Some very compelling comments stood out for me in the New York Times article.

“The diagnosis is made with no understanding of the context of their life,” Dr. van der Kolk said. “Then they’re put on these devastating medications and condemned to a life as a psychiatry patient.”

Even as an adult this issue is relavent. Your initial intake history with a psychiatrist is maybe an hour. Then you may get 15-20 minutes with them there after. If you subsequently get a therapist you typically get 50-60 minutes once a week. It's difficult, if not impossible, for them to appreciate the context of a patients life with so little interaction.

“What I want to know,” said John Darrell, a lawyer for Mr. Riley, “is how in the world you diagnose a 2-year-old and give her these strong medicines that are not approved for children.”

This issue is particularly disturbing to me. It wasn't coined "the terrible twos" for nothing. Are these mainly parents that just don't know how to cope with the issues of that age group and are looking for an easy solution?

In just the last decade, the rate of bipolar diagnosis in children under 13 has increased almost sevenfold, according to a study based on hospital discharge records.

My question with this one: is ANYONE trying to figure out WHY there has been such a huge increase? Are the diagnosis substantiated? If they are, what is the root cause of so many more beings having these disorders? My personal opinion (based on my own experiences with the medical field in general) is that for large group of professionals have lost the conscientiosness (sp?) of their professions. They're either in it for the money or they have become so hardened or numbed by whatever influences (Pharma, volume of patients, restrictions imposed by big busness HMOs, took long of work hours) that they no longer practice with the care they used to. (And I do realize there are still good docs out ther, it's just becoming much harder to find them.)

It is interesting that someone is finally considering the responsibility of a prescriber. Recently, the long ignored issue of metabolic syndrome has come to the fore with the Zyprexa litigation. One has to wonder where were the providers who were prescribing Zyprexa when it came the physical well being of their patients. Even the simplest indicators for metabolic syndrome - weight and blood pressure - are given short shrift by the majority of prescribers who treat persons dealing with schizophrenia and bipolar disorder (1). I suppose an unjustifiable defense could be, "I only took care of the mind; the body was someone else's problem" but aren't we well into the era where mental health care is putatively predicated on the principles of "Wellness and Recovery"?

(1) "Metabolic Syndrome Linked to Mental Health," The Clinical Services Journal, November 2006.
http://www.clinicalservicesjournal.com/Story.aspx?Story=1550

Excerpted:
However, only a minority of prescribers were conducting tests to monitor and facilitate management of metabolic diseases among people with schizophrenia or bipolar disorder:
• Only 27% of prescribers in the EU and 41% of prescribers in the US were checking blood pressure in people with bipolar disorder.
• Only 30% of prescribers in the EU and 29% of prescribers in the US were checking blood pressure in people with schizophrenia.
• Only 24% of prescribers in the EU and 42% of prescribers in the US were routinely weighing people with bipolar disorder.
• Only 26% of prescribers in the EU and 35% of prescribers in the US were routinely weighing people with schizophrenia.

Additionally, less than half of all carers reported prescribers taking the necessary steps to actively monitor the metabolic conditions of people with schizophrenia or bipolar disorder.

I have a child with early onset bipolar, this story is quite shocking to me. Our psychiatrist is adamant about bi-annual labs as my child takes Seroquel and Trileptal, she wants to watch for glucose and sodium effects from these meds.

While I'm not sure who is to blame in this particular tragedy, I think some is attributable to all involved. Clearly, the parents were over-medicating with the Clonodine and had been given the back story we have about 10-day prescriptions due to "lost" or "destroyed" pills. The father has a questionable history - was there abuse? Bipolar is heritable - did mom have it too? Where was child services? And finally, given all of the above, why wasn't the psychiatrist more careful - this patient should have been being seen weekly given the powerful medication combination. Also - where was the basic education on medication interactions? I can't believe they were giving this poor child cold medication on top of everything else. It's just so tragic!

The seven fold increase in diagnosis I feel is due to the fact this disorder has only been acknowledged in children in the last dozen years or so. It doesn't mean it was never there before, its just that now it has a name. We have been seeing the same scary increases in the dx of Autism - and I personally don't believe it wasn't there before, I think its because the we now have a name to attach to the symptomology.