Comparing Youth With Bipolar Disorder to Non-Bipolar Youth Referred for Bipolar Disorder

Objective Bipolar disorder (BD) diagnoses require episodes of hypomania and mania as well as depressive episodes. Given the overlap of BD symptoms with symptoms of other psychiatric conditions among youth, misdiagnosis is common. This topic was examined in a large sample of youth clinically referred for BD. Method Participants were 394 clinically referred youths ages 13 to 20 years, including 255 with confirmed BD and 139 for whom BD was not confirmed (non-BD). Participants and their parent/guardian completed a semistructured diagnostic interview and dimensional scales. Demographic and clinical variables were compared between BD and non-BD groups. Following correction for multiple comparisons, significant variables associated with BD diagnosis ( p < .05) in univariate analyses were evaluated in multivariable analyses. Results Compared with the BD group (n = 255), the non-BD group (n = 139) had significantly lower current mania symptom severity, family history of hypomania/mania, current lithium treatment, and lifetime bulimia nervosa, whereas most severe past global functioning was higher and current oppositional defiant disorder was more common in the non-BD group compared with the BD group. Use of second-generation antipsychotics was high in both groups. Common reasons for not diagnosing BD in the non-BD group included not meeting duration criteria for a hypomanic/manic episode and manic-like symptoms being better explained by other psychiatric disorders. Conclusion Youth with and without BD did not differ in the vast majority of clinical variables examined. Frequent use of second-generation antipsychotics in non-BD youth may relate to characterization of overlapping comorbidity symptoms as manic symptoms. Both groups have complex presentations, necessitating psychosocial and pharmacological treatments. Plain language summary A total of 394 youth, aged 13-20 years, were recruited from a subspecialty adolescent bipolar disorder clinic at a teaching hospital in Toronto, Canada, over a 12-year period. Participants were clinically referred for assessment and/or treatment of bipolar disorder. A bipolar spectrum disorder diagnosis was confirmed for 255 of the 394 youth. The authors examined a broad range of demographic, clinical, and familial characteristics, and over 90% did not yield significant between-group differences. The most common reasons for not confirming a bipolar disorder diagnosis were insufficient and/or fleeting manic symptoms and manic-like symptoms being better explained by other psychiatric disorders. Overall, both groups had complex presentations, emphasizing careful assessment and the need for psychosocial and pharmacological treatments in both groups. Diversity & Inclusion Statement We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

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