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Prepubertal Mania: Diagnostic Differences in US, UK and Japanese Clinicians

Leiðbeinandi
Skilað
Maí 2016
Útdráttur

Introduction: Despite having internationally operationalized diagnostic manuals of mental disorders, there are cross-national differences in the diagnosis of many mental diseases. In the years 1996- 2004, diagnosis of mania in children and adolescents increased significantly in the United States. The study raised the question of whether this significant increase in diagnosis was a universal phenomenon or specific to the US. In 2008, Dubicka B. et al. published a paper about diagnostic difference in pediatric mania between clinicians in the US and UK in the European Child & Adolescent Psychiatry Journal. This lead to more studies being conducted on this matter, and more importantly, it promoted other studies on how childhood mood disorders should be assessed. A new model for pediatric mood disorders was proposed and has been added into the DSM-5 diagnostic criteria to avoid overdiagnosis of pediatric bipolar disorder.
Objective: This study had two aims: First, to obtain a new perspective in cross-cultural differences in pediatric bipolar disorder diagnoses between two English-speaking Western countries and Japan, and second, to assess whether there is a cross-cultural difference in how pediatric depressive disorder is diagnosed.
Methods and material: A questionnaire with five case vignettes was used to evaluate difference in diagnosis of complex cases. The last vignette had a classical case of mania, which was used as a control. The vignettes in the original study were translated into Japanese and distributed to Japanese child and adolescent psychiatrists. Data from the original research was combined with the data from Japan. Statistical analyses were conducted using SPSS to test the significance of differences in each case.
Results: US clinicians generally diagnosed mania in children more often than UK and Japanese clinicians (P=<0.001). In Case 1, Case 2, and Case 4, US clinicians diagnosed mania more frequently when compared to UK and Japanese clinicians, with P=<0.001 for Cases 1 and 2, and P=0.008 for Case 4. Japanese clinicians diagnosed mania more frequently in Case 3 compared to the other two groups, with P=<0.001. UK clinicians diagnosed mania least often in all of the cases. All three groups agreed on a mania diagnosis in the last case.
Conclusion: There was a cross-national difference in how clinicians interpreted mania-like symptoms in children. These differences in perception of symptoms can lead to different diagnosis for the same case between nations, which again would have great influence on the following treatment. Therefore, it is vital to perform more cross-cultural research on mental diseases in children and adolescents.

Samþykkt
13.5.2016


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