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Hafeman et al.

Phenomenology of Bipolar Disorder Not Otherwise Specified in Youth: A Comparison of Clinical Characteristics across the Spectrum of Manic Symptoms 

Hafeman D, Axelson D, Demeter C, Findling RL, Fristad MA, Kowatch RA, Youngstrom EA, Horwitz SM, Arnold LE, Frazier TW, Ryan N, Gill MK, Hauser-Harrington JC, Depew J, Rowles BM, Birmaher B


In the field of child and adolescent psychiatry, the diagnostic categorization of children with episodic moods that cause impairment but that do not meet DSM-IV criteria for bipolar I (BD-I) or bipolar II (BD-II) disorder has proven controversial.  Dr. Danella Hafeman, Chief Resident of the Child Psychiatry Fellowship program, Dr. Boris Birmaher and their team set out to characterize the degree to which these children, who meet criteria for bipolar disorder not otherwise specified (BD-NOS), are similar to those with full syndromal bipolar disorder, versus those with no bipolar spectrum diagnosis (no BSD).  

Dr. Hafeman analyzed data collected from 707 children aged 6–12 years old, preferentially selected for higher scores on a 10-item screen for manic symptoms. Assessment interviews were conducted with the children and their primary caregivers to assess a wide array of clinical variables as well as family history.  Of the 707 children, 71 were diagnosed with BD-I, 3 with BD-II, 88 with BD-NOS (including cyclothymia) and 545 had no BSD.  The investigators found that the BD-NOS group had less severe past functional impairment compared to children with BD-I, but that current symptom severity and functional impairment did not differ between the BD-NOS and BD-I groups even though both groups were significantly more symptomatic and impaired than the no BSD group.  In addition, the psychiatric history of parents was similar for the BD-NOS and BD-I groups, and both were more likely than the no BSD group to have a parent with a history of mania. Although the children with BD-NOS and BD-I are quite similar, they were different from the no BSD group on many phenomenological measures.  These findings support the hypothesis that BD-NOS is on the same spectrum as BD-I.  These results also highlight the clinical importance of assessing subsyndromal manic symptoms in pediatric populations, even if they don’t meet full syndromal criteria for BD-I or BD–II, and the need to develop appropriate treatments for these youth.   

Contributors:  
Danella Hafeman MD, PhD, Neal Ryan, MD, Mary Kay Gill, RN, MSN, and Boris Birmaher, MD (Department of Psychiatry, University of Pittsburgh) 

Christine Demeter, MA, Brieana Rowles, MA (Department of Psychiatry, Case Western Reserve University)

Robert Findling, MD, MBA (Department of Psychiatry, Johns Hopkins University)

David Axelson, MD, Mary Fristad, PhD, ABPP, L. Eugene Arnold, MD, Jessica Hauser-Harrington, PhD (Department of Psychiatry, Ohio State University)

Robert Kowatch, MD, PhD, Judith Depew, PhD (Division of Psychiatry, Cincinnati Children’s Hospital Medical Center)

Eric Youngstrom, PhD (Department of Psychology, University of North Carolina at Chapel Hill)

Sarah Horwitz, PhD (New York University School of Medicine)

Thomas Frazier, PhD (Center for Pediatric Behavioral Health and Center for Autism, Cleveland Clinic,)

The results of this investigation were published in Bipolar Disorders.  Click here for a link to the abstract.