Phenomenology and Identification of Juvenile BPD in a Community Setting

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The diagnosis of BPD in a CMHC is frequently challenging . Incorrectly diagnosing a patient as suffering from a unipolar mood disorder or from a disruptive behavior disorder leads to sub-optimal outcome and may worsen the course of BPD. Part of the difficulty is the current lack of consensus regarding the phenomenology of juvenile BPD. At present, there also is no certainty about the base rate at which BPD might present at a CMHC, nor is there an established set of instruments that could be used to screen a juvenile community sample for bipolar spectrum disorders. The need is great for such a screening protocol, given the long-term trajectory and serious consequences of untreated or mistreated BPD, and the potential value of early intervention and prophylaxis if cases could be identified in youths. Preliminary evidence from this research group suggests that several measures perform well at distinguishing BPD from unipolar depression, disruptive behavior disorders, and other disorders in children and adolescents. However, these findings were based on a sample presenting at a hospital outpatient clinic at an academic medical center specializing in the treatment of juvenile mood disorders and psychopharmacology research. Thus, several factors prevent the immediate application of existing findings to a community setting, including the lack of soundly-established base rates of BPD at community-based mental health centers, the unknown effects of potential ascertainment bias at a mood disorders clinic versus a community setting, changes in demographics or other sample characteristics that might interact with test performance, and the fact that test performance might degrade when exported from a research framework into a community context, much as therapeutic efficacy estimates usually exceed effectiveness findings. The purpose of the proposed project is to determine the prevalence of BPD in an ethnically diverse community sample and to develop effective means of screening patients in a CMHC for bipolar spectrum disorders, as well as to improve understanding of the early presentation of bipolar spectrum disorders, especially in underserved populations.