Are pharmacologic agents effective for bipolar disorder in children and adolescents?
Benjamin I. Goldstein, PhD, MD. Bipolar disorder presents unique pharmacologic challenges. Depending on the phase of illness a patient is in, the focus may be on acute manic or mixed episodes, acute depressive episodes, maintenance treatment (ie, prevention of recurrent episodes), and/or treatment of comorbidities, such as anxiety, ADHD, and substance abuse.
Should lithium be used to treat bipolar disorder in youth?
Bipolar Disorder Among Youth. The typical period of BPD onset as a syndrome is between 16 and 24 years of age. By the conventional fully-syndromal criteria discussed earlier, the condition becomes less prevalent with decreasing age. Bipolar spectrum disorders affect 0.1% of children and 1% of adolescents.
Is there an anti-inflammatory treatment for bipolar disorder?
In light of systematic reviews, large randomized controlled trial data are emphasized wherever possible. This review addresses the treatment of acute manic/mixed episodes, including combination treatment, the preliminary literature regarding bipolar depression among youth, treatment in the face of comorbid conditions, and maintenance treatment.
Which antiepileptic agents are used in the treatment of bipolar disorder?
A retrospective chart review indicated a 73% response rate with topiramate for 26 adolescents with bipolar I disorder. 56 In a double-blind, placebo-controlled trial of 56 youths ages 6–17 years with bipolar I disorder, topiramate demonstrated preliminary evidence of improvement in symptoms; however, the trial was discontinued prematurely after trials with adults with bipolar …
What treatment is recommended for youth with bipolar disorder?
What are the pharmacological treatment for bipolar disorder?
Which of the following medications are approved by the FDA for treating bipolar depression in children ages 10 17?
What is the second line of treatment for bipolar disorder?
What is the most effective treatment for bipolar disorder?
What is the most effective drug for treating bipolar disorder?
What medications are used to treat bipolar disorder in teens?
What medication is used to treat bipolar in children?
Which of the following medications are approved by the FDA for treatment of mania in children ages 12 17?
How do antipsychotics help bipolar?
What is the purpose of bipolar disorder?
Opinion statement Purpose of review Bipolar disorder is a chronic and disabling condition that often presents in adolescence and leads to significant functional impairment , especially in the areas of emotional, cognitive, and social development. Pharmacotherapy is a vital component of the complex treatment of this disorder.The purpose of this review is to provide an overview of the available data on the management of bipolar disorder and the most common comorbid conditions in youth. Recent findings Several medications such as lithium and second-generation antipsychotics (risperidone, aripiprazole, olanzapine, quetiapine, and asenapine) are currently approved by the FDA for the management of acute mixed or manic phases of pediatric bipolar disorder. Very limited data are available on continuation treatment and management of depressive phases of bipolar disorder. There is some evidence that supports the use of a combination of an antipsychotic with lithium or an anticonvulsant for treatment of resistant cases. Summary Monotherapy with an atypical antipsychotic or lithium is the preferable initial treatment of acute manic or mixed episodes. The available evidence supports the use of an olanzapine/fluoxetine combination for the treatment of bipolar depression, which has also been approved by the FDA for this purpose. Additional studies are needed to evaluate safety and efficacy of psychopharmacological interventions, especially focusing on treatment of the depressive and maintenance phases of bipolar disorder.
What is BPSD in youth?
The past 25 years has witnessed significant advances in our knowledge of Bipolar Spectrum Disorders (BPSD) in youth. Cross-sectional and longitudinal studies are clarifying the unique features of its pediatric presentation, including continuities and discontinuities across the spectrum of severity. Advances have been made, both in the pharmacological and psychological management of BPSD in youth. Current investigations may ultimately shed light on new treatment strategies. Future research is anticipated to be influenced by NIMH's Research Domain Criteria (RDoC). With this article, we summarize what is currently known about the basic phenomenology of pediatric BPSD, its clinical course, assessment and treatment, beginning with a summary of the major studies that have shed light on the topic. Next, we present a tally and content review of current research as an indicator of trends for the future. Then, we describe what we believe are important future directions for research. Finally, we conclude with implications for contemporary clinicians and researchers.
What is AP medication?
... Antipsychotic (AP) drugs are recommended for the treatment for schizophrenia [1] and bipolar disorders [2] in children and adolescents . These drugs are effective in managing the core symptoms of these two diseases [1,2]. ...
Is PBD a psychosocial disorder?
