Because of the many overlapping symptoms that are shared with other more commonly diagnosed childhood psychiatric disorders, it is critical to know whether children who present with a specified set of symptoms have bipolar disorder or not. The correct diagnosis sets the course of treatment and can have a significant effect on outcome.
Epidemiological studies rely on accurate diagnostic criteria to distinguish one condition from another to determine the true rates of the disorder in the general population. Genetic studies, our best hope of understanding the etiology of the illness, may succeed or fail depending on whether we are able to precisely define syndromes leading to definitive behavioral phenotypes.
The failure over two decades of laborious research to identify any of the genes underlying the major psychiatric syndromes supports the view that our current nosology, embedded in DSM-IV, does not adequately define behavioral phenotypes for genetic studies.
Before any large scale epidemiological and genetic studies can proceed in earnest, it is imperative that the field come to some consensus about one or several behavioral phenotypes defined as juvenile, childhood-onset or pediatric bipolar disorder.
The JBRF Expert Diagnostic Workshop
If our goal is to establish an accurate definition of the syndrome, and the starting point is to attempt to develop or re-fashion a categorical definition of the illness, we are immediately confronted with some fundamental obstacles. With its complex cycling patterns, comorbidities, and the evolving developmental trajectories that contribute to the potential for different symptom complexes that change over time, juvenile-onset bipolar disorder does not easily fit into categories derived from adult studies.
We anticipate that all of these issues and others will come into high relief throughout the online continuous case conferences presented through JBRF’s Expert Diagnostic Workshop. Through an examination of case descriptions, course of illness, and comprehensive information (in the form of a diagnostic interview, K-SADS P/L, as well as individual behavioral and symptom inventories derived from parents, clinicians, teachers, and the patients), clinicians and researchers will have an opportunity to examine, deliberate, and then discuss the various features, advantages and disadvantages of four separate diagnostic schemas – the standard set of diagnostic criteria derived from adult studies and published in the DSM-IV, and 3 other proposed sets of diagnostic criteria for juvenile-onset bipolar disorder: the Narrow, Broad, and Core phenotypes.
Not merely an academic exercise, the data that emerges from this diagnostic workshop, coupled with open deliberations and discussions with peers in on-line forums, will, potentially, have significant implications for treatment decisions, planning and outcome, as well as for future epidemiological and genetic studies.
Click here to take a Virtual Tour of the Expert Diagnostic Workshop.