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Diagnosis pattern different for bipolar adults, children.

PITTSBURGH -- The pattern of psychiatric diagnoses preceding the diagnosis of bipolar disorder differs between adults and children, Pandurang M. Kulkarni, Ph.D., and associates reported in a poster at the Seventh International Conference on Bipolar Disorder.

Studies have found that patients with bipolar disorder often have other comorbid psychiatric conditions and may be misdiagnosed or underdiagnosed, leading to inappropriate treatment. Patients often receive other diagnoses before they are diagnosed with bipolar disorder, said Dr. Kulkarni and associates of Eli Lilly & Co., Indianapolis.

In this retrospective study funded by Eli Lilly, data were obtained from the PharMetrics Integrated Database for the years 1995-2005. A total of 23,019 patients with bipolar disorder were identified, of whom 12,476 (54%) had a prior psychiatric diagnosis. Of those, 11,897 had an ICD-9 diagnosis code of 290.xx-319.xx preceding their bipolar diagnosis and were thus eligible for the study.

Overall, depression was the most common preceding diagnosis, in 48%, followed by anxiety (10%), adjustment to chronic stress disorder (8%), substance abuse syndromes (8%), ADHD (6%), conduct disorder (4%), and schizophrenia (3%).

However, when broken down by age, the pattern was different among the 10% of patients younger than 14 years: For them, the most common preceding diagnosis was ADHD (33%), followed by depression (20%), conduct and oppositional defiant disorder (15%), adjustment to chronic stress disorder (13%), and anxiety disorder (3%).

Three-fourths of all the patients with a preceding diagnosis of ADHD had a hyperactive subtype, the investigators noted.

In contrast, the adult (age 18-65) bipolar patients were most likely to have preceding diagnoses of depression (52%), anxiety (12%), substance abuse syndromes (9%), adjustment to chronic stress disorder (8%), and schizophrenia (4%).

"A better understanding of the complexity of the diagnosis of patients with bipolar disorder will assist clinicians in the proper diagnosis and effective treatment of patients," Dr. Kulkarni and associates said.
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Title Annotation:Adult Psychiatry
Author:Tucker, Miriam E.
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Aug 1, 2007
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