Diagnosis and Treatment of Pediatric Bipolar Disorder in a Commercially Insured Population

Recent reports indicate that bipolar disorder diagnosis is increasing in U.S. children. Increased diagnoses are concerning as diagnostic criteria are unclear and most medications prescribed to treat bipolar disorder have not been tested or approved for children. No studies have been conducted to assess the use of clinical treatment guidelines in children with bipolar disorder. This is troubling as current prescribing guidelines should dictate treatment in this population. The objectives of this dissertation are to examine the medication use patterns for privately insured children with bipolar spectrum disorders, and to assess the consistency of prescribing patterns with treatment guidelines. MarketScan Commercial Claims and Encounters data (2005-2007) were used to identify children with diagnoses of bipolar disorder. Patient demographic and treatment characteristics were summarized for the cohort. Additionally, two measures were constructed to assess the quality of care received among children with bipolar I disorder. These measures, receipt of (1) appropriate first-line treatment, and (2) adequate duration of initial medication treatment, were used to determine whether a patient received guideline-recommended care. Generalized linear models were used to determine factors associated with receiving guideline-recommended care. We found an average annual prevalence of any bipolar spectrum disorder was 0.25% among privately insured children. Most children received pharmacotherapy, and treatments were similar across all bipolar subtypes. Anticonvulsants, atypical antipsychotics, antidepressants, and stimulants were prescribed commonly. Approximately 40% of the population received polypharmacy. Among children with bipolar I disorder, 84% received potentially inappropriate first line treatment. A majority of these children received either no medication or antidepressant medications without mood stabilizers. Several factors were associated with the receipt of recommended first line treatment, including bipolar episode type, having comorbid major depressive disorder diagnoses, and receiving care from a psychiatrist. Regarding early treatment regimen changes, 41% of children had initial treatment trials shorter than 6 weeks. However, none of the factors tested were consistently related to early regimen changes. These results highlight the high prevalence of bipolar diagnoses and deficiencies in the diagnosis and treatment of bipolar spectrum disorders among children by identifying trends in prescribing and gaps in the quality of care received by children