Clinical Preparation Tool – DSM: Bipolar I Disorder

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Clinical Preparation Tool

DSM: Bipolar I Disorder

Instrument: Child and Adolescent Symptom Inventory(CASI-4R).

Article: Diagnostic efficiency of the Child and Adolescent Symptom Inventory (CASI-4R) depression subscale for identifying youth mood disorders (Salcedo et al., 2018).

Appropriateness for Dx: The CASI-4R assesses broad DSM5 diagnoses, including Bipolar I Disorder (Salcedo et al., 2018). Notably, there is no evidence-based approach for specific disorders except for comprehensive tests assessing more than one DSM5 diagnosis (Ong et al., 2017). The CASI-4R can provides appropriate diagnosis for child and adolescent BD-I through a systematic assessment of standardized symptoms. Therefore, CASI-4R has limited false-positive diagnoses, which is vital in clinical settings/geographical regions where BD-I are uncommon. In this regard, CASI-4R facilitates the integration of Bayesian methods to measure associated BD-I risk factors and incorporate other information sources such as family history, gender, or scales to improve diagnostic prediction (Salcedo et al., 2018). The CASI-4R also limits client bias and heuristics that contribute to inappropriate clinician judgment. Lastly, a psychotherapist using parents’ and teachers’ reports in a span of administers CASI-4R 15-20 minutes, using both dimensional and categorical assessments.

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Response to Therapy/Treatment: The CASI-4R dimensional scores provide a significant prediction of diagnosis while controlling risk factors, including comorbidities and demographics. Moreover, categorical assessments of the presented symptoms can help determine their consistency with the established symptoms of given disorders. Salcedo et al. (2018) posit that CASI-4R provides a sensitive and specific identification of DSM-V bipolar disorders. For instance, other diagnostic tools established according to DSM-III-R or DSM-IV have a short scale that cannot provide a complete diagnosis. CASI-4R measures multiple childhood bipolar disorders and other disorders such as dysthymia, anorexia, social phobia, ODD, Asperger’s disorder, GAD, autism, schizophrenia, and conduct disorder. The broad measurement scope enhances the client’s response to therapy as most symptoms are recorded and compared against the standard BD-I symptoms.  Besides, the comprehensive measurements allow for simultaneous assessment of comorbid disorders. When using the caregiver report, the CASI-4R can predict a broad range of mood and bipolar disorders. This broad-spectrum prediction of symptom severity makes it easy to differentiate conditions and diagnose with the highest accuracy.

Psychometrics: The CASI-4R scale constitutes symptom modules for various disorders derived from DSM5 diagnosis, thus, presents a high content validity (Salcedo et al., 2018). The CASI-4R constitutes two scales, i.e., the Adolescent Symptom Inventory and the Child Symptom Inventory-4 (CSI-4), making it an appropriate tool for screening disorders in children and adolescents. Moreover, the severity score of the CASI-4R provides dimensional perspectives, while the CASI-4R mania subscale can complement other scales since it has different items and can be administered effectively, having only nine questions. Equally, the CASI-4R mania subscale is specific, thus, is effective in assessing comorbid disorders. These characteristics prove that the CASI-4R mania subscale has clinical significance due to its reliability and quick assessment of disorders by highlighting specific symptoms associated with a given condition before a structured diagnostic evaluation.  The CASI-4R also allows a clinician to determine an appropriate treatment plan for the client and follow-up decisions.

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Clinical Preparation Tool
Clinical Preparation Tool

Limitations: The major limitation of the CASI-4R tool is that parents do not report a child’s behavior during a specified time, making it challenging to elucidate the period of symptoms reported in children’s behaviors. According to Ong et al. (2017), parents provide the appropriate information of a child’s behavior, i.e., externalizing behavior, more than the children themselves do. In this context, some reported symptoms might not present current issues. In most instances, psychotherapists might want to understand a child’s lifetime behavior to facilitate the appropriate assessment of the pertinent problems with the client.  Lastly, CASI-4R is not available for free use and must be purchased by clinicians before it can be administered. 

References

Ong, M. L., Youngstrom, E. A., Chua, J. J. X., Halverson, T. F., Horwitz, S. M., Storfer-Isser, A., … & LAMS Group. (2017). Comparing the CASI-4R and the PGBI-10 M for differentiating bipolar spectrum disorders from other outpatient diagnoses in youth. Journal of abnormal child psychology45(3), 611-623. 10.1007/s10802-016-0182-4

Salcedo, S., Chen, Y. L., Youngstrom, E. A., Fristad, M. A., Gadow, K. D., Horwitz, S. M., … & Findling, R. L. (2018). Diagnostic efficiency of the Child and Adolescent Symptom Inventory (CASI-4R) depression subscale for identifying youth mood disorders. Journal of Clinical Child & Adolescent Psychology47(5), 832-846. 10.1080/15374416.2017.1280807

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