Adolescent bipolar disorder ‘does not conform to checklist’

By Liam Davenport, medwireNews Reporter

Young people with bipolar disorder who are in a depressive episode do not conform to the child behavior checklist-juvenile bipolar disorder phenotype (CBCL-JBD) profile, the results of a US study indicate.

While noting that the current population characteristics differ from those in previous studies, the team, led by Melissa DelBello (University of Cincinnati School of Medicine, Ohio), says: "Nonetheless, our study does contribute to the limited extant literature focusing on depression associated with bipolar disorder.

"Diagnostic tools that discern unipolar and bipolar depression are needed. Only after accurate and efficient diagnosis can appropriate treatment be implemented to minimize the significant morbidity and mortality that is inherent to untreated bipolar illness."

The researchers recruited 32 adolescents, aged 12-18 years, who were diagnosed with bipolar I disorder and were currently in an associated depressed episode. All participants were medication free at the time of assessment, and had a clinically significant score above 40 on the Children's Depression Rating Scale, Revised. Each patient's primary caregiver completed the CBCL, with a score of 70, or two standard deviations above the norm, being used as a cut-off for clinical significance.

Compared with accepted norms, the adolescents with bipolar depression showed significantly increased scores on the majority of the CBCL subscales, results published in the Journal of Affective Disorders reveal. However, the mean score only exceeded the cut-off for clinical significance on the internalizing subscale and the total score, at means of 70.2 and 71.5, respectively.

Although the Anxious/Depressed score was increased, at an average of 68.9, it did not reach the cut-off for clinical significance. Similarly, the CBCL-JBD phenotype score was increased, at an average of 204.6, but did not reach the cut-off score of 210.

The team writes: "In light of these findings, we propose diagnostic sensitivity of the CBCL-JBD profile is contingent upon the bipolar child presenting in a manic or mixed state; in other words, our results introduce the idea that this profile is state-specific rather than trait-specific.

"An assessment tool which supports diagnosis based on discerning and stable traits of true JBD would be ideal."

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