February 09, 2009

Unlike US, Australia Is Skeptical Of The Bipolar Child Paradigm

Most of you are well aware of the controversy around child bipolar disorder and of how some of its key proponents have become enmeshed in controversy. I won't restate any of that here.

What I will note, however, is that in Australia several child psychiatrists have gotten vocal on the issue, perhaps in an attempt to preempt the controversial diagnosis' invasion of their nation.

Anyway, there was a good article on all of this in the Sydney Morning Herald today (actually Jan. 10 over there) and Peter Parry, who's a reader of this site, was quoted.

"The British National Institute for Health and Clinical Excellence rejects as theory the suggestion that children suffer bipolar disorder. It warns it could lead to overmedication.

"In Australia the increase in childhood diagnosis worries Peter Parry, an Adelaide child psychiatrist who published a paper with Stephen Allison in last April's issue of Australasian Psychiatry. This prompted letters in the August issue, with one contributor arguing it is 'currently one of the most active and controversial areas of clinical and research interest in child psychiatry.'

"Parry and colleagues recently surveyed 199 Australian and New Zealand child psychiatrists for future publication in Child And Adolescent Mental Health. Ninety per cent thought bipolar disorder was overdiagnosed in the US, 53 per cent said they had never encountered a case in a prepubescent child and another 29 per cent said they had seen only one or two cases.

"'If you'd told me three years ago that two-year-olds were being diagnosed with bipolar disorder my reaction would have been "that's impossible," Parry said.

"'Most of us in the psychiatric profession consider it extremely rare prior to puberty, let alone in a two-year-old.'"

Isn't it interesting that in Britain NICE considers the bipolar child stuff to be "theory" while in the US the nice folks at Harvard consider it rock solid science? Isn't it telling that all these kids are getting diagnosed in the US when Down Under docs say they've never seen a case or very few? Australia isn't different enough from the US for anyone to argue huge differences in genetics as being the difference. It seems to me that their medical culture is a lot more conservative when it comes to addressing child behavior.

Just so we are all clear, the article is discussing bipolar disorder in children, not teens. It's fairly clear to me that bipolar disorder can pop up in teens--hence the pediatric bipolar disorder label being bandied about, although who knows what the appropriate prevalence would be--but when it comes to kids younger than, say, 12 years old, I am very, very skeptical of its presence. I know there are some skeptics within child psychiatry in the US, but their voices have been effectively crowded out.

Posted by Philip Dawdy at February 9, 2009 12:03 AM
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On the other hand, Australia brought the world lithium therapy for bipolar disorder, for better or worse. Make of that what you will.

Posted by: Larry at February 9, 2009 07:43 AM

I'm a bit confused. Wasn't is Australia which, you reported, was using ECT to treat bipolar in children under 4?

Posted by: bromac at February 9, 2009 09:05 AM

It is time to squelch this malicious rumor about young children receiving ECT in Australia. Being from Down Under myself, I contacted a former colleague, who committed to investigate the matter. Here is his follow-up:


… I guess it will be gaining a life of its own on the internet... Doubtless it will gain a place in the mythology of ECT...

The DHS in Victoria has found that all their cases were data entry faults. As expected, no-one under 16 had ECT.

The Commonwealth Health Insurance Commission (HIC) gets returns on all Medicare benefit items, of which ECT is one. Hence they note all ECTs given in private. They have found that every case of child ECT was mistaken. All were due to faulty data entry or occurred when a child had the same name as a parent receiving ECT and was thus listed on the same Medicare Card which is similar to a credit card and is used in all health case transactions in private. I am sorry if I am stating the obvious about Medicare, but it may help clarify those issues with your colleagues.

I am unsure if there is a mole in the HIC or if the information were gained from an FOI query by someone with a probable negative interest. There is little investigative reporting in Australia so it is likely that the reporter was fed the material.


End of story. It didn't happen.

Bernard Carroll.

Philip Dawdy responds: so you and others know, i've heard from two different sources that the data was flawed. i'm trying to confirm this for myself and will amend my earlier piece appropriately when i get confirmation. but yes it appears that the reporter either did sloppy work or got duped by flawed data.

