Symptoms leading to a bipolar diagnosis: a phone survey of child and adolescent psychiatrists

Abstract

Objective: We surveyed child and adolescent psychiatrists (CAPs) to characterize how they diagnose bipolar disorder (BPD) in children.

Methods: We approached by mail and then telephone 100 CAPs randomly sampled from five regions of the main professional organization of American CAPs; 53 CAPs were reached and agreed to participate. We asked about their training and practice setting, and asked them to name 10 symptoms indicative of BPD. We conducted descriptive analyses to determine how CAPs ranked symptoms, whether reports were consistent with Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) criteria, and whether alternative symptom models might guide their decision making.

Results: CAPs considered lability, grandiosity, family history of BPD, aggression, and expansive or euphoric mood as the most important factors in diagnosing BPD. Only 21 (39.6%) CAPs reported sufficient symptoms to meet DSM criteria for BPD (DSM-Yes status). DSM-Yes status was associated with participants' region, less expertise (< or =10 years practicing child and adolescent psychiatry), and lower levels of self-reported confidence in their ability to diagnose BPD.

Conclusions: CAPs vary in the symptoms they use to diagnose BPD, with most using a mixture of DSM and non-DSM symptoms. Expertise and confidence may lessen one's reliance on DSM criteria. Further studies are needed to understand CAPs' diagnostic decisions about BD and to develop interventions to support accurate diagnostic decision making and improve patient care.

FIG. 1.

How frequently DSM-Yes versus DSM-No CAPs named bipolar disorder clinical characteristic categories. Differences between DSM-Yes and DSM-No psychiatrists: (***) ≤ 0.001, (**) ≤ 0.01, and (*) ≤ 0.05, chi-squared tests. DSM = Diagnostic and Statistical Manual of Mental Disorders; CAP = child and adolescent psychiatrist; DSM-Yes CAP = psychiatrist who named sufficient symptoms for making a DSM-based diagnosis for a manic episode when asked to name 10 symptoms that lead them to a diagnosis of bipolar disorder.