http://thelastpsychiatrist.com/2007/11/bipolar_rates_are_increasing_a.html#more
In 1994, there were 20,000 visits for pediatric (under age 19) bipolar
disorder. In 2003, the number was...800,000. The diagnosis, therefore,
was 25/100,000 in 1994, and now it's 1000/100,000. In other words, 1% of
the population.
To compare: for adults the rates were 905/100,000 in 1994, to
1679/100,000 in 2003. In other words, 0.9% up to 1.7%.
I've heard this justified as a step forward. While "visits" isn't the
same as incidence or prevalence in a population, it makes sense as a
proxy. The adult rate is about 1-2%, consistently. Bipolar was severely
underdiagnosed in 1994, and it's better diagnosed today. Since bipolar
is a biological disorder with a strongly heritable component, it only
makes sense that the child rate should be the same as the adult rate,
assuming good diagnostic skills. So the diagnosis rate has simply risen
to match the adult rate.
The only problem is this: in 2003, 2/3 of the children visiting were
males. But 2/3 of the adults were females.
So you have some options:
1. The male children have a disorder that is actually different than the
adult females have, i.e. one of them is not bipolar.
2. The male children with bipolar got cured during puberty.
3. Bipolar disorder turns boys into women sometime around age 19,
obviously using the power of Satan.
The ridiculousness of this increase in diagnosis is only exceeded by the
potential harm such an increase is actually causing. Forget about the
safety or lack of safety of bipolar medications in kids, which is
worrisome enough. A problem few seem to want to talk about is the impact
of a bipolar diagnosis on a person, for the rest of his life. Let's say,
for the sake of argument, pediatric bipolar is overdiagnosed. Then all
those people who were misdiagnosed are, in fact, not bipolar; however,
they have no way of ever finding that out. They have to carry this with
them for the rest of their life. When they're 30 years old, and they're
asked on routine checkup if they've ever had a psychiatric diagnosis,
they have to say, "Well, pediatric bipolar, but I think that's not
right." Sure it isn't. When that 30 year old guy has kids, and those
kids grow up, they'll be asked, do you have a history of major
psychiatric illness in your family? Hmm. "Maybe bipolar...but my Dad
told me he thinks that wasn't right." Oh, ok. Did your Dad have a
temper? "Well, he did yell a lot when he was mad." I see. Did he go
without sleep? "Oh my God, when we were kids--lots of times." Then it's
settled.
If pediatric bipolar is being accurately diagnosed, then either
psychiatrists are now more sensitive to its detection--an unlikely
possibility since the diagnosis has been around for a long, long
time--did we suddenly develop a better test for it? Or else something
has changed in the world to cause it to be more frequent (a toxin in
bottled water? MySpace? Iraq?)
Early treatment of bipolar--let's call it the "real" bipolar--doesn't
slow down the progression of the illness. It helps you today, but it
doesn't change symptoms 10 years from now, they way aggressive early
treatment of diabetes actually prevents physical pathology from
worsening. So it may be worth, oh, I don't know--conservative management?
.
|
