Somatic treatment of bipolar disorder in children and adolescents

Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA.
Psychiatric Clinics of North America (Impact Factor: 2.13). 04/2004; 27(1):155-78, x-xi. DOI: 10.1016/S0193-953X(03)00116-3
Source: PubMed


The currently available data from randomized, controlled trials and a considerable amount of open clinical data suggest that adolescent-onset bipolar disorder probably responds to the same agents as adult-onset bipolar disorder. Research examining psychopharmacologic treatment approaches in the early-onset bipolar disorder is limited, however. Methodologic problems include small sample sizes, lack of comparison groups, retrospective designs,and lack of standardized measures. In addition, sometimes no clear differentiation is made between mania and bipolar disorder, the latter term being used broadly in the literature. Often the studies show that symptoms improve because of treatment, but the functioning of the patients does not improve significantly. More research is clearly needed in all aspects of this disorder but especially in examining the efficacy of various types of treatment, its longitudinal course, and diagnostic issues. The indications for, and the overall duration of, long-term maintenance therapy need further study.Many adolescents and children with bipolar disorder do not respond to any of the first-line pharmacologic treatments; therefore, studies with novel agents should be extended to patients in this age range. Furthermore, physicians will probably continue to use combination therapies when confronted by either lack of efficacy or delayed onset of efficacy with a single agent. Thus, such resultant drug-drug interactions also should also be systematically studied [97].

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    • ", or in the Geller et al . ( 2003 ) study ( 54% for individual and group therapy ) . There appeared to be limited but effective use ( 31% ) of combined mood stabilizing and antipsychotic thera - pies , or the addition of psychostimulants ( 11% ) for relief of a broader range of symptoms over time ( Strober et al . , 1995 ; Kowatch et al . , 2000 ; Weller et al . , 2002 ; Dunner , 2005 ) . It appears that the use of adjunctive individual and family treatment services facilitates the impact of combination pharmacothera - pies ( mood stabilizers , antidepressants , and SGAs ) in achieving symptom reduction and improved psycho - social functioning . Thus , the anticipated congruence between community - ba"
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    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.
    Human Psychopharmacology Clinical and Experimental 01/2008; 23(1):53-9. DOI:10.1002/hup.900 · 2.19 Impact Factor
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    • "Overall, more research is needed to better understand the role of psychopharmacological agents in the treatment of PBD (Smarty & Findling, 2007). Weller, Danielyan, & Weller (2004) highlight the need for confident bipolar diagnoses before starting medication. Unfortunately, it is difficult to arrive at correct bipolar diagnoses with such confidence. "
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    ABSTRACT: Clinical decision-making and pediatric bipolar disorder
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    ABSTRACT: An improved understanding of bipolar disorder should help clinicians in the accurate diagnosis and treatment of children and adolescents with bipolar disorder. Clinicians should use preliminary evidence and sound clinical judgment when working with patients who have, or may be at risk of, bipolar disorder. Purpose of review: This article reviews current literature on the diagnosis and treatment of bipolar disorder in children and adolescents. Controversies relating to diagnosis, common comorbid psychiatric disorders, and the safety and efficacy of pharmocotherapy are summarized. Recent findings: The presentation of bipolar disorder in children and adolescents has been described by some as ‘atypical’ in that (1) the predominant mood is often one of irritability, (2) the irritability may be severe, persistent, and violent, (3) the pattern of cycling may be ultradian, (4) comorbid psychiatric disorders and family history of bipolar disorder are common, and (5) poor treatment response and recurrence are common. However, given the prevalence of mixed mania in adult bipolar disorder and the similarities between childhood‐ and adolescent‐onset bipolar disorder and mixed mania, some claim that the child and adolescent variant may not be atypical after all. Adding to the confusion are the diverse manifestations of bipolar symptoms at different developmental stages. Lithium, valproate, and carbamazepine are the medications most commonly used to treat children and adolescents with bipolar disorder. However, current practice parameters are based on preliminary evidence and/or studies using adult patients. There is a need for randomized, double‐blind, controlled trials to determine medication safety and efficacy in children and adolescents with bipolar disorder.
    Current Opinion in Psychiatry 07/2003; 16(4):383-388. DOI:10.1097/01.yco.0000079216.36371.d5 · 3.94 Impact Factor
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