Posted by: Bernard Carroll at February 9, 2009 10:34 AM

Bipolar Ability
Bipolar (manic-depressive illness) has been defined as a major affective mood disorder in which one alternates between the mental states of deep and brutal depression and embellished elation- with the depressive episodes occurring more frequently in one who is said to be Bipolar.
Bipolar is believed to affect one’s cognition, emotions, perceptions, and behavior- along with psychosomatic presentations (such as pain with depressive episodes, for example). It is thought to be due to a physiological dysfunctional brain in one affected with bipolar by many. Yet Bipolar allows for exceptional abilities when a bipolar person is in their manic phase at times. So perhaps a brain alteration should be what has happened, or what is happening, instead of a dysfunction
The etiology for bipolar is unknown. As many as half of those suspected as having a bipolar are thought to have at least one parent with some sort of mood disorder similar to bipolar disorder, which suggests a genetic predisposition may be present.
It is also believed that bipolar presents itself with symptoms associated with the definition of bipolar when one is between the ages of 15 and 25 years old. The disorder was entered in the psychiatrists’ bible, the DSM, in 1980, although bipolar disorder is thought to have existed for quite some time.
Also, those with bipolar are thought to be in possession of heightened creativity during their manic phases, as well as they have accelerated growth of their neurons. This is not necessarily a bad thing, it seems.
Research has determined that as many as 15 to over 30 percent of bipolar patients commit suicide if they are left untreated, or undertreated. Also, as many as half of those affected with bipolar also have at times severe substance abuse issues along with their bipolar as well.
Bipolar patients are also often experiencing anxiety issues that vary, and are treated often as a result of these medical issues. The disorder varies as far as severity goes- with some bipolar patients being more severely affected than others. In fact, there are at least 6 classifications of bipolar, according to the DSM.
Bipolar patients are thought to be symptomatic half of their lives. As stated previously, the depressive episodes occur more frequently than manic ones. When symptomatic, bipolar patients are thought to be rather disabled, according to some, when in their depressive state in particular. The diagnosis has become more frequent recently. In one decade, the assigned diagnosis of bipolar rose from being about 25 per 100 thousand people to being 1000 per 100,000 people.
Most diagnosed with bipolar are not diagnosed based on solid, comprehensive, or psychiatric review that is often absent of valid or standard diagnostic methods. Some believe as many as 5 percent of the human population may be affected by bipolar disorder- which may include as many as 12 million people in the United States. This is if the diagnostic criteria developed by others were to be fully utilized.
A subjective questionnaire called the Mental Status Examination is often utilized when diagnosing one suspected has having bipolar disorder. Many believe the diagnosis has increased recently due to the progressive treatment options now available. It is an argument of increased awareness versus over-diagnosis.
Yet the diagnosis is vague, as children and adolescents are often absent in research with bipolar. Also, there is not any objective diagnostic testing to rely upon for bipolar.
Many younger than 18 years of age are prescribed atypical anti-psychotics as first line treatment, which is largely not recommended as treatment options. In fact, close to half a million of those younger than 18 years of age are prescribed the atypical anti-psychotic Risperdal alone, it has been determined. The class of medications overall is thought to be prescribed to about 10 percent of those non-adults thought to have bipolar.
While not recommended, about a half of all those assessed as being bipolar are prescribed antidepressants, such as SSRIs, as first line treatment. It has been suggested that this class of drugs has decreased the risk of suicide attempts compared with other classes of antidepressants for close to 20 years. Yet tricyclic antidepressants have been determined to be efficacious in over half of those diagnosed with bipolar - with a greater amount of research behind this class of drugs.
The most recognized treatments for bipolar long term are lithium (Ekalith or Lamictal- along with an anti-convulsant. Sugar intake is thought to vex the symptoms of one with a bipolar disorder as well.
Atypical anti-psychotics have been prescribed for bipolar, which change some aspects of the brain, physiologically, as does the disease itself. In fact, one may argue the brain becomes more efficient due to both the disorder and the treatment with the atypical anti-psychotics. Yet many recommend the utilization of this class of drugs with bipolar disorder only if psychosis is present as well.
As many as 15 percent of bipolar disorder patients diagnosed as such are prescribed an atypical presently. This class of medications may be particularly beneficial for those women who are diagnosed with bipolar who are pregnant, however.
Lithium, which is essentially a very light metal with low density in which the salts are obtained for medicinal treatment, and an anti-convulsant are believed to be standard bipolar treatment, pharmacologically, studies have shown. This is due to Dr. John Cade and his examination with lithium and its benefits with those who have psychotic excitement close to 60 years ago.
Ekalith is believed to be both neuro-protective as well as having an anti-suicidal affect in those believed to be bipolar- and is viewed as a mainstay as far as treatment for bipolar goes with many who treat the disorder. Lithium is thought to regulate the calcium molecule in the brain, so this and valporate are historically the medicinal treatment options preferred for those with bipolar disorder.
Bipolar is difficult to detect, and is often diagnosed as major depression with many affected by this disorder. There is no objective criteria protocol available to utilize when assessing any patient believed to be suffering from any mental disorder. So such mental disorders that are diagnosed are ambiguous, yet that does not conclude that such disorders do not exist, such as the case with bipolar disorder.
Yet perhaps a health care provider should be very thorough and knowledgeable when assessing a patient believed to have a mental condition such as bipolar. And those who study bipolar should consider calling it Bipolar Ability instead of Bipolar Disorder. A disorder is something considered outside the realms of within normal limits, thus no order exists. An ability is when one has the power to do something utilizing their skills, talent, and expertise.
Both words may or not apply to Bipolar. I’m going with bipolar having atypical abilities.
www.dbsalliance.org, www.nmha.org
Dan Abshear
Author’s note: What has been annotated is based upon information and belief.

Posted by: Dan at February 9, 2009 10:43 AM

bipolar disorder certainly does exist in children. i have absolute no doubt of that, i know too many children who have it. i do, however, think it is overdiagnosed, and overmedicated, and that the drugs we are giving are children are not safe - for the simple fact that we cannot trust pharma nor our doctors.

Posted by: anon mom at February 9, 2009 12:44 PM
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