Practitioner review: long-term pharmacological treatment of pediatric bipolar disorder. J Child Psychol Psychiatry

ArticleinJournal of Child Psychology and Psychiatry 55(9) · June 2014with36 Reads
Impact Factor: 6.46 · DOI: 10.1111/jcpp.12271 · Source: PubMed
Abstract

Background: 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. Methods: A MEDLINE, EMBASE, Cochrane and PsycInfo search (inception through November 2013) was performed to identify prospective studies longer than 12 weeks assessing the use of pharmacological strategies for the long-term treatment of BD in pediatric patients (0-18 years of age). Results: Four randomized controlled trials (RCT) [three placebo-controlled (assessing aripiprazole (2) and flax oil), and one head-to-head comparison of lithium vs. divalproex], and thirteen noncontrolled studies (six open-label studies assessing lithium or anticonvulsants, five assessing second-generation antipsychotics (SGAs) and four assessing combination strategies) were included in the review. Aripiprazole has shown efficacy for relapse prevention in children with pediatric bipolar disorder (PBD) 4-9 years of age in one placebo-controlled RCT. Positive results have been reported in noncontrolled studies with quetiapine and lithium for relapse prevention, as well as with lithium, quetiapine, ziprasidone, and the combination of risperidone and divalproex or lithium for long-term symptom reduction in PBD. The most frequently reported adverse events in children and adolescents treated with lithium and anticonvulsants are gastrointestinal and neurological, whereas use of SGAs is mainly related to weight gain and sedation. Conclusion: According to the limited empirical evidence, aripiprazole can be useful for relapse prevention in children with PBD. Given the lack of consistent efficacy data, clinical decision making should be based on individual clinical aspects and safety concerns.

    • "Several factors likely contributed to the paucity of long-term studies: (1) Longterm studies are expensive; (2) High percentage of participants drop out from long-term studies; (3) Regression to the mean phenomenon. Nevertheless, several long-term studies have recently been published (for review see [11]). "
    [Show abstract] [Hide abstract] ABSTRACT: Bipolar disorder is a serious psychiatric disorder that frequently begins in childhood and lasts a lifetime. In the last 10–15 years, many advances have been made in the short-term treatment of bipolar disorder in children and adolescents, especially mixed and manic episodes. Less is known about long-term treatment and treatment of depressive episodes. This paper reviews recent literature on long-term treatment strategies for pediatric bipolar disorder. Pharmacologically, several second generation antipsychotics and mood stabilizers were recently studied in long-term treatment trials. These agents showed comparable effectiveness in reducing manic symptoms. Most benefits were attained early in treatment. The majority of patients did not complete the studies. The agents varied in their side effect profiles. Based on these findings, we recommend (1) maximizing treatment benefits during acute phase, (2) choosing a pharmacological agent on the basis of side effect profile, and (3) using the lowest effective dose to minimize side effect burden. Despite the benefits of medications, a majority of patients will not adhere to permanent medication regimen. Thus, psychosocial treatments can theoretically fill the gap and complement pharmacological treatments. No definitive psychosocial treatment for pediatric bipolar disorder has been developed. However, psychosocial treatments can facilitate medication adherence and early symptom recognition through psychoeducation. Dialectical Behavioral Therapy can assist with emotional regulation and reduce suicidality, and cognitive behavioral therapy can improve adherence and satisfaction with treatment.
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    • "Control males were similarly treated with the vehicle. We assumed that this treatment is required to observe changes in behavior, as often seen in behavior studies using drugs such as lithium (a mood stabilizer and a GSK-3 inhibitor [Diaz-Caneja et al., 2014]). Nasal administration had been found to be an effective route for delivering small tides into the central nervous system in mammals [Illum, 2000; Born et al., 2002] and in birds [Hornak et al., 2015]. "
    [Show abstract] [Hide abstract] ABSTRACT: GSK-3 (glycogen synthase kinase-3) is a serine/threonine kinase which is a critical regulator in neuronal signaling, cognition, and behavior. We have previously shown that unlike other vertebrates that harbor both α and β GSK-3 genes, the α gene is missing in birds. Therefore, birds can be used as a new animal model to study the roles of GSK-3β in behavior and in regulating adult neurogenesis. In the present study, we inhibited GSK-3β in brains of adult male zebra finches (Taeniopygia guttata) and accordingly investigated how this inhibition affects behavior and cell proliferation. Our results show that GSK-3 inhibition: (1) affects specific aspects of singing behavior, which might be related to social interactions in birds, and (2) differentially affects cell proliferation in various parts of the ventricular zone. Taken together, our study demonstrates a role of GSK-3β in regulating singing behavior and neuronal proliferation in birds and highlights the importance of GSK-3β in modulating cognitive abilities as well as social behavior. © 2015 S. Karger AG, Basel.
    Full-text · Article · Jun 2015 · Brain Behavior and Evolution
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  • [Show abstract] [Hide abstract] ABSTRACT: It is well known that concerning the prevalence of unipolar depression, females have almost double rates in comparison to males. However, this does not hold true concerning BD, for which similar rates between males and females are reported. There are some data suggesting that males might be over-represented in those diagnosed with a BD-I and females over-represented in those diagnosed with a BD-II disorder.
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