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13.05.2015

Depressive mood disorder nos, what causes tinnitus to get worse - Test Out

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Objective: A tremendous increase in the diagnosis of bipolar disorder in pediatrics raises questions about current diagnostic practices.
Results: Patients with bipolar disorder improved significantly more than mood disorder NOS patients, despite similar levels of care. More specifically, in the case of pediatric bipolar disorder, it is crucial to distinguish between severely mood disordered youth and actual bipolar disordered youth.
Leibenluft describes a series of four phenotypes of “bipolarity” in the pediatric population.[6] The phenotypes range from the Diagnostic and Statistical Manual of Mental Disoders, Fourth Edition, Text Revision (DSM-IV-TR) definition of bipolar disorder to severely mood disordered youth. A retrospective chart review included all patients, five to 18 years of age, who underwent a psychiatric evaluation between September 2004 and September 2007, and were diagnosed with bipolar disorder or mood disorder NOS. Twenty-two patients were identified as having been diagnosed with mood disorder NOS and 19 patients with bipolar disorder. After approximately eight months of follow-up, patients diagnosed with bipolar disorder improved significantly more as manifested by their endpoint GAF. Patients with bipolar disorder appeared to have a more significant past histories, including more risk factors for suicidality, more medication trials, and more psychiatric hospitalizations.
One finding, contrary to research results, was the increased incidence of a family history of bipolar disorder in mood disorder NOS patients.
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. Unfortunately, there is little data in community practice highlighting the differences between bipolar disorder and severely mood disordered pediatric patients.


The authors believe that this latter issue goes to the heart of the current controversy in youth bipolar disorder. This study used standardized assessment tools to evaluate if meaningful differences emerge between different mood disorder types in children. Phenotype I matches both the symptomatic and duration criteria of the DSM-IV-TR for bipolar disorder.
Therefore, this study is an initial pilot study to look at two samples, one with bipolar disorder and one with severe mood disordered symptomatology, to see if any meaningful differences emerge. Patients with bipolar disorder were about four years older, had more risk factors for suicidality (63% of patients with past suicidality versus 45%), more inpatient hospitalizations (53% of patients vs. In many settings, where diagnostic accuracy is less than desirable, numerous patients may be diagnosed with bipolar disorder without clearly meeting pre-established criteria.
Indeed, in real-world settings, not only youth but also adults may be overdiagnosed with bipolar disorder, as such inflating the reported family histories. This has led to the identification of significant differences in the outcome between patients with bipolar disorder and mood disorder NOS.
Increased rates of bipolar disorder diagnoses among US child, adolescent, and adult inpatients, 1996–2004. Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children.
Phenomenology of prepubertal and early adolescent bipolar disorder: examples of elated mood, grandiose behaviors, decreased need for sleep, racing thoughts and hypersexuality.


Different psychophysiological and behavioral responses elicited by frustration in pediatric bipolar disorder and severe mood dysregulation. Parental diagnoses in youth with narrow phenotype bipolar disorder or severe mood dysregulation. In this paper, Leibenluft’s phenotypes I and II will be referenced as pediatric bipolar disorder, while phenotypes III and IV will be referenced as mood disorder not otherwise specified (NOS).
The explosion in bipolar disorder diagnoses in youth is probably in large part related to inadequate diagnostic workups. One wonders if this finding is related to a better understanding of the treatment needs of bipolar patients compared to severely mood disordered patients. Phenotype III does not match the symptomatic criteria for mania or hypomania, but cycling is present with irritability as the predominant mood.
In Table 3), the medications to treat the primary disorder, initially and at endpoint, are listed.
In this regard, upon reviewing the specific medications, it is of note that, at endpoint, there were significant differences in the pharmacotherapy of the two conditions: Many more patients with bipolar disorder were taking anticonvulsant mood stabilizers (42% versus 5%), while 14 percent of mood disorder NOS patients received no longer mood stabilization (0% in bipolar group). Patients in the latter groups are considered to be severely mood disordered, yet not bipolar.



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