Practitioner Review: Long-term pharmacological treatment of pediatric bipolar disorder
ABSTRACT Although long-term treatment is a core aspect of the management of children and adolescents with bipolar disorder (BD), most clinical recommendations are based on results from short-term studies or adult data. In order to guide clinical practice, we review the efficacy and safety profile of mood stabilizers, antipsychotics, and other pharmacological strategies for the long-term treatment of BD in pediatric patients.
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ABSTRACT: Abstract Objective. The purpose of this study was to investigate the long-term effectiveness of aripiprazole in Taiwanese samples of adolescents and young adults with bipolar disorders. Methods. This investigation comprises a 24-week, observational, prospective study. A total of 28 patients with bipolar I disorder, diagnosed using the Mini International Neuropsychiatric Interview, were administered aripiprazole. Effectiveness was assessed by the change from the baseline in Clinical Global Impression Scale (CGI), Brief Psychiatric Rating Scale (BPRS) and The World Health Organization Quality of Life questionnaire (WHOQOL). Results. The sample comprised 19 males and nine females with a mean (SD) age of 18.5 (3.3) years. The diagnosis was bipolar I disorder with manic (n = 8), depressive (n = 6) and mixed (n = 14) episodes. Eighteen patients (64.3%) discontinued aripiprazole prematurely. The CGI severity, BPRS total score improved significantly from the baseline to the endpoint. Conclusion. Aripiprazole led to clinically meaningful improvement of global symptoms in adolescents and young adults with bipolar disorder. However, discontinuation of medication within 6 months was high. Whether aripiparzole benefits patients with manic episodes more than those with depressive or mixed episodes warrants further investigation.International Journal of Psychiatry in Clinical Practice 10/2010; 14(4):252-256. DOI:10.3109/13651501.2010.505345 · 1.31 Impact Factor
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ABSTRACT: Bipolar disorder is an inherently recurrent disorder, requiring maintenance preventive treatments in the vast majority of patients. The authors review the data on maintenance treatments in bipolar disorder, highlighting the controlled trial literature. Literature review using PubMed, Medline, and a hand search of relevant literature. Over the last decade, a number of effective maintenance treatments for bipolar disorder have been developed with an evidence base for second-generation antipsychotics and some anticonvulsants. Increasing numbers of patients, therefore, are appropriately treated with multiple medications as a maintenance regimen. For some medications, maintenance treatment has been demonstrated in randomized controlled trials for both monotherapy and in combination with other mood stabilizers. Lithium continues as our oldest well-established maintenance treatment in bipolar disorder with somewhat better efficacy in preventing mania than depression. Lamotrigine, olanzapine, and quetiapine have bimodal efficacy in preventing both mania and depression, although lamotrigine's efficacy is more robust in preventing depression and olanzapine's efficacy is greater in preventing mania. Aripiprazole, ziprasidone, and risperidone long-acting injection all prevent mania, but not depression. Less controlled investigations have suggested some evidence of maintenance mood stabilization with carbamazepine, oxcarbazepine, and adjunctive psychotherapy. Despite the number of agents with demonstrated efficacy as maintenance treatments in bipolar disorder, optimal treatment regimens are still a combination of evidence-based therapy in combination with individualized creative treatment algorithms.Bipolar Disorders 05/2012; 14 Suppl 2:51-65. DOI:10.1111/j.1399-5618.2012.00992.x · 4.89 Impact Factor
- Journal of Child and Adolescent Psychopharmacology 02/2004; 14(2):325-8. DOI:10.1089/1044546041649101 · 3.07 Impact Factor