Pediatric bipolar disorder (PBD) has emerged as a research field in which psychosocial treatments have provided a plethora of empirical findings over the last decade . We addressed this issue through a systematic review aimed of establishing their effectiveness and feasibility as adjunctive therapies for youth with PBD or at high-risk for PBD. A comprehensive search of databases was performed between 1990 and September 2014. Overall, 33 studies were specifically related to the issue and 20 of them were original articles. Evidence suggests that both «multi-family psychoeducational psychotherapy» and «family-focused therapy» are possible effective treatments for PBD. Likewise, «child and family-focused cognitive-behavioral therapy» may be characterized as a treatment in its experimental phase. The remaining therapies fail to obtain enough empirical support due to inconsistent findings among clinical trials or data solely based on case reports. Studies of psychosocial treatments provide concluding results concerning their feasibility and acceptability. Larger sample sizes and more randomized controlled trials are mandatory for diminishing methodological shortcomings encountered in the treatments displayed. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.
Can a child have a mood disorder?
Mood disorders in children account for a significant amount of disability. However due to varied presentation of symptoms and subsyndromal episodes among children and adolescents, it is often difficult to correctly diagnose mood disorders. We are presenting a case of an adolescent male with atypical mood symptoms and highlighting on the difficulties faced in the diagnosis and the challenges in his management.
Is clozapine used for schizophrenia?
The use of clozapine (CLZ) for treatment-resistant schizophrenia is well established in adults. However, it is seldom used in youth with early onset schizophrenia (EOS) largely because of lack of clarity about its risk benefit ratio. This review synthesises and evaluates available evidence regarding the efficacy and tolerability of CLZ in EOS with the aim to assist clinical decision-making. We conducted a systematic review of the primary literature on the clinical efficacy and adverse drug reactions (ADRs) observed during CLZ treatment in EOS. We also identified relevant practice guidelines and summarised current guidance. CLZ showed superior efficacy than other antipsychotics in treating refractory EOS patients; short-term clinical trials suggest an average improvement of 69% on the Brief Psychiatric Rating Scale that was sustained during long-term follow-up (up to 9 years). No fatalities linked to CLZ treatment were reported. Sedation and hypersalivation were the most common complaints, reported by over 90% of patients. Other common ADRs (reported in 10-60% of patients) were enuresis, constipation, weight gain, and non-specific EEG changes. Less common ADRs (reported in 10-30% of patients) were akathisia, tachycardia and changes in blood pressure. Neutropenia was reported in 6-15% of cases but was usually transient while agranulocytosis was rare (<0.1%). Seizures were also uncommon (<3%). Metabolic changes were relatively common (8-22%) but emergent diabetes was not frequently observed (<6%). Overall the rate of discontinuation was low (3-6%). Current guidelines recommend the use of CLZ in EOS patients who have failed to respond to two adequate trials with different antipsychotics and provide detailed schedules of assessments to evaluate and assess potential ADRs both prior to initiation and throughout CLZ treatment. Available data although limited in terms of number of studies are consistent in demonstrating that CLZ is effective and generally safe in the treatment of refractory EOS provided patients are regularly monitored.
Does MST help with depression?
Magnetic seizure therapy (MST) has shown efficacy in adult patients with treatment-resistant depression with limited impairment in memory. To date, the use of MST in adolescent depression has not been reported. Here we describe the first successful use of MST in the treatment of an adolescent patient with refractory bipolar depression. This patient received MST in an ongoing open-label study for treatment-resistant major depression. Treatments employed a twin-coil MST apparatus, with the center of each coil placed over the frontal cortex (ie, each coil centered over F3 and F4). MST was applied at 100 Hz and 100% machine output at progressively increasing train durations. Depressive symptoms were assessed using the 24-item Hamilton Depression Rating Scale and cognitive function was assessed with a comprehensive neuropsychological battery. This adolescent patient achieved full remission of clinical symptoms after an acute course of 18 MST treatments and had no apparent cognitive decline, other than some autobiographical memory impairment that may or may not be related to the MST treatment. This case report suggests that MST may be a safe and well tolerated intervention for adolescents with treatment-resistant bipolar depression. Pilot studies to further evaluate the effectiveness and safety of MST in adolescents warrant consideration.
Is pediatric bipolarity a chronic illness?
Pediatric bipolarity is, however, a chronic illness and clinical trials are very much needed to determine the safety and efficacy of pharmacologic treatments in pediatric patients with acute manic and mixed states, during the maintenance phase of the illness.
Is gabapentin effective for BDI?
A safety and efficacy study of adjunctive gabapentin indicated that it was not an effective treatment for youth aged 16 and older and adults with BDI, manic, hypomanic, or mixed symptoms ( Pande, Crockatt, Janney, Werth, & Tsaroucha, 2000 ). This study compared gabapentin to Li +, DVPX, and Li + plus DVPX. Gabapentin was not more effective when compared to these other medications. Currently, there are no methodologically rigorous studies in pediatric-aged patients.
