Paediatric bipolar disorder (PBD) is an increasingly diagnosed disorder affecting an estimated 1% of children and adolescents. Pharmacological treatment studies in PBD have lagged far behind those in adults. Children are currently treated with pharmacological agents, most of which have proven efficacy in adults. However, PBD is distinct from adult forms of bipolar disorder (BD) and may present unique treatment challenges. PBD often presents with rapid cycling and mixed manic states and a high co-morbidity with behavioural and attention disorders. Early onset depression may also be an early sign of PBD. Due to developmental considerations, the diagnosis of BD may be difficult to make in children without semi-structured interviews. This report discusses the special issues that should be considered when treating PBD and reviews the current literature regarding pharmacotherapy of this population. Mood stabilisers have been studied mostly in an open, uncontrolled fashion but there is growing evidence that lithium, divalproex and carbamazepine are effective in treating PBD. More recent treatment options include atypical antipsychotics and newer anticonvulsants. Other novel agents are currently being investigated in adult BD and may prove applicable to the paediatric form. Finally, based on the available data, a treatment algorithm for PBD is proposed.
"A further consideration is the presentation of pediatric and adolescent forms of psychiatric disorders which may differ somewhat in terms of symptoms, disease course, and treatment options from the corresponding adult disorders. This can be seen in pediatric bipolar disorder which is often characterized by the presence of mixed-mania and rapid cycling and a high degree of comorbidity with behavioral and attention disorders (Chang and Ketter 2001) – factors that contribute to diffi culties in diagnosis. Similar problems are encountered in childhood onset schizophrenia which may be diffi cult to differentiate from affective and personality disorders due to the predominance of negative symptoms (Masi et al 2006). "
[Show abstract][Hide abstract] ABSTRACT: Successful treatment of psychiatric disorders, including bipolar disorder and schizophrenia, is complicated and is affected by a broad range of factors associated with the diagnosis, choice of treatment and social factors. In these patients, treatment management must focus on accurate and early diagnosis, to ensure that correct treatment is administered as soon as possible. In both disorders, the treatment of the disease in the acute phase must be maintained long term to provide continuous relief and normal function; the treatment choice in the early stages of the disease may impact on long-term outcomes. In schizophrenia, treatment non-compliance is an important issue, with up to 50% of patients discontinuing treatment for reasons as diverse as efficacy failure, social barriers, and more commonly, adverse events. Treatment non-compliance also remains an issue in bipolar disorder, as tolerability of mood stabilizers, especially lithium, is not always good, and combination treatments are frequent. In order to achieve an optimal outcome in which the patient continues with their medication life-long, treatment should be tailored to each individual, taking into account treatment and family history, and balancing efficacy with tolerability to maximize patient benefit and minimize the risk of discontinuation. These case studies illustrate how treatment should be monitored, tailored and often changed over time to meet these needs.
[Show abstract][Hide abstract] ABSTRACT: Bipolar disorder is a less common biologic disorder in primary care than are depressive and anxiety disorders, but there is a high risk for poor outcomes for patients. Primary care physicians (PCPs) are assuming increasing responsibility for the care of these patients in today's man-aged care environment, working independently or in collaboration with a psychiatrist. The PCP needs to carefully assess patients presenting with depression, since many are bipolar. The PCP must then skillfully man-age these patients because of the significant morbidity and mortality associated with the disorder. This article outlines a diagnostic approach for patients in primary care practice who present with mood symptoms. The article also presents a management strategy for those who are diagnosed with bipolar disorder, including patients who are considering pregnancy or who are pregnant.
[Show abstract][Hide abstract] ABSTRACT: Children and adolescents do not always respond to treatment with psychotropic agents in a similar fashion to adults. Differences in safety and therapeutic response may occur across the life cycle. For example, despite the fact that tricyclic antidepressants are traditionally the 'gold standards' of pharmacotherapy for depressed adults, it does not seem that youths with depression benefit from treatment with these agents . Similarly, it appears that earlier age at onset is associated with a reduced propensity to respond to neuroleptics for patients with schizophrenia . In addition, young patients have been noted to be at higher risk for developing neuroleptic-induced extrapyramidal side effects when compared to adults . Simply put, what is known about the safety and effectiveness of psychotropic compounds in adults cannot necessarily be presumed to be applicable to teenagers or children.
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