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 .
Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 01/2009; 37(1):27-50. DOI:10.1024/1422-49126.96.36.199 · 0.99 Impact Factor
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ABSTRACT: Aim: To review the literature on randomized clinical trials for pediatric anxiety and depression, and evaluate their quality using the criteria developed by the American Psychological Association. Method: Inclusion of randomized controlled clinical trials in the medical and psychological literature. Results: Research evidence thus far suggests that CBT is a probably efficacious treatment for depression in children. None of the CBT protocols for depressed adolescents (taken independently) meet criteria for a well-established treatment, however, if the different protocols are taken as an aggregate, then CBT meets well-established treatment criteria. In addition, IPT-A is a well-established treatment for adolescent depression. CBT is the best established treatment for a number of child and adolescent anxiety disorders. Conclusion: While there has been an increase in the number of clinical trials of psychotherapeutic interventions for depression and anxiety as well as support for empirically-based treatments, the scope of these studies is still limited and research is still needed to examine the transportability of these treatments to diverse community settings.Current Psychiatry Reviews 07/2006; 2(3):395-421. DOI:10.2174/157340006778018102
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ABSTRACT: Bipolar disorder is frequently clinically diagnosed in youths who do not actually satisfy Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; DSM-IV-TR; American Psychiatric Association, 1994) criteria, yet cases that would satisfy full DSM-IV-TR criteria are often undetected clinically. Evidence-based assessment methods that incorporate Bayesian reasoning have demonstrated improved diagnostic accuracy and consistency; however, their clinical utility is largely unexplored. The present study examines the effectiveness of promising evidence-based decision-making strategies compared with the clinical gold standard. Participants were 562 youths, ages 5 to 17 and predominantly African American, drawn from a community mental health clinic. Research diagnoses combined a semistructured interview with youths' psychiatric, developmental, and family mental health histories. Independent Bayesian estimates that relied on published risk estimates from other samples discriminated bipolar diagnoses (area under curve = .75, p < .00005). The Bayes and confidence ratings correlated at rs = .30. Agreement about an evidence-based assessment intervention threshold model (wait/assess/treat) was κ = .24, p < .05. No potential moderators of agreement between the Bayesian estimates and confidence ratings, including type of bipolar illness, were significant. Bayesian risk estimates were highly correlated with logistic regression estimates using optimal sample weights (r = .81, p < .0005). Clinical and Bayesian approaches agree in terms of overall concordance and deciding next clinical action, even when Bayesian predictions are based on published estimates from clinically and demographically different samples. Evidence-based assessment methods may be useful in settings in which gold standard assessments cannot be routinely used, and they may help decrease rates of overdiagnosis while promoting earlier identification of true cases.Psychological Assessment 10/2011; 24(2):269-81. DOI:10.1037/a0025775 · 2.99 Impact Factor