While browsing my Twitter feed (hi to those of you who have joined in the past couple of days btw) I came across this radio interview with Dr Allen Frances, an American child psychiatrist talking about paediatric bipolar disorder.
He’s surprisingly frank about the reasons why large numbers of American kids suddenly started being diagnosed as bipolar – over-zealous clinicians, aggressive marketing by drug companies, widespread ignoring of the DSM-IV criteria for bipolar disorder. All of which led to a lot of kids being prescribed frightening doses of antipsychotics, with all the side effects that come as part of the package. The overwhelming majority of those kids almost certainly didn’t have bipolar disorder.
I’m happy to say it’s a trend (Frances calls it a “fad diagnosis”) that never really took off in Britain. Nor for that matter, anywhere else in the world. Since coming to CAMHS I’ve seen very few patients with a bipolar diagnosis, and nearly all of those were around the 16-17 age range.
Frances is also very frank about the dangers of looking for a simple, elegant solution to complex, multi-faceted problems. He cautions about the limitations of psychiatric knowledge, and points out that often psychotherapy, parent training or just plain old watchful waiting need to be tried before reaching for a prescription pad.
What also surprised me about this interview was the extent to which the host doesn’t seem to want to hear it. I get the impression she was expecting him to come on the show and wow the audience with the latest discoveries and wonder drugs for paediatric bipolar disorder. He tries to point out that it’s really not that simple, but he has to hammer his points home because at times it all just seems to be going over her head.
I guess not everybody wants to be told that some problems can’t be solved with a pill.