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Atkinson S, Bachinsky M, Raiter Y, Abreu P, Ianos C, Chappell P, Findling RL. 26-Week Open-Label Extension Study Evaluating the Safety and Tolerability of Flexible Doses of Oral Ziprasidone in Children and Adolescents with Bipolar I Disorder (Most Recent Episode Manic). J Child Adolesc Psychopharmacol 2022; 32:453-458. [PMID: 36282771 DOI: 10.1089/cap.2022.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Objective: To describe the longer-term effectiveness, safety, and tolerability of open-label ziprasidone in children and adolescents with bipolar I disorder (BD-I). Methods: A subset of 23 participants aged 10-17 years, who were previously treated in a multi-site, 4-week randomized controlled trial received open-label ziprasidone (20-80 mg twice a day) for up to 26 weeks. Results: The most common adverse events (AEs) were fatigue (30%), somnolence (17%), and nausea (13%). Effects on weight, body mass index, and metabolic parameters (glucose, cholesterol, and triglycerides) were minimal. No participant had a Fridericia-corrected QT interval ≥ 460 msec or a change from baseline of ≥60 msec, and there were no cardiac-related AEs. Both the participants who continued ziprasidone and those who initiated ziprasidone in the open-label extension showed improvements in their symptoms of mania. Conclusions: The overall findings of the study are consistent with the accumulating knowledge on the safety profile of ziprasidone in the acute and long-term treatment of children and adolescents with BD-I, in the midst of a manic episode. ClinicalTrial.gov ID: NCT03768726.
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Affiliation(s)
- Sarah Atkinson
- Psychiatry, Child and Adolescent Psychiatry, Finger Lakes Clinical Research, Rochester, New York, USA
| | - Mary Bachinsky
- Clinical Development and Operations, Pfizer, Inc., Groton, Connecticut, USA
| | - Yaron Raiter
- Clinical Development, GE Healthcare, Eindhoven, The Netherlands
| | - Paula Abreu
- Global Biometrics and Data Management, Pfizer, Inc., New York, New York, USA
| | - Claudia Ianos
- Worldwide Medical and Safety, Pfizer AG, Zurich, Switzerland
| | - Phillip Chappell
- Clinical Development and Operations, Pfizer, Inc., Groton, Connecticut, USA
| | - Robert L Findling
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
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Bareis N, Lu J, Kirkwood CK, Kornstein SG, Wu E, Mezuk B. Identifying clinical net benefit of psychotropic medication use with latent variable techniques: Evidence from Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). J Affect Disord 2018; 238:147-155. [PMID: 29883936 PMCID: PMC6063799 DOI: 10.1016/j.jad.2018.05.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 04/09/2018] [Accepted: 05/28/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Poor medication adherence is common among individuals with Bipolar Disorder (BD). Understanding the sources of heterogeneity in clinical net benefit (CNB) and how it is related to psychotropic medications can provide new insight into ways to improve adherence. METHODS Data come from the baseline assessments of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Latent class analysis identified groups of CNB, and validity of this construct was assessed using the SF-36. Adherence was defined as taking 75% or more of medications as prescribed. Associations between CNB and adherence were tested using multiple logistic regression adjusting for sociodemographic characteristics. RESULTS Five classes of CNB were identified: High (24%), Moderately high (12%), Moderate (26%), Moderately low (27%) and Low (12%). Adherence to psychotropic medications did not differ across classes (71% to 75%, χ2 = 3.43, p = 0.488). Medication regimens differed by class: 57% of the High CNB were taking ≤2 medications, whereas 49% of the Low CNB were taking ≥4. CNB classes had good concordance with the SF-36. LIMITATIONS Missing data limited measures used to define CNB. Participants' perceptions of their illness and treatment were not assessed. CONCLUSIONS This novel operationalization of CNB has construct validity as indicated by the SF-36. Although CNB and polypharmacy regimens are heterogeneous in this sample, adherence is similar across CNB. Studying adherent individuals, despite suboptimal CNB, may provide novel insights into aspects influencing adherence.
