Phenomenology and Diagnosis of Bipolar Disorder in Children, Article Critique Example

The introduction evaluates the overall structure of how the system for the source -gathering operates and what obstacles itcan face within research. The problem of source-gathering for mania is problematic in a sense that when patients are diagnosed with mania they are only hospitalized briefly, treated by check-ups occasionally. Authors put an emphasis on this problem because clinicians usually do not get the chance to evaluate the advent process of mania and its ultimate resolution. Instead, the alternative research is done by interviewing the patients that are diagnosed with mania and bipolar disorder.  They provide an example for this and say that studying Van Gogh’s colors will not ultimately reveal his importance for those colors. Here, they create a paradox within their example because even though studying colors cannot directly tell Van Gogh’s importance for them, one can have a pretty clear picture of why those colors were important to him, to its very least one can have a good idea of why those colors mattered to him.  Furthermore, as authors claimed, clinicians should get a thorough history of the developmental process and find its roots. In order to do that research one needs to obtain” prenatal risk factors, temperament quality of attachment relationships, abuse history, early play behaviors,  developmental milestones, adaptation to school and peer relationships, as well as relevant family factors, including parental psychopathology and family history of psychiatric illness.”

Theoretical context of the problem: When authors survey the question of mania and bipolar disorder, they distance themselves from traditional definition and lean towards a controversial one which not only gives them more space for critical thinking but also makes clear sense when read.  Many frequently cite Diagnostic and Statistic Manual of Mental Disorders(DSM)which divides mania and depression to 4 categories. Authors, however, cite International Classification of Diseases (ICD).  This is applauding since the authors deconstruct the general variant of mania and depression that is mostly found in adults. Authors also discuss these symptoms in children and DSM only concentrates on adults. ICD on the other hand widens its study to not only adults but children as well.

Variables of interest:Within that context, authors try to define the disorder and what branch they can possibly belong in. Authors propose two definitions: in the first one, the definition, which was quite popular in early 20th century proposes that all the branches of this disorder fall under one context, whereas in the second definition they offer is one which claims that it is not the disorder itself but the “biological predisposition to affective disorder” which offers a clear solution to the variety of branches of mania and depression. This theory, in a way, battles between early studies of this disorder which was itself the foundation of this study and later reformation of its definition.

Description of Design: The thorough study of the design and the depiction of this disorder has started about a hundred years ago. It is vital to say that authors caught the most important portion of survey for this disorder: German psychiatrist Emil Kraepelinis noted in this analysis for this design. Though the latter had some flaws in his writing, authors took the information in its correct form which depicted the overall analysis of depression and its opposite branch of the disorder, mania.  Even though both states widely differed from one another, authors correctly point out that they do have one thing in common- irritability. Early psychiatrists could not believe that both states could occur within one. Here, however, authors fail to elaborate why the early psychiatrists did not see this as a realistic possibility. In my opinion, early psychiatrists saw mania as a more unique state out of the two states. Also, they failed to realize that these could correlate simultaneously because of their paradoxical features.

Control of extraneous variables: the study of mania and depression, which was studied in a balanced fashion, changed its course when mania was put in a sort of de-emphasis mode. I believe that the reason behind it was not its lack of seriousness, but in fact its extreme seriousness that made the “clinical community” return to the study of this branch of the disorder.

Sampling design: Authors define mania with “a manic episode, elation, extreme irritability and combativeness, and mood lability, including depression and crying” and bring forth an example of a guy named Toni who suffered mania first when he was 18. This got him involved in drugs but went away after a short while. Ten years later he experience mania again (as stated, mania can have several episodes in life, with several stages, in several times, which can increase the seriousness of the disorder). The second time mania appeared, a thorough research was done on Toni. Researchers thoroughly observed his behavior which showed all the detailed symptoms of mania. Authors, however, compare and contrast this research with researches done by Kraeplin early in the 20th century. This comparison is unreliable since Kraeplin’s research on mania was still in its infancy as it did not have the adequate research technology and was not mastering in research techniques to do as thorough research as contemporary researchers have done on Toni. Apart from this example, however, authors correctly note all the different aspects of mania. Also, they set the record straight on the issue of elation. In contemporary psychiatry literature one will often come across the issue of elation being dismissed. Many claim that elation is not the correct label that children experience but rather “irritability” or in other cases “euphoria.” Authors, based on their personal experience at their inpatient unit where they observed numerous children, conclude that “true euphoria is rarely seen.” As an example, they note an instance with an 8-year old girl, whose story concludes that elation can only be seen as elation and not be labeled in other way.

Data Analysis: The analysis done based on surveys explain various factors regarding the disorder.  One of the main topics covered in the first data was the presence of comorbidity with ADHD and bipolar disorder. There is, however, one area of study which the first data (Table 1) does not aid.  Meyer says, “It remainsunclear whether children with comorbid ADHD and bipolar disorder diagnoses areon a trajectory similar to children with mooddisorders or those with externalizing diagnoses.” This result can be concluded in two somewhat different ways: children with those results can either have aggressive behavior or can have it as “comorbid ADHD.” Even though this problem did not fully answer the question of  comorbid ADHD and bipolar disorder, it did produce some results and data was relatively fruitful. Other interesting data can be found on page 958, where about 318 families were researched.  Here the survey discusses the problem of rage when diagnosed with bipolar disorder.  The survey concluded that different varieties of showing rage (slamming, kidding, or outburst) was an inner self problem with kids and had nothing to do with race, income, or parent education. It can be said that occurrence of rage is a normal factor that occurs and has nothing to do with the external circle of the child.  Lastly,  authors provide us with another graph (Table 2) which clearly explains the commodity of effects that occur for all (the research was not focused on a particular group of people since last research was focused on children) and it depicts that grandiosity is the main effect occurs with children and adults.

Communication: Overall, the research provides the reader with a great survey that was done on bipolar disorder in children and adults alike. There were only a handful of questions that were either left unresolved (noted above) or did not specifically come to an ultimate resolution.  The paper started off really complex and lost me within its sentences as it jumped from one topic to another. Later in the article, however, authors kind of stepped back and began annalyzing the overall question of bipolar disorder and its two main states, mania and depression. They began analyzing each in a thorough manner which helped me understand each state and how it affects children and adults.  In particular, both groups were evaluated on their behavior on comorbid disorder, ADHD, mania, and depression. Also, I have to add that more space was reserved on mania and not depression. It can only be explained in one way- their sources, mainly  renowned psychiatrist Kaepelin, saw mania as a more important state than depression. And indeed it was and still is since depression can be seen as a normal occurrence but symptoms for mania are quite extraordinary.  Another vital point that this article made was regarding meeting the same criteria, yet having a different condition in adults and children. Meyer says, “our understand of the current literature, and from evaluating many different children referred with mood problems, is that not everyone who meets adult criteria for mania either really meets the intent of criteria or has the same condition.” This point was elaborated in the early part of the article. In sum, this was an informative and in-depth  article which can be exercised with relative security for clinicians and psychiatrists.