2. Incentivized Medicine and Misdiagnosis of Pediatric Bipolar Disorder (PBD) By Tristin Pfeifer United States Food and Drug Administration Image 1

3. Pediatric Bipolar Disorder went from being rarely diagnosed up until the 1990’s to being the most frequent (Littrell & Lyons 2010) It became a trendy diagnosis and a result of incentivized medicine (Littrell & Lyons 2010) Considered a severe mental disorder Medications not approved for children Critical Situation

4. Rhetorical Timing Negative effects on child's/adolescent health Worrisome spike in a particular diagnosis Clonidine causes death of 2 year old (Kaplen, 2011) Image 2

5. Causes Media Attention (Littrell & Lyons 2010) Pressure to give clinical diagnosis (Spiegel, 2010) Too broad/vague diagnostic tools (As cited by Jenkins, Youngstrom, & Washburn, 2011). Pharmaceutical Companies (Frances, 2012)

6. Effects Over diagnosis of PBD due to being “trendy” (Littrell & Lyons 2010) Children taking potentially harmful pharmaceuticals (As cited by Jenkins, Youngstrom, & Washburn, 2011). Incentives for Clinicians (Littrell & Lyons 2010)

7. Image 3 Pharmaceutical Spending

8. Solutions Updates to Diagnostic and Statistical Manual of Mental Disorders (DSM) Improve Parent awareness Mandatory reporting of any cases of children prescribed dangerous medications Mandatory reporting of any financial exchange between pharmaceutical companies and clinicians.

9. Questions? tpfeifer@csumb.edu

10. Image References Image 1 https://encrypted- tbn1.gstatic.com/images?q=tbn:ANd9GcRP6Q5kixwgWcidqwCVHf6hdg27i6I VR9FvtgmYoC9wD4NtnGTB Image 2 http://newsblaze.com/pix/2008/0820/pix/History-of-Bipolar-Disorder-.jpg Image 3 http://www.pewhealth.org/uploadedImages/PHG/Content_Level_Pages/Issue_B riefs/rxp-chart2.jpg

11. References Frances, A. (2012, April 3). The False Epidemic of Childhood Bipolar Disorder. Retrieved from HuffingtonPost: http://www.huffingtonpost.com/allen-frances/children-bipolar-disorder_b_1213028.html Instruments in the Application of DSM-IV-TR Criteria for Pediatric Bipolar Disorder. Journal Of The American Academy Of Child & Adolescent Psychiatry,51(6), 605-621 Galanter, C., Hundt, S., Goyal, P., Le, J., & Fisher, P. (2012). Variability Among Research Diagnostic Interview Jenkins, M. M., Youngstrom, E. A., & Washburn, J. J. (2011). Evidence-Based Strategies Improve Assessment of Pediatric Bipolar Disorder by Community Practitioners. Professional Psychology, Research And Practice, 42(2), 121-129 Lance, Jeffrey, I., Boris, Michael, Shirley, Bettina, B.,... Martin. (2013). Manic symptoms in youth with bipolar disorder: Factor analysis by age of symptom onset and current age. Journal of Affective Disorders, 145(3), 409-412. doi: http://dx.doi.org/10.1016/j.jad.2012.06.024 Littrell, J., & Lyons, P. (2010). Pediatric Bipolar Disorder: An issue for Child Welfare. Children & Youth Services Review, 32(7), 965-973. Miller, L., & Barnett, S. (2008). Mood lability and bipolar disorder in children and adolescents. International Review of Psychiatry (Abingdon, England), 20(2), 171-176. doi: http://dx.doi.org/10.1080/09540260801889088http://dx.doi.org/10.1080/09540260801889088 PEW. (2013, January). Persuading the prescribers: Pharmaceutical Industry Marketing and its influence on Physicains and patients. Retrieved from PEW: http://www.pewhealth.org/other-resource/persuading-the-prescribers- pharmaceutical-industry-marketing-and-its-influence-on-physicians-and-patients-85899439814http://www.pewhealth.org/other-resource/persuading-the-prescribers- Spiegel, A. (2010, Febuary 10). Children Labeled 'Bipolar' May Get A New Diagnosis. Retrieved from National Public Radio: http://www.npr.org/templates/story/story.php?storyId=123544191 Staurt L. Kaplan, M. (2011, June 19). Mommy, Am I Really Bipolar? Retrieved from The daily beast: http://www.thedailybeast.com/newsweek/2011/06/19/mommy-am-i-really-bipolar.html