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Affiliation(s)
- Natalie Bareis
- Division of Behavioral Health Services and Policy Research, Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, 1051 Riverside Drive, Room 6402A, New York, NY 10032, United States.
| | - Juan Lu
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, 830 East Main Street, 8th floor, Richmond 23219, VA, United States
| | - Cynthia K Kirkwood
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, United States
| | - Susan G Kornstein
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, United States
| | - Elwin Wu
- Social Intervention Group, Columbia School of Social Work, United States
| | - Briana Mezuk
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, 830 East Main Street, 8th floor, Richmond 23219, VA, United States; Department of Epidemiology, University of Michigan School of Public Health, United States
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Yektaş Ç, Paşabeyoğlu B, Mutlu C, Erdoğan A. The prescribing pattern of paliperidone in a pediatric population. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1387404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Çiğdem Yektaş
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Düzce University, Duzce, Turkey
| | - Başak Paşabeyoğlu
- Psychology Department, Faculty of Humanities and Social Sciences, Uskudar University, Istanbul, Turkey
| | - Caner Mutlu
- Department of Child and Adolescent Psychiatry, Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Ayten Erdoğan
- Department of Psychology, Beykent University, Istanbul, Turkey
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Giles LL, Martini DR. Challenges and Promises of Pediatric Psychopharmacology. Acad Pediatr 2016; 16:508-18. [PMID: 27064142 DOI: 10.1016/j.acap.2016.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 03/05/2016] [Accepted: 03/28/2016] [Indexed: 01/27/2023]
Abstract
Most prescriptions for psychotropic medications are written by primary care physicians, yet pediatricians, many of whom are teaching residents and medical students about pediatric psychopharmacology, often feel inadequately trained to treat mental health concerns. Over the past several decades, the number, size, and quality of psychopharmacologic studies in youth has greatly increased. Here we review the current evidence for efficacy and safety of each of the major pharmacologic drug classes in youth (psychostimulants, antidepressants, mood stabilizers, and antipsychotics). Psychostimulants have a robust body of literature supporting their evidence as first-line treatment for attention-deficit/hyperactivity disorder. Selective serotonin reuptake inhibitors (SSRIs) have documented efficacy for pediatric depression and multiple different anxiety disorders with childhood onset. Combining cognitive-behavioral therapy with SSRI treatment enhances treatment benefit and minimizes adverse events of medication. Mood stabilizers, including lithium and anticonvulsant medications, have a less robust strength of evidence and come with more problematic side effects. However, they are increasingly prescribed to youth, often to treat irritability, mood lability, and aggression, along with treatment of bipolar disorder. Antipsychotics have long been a mainstay of treatment for childhood-onset schizophrenia, and in recent years, the evidence base for providing antipsychotics to youth with bipolar mania and autistic disorder has grown. Most concerning with antipsychotics are the metabolic side effects, which appear even more problematic in youth than adults. By better understanding the evidence-based psychopharmacologic interventions, academic pediatricians will be able to treat patients and prepare future pediatrician to address the growing mental health care needs of youth.
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Affiliation(s)
- Lisa L Giles
- Departments of Pediatrics and Psychiatry, University of Utah School of Medicine and Department of Psychiatry and Behavioral Health, Primary Children's Hospital, Salt Lake City, Utah.
