New research from the US adds to mounting evidence that when diagnosing bipolar disorder in children doctors and clinicians should consider irritability as a possible symptom.

The study, by researchers at the Bradley Hospital and The Warren Alpert Medical School of Brown University, both in Rhode Island, and colleagues from other centers, is published online in the July issue of the Journal of the American Academy of Child & Adolescent Psychiatry.

Lead author Dr Jeffrey Hunt, a child psychiatrist and training director at Bradley Hospital, and colleagues, write that a small proportion of children with bipolar disorder have manic episodes without extreme elation, which is normally a distinguishing characteristic of bipolar disorder, and these are diagnosed on the basis of irritable mood only.

Bipolar disorder manifests as dramatic changes in mood that swings from the manic phase where euphoria, elation and irritability are present, to severe depression.

The disorder usually starts in the late teens to early adult, although it can also appear during preschool years.

Recent research suggests that the number of children diagnosed and being treated for bipolar disorder has shot up in the last ten years, and while it is not clear what is behind this sudden increase, many scientists believe it could be due to greater awareness of this condition among pediatricians and more aggressive diagnoses.

Hunt explained in a separate statement that diagnosing children with bipolar disorder was “challenging”, and that:

“One of the chief controversies is whether irritability should be included among the criteria for this diagnosis because it can also overlap with a number of other psychiatric disorders, such as attention deficit hyperactivity disorder.”

But he and his colleagues found that while irritable-only mania is not common, it does exist, “particularly in younger children and should be considered in a bipolar diagnosis”.

For their research they studied 361 children aged from 7 to 17 diagnosed with bipolar disorder who were taking part in a study called Course and Outcome of Bipolar Illness in Youth (COBY) that was based at Bradley Hospital and Alpert Medical School, the University of Pittsburgh and the University of California-Los Angeles.

COBY is said to be the largest and most comprehensive study of children and teenagers with bipolar disorder.

Hunt and colleagues worked out how often and how severe the manic symptoms were for each participant, including whether irritability and elation were among them.

They then put the participants into three groups: elation-only, irritable-only and both elated and irritable.

The results showed that:

  • About 10 per cent of the children were in the irritable-only group, while elated-only was about 15 percent.

  • Nearly 75 per cent were in the both elated and irritable group.

  • The only sociodemographically significant difference between the irritable-only group was that the participants were significantly younger than those in the other two groups.

  • There were also no differences in bipolar subtype, rate of other psychiatric conditions, severity and duration of the illness, family history, history of mania, and history of other psychiatric conditions.

  • However, the children in the irritable-only group were more likely to have second degree relatives with depression and alcohol abuse.

The researchers concluded that the study supports established criteria for mania in young peolple, and that:

” Irritable-only mania exists, particularly in younger children, but similar to elated-only mania, it occurs infrequently.”

“The fact that the irritable-only subgroup has similar clinical characteristics and family histories of BP [bipolar disorder], as compared with subgroups with predominant elation, provides support for continuing to consider episodic irritability in the diagnosis of pediatric BP,” they added.

They said that following these participants continually for a longer period will help to show whether elation or irritability present or dominant at the start of the study will predict future outcomes.

“Irritability Without Elation in a Large Bipolar Youth Sample: Frequency and Clinical Description.”
HUNT, JEFFREY; BIRMAHER, BORIS; LEONARD, HENRIETTA; STROBER, MICHAEL; AXELSON, DAVID; RYAN, NEAL; YANG, MEI; GILL, MARYKAY; DYL, JENNIFER; ESPOSITO-SMYTHERS, CHRISTIANNE; SWENSON, LANCE; GOLDSTEIN, BENJAMIN; GOLDSTEIN, TINA; STOUT, ROBERT; KELLER, MARTIN
Journal of Amer Academy of Child & Adolescent Psychiatry. 48(7):730-739, July 2009.
doi: 10.1097/CHI.0b013e3181a565db

Source: Lifespan News.

Written by: Catharine Paddock, PhD