Academic Department of Psychiatry, Faculty of Medicine and Health, Kolling Institute, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales, Australia.
Bipolar Disord. 2023 Sep;25(6):469-477. doi: 10.1111/bdi.13367. Epub 2023 Jul 11.
This article examines the ongoing debate concerning the diagnosis of bipolar disorder in children and adolescents. This contentious issue has generated robust discussion over the past two decades without consensus, and as such the true prevalence of so-called paediatric bipolar disorder (PBD) remains unknown. In this article we offer a solution to break this deadlock.
Recent meta-analyses and additional literature concerning the definition and prevalence of PBD was critically reviewed with a view to understanding the perspectives of those developing the taxonomy of PBD, and those engaged in research and clinical practice.
A key finding is the lack of iteration and meaningful communication between the various groups interested in PBD that stems from deep-seated problems within our classificatory systems. This undermines our research efforts and complicates clinical practice. These problems make the already difficult diagnosis of bipolar disorder in adults even more challenging to transpose to younger populations, and additional complexities arise when parsing clinical phenomenology from normative developmental changes in youth. Therefore, in those manifesting bipolar symptoms post-puberty, we argue for the use of adolescent bipolar disorder to describe bipolar symptoms whereas in pre-pubertal children, we propose a reconceptualisation that allows symptomatic treatment to be advanced whilst requiring critical review of these symptoms over time.
Significant changes in our current taxonomy are necessary and to be clinically meaningful, these revisions to our diagnoses need to be developmentally-informed.
本文探讨了目前有关儿童和青少年双相障碍诊断的争论。这个有争议的问题在过去二十年中引发了激烈的讨论，但仍未达成共识，因此所谓的儿童双相障碍（PBD）的真实患病率仍不清楚。在本文中，我们提供了一个解决方案来打破这一僵局。
我们对最近的荟萃分析和其他关于 PBD 定义和患病率的文献进行了批判性回顾，以期了解那些制定 PBD 分类法的人的观点，以及那些从事研究和临床实践的人的观点。
一个关键发现是，对 PBD 感兴趣的各个群体之间缺乏迭代和有意义的沟通，这源于我们分类系统中的深层次问题。这破坏了我们的研究工作，使临床实践变得复杂。这些问题使得在成年人中已经很难诊断的双相障碍更难以应用于年轻人群，而在青少年中从临床现象学中解析出与正常发展变化的差异则会出现更多的复杂性。因此，对于那些在青春期后表现出双相症状的人，我们主张使用青少年双相障碍来描述双相症状，而对于青春期前的儿童，我们提出了一种重新概念化的方法，允许对这些症状进行对症治疗，同时需要随着时间的推移对这些症状进行批判性审查。
我们目前的分类法需要进行重大修改，为了具有临床意义，这些诊断的修订需要考虑到发育因素。
