Bipolar Illness Soars as a Diagnosis for the Young, NY Times

[Guest guest]

As a teacher for twenty-five years I saw the attention problems

getting worse each year. I also was more aware of the pesticide

spraying on campus, the contaminated soil students were exposed to,

the gas leaks in the building, the particle board furniture, the harsh

cleaning products, the mold from the A/C that wasn't remediated, the

solvents from the paint, the asbestos, etc. What small, growing body

wouldn't have problems concentrating in that toxic soup?

Today I called in a public radio station discussing this explosion of

bipolar disorder (see article below). I wanted to comment about the

mis-diagnosis of bipolar for our family because of our environmental

exposures. I reflected that I was concerned that an infectious disease

doctor can make a bipolar diagnosis in a 15 minute consult without any

testing and then turn in a family to CPS because of a brief consult.

The guest, Dr. Mark Olsen, who has written about bipolar in young

people, stated that no doctor can make a diagnosis of bipolar disorder

in a single visit. It takes a long history with many people who know

the child to make the determination he said. Another mother called in

and said it took a team of doctors more than two weeks to evaluate her

son accurately.

So beware to our members, if any doctor tries to diagnose bipolar in a

15 minute consult, run the other way. She/he is probably affiliated

with many pharmaceutical companies, like the doctor we saw, and

looking to increase his/her target market.

http://www.nytimes.com/2007/09/04/health/04psych.html?ei=5087%

0A & em= & en=13c932cc4a338702 & ex=1189051200 & pagewanted=print

The New York Times

September 4, 2007

Bipolar Illness Soars as a Diagnosis for the Young

By BENEDICT CAREY

The number of American children and adolescents treated for bipolar

disorder increased 40-fold from 1994 to 2003, researchers report

today in the most comprehensive study of the controversial diagnosis.

Experts say the number has almost certainly risen further since 2003.

Many experts theorize that the jump reflects that doctors are more

aggressively applying the diagnosis to children, and not that the

incidence of the disorder has increased.

But the magnitude of the increase surprises many psychiatrists. They

say it is likely to intensify the debate over the validity of the

diagnosis, which has shaken child psychiatry.

Bipolar disorder is characterized by extreme mood swings. Until

relatively recently, it was thought to emerge almost exclusively in

adulthood. But in the 1990s, psychiatrists began looking more closely

for symptoms in younger patients.

Some experts say greater awareness, reflected in the increasing

diagnoses, is letting youngsters with the disorder obtain the

treatment they need.

Other experts say bipolar disorder is overdiagnosed. The term, the

critics say, has become a catchall applied to almost any explosive,

aggressive child.

After children are classified, the experts add, they are treated with

powerful psychiatric drugs that have few proven benefits in children

and potentially serious side effects like rapid weight gain.

In the study, researchers from New York, land and Madrid analyzed

a National Center for Health Statistics survey of office visits that

focused on doctors in private or group practices. The researchers

calculated the number of visits in which doctors recorded diagnoses

of bipolar disorder and found that they increased, from 20,000 in

1994 to 800,000 in 2003, about 1 percent of the population under age

20.

The spread of the diagnosis is a boon to drug makers, some

psychiatrists point out, because treatments typically include

medications that can be three to five times more expensive than those

for other disorders like depression or anxiety.

" I think the increase shows that the field is maturing when it comes

to recognizing pediatric bipolar disorder, but the tremendous

controversy reflects the fact that we haven't matured enough, " said

Dr. March, chief of child and adolescent psychiatry at the Duke

University School of Medicine, who was not involved in the research.

" From a developmental point of view, " Dr. March said, " 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. The label may or may not reflect reality. "

Most children who qualify for the diagnosis do not proceed to develop

the classic features of adult bipolar disorder like mania,

researchers have found. They are far more likely to become depressed.

Dr. Mani Pavuluri, director of the pediatric mood disorders program

at the University of Illinois, Chicago, said the label was often

better than any of the other diagnoses often given to difficult

children.

" These are kids that have rage, anger, bubbling emotions that are

just intolerable for them, " Dr. Pavuluri said, " and it is good that

this is finally being recognized as part of a single disorder. "

The senior author of the study, Dr. Mark Olfson of the New York State

Psychiatric Institute at the Columbia University Medical Center,

said, " 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. "

The increase makes bipolar disorder more common among children than

clinical depression, the authors said. Psychiatrists made almost 90

percent of the diagnoses, and two-thirds of the young patients were

boys, said the study, published in the September issue of The

Archives of General Psychiatry.

About half the patients were identified as having other mental

difficulties, mostly attention deficit disorder.

The children's treatments 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. Antidepressants and stimulants were also

common.

Most children took a combination of two or more drugs, and 4 in 10

received psychotherapy.

The regimens were 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, " Dr. Olfson said.

The increased children's diagnoses reflect several factors, experts

say. Symptoms appear earlier in life than previously thought, in

teenagers and young children who later develop the full-scale

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.

In addition, drug makers and company-sponsored psychiatrists have

been encouraging doctors to look for the disorder since several drugs

were approved to treat it in adults.

Last month, the Food and Drug Administration approved one of the

medications, Risperdal, to treat bipolar in children. Experts say

they expect that move will increase the use of Risperdal and similar

drugs for young people.

" We are just inundated with stuff from drug companies, publications,

throwaways, that tell us six ways from Sunday that, Oh my God, we're

missing bipolar, " said Dr. le Carlson, a professor of

psychiatry and pediatrics at the Stony Brook University School of

Medicine on Long Island. " And if you're a parent with a difficult

child, you go online, and there's a Web site for bipolar, and you

think: `Thank God, I've found a diagnosis. I've found a home.' "

Some parents whose children have received the diagnosis say that,

with time, the label led to effective treatment.

" It's been a godsend for us, " said Simons of Montrose, Colo.,

whose son Brit, 15, was prone to angry outbursts until given a

combination of lithium, a mood stabilizer, and Risperdal, which was

often given to children " off label, " several years ago. He now takes

just lithium and is an honor roll student.

Other parents say their children have suffered side effects of drugs

for bipolar disorder.

Ocampo, 40, of Tallahassee, Fla., whose 8-year-old son is

being treated for bipolar, said that he had tried several

antipsychotic drugs and mood stabilizers and that he had improved.

" He has gained weight, " Ms. Ocampo said, " to the point where we were

struggling find clothes for him. He's had tremors and still has some

fine motor problems that he's getting therapy for. But he's a

fabulous kid. And I think, I hope, that we're close to finding the

right combination of medications to help him. "