Is quetiapine more effective than placebo?
In a pilot study of quetiapine, DelBello and colleagues found that quetiapine was not more effective than placebo in treating adolescents with bipolar depression ( DelBello et al., 2009 ). It was suggested that the high placebo response rate may have had an impact on the study findings, which should be a consideration in designing future studies.
What is Li +?
Lithium carbonate (Li +) was the first FDA-approved medication prescribed for treating BDI in adolescents ages 12 and older. Li + was initially studied and FDA-approved for the treatment of bipolar disorder in adults. There are, however, only a few rigorous, evidence-based treatment studies of Li + in pediatric populations.
What is the purpose of the article "Bipolar Disorder"?
The primary purpose of this article is to distill the extant literature, dispel myths or exaggerated assertions in the field, and disseminate clinically relevant findings.
What is the best medication for mania?
Second-generation antipsychotics (SGAs) approved by the United States Food and Drug Administration (FDA) for the treatment of acute mania and/or mixed mania in children and adolescents (10-17 years) include risperidone, aripiprazole and quetiapine, olanzapine, and asenapine 13 - 17 ( http://www.accessdata.fda.gov/scripts/cder/daf/ ). Lithium has FDA indication for the treatment and recurrence prevention of mania in youths aged 12 years and older, bolstered by a recently published positive 8-week RCT for youths 7-17 years old with BD-I manic/mixed episodes. 130 In that study, change in mania symptom scores was significantly larger in lithium-treated participants, as was global improvement at week 8, compared to placebo-treated participants.
What is the role of the amygdala in the ECN?
Within the ECN, the amygdala plays a central role in emotional regulation. Two meta-analyses of magnetic resonance imaging (MRI) studies reported that youth with PBD present with smaller amygdala volumes compared with controls. 191, 192 One prospective study that evaluated youth after their first manic episode showed that amygdala volumes failed to show a normal increase with aging in patients, whereas this did not occur in controls or in youth with ADHD, suggesting that hampered neurodevelopment of the amygdala may underlie the dysfunctional emotional processing present in the ventral-limbic pathway. 193 Diffusion tensor imaging (DTI) studies have investigated abnormalities in the white matter microstructure of youth with PBD. Preliminary findings suggest the presence of abnormal white matter microstructure in superior frontal regions, 194, 195 and inferior/ventral frontal areas, such as the orbitofrontal or anterior cingulate cortex, and anterior regions of the corpus callosum 196 - 200 compared to controls. One study found even greater reduction in white matter integrity in the anterior limb of the internal capsule in PBD vs adult BD. 201 Most of these studies had very small sample sizes, but, together, they are consistent with a hypothesis of structural connectivity deficits between prefrontal-subcortical areas that underlie the prefrontal-limbic dysfunction in PBD.
What are the two hypotheses of BD?
Proton magnetic resonance spectroscopy studies are particularly important to help understand two current neurobiological hypotheses of BD, ie, glutamatergic dysfunction and mitochondrial dysfunction or energy metabolism dysfunction . Several studies in PBD have shown abnormalities in glutamate or glutamine levels in prefrontal brain areas. 214, 215 Abnormal levels of metabolites that are considered to be biomarkers of mitochondrial dysfunction or cell energy metabolism, such as decreased N-acetyl-aspartate or increased myo-inositol levels, were found in dorsal and ventral areas of the prefrontal cortex in PBD. 216 - 224
What are the cognitive deficits of PBD?
232 A meta-analysis of 10 cognitive studies reported overall cognitive deficits in PBD (n = 352) compared to healthy controls (HCs; n = 439) with mean effect sizes that are: large in verbal memory; moderate to large in attention and working memory; moderate in executive functioning, visual perceptual skills, and visual memory; and small to moderate in motor speed, reading achievement, full-scale IQ, and verbal fluency. 232 A prospective study showed that youth with PBD may exhibit a delay in cognitive development compared with controls in some cognitive domains (eg, executive functioning and verbal memory), despite optimal pharmacologic management. 233 Thus, it is essential to investigate therapeutic strategies, such as cognitive remediation 234 and/or optimizing cardiometabolic health, 78 that might be useful to restore these cognitive deficits and improve academic, social and functional impairments in youth with PBD.
What is a selective review of literature?
An international group of experts completed a selective review of the literature, emphasizing areas of consensus, identifying limitations and gaps in the literature, and highlighting future directions to mitigate these gaps.