Comments on: Bipolar Disorder Overdiagnosed in Children? http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html Information and support Sat, 05 Jul 2008 19:52:54 +0000 http://wordpress.org/?v=2.3.3 By: Lee Anne http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-1179 Lee Anne Sun, 22 Jun 2008 11:51:26 +0000 http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-1179 I was initially diagnosed Bipolar 2 when I was 22. The doctors ignored major facts in my life, and even created new ones for me just to make the diagnosis stick- I was told I heard voices when I was inpatient (when I didn't) and that I was drunk, and an alcoholic when I just didn't have the history to back it up. It took several years before I found the right doctor; and they did not see bipolar. I was unsure of my label because I thought I was bipolar. Having a diagnosis like bipolar carries a horrible attachment. My current family physician wants to think I am bipolar without even considering the fact my history is so spotty, and I come into her office not presenting as manic, or depressed. My last doctor went bipolar gung ho and called me bipolar in front of another doctor- despite knowing that I was there to rule out bipolar and seek appropriate treatment. She then recanted on the diagnosis, saying that she was only speaking figuratively. She tried to put me on lithium with her figurative thinking! I have PTSD, dissociation, and chronic anxieties and phobias. As for bipolar, I don't know anymore, don't care, and will return to the hospital when it becomes apparent that I do have it. I was initially diagnosed Bipolar 2 when I was 22. The doctors ignored major facts in my life, and even created new ones for me just to make the diagnosis stick- I was told I heard voices when I was inpatient (when I didn’t) and that I was drunk, and an alcoholic when I just didn’t have the history to back it up.

It took several years before I found the right doctor; and they did not see bipolar. I was unsure of my label because I thought I was bipolar.

Having a diagnosis like bipolar carries a horrible attachment. My current family physician wants to think I am bipolar without even considering the fact my history is so spotty, and I come into her office not presenting as manic, or depressed.

My last doctor went bipolar gung ho and called me bipolar in front of another doctor- despite knowing that I was there to rule out bipolar and seek appropriate treatment. She then recanted on the diagnosis, saying that she was only speaking figuratively. She tried to put me on lithium with her figurative thinking!

I have PTSD, dissociation, and chronic anxieties and phobias. As for bipolar, I don’t know anymore, don’t care, and will return to the hospital when it becomes apparent that I do have it.

]]> By: Bipolar Blog | Bipolar Disorder For Dummies | Bipolar Disorder Diagnosis http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-769 Bipolar Blog | Bipolar Disorder For Dummies | Bipolar Disorder Diagnosis Fri, 02 May 2008 19:41:07 +0000 http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-769 [...] see as the potential problems posed by over-diagnosing bipolar in children, as I discuss in “Bipolar Disorder Overdiagnosed in Children?“) “Dr. Biederman’s stance is we diagnose young, so we can fix it early,” [...] […] see as the potential problems posed by over-diagnosing bipolar in children, as I discuss in “Bipolar Disorder Overdiagnosed in Children?“) “Dr. Biederman’s stance is we diagnose young, so we can fix it early,” […]

]]> By: eugene pastore http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-609 eugene pastore Tue, 08 Apr 2008 07:57:46 +0000 http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-609 I was diagnosed with adhd, then it was changed to BP, then back to adhd, when I resr the two disorders, it seems i have symptoms of both, many of the adhd meds wired me, such as lexipro, straterra, and ridilin, the BP mood stabilizer lithium, had no effect, some of my symptoms seem to be assosiated and UNIQUE to anxiety-panic disorder, however, none of the docs will go along with me on this, I am 30 years old and not happy with my docs and therapist I was diagnosed with adhd, then it was changed to BP, then back to adhd, when I resr the two disorders, it seems i have symptoms of both, many of the adhd meds wired me, such as lexipro, straterra, and ridilin, the BP mood stabilizer lithium, had no effect, some of my symptoms seem to be assosiated and UNIQUE to anxiety-panic disorder, however, none of the docs will go along with me on this, I am 30 years old and not happy with my docs and therapist

