To examine characteristics between subjects with a prepubertal and early adolescent bipolar disorder phenotype from pediatric versus psychiatric venues.

Subjects (N = 93) with a prepubertal and early adolescent bipolar disorder phenotype were obtained through consecutive new case ascertainment from designated pediatric and psychiatric sites from 1995 to 1998. Children needed DSM-IV bipolar I disorder (manic or mixed phase) with elation and/or grandiosity as one criterion to avoid diagnosing mania only by symptoms that overlapped with those of attention-deficit/hyperactivity disorder. Comprehensive assessment included the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia, given separately to parents about their children and to children about themselves by experienced research nurses blinded to subjects’ diagnostic status.

Rates of mixed mania (χ² = 7.1, p = .008) and suicidality (χ² = 7.2, p = .007) were significantly higher at psychiatric versus pediatric venues. Subjects from pediatric sites were significantly more likely to be living with their intact biological family (χ² = 5.3, p = .022). Significantly more subjects with a prepubertal and early adolescent bipolar disorder phenotype ascertained at psychiatric sites versus pediatric sites were taking an antimanic medication (χ² = 9.5, p = .002), while stimulant medication was significantly more common among subjects ascertained at pediatric sites (χ² = 19.0, p < .0001).

These pediatric versus psychiatric site differences suggest that pediatricians may underrecognize mania and thus do not prescribe antimanic mood-stabilizing medications. Moreover, pediatricians may be more likely to refer children to psychiatrists when depression or suicidality is evident.