Reaction to another book that questions the validity of pediatric bipolar disorder:
Sometimes ignorance is a bliss but more frequently a little knowldege is a dangerous thing. Here is a perfect example: Have this well-intentioned doctor ever heard the testimonies of so many parents that can't thank enough modern medicine for restoring mood stability to their children?
It is disheartening to think that in psychiatry we could be facing something akin to the scary scenario of our current political discussion: Women are been threaten with losing the right to choose and minorities the possibility of electing the candidates of their like.
We seem to be marching backward to the years when prestigious members of our community embraced practices that were the Law of the Land when Dr. Kaplan began to practice in a field dominated by the psychoanalytic movement. With the arrival of Biederman, Wosniak, Akiskal, Cassano and a few others we bankrupted the myth that “children cannot develop depression because they lack enough ego development.” We reminded our colleagues that even before Kraepelin described manic-depressive illness in pre-pubertal patients (1921) the French psychiatrist Jean Etienne Esquirol published a book that included the report of several school-age children with bipolar spectrum disease.
I would like to give the benefit of the doubt to Dr. Kaplan and Dr. Scallon because maybe they are looking at bipolar disorder as presented in the DSM which essentially follows what Kraepelin described in his original report, more than one hundred years ago. It seems to me that they are no in agreement with one of the foremost psychiatrist in the world, Hagop Akiskal, when he said:
“The patients seen today in psychiatric practice deviate considerably from such a classical prototype. The rubric classical bipolar disorder is generally reserved for non-mixed euphoric mania that alternates with depression in a cyclical, episodic fashion. I haven’t seen such patients in this strict sense for a long time. Most patients have rather subtle presentation.”
Furthermore, neither the author nor the book reviewer appears to pay attention to the genetic endowment at the time of making a diagnosis. In a Commentary written for Psychiatric Times (Schizophrenia + Bipolar= ADHD?) in 2003 I questioned the rational for given a diagnosis of ADHD to the child of parents with severe mental illness, that was exhibiting aggressive behaviors, insomnia, defiance, complaining of racing thoughts and been angry for no clear reason. Almost 10 years have passed and this trend still persists.
Devoted academic psychiatrists, like Dr. Kaplan and Dr. Scallon, talk of “serious side effects” and “Pharma influence” in the thinking of doctors like me, even though we can give this strong response to such allegations: lithium and lamotrigine are generic, not “expensive drugs” and the second one can be taken by a pregnant patient without harm to the “developing brain.” Moreover, Dr. Nora Volkow’s studies of methylphenidate have demonstrated that the effects of this drug in the brain are similar to those of cocaine. Regarding methamphetamine nothing needs to be said when talking to an audience of professionals educated in psychopharmacology. Ugly enough I just saw a 50 pounds boy that was “treated” with 80 mg of Adderall for ADHD and ODD despite the fact of having persistent “voices” and tics. The real diagnosis was PTSD.
Finally, I want to “boldly” state that the phenotype of pediatric bipolar spectrum disorder does exist. A child with an unbalanced mood presents with defiance and unprovoked rage or excessive clowning, insomnia due to racing thoughts and is unable to take a no for answer.
I understand this is an oversimplification but it would take a long explanation to present the full picture required by an academic discussion. The bottom line is that we can expend years arguing this issue but can somebody answer these questions: How could be possible that a doctor give the same diagnosis to 90% of his or her patients?
Would you go to see a dermatologist that diagnoses 90% of patients with Malignant Melanoma? ...well, this is exactly what happens in the ADHD clinics.