Which tool is most useful in diagnosing bipolar disorder in children?

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Clinical Inquiries

Which tool is most useful in diagnosing bipolar disorder in children?

J Fam Pract. 2007 October;56(10):838-840

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References

1. Post R, Kowatch R. The health care crisis of childhood-onset bipolar illness: some recommendations for its amelioration. J Clin Psychiatry 2006;67:115-125.

2. National Institute of Mental Health research round-table on prepubertal bipolar disorder J Am Acad Chld Adolesc Psychiatry 2001;40:871-878.

3. Youngstrom E, Findling R, Calabrese J, et al. Comparing the diagnostic accuracy of six potential screening instruments for bipolar disorder in youths aged 5 to 17 years. J Am Acad Child Adolesc Psychiatry 2004;43:847-858.

4. Weckerly J. Pediatric bipolar mood disorder. J Dev Behav Pediatr 2002;23:42-56.

5. Coyle J, Pine D, Charney D, et al. Depression and bipolar support alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in children and adolescents. J Am Acad Child Adolesc Psychiatry 2003;42:1494-1503.

6. Carlson G, Jensen P, Findling R, et al. Methodological Issues and Controversies in Clinical Trials with Child and Adolescent Patients with Bipolar Disorder: Report of a Consensus Conference. J Child Adolesc Psychopharamcol 2003;13:13-27.

7. Youngstrom E, Findling R, Youngstrom J, Calabrese J. Toward an evidence-based assessment of pediatric bipolar disorder. J Clin Child Adolesc Psychol 2005;34:433-448.

8. Yatham L, Kennedy S, O’Donovan C, et al. Canadian Network for Mood and Anxiety Treatments (CAN-MAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disord 2005;7(Suppl 3):5-69.

Three screening tests (CBCL, P-GBI, and P-YMRS) available for the office setting use parent-reported scores, and perform best when compared with KSADS as the standard.³ These instruments were associated with likelihood ratios that significantly improved the odds of diagnosis and could allow clinicians to stratify patients as high or low risk (TABLE).³

TABLE
Likelihood ratios for 3 screening tools you can use in the office

For ages 5–10*					For ages 11–17^†
IF THE SCORE IS…					IF THE SCORE IS…
	LOW	MOD. LOW	HIGH	VERY HIGH	LOW	MOD. LOW	HIGH	VERY HIGH
THEN THE LR FOR THE INSTRUMENT IS…					THEN THE LR FOR THE INSTRUMENT IS…
P-YMRS	0.08	0.48	6.94	8.92	0.20	0 .32	4.07	7.41
P-GBI	0.10	0.48	4.90	6.29	0.06	0.25	4.82	9.21
CBCL	0.07	0.47	3.15	3.52	0.04	0.53	2.65	4.29
* Population studied had a 50.3% prevalence of bipolar disorder.					† Population studied had a 40.7% prevalence of bipolar disorder.

Recommendations from others

Two consensus conferences, a Canadian guideline, and a National Institute of Mental Health round-table all concluded that there is currently no ideal test for the diagnosis of child and adolescent bipolar disorder, but that such an instrument needed to be developed.^2,5,6,8 One consensus conference further concluded that the diagnosis is best made by childhood mental health specialists based on multiple informants, such as the child and parents, with symptoms present in at least 2 settings or by direct observation.⁶

A Canadian consensus conference proposed screening patients with depressive symptoms for a history of hypomanic or manic symptoms, and consider an underlying mood disorder in those with vague or nonspecific somatic symptoms or reverse vegetative symptoms (eg, hypersomnia and hyperphagia). Their recommendations also emphasized screening for family history of bipolar disorder when there were clinical concerns.⁸

Evidence-based answers from the Family Physicians Inquiries Network

Which tool is most useful in diagnosing bipolar disorder in children?

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