Psychiatric Diagnosis Going Wild. The Epidemic Of Childhood Bipolar Disorder - Psychiatricanswers

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Some comments on the Psychiatry times web as a respond to an article by Dr. Allen Frances...    

Psychiatric Diagnosis Gone Wild:
The "Epidemic" Of Childhood Bipolar Disorder.

By Allen J. Frances, M.D.
April 7, 2010

I can't understand how is it that scientists accept the role of genetics for HTN or Diabetes but not for mental illness. How come the child of two bipolar individuals should have "the flavor of the decade" (ADHD) if he or she is showing clear manic symptoms?
Are we suppossed to understand behavior? Why is it that, instead we label a child as "oppositional-defiant" (intentional behavior) rather than attributing his or her symptoms to an elevated mood, anxiety, psychosis, etc.?
Can anybody explain me why a little child can be Dx with cancer and not with the same mental illness than runs in the family?
Where is the evidence (proof) to support that children are shielded from mental illness?
We don't want to label children with what they have?
What is the benefit of giving a wrong Dx to a child?
I tell you the bad consequences: Amphetamines make aggression and OCD traits worse and antidepressants worsen mania.
Are we going to talk logic and common sense or are we going to allow fear to harm the future of so many children now in RTC and detention centers because of wrong Dx and treatment.
Please, get DSM-V right.!

Manuel Mota-Castillo, M.D.
Lake Mary, Florida
May 2010


Keith Conners said:
I first began observing children's behavior disoders 50 years ago at Johns Hopkins with the late, great Leon Eisenberg as my mentor. In the course of evaluating thousands of children over these years, I have seldom seen any child who fits the true bipolar definition. In the MTA study we objectively diagnosed several thousand children in the course of identifying 573 who met ADHD criteria. We never found a single bipolar diagnosis. I fully agree with Dr. Frances' statements. The same arguments could be applied to the overdiagnosis of autism today, just as rare as bipolar disorder in children.

C. Keith Conners, Ph.D.
Professor Emeritus
June 2010


Manuel Mota-Castillo said:
Everyone in this debate has a piece of truth but an incomplete story stands near to been false. The respected Dr. Conners reports "In the MTA study we objectively diagnosed several thousand children in the course of identifying 573 who met ADHD criteria. We never found a single bipolar diagnosis. I fully agree with Dr. Frances' statements."
The missing part is that DSM-IV criteria for bipolar disorder excludes those with "bipolar spectrum" or "sub-threshold" symptoms who contribute to enrich the collection of Oppositional-Defiant Disorder included in the MTA. Besides, the psychiatric establishment in general has decided to ignore the genetic relevance at the time of making a diagnosis.
Drs. José and Applbaum make a very valid reference Pharma but, from my perspective, the wrong target was hit. The current push is toward making every hyperactive child to be ADHD. I have not received one cent from any pharmaceutical company to promote bipolar illness in children and I have the capacity to listen to parents. One of them told me last week: "Is very unfair that my son had to be hospitalized because his doctor kept giving him amphetamines despite my warning that these drugs can make people more violent." She is bipolar and her husband too.
With regard to the BPD disorder I can only say that it could be in the best interest of the patient to try him or without antidepressant and to Rx enough mood stabilizers.  After a few months without the destabilizing effect of the Ads chances are that the "BPD's symptoms" could a matter of the past.
Finally, I would like to note that the MTA was based on hundreds of patients and my statements on thousands of children treated in the past 15 years. Unfortunately, I am very aware of this fact: Conners is a venerable name whereas the only famous Manny Mota quit playing baseball more than 20 years ago.

Manuel Mota-Castillo
Lake Mary, Florida
Jun 2010

When this comment was published nobody dared to debate Dr. Conners’ strange statement possibly because it was coming from somebody that made a great contribution to the field of psychiatry and deserves respect.  I agree with the second part but not with the idea of allowing “our founding fathers” to become untouchables.  The people who opposed Galileo Galilei were his teachers of astronomy but he “saw the light at the other side of the river” and confronted them with facts. They, as we know, responded with a death threat. This is a paragraph from his biography in Wikipedia:
Galileo's championing of Copernicanism was controversial within his lifetime, when a large majority of philosophers and astronomers still subscribed to the geocentric view that the Earth is at the center of the universe. After 1610, when he began publicly supporting the heliocentric view, which placed the Sun at the center of the universe, he met with bitter opposition from some philosophers and clerics, and two of the latter eventually denounced him to the Roman Inquisition early in 1615.
Well, Dr. Conners, I am not Galileo but time is already proving you wrong. With regard to the MTA study, one of the investigators was Director of Training when I did my child & adolescent fellowship.  I am grateful for the fine training I got under his leadership but I still have the objectivity to say that this celebrated investigation is irrelevant because it includes Oppositional-Defiant Disorder (ODD) as a real diagnosis. When psychiatry get it together and realizes that “ODD children” have other real diagnoses it will become clear that the MTA outcomes are invalid because its data is contaminated with false information. Unfortunately, since DSM-V is going to keep ODD alive is highly unlike that either Dr. Conners or me will be around to witness the demise of this calamity that fell upon children decades ago.

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