Age, Gender, and Cultural Issues in Diagnosis and Assessment
It is important to note that manic–depressive disorder is a worldwide problem and is among the top 10 of all diseases in terms of global burden worldwide, and fifth in terms of self-reported disability. There are no major differences in the mani-festations of manic–depressive disorder across gender, age, or culture. However, women appear to be at higher risk for rapid cycling dysphoria during mania and comorbid disorders. Note, however, that affective psychoses may be relatively under-diagnosed and schizophrenia over-diagnosed, in African-Americans compared with Caucasians. Among children and adolescents, the diagnosis of manic–depressive disorder is often complicated by less consistent mood and behavior base-line than occur in adults. Little evidence is available regarding course and outcome in children. Available data indicate that, as with adults, mixed or cycling episodes predict more recur-rences; unlike in adults, manic and mixed presentations may be associated with relatively shorter episodes compared with depressive presentations.