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Developing a 10-Item Mania Scale From the Parent General Behavior Inventory for Children and Adolescents

J Clin Psychiatry 2008;69(5):831-839

Objective: Bipolar disorder is being diagnosed and treated in children and adolescents at a rapidly increasing rate, despite the lack of validated instruments to help screen for the condition or differentiate it from more common disorders. The goal of the present study was to develop and validate a brief (10 item) instrument to assess mania in a large sample of outpatients presenting with a variety of different DSM-IV diagnoses, including frequent comorbid conditions.

Method: Parents presenting to a Midwestern academic outpatient medical center for psychiatric evaluation of their child completed the Parent General Behavior Inventory (P-GBI), a 73-item mood inventory that comprises a 46-item depressive symptom scale and a 28-item hypomanic/biphasic scale (1 item is used in both scales), as part of a screening assessment that included a semistructured psychiatric interview of both the parent and the child to determine the child's diagnoses. The study was conducted between the years 1999 and 2004.

Results: Six hundred thirty-seven youths received a diagnostic assessment with either the Epidemiologic or Present and Lifetime Version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children. A 10-item form derived from the 73-item P-GBI had good reliability (alpha = .92), correlated (r = 0.95) with the 28-item scale, and showed significantly better discrimination of bipolar disorders (area under the receiving operating characteristic [AUROC] curve of 0.856 vs. 0.832 for the 28-item scale, p < .005), with good precision for estimation of individual scores for cases up to 2 standard deviations elevated on the latent trait. The 10-item scale also did well discriminating bipolar from unipolar (AUROC = 0.86) and bipolar from attention-deficit/hyperactivity disorder (AUROC = 0.82) cases.

Conclusions: Findings suggest that parents most notice elated mood, high energy, irritability, and rapid changes in mood and energy as the prominent features of juvenile bipolar disorder.