]]> By: Dr. Fink http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-536 Dr. Fink Mon, 03 Mar 2008 17:41:29 +0000 http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-536 Thanks Dr. Turley for your insightful comments. I see that we share a common concern with trying to avoid the over-diagnosis of bipolar disorder, yet stay working in a community that has come to rely on this language to describe many of the difficult children whom we see in practice. I agree completely that using some type of temporal criteria to identify “card carrying mania” as Gabrielle Carlson MD puts it will drastically reduce the diagnosis of JOBPD. Being moody and reactive is not bipolar disorder – it is not mania. It can be a real problem, but the “quick fix” of a bipolar diagnosis and the associated medications – which are hardly supported in the literature and carry numerous risks – is not the answer. Having written a couple of books about bipolar disorder, I see a lot of kids now that have already been diagnosed with BP or kids whose parents have read up on JOBPD and think that their child has Bipolar Disorder. I spend far more time on the un-diagnosis of BP in children than I do diagnosing it. Easily 10 to 1 or more. Thanks for joining in the conversation – it is great to know that there are more and more child psychiatrists who are trying to be rational about this discussion and provide good care to kids who are in a lot of pain. Thanks Dr. Turley for your insightful comments. I see that we share a common concern with trying to avoid the over-diagnosis of bipolar disorder, yet stay working in a community that has come to rely on this language to describe many of the difficult children whom we see in practice.

I agree completely that using some type of temporal criteria to identify “card carrying mania” as Gabrielle Carlson MD puts it will drastically reduce the diagnosis of JOBPD. Being moody and reactive is not bipolar disorder – it is not mania. It can be a real problem, but the “quick fix” of a bipolar diagnosis and the associated medications – which are hardly supported in the literature and carry numerous risks – is not the answer.

Having written a couple of books about bipolar disorder, I see a lot of kids now that have already been diagnosed with BP or kids whose parents have read up on JOBPD and think that their child has Bipolar Disorder. I spend far more time on the un-diagnosis of BP in children than I do diagnosing it. Easily 10 to 1 or more.

Thanks for joining in the conversation – it is great to know that there are more and more child psychiatrists who are trying to be rational about this discussion and provide good care to kids who are in a lot of pain.

]]> By: Jeff Turley, M.D. http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-531 Jeff Turley, M.D. Thu, 28 Feb 2008 23:30:30 +0000 http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-531 Dr. Fink's discussion of the juvenile-onset bipolar disorder (JOBPD) controversy is well reasoned and practical. As a busy child and adolescent psychiatrist practicing south of Boston, in the shadow of the Massachusetts General Hospital where the bipolar frenzy started, I am constantly posed with the ethical dilemma of either refuting the diagnosis of a colleague or "going along" with the trend of (over) diagnosis. The pressures to "go along" are numerous. A bipolar diagnosis takes parents and kids off the hook (where they probably shouldn't have been in the first place). Insurance companies are more likely to pay for intensive services, especially at hospital levels of care, if the patient carries a bipolar diagnosis. One would think, with the push to diagnose so many challenging kids with bipolar disorder, that we had great treatments for the condition. Medications for this disorder are only marginally effective in kids (probably because most of them do not have BPD) and fraught with problems. All but a few cause significant obesity (a real epidemic) and many cause metabolic problems. Why so many medications? Medication interventions are discrete, active, and easy. Medications are prescribed by the professionals, like myself, who make the diagnosis. Without diagnosis and medication management, psychiatrists would have to find a new role in mental health care delivery. . Like Dr. Fink, I often feel hindered by the JOBPD diagnosis because bipolar disorder represents relative contraindications to stimulants (for ADHD) and antidepressants (for depression and anxiety). In practice, I have rarely observed these common treatments to precipitate mania and have often used them to clear up the apparent “bipolar” disorder. The trend of over-diagnosis may be shifting. The National Institutes of Mental Health recently documented concerns about over-diagnosis on their web-site. The recent Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder Journal of the American Academy of Child and Adolescent Psychiatry, January 2007 (46:1), recommends that four continuous days of mania be observed before the diagnosis of bipolar disorder is made. If we hold to this standard, over-diagnosis should be rare. Dr. Fink’s discussion of the juvenile-onset bipolar disorder (JOBPD) controversy is well reasoned and practical. As a busy child and adolescent psychiatrist practicing south of Boston, in the shadow of the Massachusetts General Hospital where the bipolar frenzy started, I am constantly posed with the ethical dilemma of either refuting the diagnosis of a colleague or “going along” with the trend of (over) diagnosis. The pressures to “go along” are numerous. A bipolar diagnosis takes parents and kids off the hook (where they probably shouldn’t have been in the first place). Insurance companies are more likely to pay for intensive services, especially at hospital levels of care, if the patient carries a bipolar diagnosis. One would think, with the push to diagnose so many challenging kids with bipolar disorder, that we had great treatments for the condition. Medications for this disorder are only marginally effective in kids (probably because most of them do not have BPD) and fraught with problems. All but a few cause significant obesity (a real epidemic) and many cause metabolic problems. Why so many medications? Medication interventions are discrete, active, and easy. Medications are prescribed by the professionals, like myself, who make the diagnosis. Without diagnosis and medication management, psychiatrists would have to find a new role in mental health care delivery. . Like Dr. Fink, I often feel hindered by the JOBPD diagnosis because bipolar disorder represents relative contraindications to stimulants (for ADHD) and antidepressants (for depression and anxiety). In practice, I have rarely observed these common treatments to precipitate mania and have often used them to clear up the apparent “bipolar” disorder. The trend of over-diagnosis may be shifting. The National Institutes of Mental Health recently documented concerns about over-diagnosis on their web-site. The recent Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder Journal of the American Academy of Child and Adolescent Psychiatry, January 2007 (46:1), recommends that four continuous days of mania be observed before the diagnosis of bipolar disorder is made. If we hold to this standard, over-diagnosis should be rare.

