SAN DIEGO -- Certain children may be misdiagnosed with bipolar disorder, and a diagnostic category introduced in DSM-5 may capture these children better, researchers reported here.
In a retrospective study of 100 children treated in an inpatient psychiatric hospital between 2005 and 2014, none of the cases with discharge diagnoses of bipolar disorder or mood disorder not otherwise specified (MDNOS) actually met diagnostic criteria for those disorders, according to David Pogge, PhD, of Four Winds Hospital in Katonah, N.Y., and colleagues.
More than two-thirds of these kids did, however, meet diagnostic criteria for disruptive mood dysregulation disorder (DMDD), a new diagnosis included in DSM-5, they reported during a poster session at the American Psychiatric Association meeting here.
"Surprisingly, none of the cases with discharge diagnoses of BD or MDNOS actually met criteria for BD," Pogge told Ƶ.
Children with mood disorders and disruptive behavior have often been diagnosed with bipolar disorder, despite minimal evidence of mixed or manic symptoms, the researchers explained. DMDD -- a condition marked by intense temper outbursts superimposed on a background of persistent depressed or irritable mood -- was introduced in DSM-5 to capture these children.
To assess the extent to which cases that had been given clinical diagnoses of bipolar disorder or MDNOS in the past would have met criteria for DMDD, the researchers used a structured diagnostic procedure to re-evaluate diagnoses of the two conditions.
The prevalence of DMDD was examined using a structured retrospective chart analysis conducted by two independent raters. This study used an abstraction tool that consisted of a checklist of the variables corresponding to DSM-IV criteria for bipolar disorder and other mood disorders, and the DSM-5 criteria for DMDD and all the other relevant childhood disorders.
Overall, 61% of kids had been discharged with a diagnosis of bipolar disorder, and 39% with a diagnosis of MDNOS with high irritability or hostility at admission -- yet none of the diagnoses of bipolar disorder could be confirmed, the researchers reported.
Instead, 37% of these children met criteria for the new DSM-5 category of DMDD. The next most common diagnosis was conduct disorder, which applied to 25% of these patients. The remaining cases met criteria for ADHD, major depression, psychotic disorders, PTSD, and anxiety disorders.
Pogge noted that child and adolescent mood disorders are historically difficult to diagnose, and prior to DSM-5 there was no diagnosis available for children whose primary problem involved outbursts of anger. DMDD was introduced in the DSM-5, launched in 2013, to capture these children, whose condition is marked by intense temper outbursts superimposed on a background of persistent depressed or irritable mood.
These data support the belief that bipolar disorder was overdiagnosed in children during this era, Pogge said. However, even though DMDD does appear to capture many of the children previously misdiagnosed, it does not account for most of those cases.
And although DMDD does appear to occur frequently in this population, the researchers concluded, it does not solve the problem of the misdiagnosis of misbehaving children as suffering from bipolar disorder.
Disclosures
The authors disclosed no financial relationships with industry.
Primary Source
American Psychiatric Association
Pogge DL, et al "Bipolar, DMDD, or What? Re-evaluation of clinical diagnoses of children in light of DSM-5" APA 2017.