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October 5, 2018 by Peter Parry, Stephen Allison, Tarun Bastiampillai | Bipolar Disorders

Missing evidence for pediatric bipolar disorder: A response to the ISBD Task Force Report

Introduction

The International Society for Bipolar Disorders (ISBD) has released a Task Force Report (TFR) that details the research into pediatric bipolar disorder (PBD). The TFR suggests a high prevalence for the PBD phenotypes in community samples around the world (2.06% of children and youth aged 7–21 years). The prevalence estimate suggests that millions of young people could have early forms of bipolar disorder (BD) that require combined pharmacologic and psychosocial treatment. This claim deserves further discussion and debate, as it has major implications for world psychiatry.

Pediatric bipolar disorder is controversial, especially the treatment of BD among prepubertal children.  While early intervention for BD may prove effective in reducing long‐term morbidity, the level of evidence needs to be very high, because the benefits have to outweigh the known harms of false positive diagnoses of BD in childhood. These harms include the serious side effects from the long‐term use of BD medications such as second‐generation antipsychotics (SGAs) for children who are incorrectly diagnosed with BD; the psychological effects of inaccurately labeling children with a severe lifelong mental illness; and overlooking alternative causes for mood lability in childhood. Our article critically examines the evidence presented for the PBD phenotypes, questions the TFR’s interpretations, and proposes new studies to fill lacunae in the research.

Full Article (ePDF)

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