JAACAP Open. 2024 Sep 27;3(3):782-792. doi: 10.1016/j.jaacop.2024.09.004. eCollection 2025 Sep.
ABSTRACT
OBJECTIVE: Bipolar disorder (BD) diagnoses require episodes of hypomania and mania as well as depressive episodes. Given the overlap of BD symptoms with symptoms of other psychiatric conditions among youth, misdiagnosis is common. This topic was examined in a large sample of youth clinically referred for BD.
METHOD: Participants were 394 clinically referred youths ages 13 to 20 years, including 255 with confirmed BD and 139 for whom BD was not confirmed (non-BD). Participants and their parent/guardian completed a semistructured diagnostic interview and dimensional scales. Demographic and clinical variables were compared between BD and non-BD groups. Following correction for multiple comparisons, significant variables associated with BD diagnosis (p < .05) in univariate analyses were evaluated in multivariable analyses.
RESULTS: Compared with the BD group (n = 255), the non-BD group (n = 139) had significantly lower current mania symptom severity, family history of hypomania/mania, current lithium treatment, and lifetime bulimia nervosa, whereas most severe past global functioning was higher and current oppositional defiant disorder was more common in the non-BD group compared with the BD group. Use of second-generation antipsychotics was high in both groups. Common reasons for not diagnosing BD in the non-BD group included not meeting duration criteria for a hypomanic/manic episode and manic-like symptoms being better explained by other psychiatric disorders.
CONCLUSION: Youth with and without BD did not differ in the vast majority of clinical variables examined. Frequent use of second-generation antipsychotics in non-BD youth may relate to characterization of overlapping comorbidity symptoms as manic symptoms. Both groups have complex presentations, necessitating psychosocial and pharmacological treatments.
DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
PMID:40922790 | PMC:PMC12414307 | DOI:10.1016/j.jaacop.2024.09.004
