A expansão das classificações psiquiátricas nos últimos 30 anos e suas repercussões na psiquiatria infantil: o caso do Transtorno Bipolar em crianças e adolescentes.

Abstract

The diagnosis of pediatric bipolar disorder was only recently recognized in pediatric psychiatry, especially in the United States. Until the middle of the 20th century, it was not believed that prepubertal children could present symptoms compatible with this diagnosis, described for the first time by Emil Kraepelin at the end of the 19th century with the name of manic-depressive psychosis. The term bipolar disorder was used to replace the term manic-depressive psychosis in the transition from the second edition of the Diagnostic and Statistic Manual, DSM II, to the DSM III, in 1980. Between 1994 and 2004, the number of children who received this diagnosis in the United States increased 40 times, representing the biggest diagnostic bubble since the first edition of the DSM. This event is a result of the alteration of the diagnostic criteria for the bipolar disorder in adults, which are transposed to childhood changing its basis, that consists of extreme mood swings, in a chronic condition, not of depression and euphoria anymore, but of irritability now. This didn t happen in the same way in other countries, where the prevalence rates are considerably smaller. In Brazil, these data are still insufficient. The main goal of this study was to investigate if the discussion concerning pediatric bipolar disorder is well known by Brazilian psychiatrists and how it influences the clinical practice in Brazil. This assessment was conducted through a series of semi structured interviews with 20 pediatric psychiatrists, established in five major cities where the main academic and research centers are established. Evidence shows that the main Brazilian research centers specialized in the diagnosis of child bipolar disorder reproduce the North American model, finding very similar rates to the ones in the United States, whereas the services not organized on the basis of diagnosis (CAPSi, for instance) present a very different profile. The main determinant factor of this reality is the transposition of the research logic, with its scales and diagnosis tools, to the complex field of the daily clinical practice, reproducing a pattern of assessment decontextualized and that underestimates de personal history of the child. This dissertation contributes to the knowledge enhancement of how an important part of the Brazilian pediatric psychiatrists deal with the issue of the pediatric bipolar disorder.