Decreasing rate of inpatient pediatric bipolar disorder diagnosis in the US between 2004 and 2010.

OBJECTIVES: Diagnosis of bipolar disorder (BD) increased substantially among youth between the mid-1990s and mid-2000s in the United States. This dramatic increase in diagnosis resulted in concern regarding the potential for misdiagnosis of BD among youth. However, the rate of BD diagnosis in the United States had not been evaluated nationally since the mid-2000s. It was unclear whether changes in diagnostic rates continued to occur. Therefore, the present study aimed to assess the pattern of longitudinal trends in the rate of national inpatient BD diagnosis subsequent to 2004. METHODS: Data included a nationally representative dataset of inpatient hospitalizations between 1996 and 2010. De-identified data were obtained from the National Hospital Discharge Survey (NHDS) conducted annually by the National Center for Health Statistics. RESULTS: The proportion of BD diagnoses relative to all psychiatric diagnoses increased between 1996 and 2004 among children and adolescents. The proportion of BD diagnoses then decreased between 2004 and 2010 among children but continued to increase for adolescents. However, population-adjusted rates of BD diagnosis per 10,000 individuals in the general population initially increased until the mid-2000s and then decreased until 2010 for both children and adolescents. CONCLUSIONS: Rates of BD diagnosis substantially decreased for youth between the mid-2000s and 2010. This decline coincided with recommendations for more conservative diagnostic practices due to concerns about overdiagnosis and increasing awareness of the side effects of front-line medications used to treat BD in youth. Findings provide insight into changing trends in inpatient service utilization for BD in the United States.

Irritability Is Associated with Illness Severity and Anhedonia Is Associated with Functional Impairment Among Depressed Children and Adolescents.

Objectives: Irritability and anhedonia are cardinal symptoms of depression for children and adolescents. However, anhedonia may be more strongly associated with illness severity compared with irritability. The present study evaluated the impact of irritability and anhedonia on symptom severity and functional impairment among depressed children and adolescents. Methods: Participants were 383 children and adolescents presenting for outpatient treatment at a community mental health center or academic medical center. Children and adolescents were diagnosed with unipolar depression or bipolar disorder. Regression models predicted depression severity and functional impairment from irritability and anhedonia after covarying age, gender, depressive and hypomanic symptoms, and diagnosis. Results: Greater irritability and anhedonia were associated with more severe depression symptoms. Greater irritability, but not anhedonia, was associated with lower global functioning and family quality of life (QoL), and more externalizing problems. Greater anhedonia was associated with lower overall, emotional, self-esteem, and social QoL. Neither irritability nor anhedonia was associated with school or physical QoL, nonsuicidal self-injury, suicidal ideation, number of comorbid diagnoses, or internalizing problems. Conclusions: Irritability was associated with more markers of depression severity, whereas anhedonia was associated with indicators of functional impairment. This study used a cross-sectional observational design and therefore cannot provide information about cause and effect relationships between variables. Irritability and anhedonia were derived from their respective subscales of the General Behavior Inventory and included only caregiver-reported symptoms but not child- or adolescent-reported symptoms. Identifying the impact of specific symptoms of depression may assist clinicians in delivering more individualized interventions to target symptoms that result in greater impairment.

Decreasing rate of inpatient pediatric bipolar disorder diagnosis between 2005 and 2015.

INTRODUCTION: The rate of bipolar disorder (BD) diagnosis in youth increased between the mid-1990s and mid-2000s in the U.S. and remained low in other countries. The discrepancy resulted in concerns regarding misdiagnosis of BD. However, the longitudinal trajectory of BD diagnosis subsequent to the mid-2000s was unclear. Therefore, the current study assessed longitudinal changes in the rate of inpatient BD diagnosis in the state of Nevada between 2005 and 2015. METHODS: Data included Medicaid administrative billing claims (n = 48,108 unique admissions) for youth 5-17 hospitalized at one of five psychiatric inpatient hospitals in Nevada. Regressions assessed changes in the rate of diagnosis over time for BD and compared to depressive disorders (DD). RESULTS: The rate of BD diagnosis declined between 2005 and 2015. The rate of DD diagnosis remained stable for boys and increased substantially for girls during the same time period. LIMITATIONS: Some individuals may have been repeatedly hospitalized throughout the study period and contribute more than one unique admission. Findings from this study were limited to a sample of Medicaid-insured youth in a single state. CONCLUSIONS: The rate of mood disorder diagnosis in inpatient units is changing. The use of BD as a diagnosis is decreasing in Nevada which may reflect US trends nationally, though still high by international comparison. In contrast, DD increased for girls but not boys. Awareness of the current diagnostic trends for BD may assist inpatient administrators and clinicians in preparing for anticipated service utilization and planning allocation of resources.

Association Between Altitude and Regional Variation of ADHD in Youth.

OBJECTIVE: The purpose of this study was to evaluate the effect of altitude on rates of ADHD. As decreased dopamine (DA) activity has been reported with ADHD and hypoxia has shown to be associated with increased DA, we hypothesized that states at higher altitudes would have lower rates of ADHD. METHOD: State estimates from the 2007 National Survey of Children's Health (NSCH) report and 2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) report were used to extract the percentages of youth ages 4 to 17 diagnosed with ADHD. RESULTS: Both the datasets independently revealed that the prevalence of ADHD decreases with increasing altitude ( R2 = .38, p < .001; R2 = .31, p < .001), respectively. This study controlled for potential confounds (e.g., low birth weight, ethnicity, and household size). CONCLUSION: These findings suggest a need for further investigation into the extent by which altitude may serve as a protective factor for ADHD.