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Study Suggests Irritability Should Be Considered When Diagnosing Bipolar Disorder in Children EAST PROVIDENCE, RI -- June 26, 2009 -- A study published in the July issue of the Journal of the American Academy of Child and Adolescent Psychiatry adds to mounting evidence that clinicians consider irritability as a symptom when diagnosing paediatric bipolar disorder. The researchers said a small percentage of children with bipolar disorder experience manic episodes without extreme elation and are diagnosed based on irritable mood alone. “Diagnosing children with bipolar disorder is challenging,” said lead author Jeffrey Hunt, MD, Bradley Hospital, Riverside, Rhode Island. “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.” “Our findings confirm that while irritable-only mania is uncommon, it does exist -- particularly in younger children -- and should be considered in a bipolar diagnosis.” Dr. Hunt and colleagues studied 361 children aged 7 to 17 years with bipolar disorder participating in the multisite Course and Outcome of Bipolar Illness in Youth (COBY) study. COBY is the largest and most comprehensive study of children and adolescents with bipolar disorder to date. Researchers quantified the frequency and severity of manic symptoms of each participant, including whether irritability and elation were present. Based on this data, the group was then reclassified into 3 subgroups: elation-only, irritable-only, and both elated and irritable. Approximately 10% of children fell into the irritable-only category, while elated-only constituted about 15%. Nearly three-quarters experienced both elation and irritability. The irritable-only participants were significantly younger in age than the other 2 groups; however, there were no other sociodemographic differences between the groups. There were also no significant differences in terms of bipolar subtype, rate of psychiatric comorbidities, severity and duration of illness, and family history of mania and other psychiatric disorders. However, depression and alcohol abuse in second-degree relatives occurred more frequently in the irritable-only subgroup. “The fact that the irritable-only and elation-only subgroup had similar clinical characteristics and family histories of bipolar disorder provides support for continuing to consider episodic irritability in the diagnosis of paediatric bipolar disorder,” said Dr. Hunt The authors said continual, long-term follow-up of this study sample will help clarify whether the presence or predominance of elation or irritability at baseline will predict future clinical outcomes. SOURCE: Lifespan E-mail this page to a friend or colleague! To print, use this version