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Bipolar disorder divides two nations


Health and children are a potent mix. Throw in commercial interests and flawed science and the end result is hugely controversial, as PhD candidate Jane Roberts is discovering.

We live in an age where health ailments are diagnosed at the click of a button, usually thanks to a search engine called Google – the bane of doctors’ lives.

Whether it’s a good thing or not is a moot point, but there is no doubt that people have more access to health information than ever before.

The question is: ‘how accurate is it?’

Jane-RobertsJane Roberts has spent the past 18 months researching one of the more recent, controversial health conditions: the incidence of paediatric bipolar disorder or PBD, formerly known as “manic depression”.

It’s controversial because two of the world’s major developed countries – the US and the UK – differ widely in their acceptance and even diagnosis of the condition among children.

Jane, a PhD candidate in the Department of Social Psychology at LSE, is exploring why rates of paediatric bipolar disorder have skyrocketed in the US over the past decade compared to the UK, where there is still a lot of hesitation and even resistance to acknowledging PBD.

“In the US, the condition gained acceptance more than a decade ago, driven partly by an aggressive pharmaceutical industry and the direct-to-consumer marketing that is allowed there,” Jane said.

“Anti-psychotic drugs are used to treat paediatric bipolar disorder in the US and are advertised on prime time television. This means there is a level of familiarity, not just with the medication but also with the nature of the disorder.”

The UK, in contrast, has taken a wait-and-see approach with PBD, expressing a reluctance to give it a label when the symptoms are so similar to other childhood conditions such as ADHD.

“If a child is given the wrong medication it can create a disorder when one wasn’t actually present in the first place,” Jane said. “In the UK there appears to be less an inclination to have a quick fix and a greater desire to hold back and work with families for a while, avoiding the medication route.”

This creates a lot of frustration for parents in the UK who suspect their child has bipolar disorder and are struggling with behavioural problems beyond the “norm”.

These include excessive happiness or rage, sadness, irritability, changes in appetite or weight, inflated self-esteem, a short attention span and engaging in risky or dangerous activities.

The problem lies with distinguishing what is considered “normal” childhood behaviour, particularly among teens, and what constitutes something more serious, justifying medical treatment.

According to Jane, the general consensus among psychiatrists is that paediatric bipolar disorder can exist but the age of children at onset and the symptoms they present with are a point of contention, as are approaches to treatment.

Another factor adding confusion to the PBD debate – and skewing the statistics – is the differing diagnostic criteria used by each country.

“The UK has very strict criteria following the more established guidelines for bipolar in adults where children must experience more than one manic episode, each lasting days, if not weeks at a time. Clinicians in the US, however, are more inclined to diagnose a child with PBD after just one manic episode or if they are showing signs of irritability.”

All of this leads to the widely debated question of whether PBD is a relatively new condition, whether it has been under-diagnosed in the past, or whether behaviour previously considered “normal” is being redefined.

It also invites speculation about the influence of big pharmaceutical companies on consumers and clinicians.

“There are so many different factors at play here. It’s important we reach some understanding of how diagnoses such as PBD emerge in order to prevent the possible mislabelling and over-medication of children.”

Jane is expected to complete her PhD by September 2015.

Posted: 28 March 2014

Useful notes

Jane Roberts is originally from the United States and studied Clinical Psychology at Northwestern University in Chicago prior to pursuing a Masters in Medical Anthropology at UCL and enrolling for a PhD at the London School of Economics and Political Science in 2012.