Article

Double-blind 18-month trial of lithium versus divalproex maintenance treatment in pediatric bipolar disorder.

Department of Psychiatry, Case Western Reserve University, USA.
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 6.35). 06/2005; 44(5):409-17. DOI: 10.1097/01.chi.0000155981.83865.ea
Source: PubMed

ABSTRACT To determine whether divalproex sodium (DVPX) was superior to lithium carbonate (Li+) in the maintenance monotherapy treatment of youths diagnosed with bipolar disorder who had been previously stabilized on combination Li+ and DVPX (Li+/DVPX) pharmacotherapy.
Youths ages 5-17 years with bipolar I or II disorder were initially treated with Li /DVPX. Patients meeting remission criteria for four consecutive weeks were then randomized in a double-blind fashion to treatment with either Li+ or DVPX for up to 76 weeks. Study participation ended if the subject required additional clinical intervention or if the subject did not adhere to study procedures.
Patients were recruited between July 1998 and May 2002. One hundred thirty-nine youths with a mean (SD) age of 10.8 (3.5) years were initially treated with Li+/DVPX for a mean (SD) duration of 10.7 (5.4) weeks. Sixty youths were then randomized to receive monotherapy with Li+ (n = 30) or DVPX (n = 30). The Li+ and DVPX treatment groups did not differ in survival time until emerging symptoms of relapse (p = .55) or survival time until discontinuation for any reason (p = .72).
DVPX was not found to be superior to Li+ as maintenance treatment in youths who stabilized on combination Li+/DVPX pharmacotherapy.

1 Follower
 · 
88 Views
  • [Show abstract] [Hide abstract]
    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.
    Journal of Child Psychology and Psychiatry 06/2014; 55(9). DOI:10.1111/jcpp.12271 · 5.67 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives : This study was conducted in order to describe prescribing practices in treatment of pediatric bipolar disorder in a Korean inpatient sample. Methods : We performed a retrospective chart review of 66 youths who had been hospitalized and diagnosed with bipolar disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. Demographics, clinical characteristics, medications used, doses, and related adverse events were examined. Results : Mood stabilizers and/or atypical antipsychotic medications were the primary treatment. Risperidone, valproate, and lithium were the most commonly used. Thirty seven patients (58.1%) were treated with combination therapy of an atypical antipsychotic and mood stabilizer for improvement of manic/mixed symptoms. Conclusion : Combination pharmacotherapy was necessary for most patients in this admission sample group. Conduct of further studies will be needed for evaluation of treatment response according to the clinical characteristics, and the safety and efficacy of treatment for child and adolescent bipolar disorder.
    03/2014; 25(1). DOI:10.5765/jkacap.2014.25.1.14
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: Little is known regarding demographic and/or clinical characteristics associated with the use of lithium among adolescents with bipolar disorder (BP) in naturalistic clinical settings. We therefore examined factors associated with lithium among adolescents with BP presenting to a tertiary outpatient clinic. Methods: Participants were 100 adolescents 13-19 years of age, with BP-I, BP-II, or BP not otherwise specified (BP-NOS). Diagnoses and lifetime medication exposure were determined using the Schedule for Affective Disorders and Schizophrenia for School Age Children, Present and Lifetime Version (KSADS-PL). Analyses examined for demographic and clinical correlates of lifetime lithium exposure. Results: Twenty percent of participants reported lifetime lithium use. Participants with, versus those without, lifetime lithium use were significantly older and significantly more likely to have BP-I, lifetime history of psychiatric hospitalization, and psychosis. Lithium-treated participants were significantly more likely to report use of second-generation antipsychotics (SGAs) and antimanic anticonvulsants. In contrast, participants with lithium exposure were significantly less likely to have BP-II, self-injurious behavior, and a family history of depression. Adolescents with lithium exposure had significantly less parent-reported family conflict and mood lability, and significantly less self-reported impulsivity, emotional dysregulation, identity confusion, and interpersonal problems. In multivariable analyses, lithium use was associated with greater lifetime SGA use, lower parent-reported family conflict, and lower adolescent-reported interpersonal problems. Conclusions: Lithium was infrequently used among adolescents with BP in this sample. Although constrained by retrospective methodology and a single site, our findings suggest that clinicians may be deferring lithium use until late in treatment. The fact that there are lower rates of lithium use among adolescents with suicidal ideation, impulsivity, mood lability, and family history of depression suggests potential missed opportunities for use of lithium among high-risk adolescents with BP.
    Journal of Child and Adolescent Psychopharmacology 07/2014; 24(7). DOI:10.1089/cap.2013.0120 · 3.07 Impact Factor