Severely Mood-disordered Youth Respond Less Well to Treatment in a Community Clinic than Youth with Bipolar Disorder.

OBJECTIVE: A tremendous increase in the diagnosis of bipolar disorder in pediatrics raises questions about current diagnostic practices. Even though researchers are providing initial follow-up data about rigorously diagnosed bipolar youth versus youth with severe nonbipolar mood symptomatology, not much is known about these different patient groups in the community. This study used standardized assessment tools to evaluate if meaningful differences emerge between different mood disorder types in children.
DESIGN: The Mini International Neuropsychiatric Interview and the Child/Adolescent Symptom Inventory were used to classify patients as having bipolar disorder or mood disorder not otherwise specified (NOS) according to criteria set forth by the National Institute of Mental Health. A retrospective chart review followed back the treatment for eight months.
SETTING: A community mental health clinic. PARTICIPANTS: 41 pediatric patients between six and 18 years old. MEASUREMENTS: Global Assessment of Functioning scale and Clinical Global Impression scales were compared pre- and post-treatment.
RESULTS: Patients with bipolar disorder improved significantly more than mood disorder NOS patients, despite similar levels of care. Meaningful differences in diagnostic and treatment variables were apparent at baseline and at endpoint.
CONCLUSION: Standardized assessments in community clinics are feasible and lead to the identification of meaningful differences between "similar" patient groups. Improving diagnostic practices across different psychiatric settings appears paramount.