The confusion between bipolar disorder and schizophrenia in youth: where does it stand in the 1990s?

OBJECTIVE

To determine whether the bias against diagnosing bipolar disorder in youth continues, and if so, why.

METHOD

Subjects are bipolar and schizophrenic patients taken from a county-wide sample of first admissions for psychosis. Patients are given structured interviews and consensus diagnoses at intake and 6 months. Age of onset of psychosis, gender, and 6-month consensus diagnosis between both groups are compared. To assess diagnostic bias, diagnostic stability and facility discharge diagnoses are examined in young (aged 15 through 20 years) versus adult (aged 30 through 40 years) patients.

RESULTS

Bipolar disorder and schizophrenia are diagnosed at similar rates in younger age groups by 6-month consensus. However, bipolar disorder was underdiagnosed by Suffolk County's psychiatric hospitals in the youth. The stability of both disorders in both age groups was similar and excellent. Schizophrenia had a slightly older age at first psychosis than bipolar disorder and an equal gender representation. Bipolar disorder in males was rare after age 30.

CONCLUSION

Community psychiatrists no longer call young bipolar patients schizophrenic, but they underdiagnose bipolar disorder. The more complicated nature of early-onset bipolar disorder may be a contributing factor.