Article

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: 1.85). 01/2008; 23(1):53-9. DOI: 10.1002/hup.900
Source: PubMed

ABSTRACT 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.

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    • "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). "
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