Mood Swings

A psychiatrist surveys the mind and the wider world

An Australian Fad: Ignoring Childhood Bipolar Disorder

Bipolar is a fad, but trauma isn't, according to Australians.
Stuart L. Kaplan, M.D.
This post is a response to The Geography of Pediatric Bipolar Disorder, Part II by Stuart L. Kaplan, M.D.

Australian psychiatrist Peter Parry in these posts identifies pediatric bipolar disorder as “a fad diagnosis mostly confined to the USA.” This is interesting since I’ve shown that 7% of persons with mania admitted to the hospital in 1845 Paris by the great Esquirol were as young as 15 years of age. Quite an American fad.

Surely, the fact that Australians and Englishmen and other members of the British Commonwealth have opinions that differ from Americans doesn’t mean that they are right and we are wrong. If that is the case, let’s turn the clock back to 1775 right now.

The causes? Our Australian colleague cites biomedical reductionism. But who is more reductionistic? The child psychiatrist who diagnoses bipolar disorder and prescribes medications, or the child psychiatrist who refuses to diagnose bipolar disorder and prescribes other medications. The first might give antipsychotics; the latter diagnoses ADHD and depression and intermittent explosive disorder and temper dysregulation disorder - and gives antidepressants and amphetamines, and sometimes antipsychotics. Either way, children are getting lots of medications. I don’t see how making multiple other diagnoses, and then giving drugs, improves upon diagnosing one condition, and giving drugs.

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Another cause is insurance coding. In the US, to get paid, one has to diagnose a “real” condition. But this can be done with ADHD and MDD also. Bipolar disorder is not required.

A third cause: the simplistic checklist system of DSM. But what is PTSD and the trauma which our author supports instead but another set of simplistic checklists? Why replace one checklist with another?

Our Australian colleague believes in trauma, not bipolar disorder; in giving antidepressants and amphetamines, I presume, not antipsychotics.

If this is the case, let’s submit it to the tribunal of science, not querulous and historically false claims of cultural fads.  The scientific studies cited in these posts are selective and incomplete; other studies find opposite results. For instance, we found that only 1/3 of children in a US pediatric clinic meeting DSM-IV criteria for mania have actually been diagnosed in the past with bipolar disorder.  In contrast, over 1/2 of children who did not meet criteria for ADHD had received that diagnosis. 

Even the belief in the widespread prevalence and psychiatric importance of trauma can be said to be a cultural fad from Victorian Vienna, transmitted to American and other shores, which appears to persist especially strongly in Australia.

 

 

Nassir Ghaemi, M.D., M.P.H.,

is Professor of Psychiatry at Tufts University School of Medicine, and Director of the Mood Disorders Program at Tufts Medical Center in Boston. more...

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