Do child psychiatrists in Germany diagnose bipolar disorders in children and adolescents? Results from a survey

OBJECTIVES: There is a controversy about the prevalence of childhood bipolar disorders (BD). Based on discrepant results, we studied if German psychiatrists in outpatient settings diagnose BD in children and adolescents at all, and if there are possible correlates of the diagnoses of pediatric BD. We also asked how often typical manic symptoms (e.g. elated mood) are actually seen in attention deficit hyperactivity disorder (ADHD) patients. METHODS: Provided by the medical register we had a complete list of all 251 psychiatrists in the area. Using a questionnaire we asked if and how often they diagnose BD among children and adolescents and how often they observe manic-like symptoms in children with ADHD (response rate 61%). RESULTS: While 63% of all psychiatrists have diagnosed BD in adolescents, only 7.8% did so in children. Age and therapeutic approach of the psychiatrists were associated with the likelihood of having diagnosed BD in children. Furthermore some typical bipolar symptoms were also present in ADHD patients. CONCLUSIONS: Our study only relied on self-reports of the psychiatrists about the diagnoses and number of cases, but BD in children seems to be rarely diagnosed in outpatient settings in Germany. The design of our study, however, cannot resolve the questions what the reasons are for this low rate of BD diagnoses, e.g. misdiagnoses, overlooking comorbidity or referral strategies. Epidemiological studies are needed and should consider multiple follow-ups.