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Diagnosis for Bipolar disorder amongst children and adolescents usualy late

Submitted by on 25 November, 2020 – 4:32 am
75% of cases of pediatric bipolar disorder are diagnosed late – until 18 months – because of the symptoms that manifest themselves differently depending on whether the patient is a child or adult. Furthermore, 25% of patients have delayed medical diagnosis of up to three years and four months, according to a study by the Department of Psychiatry and Medical Psychology at the University Clinic of Navarra, in collaboration with the Pediatric Psychopharmacology Unit l in the Massachusetts General Hospital at Harvard University (Boston, USA).

As a doctor of the Immaculate Escamilla Networks, specialist in Madrid-based Child and Adolescent Psychiatric Unit at the University Hospital of Navarra has explained, the investigation was based on an article previously published by his department in 2005 when the prospects bipolar disorder among children outside the U.S. were reviewed. A very low incidence observed in Europe compared with North American samples, particularly among some countries. Moreover, in Britain, a study of a representative sample found that the rate of this disease was lacking.

This research was the focus of the doctoral thesis of D. ª Inmaculada Escamilla, and completed the contrasting results during their stay in hospital in Massachusetts. It was noted that there was a gap between the U.S. and Europe regarding the incidence and diagnosis of bipolar disorder among children and adolescents. The researchers wanted to find out why this is the case. They concluded that in Europe the disease is under-diagnosed in most cases. He was being diagnosed late or incorrectly, a situation that has had a negative influence on treatment response, Ms. Escamilla said.

According to Dr. Escamilla, research is original and tackles a controversial issue in Europe where the disease is known and diagnosed among adults but not among children. In fact, studies carried out among adults show that 60% had the onset before the age of 20 years.

A sample of 38 cases diagnosed in six years

The research was conducted with a group of 38 children who had been diagnosed with bipolar disorder in children and adolescent psychiatric unit of the University Clinic of Navarra in a period of six years. According to Dr. Escamilla, symptoms are present before and during the assessment were recorded, analyzed psychiatric family history, any treatment received, progress in school, and so on. The aim was to describe the disease so that early detection and diagnosis that could be done, doctor said Escamilla.

Consequently, an incidence of 4.6% was found, a percentage that is about a series of U.S. studies with the same clinical samples. The results suggest that bipolar disorder among children and adolescents extends beyond the borders of the United States, despite criticism and skepticism of much of European scientists. The mean age at diagnosis was 13.9 years.

Thus, the study showed that only 25% of patients are diagnosed in the first seven months from the time that symptoms of the disease appear. Another 50% receive a proper assessment of their status between 18 months and three years and four months after the onset of symptoms. This delay is more than three years and four months for the remaining 25%.

According to other results of this investigation before the final medical report, patients were diagnosed with multiple disorders, up to four different in 14% of cases. The most common of these were: conduct disorders, inattention and hyperactivity and depression. As a result, Escamilla said doctor, patients received a different treatment: a third of the cases had been treated with three different pharmaceutical drugs. How do these courses of medication influence the course of the disease is currently being studied, since in some cases acted as stimulants.

The study also showed that 92% of patients diagnosed with pediatric bipolar disorder manifests itself in another. 18% had at least three associated psychiatric disorders, a situation that indicates a significant comorbidity in this disease. Disorders that frequently occur in association with attention deficit hyperactivity disorder (21%) and those from the substance, which reach 18%.

Irritability the most common symptom among children and adolescents

Both diagnostic delay and error with pediatric bipolar disorder are related, according to the physician of the Immaculate Escamilla, with the different presentation of the disease in children and adults. Among children, the change of mood is irritability more common, while in adults is a typical manifestation of the euphoria and expansion. In fact, a symptom such as euphoria, associated with bipolar disorder, appears in at least half of pediatric patients.

In this sense specialist points that the key is to assess the type of irritability, but the rally also appears in depressive disorders. In the pediatric bipolar disorder, irritability and serious property is explosive. Sometimes the violence that occurs in outbreaks or sporadic significant short and often this is not reactive to anything or the shutter is minimal. It can be confused with a tantrum, but it is much more disproportionate. He added, unlike the evolution of the disease among adults, the episodes in children are not clearly defined: very frequent changes in mood and these fluctuations quickly. It is rare that a patient has a period of at least two months without symptoms. This form of instability means that the disease is highly disabling.

In addition, symptoms such as euphoria and expansion occurs in pediatric patients, but less frequently than in adults and with other characteristics: capacity expansion in a child can manifest at school, as deemed by the patient that he or she has more authority than the teacher, who is defying, and is interpreted as a behavior problem. It was also noted that social inhibition is not among these children. For example, derogatory comments or rude to loudly about other people in public or even sexual content inappropriate for their age, said the specialist.

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