]]> By: Joe http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-471 Joe Tue, 29 Jan 2008 12:31:33 +0000 http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-471 This is a well-balanced article that demonstrates Dr. Fink's sensitivity on this issue. Dr. Fink does not rule out the bipolar diagnosis for some children, in fact, she says, "Some children do have classic manic symptoms that require a bipolar diagnosis." Furthermore, she goes on to say, "I couldn’t agree more that the benefit of this trend has been to identify that these children are truly struggling with 'wiring' issues...." Dr. Fink also acknowledges in this article how difficult it is for families to deal with these issues. As she says, "Families are overwhelmed and exhausted and everyone is hurting...." She does not say or even imply anywhere in this article that individual parents are somehow at fault for these "wiring issues" or for accepting the bipolar diagnosis for their children. She is only saying that the trend--a 40-fold increase the the diagnosis of bipolar disorder in children from 1994 to 2003 is disturbing. We all need to be careful with our words, as Dr. Fink has been, but we cannot expect the experts to be silent over such an important issue. This is a well-balanced article that demonstrates Dr. Fink’s sensitivity on this issue. Dr. Fink does not rule out the bipolar diagnosis for some children, in fact, she says, “Some children do have classic manic symptoms that require a bipolar diagnosis.” Furthermore, she goes on to say, “I couldn’t agree more that the benefit of this trend has been to identify that these children are truly struggling with ‘wiring’ issues….” Dr. Fink also acknowledges in this article how difficult it is for families to deal with these issues. As she says, “Families are overwhelmed and exhausted and everyone is hurting….”

She does not say or even imply anywhere in this article that individual parents are somehow at fault for these “wiring issues” or for accepting the bipolar diagnosis for their children. She is only saying that the trend–a 40-fold increase the the diagnosis of bipolar disorder in children from 1994 to 2003 is disturbing.

We all need to be careful with our words, as Dr. Fink has been, but we cannot expect the experts to be silent over such an important issue.

]]> By: Diane Kratt http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-469 Diane Kratt Mon, 28 Jan 2008 19:36:16 +0000 http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-469 As a mother of a son with bipolar disorder, this article is upsetting. It was a very long road for us to finally get a correct diagnosi of bipolar disorder. It finally took a SPECT scan to show us the way his brain was funtioning. I blieve tools such as that are needed in order to avoid people's opinions and biased thoughts. If we could ahve had the correct diagnosis and tratment years prior, we could have avoided a lot fo problems and helped him much sooner. The right medication has made all the difference in the world for him. The medication is scary but living with untreated bipolar is worse. Articles like this make parents feel like they they are at fault or just imagining problems and it also gives people in or society more amunition against a mental illness diagnosis which increases stigma. I wish people were more careful with their words. As a mother of a son with bipolar disorder, this article is upsetting. It was a very long road for us to finally get a correct diagnosi of bipolar disorder. It finally took a SPECT scan to show us the way his brain was funtioning. I blieve tools such as that are needed in order to avoid people’s opinions and biased thoughts. If we could ahve had the correct diagnosis and tratment years prior, we could have avoided a lot fo problems and helped him much sooner. The right medication has made all the difference in the world for him. The medication is scary but living with untreated bipolar is worse. Articles like this make parents feel like they they are at fault or just imagining problems and it also gives people in or society more amunition against a mental illness diagnosis which increases stigma. I wish people were more careful with their words.

]]> By: Dr. Diane Fisher http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-411 Dr. Diane Fisher Mon, 07 Jan 2008 09:46:40 +0000 http://finkshrink.com/blog/children/bipolar-disorder-overdiagnosed-in-children.html#comment-411 this is o ne of the best discussions of this issue that I have seen -also, I couldn't agree more with your endorsement of cps -thanks! this is o ne of the best discussions of this issue that I have seen -also, I couldn’t agree more with your endorsement of cps -thanks!

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