Pharmacotherapy in the community-based treatment of children with bipolar I disorder

Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, South Carolina 29203, USA.
Human Psychopharmacology Clinical and Experimental (Impact Factor: 2.19). 01/2008; 23(1):53-9. DOI: 10.1002/hup.900
Source: PubMed


To examine the services and medications received, and psychosocial functioning changes over time of children and adolescents with bipolar I disorder in a public mental health system.
Medical records were reviewed for 82 patients, 6-17 years of age, diagnosed with bipolar I disorder, and newly admitted to one public mental health system between 1 July 2003 and 30 June 2004. A retrospective cohort design was employed, with an 18-month follow-up period.
One-third of the patients dropped out treatment within a few months. The psychosocial functioning ratings of patients who remained in treatment improved over time on several dimensions (total, school/work, behavior toward others). Children and adolescents prescribed both a mood stabilizer and an atypical antipsychotic medication regimen (35%) were rated as higher functioning on self-harm behavior and mood/emotions by clinical staff, but their improvement could not be attributed directly to the pharmacotherapy in this small cohort.
Community-based pharmacotherapy for children and adolescents with bipolar I disorder does not differ substantially from the extant literature, given the complexity and severity of these cases, and may lead to improvement for children and adolescents who remain in treatment.

Download full-text


Available from: Jeanette M Jerrell, Oct 16, 2014
7 Reads
  • Source
    • "Several factors have been implicated as contributing to high overall rates of medication use and the frequent medication trials among youth with bipolar disorder. For one, youth with bipolar disorder often have more psychiatric comorbidities than youth with other psychiatric disorders (Geller et al., 1994; Jerrell and Shugart, 2004; Birmaher et al., 2006; Moreno et al., 2007; Jerrell, 2008). The Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) established guidelines that advise treating each disorder separately because comorbidity worsens the prognosis for youth with bipolar disorder (Kowatch and DelBello, 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To examine longitudinal patterns of complexity, continuity, and initiation of treatment for youth diagnosed with bipolar disorder. Additionally, we explore bipolar diagnosis stability and its relationship to observed treatment patterns. Methods: A cohort of 426 privately insured youth (ages 6-18) diagnosed with bipolar disorder was identified from the 2000-2001 Thomson/Medstat-MarketScan(®) database. Medication complexity was defined as number of different psychotropic medication classes dispensed during a 6-month period following a new treatment episode of bipolar disorder. Treatment continuity was examined over a 6-month follow-up period, specifically focusing on mood stabilizing medications and antidepressant monotherapy. Predictors of complexity and continuity were investigated. Results: Fifty-five percent of youth received more than one and 25% received three or more different types of psychotropic medication classes during follow-up. This was contrasted with several youth having no prescription fills (21%) and 31% discontinuing mood stabilizing medication. Youth with a stable bipolar diagnosis were more likely to have continuity of mood stabilizing prescriptions (OR: 4.05), but also greater psychotropic medication complexity. Age, health status/comorbidity, and being in a managed care plan were also related to complexity and continuity of psychotropic medication class regimens. Conclusions: More evidence is needed on the causal patterns leading to increased psychotropic medication complexity and continuity and how diagnosis of bipolar disorder may drive treatment patterns.
    Frontiers in Psychiatry 11/2010; 1:144. DOI:10.3389/fpsyt.2010.00144
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Few studies of psychotropic medication use among children and adolescents address the effectiveness of this medication, as it is typically used in naturalistic treatment settings. The objective of this study was to investigate psychotropic medication use among children and adolescents treated in system of care communities, to identify subject characteristics associated with psychotropic medication use, and determine whether psychotropic medication use is associated with reduced symptom severity. Methods: Data were collected through the National Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program. For this evaluation, 27 system of care communities reported data on medication use and clinical ratings at intake and 6-month follow-up on children and adolescents 6-18 years of age receiving mental health services between 2006 and 2009. We used mixed-effects logistic regression to determine associations between patient characteristics and medication use, and mixed-effects linear regression to determine whether subjects taking medication and those not taking medication experienced different changes in symptom severity between intake and 6 months. Results: Subject characteristics associated with psychotropic medication use, when controlling for other characteristics, included having more severe emotional and behavioral symptoms at intake, having more co-occurring diagnoses, and receiving more than one type of service. Those both taking and not taking medication showed symptom reduction at 6 months, although symptom severity among subjects taking medication remained in the clinical range. When controlling for covariates, symptom reduction was associated with medication use. Conclusion: Taking psychotropic medication was more strongly associated with measures of illness severity-greater symptom severity at intake, more co-occurring diagnoses, and more service intensity-than with other demographic characteristics. Subjects who took medication showed more symptom reduction at 6 months than those not taking medication, although this reduction was not sufficient to normalize symptoms among those taking medication.
    Journal of child and adolescent psychopharmacology 02/2013; 23(1):36-43. DOI:10.1089/cap.2012.0026 · 2.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE To evaluate the prevalence, demographic and clinical correlates, and specificity of classes of psychotropic medications indicated for mental disorders. DESIGN Cross-sectional survey. SETTING Direct household interviews of combined household and school samples representative of the general population of adolescents in the United States. PARTICIPANTS Ten thousand one hundred twenty-three adolescents aged 13 to 18 years who participated in the National Comorbidity Survey Adolescent Supplement. MAIN EXPOSURES Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) mental disorders and neurodevelopmental disorders. OUTCOME MEASURE Psychotropic medication use in the past 12 months. RESULTS Among youth with any DSM-IV mental disorder, 14.2% reported that they had been treated with a psychotropic medication in the past 12 months. Strong associations emerged between specific disorders and classes of medications with evidence for efficacy. Antidepressants were most frequently used among those with primary mood disorders (14.1%); stimulant use was most common among those with attention-deficit/hyperactivity disorder (20.4%); and antipsychotic use was infrequent and mostly seen among those with serious developmental disorders. Less than 2.5% of adolescents without a 12-month mental disorder had been prescribed psychotropic medications, and most had evidence of psychological distress or impairment reflected in a previous mental disorder, subthreshold condition, or developmental disorder. Appropriate medication use was significantly more frequent among those in treatment in the mental health specialty sector than general medicine or other settings. CONCLUSIONS These findings challenge recent concerns over widespread overmedication and misuse of psychotropic medications in US youth. In fact, these data highlight the need for greater recognition and appropriate treatment of youth with mental health disorders.
    02/2013; 167(2):141-8. DOI:10.1001/jamapediatrics.2013.431
Show more