Misdiagnosed Youngsters?

It was with great interest that I read in your June 21 issue a review of the study by Dr. Barbara Geller, “Two-Year Prospective Follow-Up of Children With a Prepubertal and Early Adolescent Bipolar Disorder Phenotype.” This study should be a wake-up call to the legions of psychiatrists who continue to pollute our youth with medications that have no real benefit or solid research to support there use.

I found it most puzzling that the author, while speculating why none of the “treatment” worked but a two-parent home was of benefit, did not consider the most obvious answer: that most of the children in her study (as well as in the United States) whom we call “bipolar” are not. Have we all forgotten what Kraepelin taught us, and how this illness is defined? The psychiatric community needs to recognize the limits of descriptive diagnosis with regard to both treatment and research. Most of us recognize there is a spectrum to this illness, but we must end this practice of labeling all children with mood lability and chaotic behavior—as well as adults with personality disorders—as bipolar.

I have cared for hundreds of adolescents in a residential setting who were diagnosed as bipolar, and many had reported psychotic symptoms. None of them was helped by medications that we acknowledge help adults with manic-depressive illness. Many of the youngsters improved with time because of structured environment and growth. Neuropsychiatric illnesses such as obsessive-compulsive disorder, major depression, and schizophrenia can present in young people, but let’s stop pretending that all behaviorally disordered children have an illness that by definition will never go away.

Have we also forgotten that our first job as physicians is to recognize our limits and to do no harm?