Diagnosis of manic episodes in adolescent inpatients: Structured diagnostic procedures compared to clinical chart diagnoses

David L. Pogge, Douglas Wayland-Smith, Michele Zaccario, Susan Borgaro, John Stokes, Philip D. Harvey

Research output: Contribution to journalArticle

47 Scopus citations

Abstract

This study examined the accuracy of clinical chart diagnoses of manic episodes in adolescent psychiatric patients, as well as treatment selection and patient outcome. A consecutive sample of 120 consenting adolescent patients was assessed at admission, discharge, and 30 and 120 days post-discharge. Clinical chart diagnoses were compared to research-quality diagnoses involving structured interview, chart review, and consensus. Agreement statistics were computed, and the symptom and treatment differences were compared between patients for whom there was and was not diagnostic agreement. Clinical diagnoses of manic episodes were more common than research diagnoses, and the rate of agreement between diagnoses was low (kappa = 0.15). Patients diagnosed as experiencing a manic episode by the clinical chart, but not via the research procedure, had reduced severity scores on elation and activity, and higher scores on depression. These patients also had more severe scores on depressive symptoms at follow-up. Manic episodes were diagnosed more frequently by clinicians relative to research-quality procedures. Patients who were diagnosed as experiencing manic episodes by the clinician, but not the research procedure, appeared to have depression and hostility, but not elation. The depression in these patients may not be adequately treated, and there are potential clinical implications of over-diagnosis of manic episodes in adolescents.

Original languageEnglish (US)
Pages (from-to)47-54
Number of pages8
JournalPsychiatry Research
Volume101
Issue number1
DOIs
StatePublished - Feb 14 2001
Externally publishedYes

Keywords

  • Bipolar disorder
  • Diagnosis
  • Diagnostic interview for children and adolescents
  • Outcome

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry
  • Psychology(all)

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