Bipolar disorder in children and adolescents: international perspective on epidemiology and phenomenology

Authors

  • César A Soutullo,

    1. Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, Clínica Universitaria, University of Navarra, Pamplona, Spain
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  • Kiki D Chang,

    1. Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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  • Azucena Díez-Suárez,

    1. Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, Clínica Universitaria, University of Navarra, Pamplona, Spain
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  • Ana Figueroa-Quintana,

    1. Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, Clínica Universitaria, University of Navarra, Pamplona, Spain
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  • Inmaculada Escamilla-Canales,

    1. Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, Clínica Universitaria, University of Navarra, Pamplona, Spain
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  • Marta Rapado-Castro,

    1. Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, Clínica Universitaria, University of Navarra, Pamplona, Spain
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  • Felipe Ortuño

    1. Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, Clínica Universitaria, University of Navarra, Pamplona, Spain
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  • An abstract of this paper was presented at the American Academy of Child and Adolescent Psychiatry Annual Meeting, In: Saxena K, Kowatch R, Liebenluft E, Chang KD. AACAP Symposium 63, Scientific Proceedings: 99-100, Miami, FL, USA, October 18 2003.

  • CAS has received research funding from Abbott Laboratories, Eli Lilly & Co., Novartis, Solvay, The Alicia Koplowitz Foundation, The Spanish Department of Health (Instituto de Salud Carlos III-FIS), Navarra Department of Health; consultant for EINAQ-Thomson ATC, Eli Lilly & Co., Janssen-Cilag, Shire; and serves on the speakers bureau for Admirall-Prodesfarma, AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co., Esteve, GlaxoSmithKline, Janssen-Cilag, Novartis, Pharmacia Spain and Solvay. KDC has received research funding from Abbott Laboratories, AstraZeneca, GlaxoSmithKline, NIH, The Heinz C. Prechter Foundation, The National Alliance for Research in Schizophrenia and Depression; consultant for Abbott Laboratories, AstraZeneca, Eli Lilly & Co., GlaxoSmithKline, Janssen Pharmaceutica, Shire US, UCB Pharma; and serves on the speakers bureau for Abbott Laboratories, AstraZeneca, Eli Lilly & Co. and GlaxoSmithKline. AD-S has received research funding from Eli Lilly & Company and The Alicia Koplowitz Foundation. FO has received research funding from The Alicia Koplowitz Foundation, The Spanish Department of Health (Instituto de Salud Carlos III-FIS), Navarra Department of Health, University of Navarra Research Funds (PIUNA); and serves on the speakers bureau for Admirall-Prodesfarma, AstraZeneca, Bristol-Myers Squibb/Otsuka Pharmaceutical, Eli Lilly & Co., Esteve, GlaxoSmithKline, Janssen-Cilag, Novartis and Solvay. AF-Q, IE-C and MR-C have no reported conflict of interest.

Cesar A Soutullo, MD, PhD, Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, Clínica Universitaria, University of Navarra, Apartado 4209, 31008 Pamplona, Spain. Fax: +34 948 296 500; e-mail: csoutullo@unav.es

Abstract

Objective:  There is considerable skepticism outside the US over the prevalence of pediatric bipolar disorder (BD). We wished to evaluate the epidemiology of BD in children and adolescents in non-US samples.

Method:  We reviewed studies on the prevalence of BD in children and adolescents in international samples. We also describe our sample of 27 children with BD at the University of Navarra.

Results:  There are important and frequently overlooked differences in the definition of BD between the International Classification of Diseases 10th edition (ICD-10) and DSM-IV and methodological differences in epidemiological studies that may partially explain international differences in prevalence of pediatric BD. The prevalence of bipolar spectrum disorder in young adults in Switzerland is 11%. In Holland the 6-month prevalence of mania in adolescents was 1.9% and of hypomania 0.9%. Only 1.2% of hospitalized youth (<15 years) in Denmark and 1.7% of adolescents in Finland had BD. In our clinic, the prevalence of DSM-IV BD in children 5–18 years old is 4%, and of any mood disorders 27%. There are also data from Brazil, India and Turkey with varying results.

Conclusion:  Relative lack of data, ICD-10 and DSM-IV differences in diagnostic criteria, different levels of recognition of Child and Adolescent Psychiatry as a true specialty in Europe, clinician bias against BD, an overdiagnosis of the disorder in USA and/or a true higher prevalence of pediatric BD in USA may explain these results. US–International differences may be a methodological artifact and research is needed in this field.

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