{"id":10825,"date":"2011-07-01T10:12:10","date_gmt":"2011-07-01T14:12:10","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=10825"},"modified":"2011-07-01T16:52:07","modified_gmt":"2011-07-01T20:52:07","slug":"bipolar-kids-my-take-from-coby","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/07\/01\/bipolar-kids-my-take-from-coby\/","title":{"rendered":"bipolar kids: my take from COBY…"},"content":{"rendered":"\n
The DSM-III<\/font><\/strong> [1980] fractionated what had been called Manic Depressive Illness into two disorders – Major Depression, Recurrent and Bipolar Disorder[s] – based on the presence of a Manic Episode. It had a category – Atypical Bipolar Dsorder – for cases that did not meet their full criteria for Mania. In the DSM-IIIR<\/font><\/strong> [1988], they added that group as Bipolar Disorder NOS [and mentioned that it was being called "Bipolar II"]. By the coming of the DSM-IV<\/font><\/strong> [1994], that group had become Bipolar II. Now, in the COBY<\/font><\/strong> Study, Bipolar NOS is defined as another member of the family:<\/div>\n
\n
Children and adolescents aged 7 to 17 years 11 months (mean±SD age, 13.0±3.1 years) whose primary diagnoses were DSM-IV BP-I or BP-II or an operationalized definition of BP-NOS were enrolled in the COBY study. Because the DSM-IV definition of BP-NOS is vague, BP-NOS was defined as the presence of clinically relevant BP symptoms that did not fulfill the DSM-IV criteria for BP-I or BP-II. In addition, subjects were required to have a minimum of elated mood plus 2 associated DSM-IV symptoms or irritable mood plus 3 DSM-IV associated symptoms, along with a change in the level of functioning, duration of a minimum of 4 hours within a 24-hour period, and at least 4 cumulative lifetime days meeting the criteria.<\/strong><\/sup><\/div>\n<\/blockquote>\n
And notice that the Polarity of the Index Episode<\/font><\/strong><\/em> in those cases is also Not otherwise specified<\/strong><\/em>: <\/div>\n
<\/div>\n
Furthermore, in their new Bipolar NOS, between 30 and 40% of the cases don’t even have a periodic illness: <\/div>\n
<\/div>\n
<\/div>\n
So if  Bipolar II<\/font><\/strong> is Bipolar Lite<\/font><\/strong>, then I guess that their version of Bipolar NOS<\/font><\/strong> is Bipolar UltraLite<\/font><\/strong>. I’m being facetious because I feel like I’m being played in this Study. It hides too much. I’d like to see a symptom breakdown, for example. The DSM isn’t solid enough to accept without some proof. Evidence-based medicine calls for evidence. And their  comments about "subsyndromal" symptoms or:<\/div>\n
\n
… a minimum of elated mood plus 2 associated DSM-IV symptoms or irritable mood plus 3 DSM-IV associated symptoms, along with a change in the level of functioning, duration of a minimum of 4 hours within a 24-hour period, and at least 4 cumulative lifetime days meeting the criteria.<\/strong><\/sup><\/div>\n<\/blockquote>\n
feels contrived. So, I think they’re stretching the diagnosis of Bipolar Disorder to fit their preconceived notions. I admit to being a "preconceived" skeptic myself. For thirty years, I’ve been looking for the promised cohort of mis-diagnosed Bipolar adults, and they haven’t materialized. And since I’ve been working in the general clinics after my retirement, I’ve had to learn not to wince when people say, "I’ve been diagnosed Bipolar" or "Do you think I might be Bipolar?" There are some, sure enough, but the majority are people with longstanding characterologic problems of various sorts who take Bipolar medicines [which have not altered the course of their lives, by their own admission]. So I’m staying Kraepelinian, at least with adults.<\/div>\n

On the other hand, I accept that the COBY<\/font><\/strong> Study has a respectable number of Bipolar I<\/font><\/strong> kids that seem to have all the right stuff for the diagnosis – duration of episode, appropriate periodicity, syndrome specific symptoms, family history. So, my take from this study is that I’m not a bipolar-kids-deny-er, just someone who thinks they’re pushing the diagnosis way further than they ought to. It makes perfect sense that the disorder would start in childhood, but I’d still like to see cases from childhood that went on to develop "classic" Manic Depressive adulthoods [and I’d still like to see a case in the flesh<\/em>!]. <\/p>\n

I’m particularly interested in the child and adolescent diagnostic category because I see them now [there’s not anyone else to see them here in the woods]. I may not know all I need to know to see them, but I’m way ahead of the alternatives. And I see lots of kids on Atypicals or some kind of Mood Stabilizers for questionable reasons, even by COBY <\/font><\/strong>standards. So I have first-hand knowledge that kids are being over-medicated or badly medicated. I have yet to see a child that fits these criteria, but I’ll keep looking. There are a couple of adolescents I’d give a maybe<\/em> – usually with a very<\/em> Bipolar parent. <\/div>\n","protected":false},"excerpt":{"rendered":"

The DSM-III [1980] fractionated what had been called Manic Depressive Illness into two disorders – Major Depression, Recurrent and Bipolar Disorder[s] – based on the presence of a Manic Episode. It had a category – Atypical Bipolar Dsorder – for cases that did not meet their full criteria for Mania. In the DSM-IIIR [1988], they […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-10825","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/10825","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=10825"}],"version-history":[{"count":24,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/10825\/revisions"}],"predecessor-version":[{"id":10849,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/10825\/revisions\/10849"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=10825"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=10825"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=10825"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}