The diagnosis of BPD in a CMHC is frequently challenging . Incorrectly diagnosing a patient as suffering from a unipolar mood disorder or from a? ? disruptive behavior disorder leads to sub-optimal outcome and may worsen the course of BPD. Part of the difficulty? ? is the current lack of consensus regarding the phenomenology of juvenile BPD. At present, there? ? also is no certainty about the base rate at which BPD might present at a CMHC, nor is there an established set of? ? instruments that could be used to screen a juvenile community sample for bipolar spectrum disorders. The need is great for such a screening protocol, given the long-term trajectory and? ? serious consequences of untreated or mistreated BPD, and the potential value of early intervention and prophylaxis? ? if cases could be identified in youths. Preliminary evidence from this research group suggests that several measures? ? perform well at distinguishing BPD from unipolar depression, disruptive behavior disorders, and other disorders in? ? children and adolescents. However, these findings were based on a sample presenting at a hospital outpatient clinic? ? at an academic medical center specializing in the treatment of juvenile mood disorders and psychopharmacology? ? research. Thus, several factors prevent the immediate application of existing findings to a community setting,? ? including the lack of soundly-established base rates of BPD at community-based mental health centers, the? ? unknown effects of potential ascertainment bias at a mood disorders clinic versus a community setting, changes in? ? demographics or other sample characteristics that might interact with test performance, and the fact that test? ? performance might degrade when exported from a research framework into a community context, much as? ? therapeutic efficacy estimates usually exceed effectiveness findings. The purpose of the proposed project is to? ? determine the prevalence of BPD in an ethnically diverse community sample and to develop effective means of? ? screening patients in a CMHC for bipolar spectrum disorders, as well as to improve understanding of the early? ? presentation of bipolar spectrum disorders, especially in underserved populations.? ?
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