Mental Health Treatment Received by Youths in the Year Before and After a New Diagnosis of Bipolar Disorder

Changes in the Quality of Care for Bipolar I Disorder During the 1990s

Although bipolar disorder may have its onset during childhood, little is known about national trends in the diagnosis and management of bipolar disorder in young people. To present national trends in outpatient visits with a diagnosis of bipolar disorder and to compare the treatment provided to youth and adults during those visits. We compare rates of growth between 1994-1995 and 2002-2003 in visits with a bipolar disorder diagnosis by individuals aged 0 to 19 years vs those aged 20 years or older. For the period of 1999 to 2003, we also compare demographic, clinical, and treatment characteristics of youth and adult bipolar disorder visits. Outpatient visits to physicians in office-based practice. Patient visits from the National Ambulatory Medical Care Survey (1999-2003) with a bipolar disorder diagnosis (n = 962). Visits with a diagnosis of bipolar disorder by youth (aged 0-19 years) and by adults (aged > or = 20 years). The estimated annual number of youth office-based visits with a diagnosis of bipolar disorder increased from 25 (1994-1995) to 1003 (2002-2003) visits per 100,000 population, and adult visits with a diagnosis of bipolar disorder increased from 905 to 1679 visits per 100,000 population during this period. In 1999 to 2003, most youth bipolar disorder visits were by males (66.5%), whereas most adult bipolar disorder visits were by females (67.6%); youth were more likely than adults to receive a comorbid diagnosis of attention-deficit/hyperactivity disorder (32.2% vs 3.0%, respectively; P < .001); and most youth (90.6%) and adults (86.4%) received a psychotropic medication during bipolar disorder visits, with comparable rates of mood stabilizers, antipsychotics, and antidepressants prescribed for both age groups. There has been a recent rapid increase in the diagnosis of youth bipolar disorder in office-based medical settings. This increase highlights a need for clinical epidemiological reliability studies to determine the accuracy of clinical diagnoses of child and adolescent bipolar disorder in community practice.

Patterns of Psychotropic Drug Prescription for U.S. Patients With Diagnoses of Bipolar Disorders

Although psychological trauma affects millions of Americans, few studies have examined treatment of posttraumatic stress disorder (PTSD) in real-world service environments. This study explored pharmacological treatment of PTSD among privately insured individuals. Data were from the MarketScan database, which compiles claims from private health insurance plans nationwide. Descriptive statistics and multivariate logistic regression were used to identify predictors of any use of a psychotropic medication and use of three medication classes: antidepressants, anxiolytics or sedative-hypnotics, and antipsychotics. Of 860,090 adult mental health care users in 2005, only 10,636 (1.2%) had a diagnosis of PTSD. Sixty percent of PTSD patients received any psychotropic medication: 74.3% of those received antidepressants, 73.7% received anxiolytics or sedative-hypnotics, and 21.3% received antipsychotics. Greater likelihood of any medication use was associated with greater use of mental health services and with several comorbid psychiatric disorders. Having a comorbid diagnosis of an indicated disorder was the most robust predictor of use of each of the three medication classes: major depressive disorder and dysthymia were most strongly associated with antidepressant use, schizophrenia and bipolar disorder were associated with antipsychotic use, and anxiety disorders were associated with use of anxiolytics or sedative-hypnotics. Psychotropic medications were frequently used in the treatment of PTSD among privately insured clients. Although use targeted specifically to PTSD and to comorbid disorders was common, substantial use appeared to be unrelated to diagnosis and may be targeted at specific symptoms rather than diagnosed illnesses. Further research is needed to determine symptom-specific responses to medications across diagnoses.

This study aimed to determine the prevalence of prescribing antipsychotics to adults without schizophrenia or bipolar disorder and to identify factors associated with such off-label use. Patients with at least one prescription for an antipsychotic medication from the Department of Veterans Affairs (VA) during fiscal year (FY) 2007 were identified in national VA administrative databases. Rates of off-label antipsychotic use were determined along with average doses. Multivariate logistic regression models identified sociodemographic and clinical characteristics associated with off-label use. Of the 279,778 individuals in FY 2007 who received an antipsychotic medication, 168,442 (60.2%) had no record of a diagnosis for which these drugs are approved. The most common mental illness diagnoses among patients given prescriptions for antipsychotics off label were posttraumatic stress disorder (PTSD, 41.8%), minor depression (39.5%), major depression (23.4%), and anxiety disorder (20.0%). Among VA patients with mental illness other than schizophrenia or bipolar disorder, the proportion who received prescriptions for antipsychotic medications ranged from a low of 9.1% among patients with adjustment reaction; to about 20% for those with depression, dementia, or PTSD; and to a high of 40.7% among patients with other psychoses. Doses were low, with over half of patients who received off-label quetiapine, risperidone, or first-generation antipsychotics receiving doses below those recommended for schizophrenia. In logistic regression models, patients diagnosed as having other psychosis or dementia had the highest odds of receiving an antipsychotic medication off label. Off-label use of antipsychotic medications was common. Given that these drugs are expensive, have potentially severe side effects, and have limited evidence supporting their effectiveness for off-label usage, they should be used with greater caution.

