Somatic treatment of bipolar disorder in children and adolescents.
ABSTRACT 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 .
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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 · 1.85 Impact Factor
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ABSTRACT: It is well-known that electroconvulsive therapy (ECT) is a safe and effective treatment for some mental disorders in adults. However, its use in children and adolescents is still the cause of some fears which may not be justified. The aim of this article is to clarify and to present the state of this question by reviewing the literature about ECT in children and adolescents, with emphasis on efficacy, indications, adverse effects and limitations. Results from studies in this population group show similar safety and efficacy data as those observed in adults. There exists a misinformation about the ECT technique among child psychologists and psychiatrists. Large follow-up studies are needed.Medicina Clínica 04/2004; 122(9):349-54. · 1.25 Impact Factor