Comorbidity in child psychiatry: is the comorbidity of pediatric mania and ADHD really that high?
Balazs J, Gadoros J.
Vadaskert Gyermekpszichiatriai Korhaz es Szakambulancia; Beregszasz u. 145, Budapest, 1112 Hungary. jubalazs@axelero.hu
OBJECTIVE: The purpose of our study was to investigate possible reasons of diagnosing comorbidity in child psychiatric disorders, with special attention to the comorbidity of mania and attention deficit-hyperactivity syndrome (ADHD). METHOD: Using a structured interview, the Mini International Neuropsychiatric Interview Kid (M.I.N.I. Kid) we examined 112 consecutive admitted children aged under 18 in the Vadaskert Children's Psychiatric Hospital. For all children, best-estimated diagnoses were made by an independent child-psychiatrist as well, who was blind to the diagnoses of the M.I.N.I. Kid. Six children were diagnosed as having pervasive developmental disorder by the independent clinician, their data were excluded. In this way the data of 106 children were included in the statistical analysis. RESULTS: Comorbidity: Based on the M.I.N.I. Kid test comorbid diagnoses were found in 74.53% of the children and 51.90% of the children with comorbid diagnoses had three or more concomitant diagnoses. The maximum number of diagnoses obtained concomitantly by the M.I.N.I. Kid was 9. The M.I.N.I. Kid produced 2.58 diagnoses for one child on average. The independent child-psychiatrist found comorbid diagnoses in 25.47% of the children. The maximum number of diagnoses made by the independent child-psychiatrist for 1 child was 2. The independent child-psychiatrist established 1.25 diagnoses for one child on average. Manic/hypomanic episode: Based on the M.I.N.I. Kid manic episode was diagnosed in 14.15% of the children and hypomanic episode in 6,60% of them, while the independent psychiatrist did not diagnose these conditions in any of the children. 99.33% of the children with manic episode were diagnosed together with ADHD by the M.I.N.I. Kid . In 57.14% of those cases, where the M.I.N.I. Kid diagnosed a hypomanic episode, it found an ADHD at the same time. The independent psychiatrist found ADHD in 73.33% of the children with the diagnoses of manic episode and in 57.14% of the children with hypomanic episode determined by the M.I.N.I. Kid. CONCLUSIONS: The considerable differences found in the number of diagnoses made by using the M.I.N.I. Kid and by the independent child psychiatrist may indicate the possible over-sensitivity of structured interviews and the characteristics of diagnostic systems: several disorders have overlapping symptoms, making the differential diagnoses difficult.
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