An Article by Gabrielle Carlson MD in World Psychiatry Addresses the Challenges of Making a Diagnosis of Bipolar Disorder in Children and Adolescents



In a special article in the October 2012 edition of World Psychiatry, Professor Gabrielle Carlson MD presented an overview of the challenging task of making a differential diagnosis of bipolar disorder in children and adolescents. Dr. Carlson’s main focus in the article was mania, although she addressed in some detail issues related to mood dysregulation, depressive and anxiety disorders, and the emerging diagnosis of disruptive dysregulation disorder.

Throughout the article Dr. Carlson dealt with the difficult challenge of differentiating bipolar disorder from other disorders which share symptoms with it such as irritability, hyperactivity and explosive outbursts, noting that psychosis, substance abuse and agitated unipolar depression pose the greatest problems in the differential diagnosis of teens while disorders of executive function are the most difficult to differentiate from bipolar disorder in children. She reviewed the literature related to integrating information from multiple sources—patients, parents and teachers—and stressed the importance of distinguishing episodic events from chronic or baseline states.

Dr. Carlson concluded by cautioning that the diagnosis of bipolar disorder may not become clear for a number of years. “Until there are biomarkers that can confirm the diagnosis,” she said, “it is wise to make a diagnosis of bipolar disorder in children provisionally and keep an open mind to the likelihood that revisions may be necessary.”

Dr. Carlson is Head of Child and Adult Psychiatry in the Department of Psychiatry and Behavioral Science at Stony Brook University. According to the World Psychiatry Association’s website, World Psychiatry is the most widespread psychiatric journal worldwide, reaching more than 33,000 psychiatrists.