Bipolar Disorder More Common Than Expected in Hospitalized Adolescents
December 28, 2005
Clinicians at Bradley Hospital, the nation’s first psychiatric
hospital for children and adolescents, have found that bipolar
disorder is more common than expected in teens in a psychiatric
inpatient setting.
“In the past, mental health professionals thought that about
one percent of teens was bipolar—our research indicates that
if a strict definition of the illness is applied, up to twenty
percent of adolescents on psychiatric units may be manic-depressive,”
says lead author Jeffrey Hunt, MD, a child psychiatrist at Bradley
Hospital and associate professor of psychiatry at Brown Medical
School. The study appears in the December issue of the Journal
of Child and Adolescent Psychopharmacology.
Bipolar disorder, also known as manic depression, is characterized
by dramatic mood swings—from overly “high” and/or
irritable to sad and hopeless, and then back again. “There
are often periods of normal mood in between, but there is always
accompanying serious impairment in functioning,” says Hunt.
This disorder was once believed to be rare in children and adolescents,
but because of controversies surrounding diagnosis in juveniles,
and because few large-scale studies have been conducted, prevalence
rates of bipolar disorder in clinical and community samples of
children and adolescents remain difficult to determine, the authors
write.
The authors say that screening patients for manic symptoms upon
admittance to a psychiatric unit can ultimately lead to better
treatment overall. For example, many psychiatric patients first
present with symptoms of depression, but depression can also be
an indicator of bipolar disorder. The danger lies in the fact
that the medication for treating depression can actually have
an adverse effect on someone with manic-depression.
“This research is important because diagnosis of juvenile
bipolar disorder is controversial—impulsivity, irritability
and hyperactivity commonly occur in adolescents in general. If
these symptoms all present concurrently, the challenge is to determine
whether they are symptoms of bipolar disorder, or are simply a
normal part of teenage development,” says Hunt.
The authors assessed a total of 391 consecutive admissions to
the psychiatric inpatient unit at Bradley Hospital using a mania
rating scale derived from a well-known research interview called
the K-SADS (the Kiddie Schedule for Affective Disorders and Schizophrenia)
as well as other history from both parents and adolescents. They
found that manic symptoms such as severe irritability, impulsivity,
depression, and hypersexuality are frequently found in hospitalized
adolescents. Twenty percent of these patients were diagnosed with
juvenile bipolar disorder when information from all sources was
integrated with the scores from the K-SADS mania rating scale.
This study is the first to apply the K-SADS mania rating scale
with patients “off the street” (i.e., not selected for
the study). The authors screened all adolescent admissions to
Bradley Hospital regardless if they had a history of mania. Prior
research studies using this scale on bipolar prevalence rates
only looked at previously diagnosed patients.
The authors found that, compared to patients admitted for depression
alone, bipolar patients were more suicidal and aggressive, consequently
needing higher levels of care. In addition, over half of the patients
diagnosed with juvenile bipolar disorder were admitted during
a depressive episode.
“So you might not be able to tease out the difference between
a manic-depressive episode and depression unless you can accurately
test for bipolar disorder,” says Hunt. “We found that
the K-SADS was an effective way to as accurately as possible diagnose
bipolar disorder, and to help prevent treating bipolar patients
presenting in a depressed phase with antidepressants,” Hunt
states.
According to the National Institute of Mental Health, bipolar
disorder typically develops in late adolescence or early adulthood.
However, some people have their first symptoms during childhood,
and some develop them late in life. It is often not recognized
as an illness, and people may suffer for years before it is properly
diagnosed and treated.
This study was funded by Bradley Hospital.
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