling emotions that are just intolerable for them, and it is good that this is finally being recognized as part of a single disorder," to better tailor treatment, she said.

In the study, researchers from New York, Maryland and Madrid analyzed data from a National Center for Health Statistics survey of office visits, which focused on doctors in private or group practices. The researchers calculated the number of visits in which doctors recorded a diagnosis of bipolar disorder, and found that the numbers went up from roughly 20,000 such diagnoses in 1994 to about 800,000 in 2003.

"I have been studying trends in mental health services for some time, and this finding really stands out as one of the most striking increases in this short a time," said Dr. Mark Olfson of the New York State Psychiatric Institute at Columbia University, the senior author of the study, which appears in the September issue of Archives of General Psychiatry, to be published Tuesday.

The increase makes bipolar disorder more common among children than clinical depression, the authors said. The study found that psychiatrists made almost 90 percent of the diagnoses, and that two-thirds of the young patients were boys. About half the patients also had been identified as having other mental difficulties, most often attention-deficit disorder.

The treatment given the children almost always included medication. About half received antipsychotic drugs, like Risperdal from Janssen or Seroquel from Astrazeneca, both developed to treat schizophrenia; a third were prescribed so-called mood stabilizers, most often the epilepsy drug Depakote; and antidepressants and stimulants were also common. Most children were on some combination of two or more drugs, and about 4 in 10 received some psychotherapy.

Their regimens were very similar to those of a group of adults with bipolar diagnoses, the study found. "You get the sense looking at the data that doctors are generalizing from the adult literature and applying the same principles to children," Olfson said.

The rise in bipolar diagnoses in children reflects several factors, experts say. Bipolar symptoms do appear earlier in life than previously thought, in teenagers and young children who later develop the full-blown disorder, recent studies suggest. The label also gives doctors and desperate parents a quick way to try to manage children's rages and outbursts, in an era when long-term psychotherapy and hospital care are less accessible, they say.

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