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Western Psych to be 1st inpatient center for Bipolar disorder in nation

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Thursday, Oct. 21, 2010

Pittsburgh is becoming a leader in diagnosing and treating a pediatric disorder that, 30 years ago, psychiatrists didn't think existed in children.

The University of Pittsburgh Medical Center's Western Psychiatric Institute will become home to the nation's first inpatient facility for diagnosing and treating bipolar disorder in children, which doctors gradually are recognizing as a deadly problem.

Research increasingly shows that bipolar disorders -- often taking the form of swings between depression and mania, changing levels of activity and sleep, and appetite disorders -- can manifest in young children and teenagers in worse forms than in adults and lead to higher rates of attempted suicide in young people, said Dr. Rasim Somer Diler, medical director of UPMC's Inpatient Child and Adolescent Bipolar Services, or in-CABS.

"Up until 1978, kids were not actually considered to be capable of depression," Diler said. "Thanks to recent studies, we now know bipolar disorder exists in both adolescents and children."

About 1,200 children a year are brought to Western Psych for assessment, and nearly half display symptoms that fit criteria for bipolar disorders, he said.

The in-CABS program is designed to correctly diagnose young people with bipolar disorder. It can be hard to detect in short emergency room visits or outpatient therapy because it shares symptoms with attention-deficit hyperactivity disorder, depression, pervasive developmental disorder and substance abuse problems.

Through extensive interviews with the patient and family, and a "child mania rating scale" questionnaire, Diler hopes the clinic can better diagnose children with the disorder and weed out those who might have been misdiagnosed.

"If you've missed the big picture, you're more likely to prescribe medications that can make the disorder worse," he said.

For example, some antidepressants can cause suicidal thoughts in bipolar children, he said. Once children are diagnosed, the program can connect them with long-term therapy and educate their families about things such as mood monitoring, healthy nutrition and exercise.

"When a child is diagnosed with bipolar disorder, or any mental illness, the whole family is affected," said Christine Michaels, executive director of the National Alliance on Mental Illness, Southwestern Pennsylvania.

The Child & Adolescent Bipolar Foundation, a nonprofit awareness and advocacy group based in Evanston, Ill., says bipolar disorder can be harder to diagnose in children than in adults, and symptoms worsen as children age.

The foundation cited a study by Dr. David Axelson, a co-director of the outpatient program for bipolar children at Western Psych, that said childhood sufferers had longer episodes, cycled between moods more frequently and went from milder forms of the disorder to more severe forms at a higher rate than adults.

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