Background: The aim of the study was to investigate whether patients with bipolar depression and patients with recurrent depressive disorder present with different subtypes of depressive episode as according to ICD-10. Sampling and Methods: All patients who got a diagnosis of bipolar affective disorder, current episode of depression, or a diagnosis of recurrent depressive disorder, current episode of depression, in a period from 1994 to 2002 at the first outpatient treatment or at the first discharge from psychiatric hospitalization in Denmark were identified in a nationwide register. Results: Totally, 389 patients got a diagnosis of bipolar disorder, current episode of depression, and 5.391 patients got a diagnosis of recurrent depressive disorder, current episode of depression, at first contact. Compared with patients with a diagnosis of recurrent depressive disorder, patients with bipolar disorder, current episode of depression, were significantly less often outpatients (49.4 vs. 68.0%), significantly more often got a diagnosis of severe depression (42.7 vs. 23.3%) or a diagnosis of depression with psychotic symptoms (14.9 vs. 7.2%). The rate of subsequent hospitalization was increased for patients with bipolar disorder, current episode of depression, compared with patients with a current depression as part of a recurrent depressive disorder (HR = 1.50, 95% CI = 1.20–1.86). Conclusions: The results consistently indicate that a depressive episode is severer and/or more often associated with psychotic symptoms when it occurs as part of a bipolar disorder than as part of a recurrent depressive disorder.

Diagnostic Instability: How Much Is Too Much?

Bipolar disorder is challenging to diagnose in medical practice. Our objectives were (1) to determine the rate of depression misdiagnosis in patients previously diagnosed with bipolar disorder in administrative claims, (2) to determine the resulting increased treatment costs, and (3) to verify the misdiagnoses in the medical charts for a subset of patients. We employed cohort analysis using claims from a large, commercial, U.S. health plan from January 2001 through December 2003. Inclusion criteria included 2 bipolar disorder diagnoses (ICD-9-CM criteria), continuous enrollment for 1 year before and after initial bipolar disorder diagnosis, age 18-64 years, and a pharmacy benefit. Propensity scoring was used to control for differences between patients with and without 2 depression diagnoses in the year following their bipolar disorder diagnosis. Medical charts were obtained for 100 patients, including 76 with a bipolar disorder diagnosis chart from one provider and a depression diagnosis chart from a second provider. Of 3119 bipolar disorder patients meeting inclusion criteria, 857 (27.5%) had subsequent depression misdiagnoses during the follow-up year. These patients had 1.82 times more psychiatric hospitalizations and 2.47 times more psychiatric emergency room visits. For 673 patients (78.5%), a different provider gave the depression misdiagnosis. Annual per-patient treatment costs were significantly higher (p < .001) for those diagnosed with depression ($12,594) than for those not ($9405). In the chart review, both the bipolar disorder and subsequent depression diagnoses were confirmed for 65.8% (50/76) of the patients who had charts from 2 different providers. More than one quarter of individuals diagnosed with bipolar disorder received an ostensible depression misdiagnosis during the follow-up period. Significant (p = .001) increases in psychiatric inpatient hospitalization suggest that improvements in the continuity of care could improve outcomes and reduce costs.

Treatment Costs Related to Bipolar Disorder and Comorbid Conditions Among Medicaid Patients With Bipolar Disorder

Relapse prevention and antidepressants

Masques trompeurs et diagnostics différentiels du trouble bipolaire

The association of pain screening and pain level with suicide among US veterans with comorbid musculoskeletal and bipolar disorder diagnoses

The aim of the present study was to investigate the clinical usefulness of an observational tool—the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS)—in the diagnosis of disruptive behavior disorders (DBD) and attention deficit/hyperactivity disorder (ADHD) in preschoolers. We hypothesized that the DB-DOS may help support the presumption of a diagnosis generated by the information from parents and teachers (or other caregivers). Participants were referred preschool children with externalizing behavioral problems (N = 193; 83% male) and typically developing children (N = 58; 71% male). In view of the clinical validity study each child was given a diagnosis of either DBD (N = 40), or ADHD (N = 54) or comorbid (DBD + ADHD; N = 66) based on best-estimate diagnosis. The DB-DOS demonstrated good interrater and test–retest reliability for DBD and ADHD symptom scores. Confirmatory factor analysis demonstrated an excellent fit of the DB-DOS multidomain model of DBD symptom scores and a satisfactory fit of ADHD symptom scores. The DB-DOS demonstrated good convergent validity, moderate divergent validity, and good clinical validity on a diagnostic group level for DBD and ADHD symptom scores. The Receiver Operating Characteristic curve analyses revealed that for DBD the sensitivity and specificity are moderate and for ADHD good to excellent. The presumption of a diagnosis based on information from parents, teachers, and cognitive assessment was supported by the DB-DOS in 60% for DBD and 75% for ADHD. The DB-DOS can be used to help support a presumption of a DBD and/or ADHD diagnosis in preschool children.

A convolutional neural network-based diagnostic method using resting-state electroencephalograph signals for major depressive and bipolar disorders

Ethnic Disparities in Antipsychotic Drug Use in British Columbia: A Cross-Sectional Retrospective Study