Pharmacotherapy of bipolar disorder in children and adolescents: an update (original) (raw)
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Pharmacotherapy of Bipolar Disorder in Children and Adolescents
CNS Drugs, 2010
Child and adolescent bipolar disorder (BPD) is a serious psychiatric disorder that often causes significant impairment in functioning. Pharmacological intervention is the cornerstone of treatment for bipolar youth, although psychotherapeutic interventions may be beneficial as adjunctive treatment. Medications used for the treatment of BPD in adults are still commonly used for bipolar children and adolescents. With the recent US FDA indication of risperidone, aripiprazole, quetiapine and olanzapine for the treatment of bipolar youth, the atypical antipsychotics are rapidly becoming a first-line
Psychopharmacology of pediatric bipolar disorder
Expert Review of Neurotherapeutics, 2010
This comprehensive literature review incorporates research studies evaluating the effectiveness of psychotropic medications in children and adolescents with pediatric bipolar disorder. Research articles were obtained using Medline. Open-label studies, prospective and retrospective chart reviews and randomized controlled trials evaluating the effectiveness of medication in pediatric bipolar disorder with greater than ten subjects are included in this article. Antipsychotics, anticonvulsants and lithium as monotherapy, as well as their use in combination treatment, were evaluated to determine their effectiveness in pediatric bipolar disorder. Clinical recommendations of medication and management strategies are made from a synthesis of the data. In addition, adherence concerns caused by adverse effects and nonresponse as they impact physical and mental health are addressed.
An Open-Label Trial of Risperidone in Children and Adolescents with Bipolar Disorder
Journal of Child and Adolescent Psychopharmacology, 2005
Objective: The diagnosis and treatment of youth with severe nonepisodic irritability and hyperarousal, a syndrome defined as severe mood dysregulation (SMD), has been the focus of increasing concern and debate among clinicians and researchers. Our main objective was to assess the effectiveness of risperidone for youths with SMD. Methods: An 8-week open label trial with risperidone was conducted. We extensively assessed 97 subjects with semistructured and clinical interviews and enrolled 21 patients in the study. Risperidone was titrated from 0.5 to 3 mg/day in the first 2 weeks. Evaluations were performed at baseline and weeks 2, 4, 6, and 8. Clinical outcome measures were (1) Aberrant Behavior Checklist-Irritability Subscale, (2) Clinical Global Impressions, and (3) severity of co-morbid conditions. Results: We found a significant reduction of the Aberrant Behavior Checklist-Irritability scores during the trial after risperidone use ( p < 0.001). The scores at week 2 (mean ¼ 12.03; standard error [SE] ¼ 2.94), week 4 (mean ¼ 15.48; SE ¼ 2.93), week 6 (mean ¼ 12.29; SE ¼ 2.86), and week 8 (mean ¼ 11.28; SE ¼ 3.06) were significantly reduced compared with the baseline mean score (mean ¼ 25.89; SE ¼ 2.76) ( p < 0.001). We also found an improvement in attention-deficit/ hyperactivity disorder, depression, and global functioning ( p < 0.001). Conclusion: Risperidone was effective in reducing irritability in SMD youth. To the best of our knowledge, this is the first psychopharmacological trial in this group of patients with positive results. Further randomized, controlled studies are needed.
Risperidone treatment for ADHD in children and adolescents with bipolar disorder
2008
Children and adolescents with bipolar disorder are also at high risk of having comorbid attention-defi cit hyperactivity disorder (ADHD). The objective of this study was to estimate improvement in ADHD symptoms in children with bipolar disorder. Methods: This was an open-label, study of risperidone monotherapy for the treatment of pediatric bipolar disorder. Thirty-one children and adolescents 4-15 years of age (7.2 ± 2.8 years) of both sexes (71%, N = 22 male) with pediatric bipolar disorder (YMRS score = 32.9 ± 8.8) and ADHD (ADHD-RS score = 37.9 ± 8.9) were included in these analyses. Results: Improvement in ADHD symptoms was contingent on improvement in manic symptoms. Although both hyperactive/impulsive (−7.5 ± 5.5.6, p Ͻ 0.05) and inattentive (−6.8 ± 5.0, p Ͻ 0.05) ADHD symptoms were signifi cantly improved with risperidone, improvement was modest, and only 29% of subjects (N = 6) showed a 30% reduction in ADHD rating scale scores and had a CGI-I Յ 2. Conclusions: These results suggest that that treatment with risperidone is associated with tangible but generally modest improvement of symptoms of ADHD in children with bipolar disorder.
Treatments in child and adolescent bipolar disorders
European child & …, 2007
The existence of bipolar disorder in adolescents is now clearly established. However, whether bipolarity exists in children is more controversial. We reviewed the literature on acute and prophylactic treatment of bipolar disorder in youths. The guidelines for the treatment of bipolar disorder in children and adolescents are generally similar to those applied in adult practice. But no evidence-based data support the use of mood stabilisers or antipsychotics since we only found two placebo-randomised controlled trials testing the efficacy of lithium in the paediatric literature. Therefore, we support the view that prescriptions should be limited to the most typical cases. In fact, the use of mood stabilisers or antipsychotics in the treatment of bipolar disorder in children and adolescents appears to be of limited use when a comorbid condition, such as attention deficit hyperactivity disorder, occurs unless aggressive behaviour is the target symptom.
Biological Psychiatry, 2005
To evaluate short-term safety and efficacy of atypical antipsychotics in a single-site, prospective, open-label, 8-week study of risperidone and olanzapine monotherapy in preschoolers with bipolar disorder (BPD). Methods: Risperidone was initiated at an open-label dose of .25 mg/day, increased weekly according to response and tolerability to a maximum does of 2.0 mg/day. Olanzapine was initiated at 1.25 mg/day and increased to no more than 10 mg/day. Results: Thirty-one children aged 4 -6 years were treated with olanzapine (n ϭ 15, 6.3 Ϯ 2.3 mg/day) or risperidone (n ϭ 16, 1.4 Ϯ .5 mg/day). At study end point (week 8 or last observation carried forward), there was a 18.3 Ϯ 11.9 point (t ϭ -5.6, p Ͻ .001) reduction in risperidone-treated subjects and a 12.1 Ϯ 10.4 point (t ϭ -4.4, p Ͻ .001) reduction in Young Mania Rating Scale (YMRS) scores in olanzapine-treated subjects that did not differ between groups (t ϭ . Response criteria (Clinical Global Impression improvement of "Much" or "Very Much" improved or a YMRS change of Ն 30% or more) indicated no difference in rate of response with risperidone and olanzapine (69% vs. 53%, 2