| | - D Richard Martini
- Departments of Pediatrics and Psychiatry, University of Utah School of Medicine and Department of Psychiatry and Behavioral Health, Primary Children's Hospital, Salt Lake City, Utah
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Oh J, Chang JG, Lee SB, Song DH, Cheon KA. Comparison of aripiprazole and other atypical antipsychotics for pediatric bipolar disorder: a retrospective chart review of efficacy and tolerability. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2013; 11:72-9. [PMID: 24023551 PMCID: PMC3766758 DOI: 10.9758/cpn.2013.11.2.72] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/08/2013] [Accepted: 04/12/2013] [Indexed: 11/24/2022]
Abstract
Objective This study compared the efficacy and tolerability of aripiprazole with that of other atypical antipsychotics by examining patients with pediatric bipolar disorder (PBD) at a child and adolescent psychiatric clinic in a university hospital in Korea. Methods We reviewed the medical records of 127 pediatric patients with bipolar disorder aged 4-18 years treated at Department of Child and Adolescent Psychiatric, Yonsei University Severance Hospital between January 2010 and October 2011 to collect demographic and clinical data. Using the Clinical Global Impression (CGI) scales, we evaluated levels of severity of and improvements in symptoms at the first, second, third, fourth, and fifth hospital visits. Results The mean age of patients was 12.29±3.47 years. The sample included 91 (71.7%) male and 36 (28.3%) female patients. Aripiprazole was prescribed to 62 (48.8%) patients, risperidone to 52 (40.9%), quetiapine to 11 (8.7%), and paliperidone to two (1.6%). Patients treated with aripiprazole had lower CGI-Severity (CGI-S) scores than did patients treated with other atypical antipsychotics at the second and third visits. The CGI-Improvement (CGI-I) scores of patients treated with aripiprazole were lower at the second visit. Treatment with atypical antipsychotics was well tolerated, and no serious or fatal side effects were observed. Conclusion The present retrospective chart review suggests that atypical antipsychotics may be effective and safe for the treatment of patients with PBD. In particular, treatment with aripiprazole may be more effective than treatment with other atypical antipsychotics in the early phase. These results should be verified in future multi-center controlled studies.
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Affiliation(s)
- Jooyoung Oh
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
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Rappaport N, Kulick D, Phelps L. PSYCHOTROPIC MEDICATIONS: AN UPDATE FOR SCHOOL PSYCHOLOGISTS. PSYCHOLOGY IN THE SCHOOLS 2013. [DOI: 10.1002/pits.21696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Liu HY, Potter MP, Woodworth KY, Yorks DM, Petty CR, Wozniak JR, Faraone SV, Biederman J. Pharmacologic treatments for pediatric bipolar disorder: a review and meta-analysis. J Am Acad Child Adolesc Psychiatry 2011; 50:749-62.e39. [PMID: 21784295 DOI: 10.1016/j.jaac.2011.05.011] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 05/19/2011] [Accepted: 05/23/2011] [Indexed: 12/13/2022]
Abstract
OBJECTIVE A growing body of literature has documented pediatric bipolar disorder to be a severely impairing form of psychopathology. However, concerns remain as to the inadequacy of the extant literature on its pharmacotherapy. Furthermore, treatment studies have not been systematically reviewed for treatment effects on core and associated symptoms. Thus, a systematic evaluation and synthesis of the available literature on the efficacy of antimanic pharmacotherapy for pediatric bipolar disorder on symptoms of mania, depression, and attention-deficit/hyperactivity disorder was undertaken. METHOD A systematic search was conducted through PubMed from 1989 through 2010 for open-label and randomized controlled trials published in English on the pharmacotherapy of pediatric mania. RESULTS There have been 46 open-label (n = 29) and randomized (n = 17) clinical trials of antimanic agents in pediatric bipolar disorder encompassing 2,666 subjects that evaluated a range of therapeutic agents, including traditional mood stabilizers, other anticonvulsants, second-generation antipsychotics, and naturopathic compounds. This literature has documented that the available armamentarium has different levels of efficacy in the treatment of pediatric mania. Because all psychotropic classes are associated with important adverse effects, a careful risk-benefit analysis is warranted when initiating pharmacologic treatment with any of these compounds. In the limited data available, the effects of antimanic agents on depression and symptoms of attention-deficit/hyperactivity disorder have been, in general, modest. Few studies have evaluated the effects of antimanic agents in children younger than 10 years. CONCLUSIONS A substantial body of scientific literature has evaluated the safety and efficacy of various medicines and drug classes in the treatment of mania in pediatric bipolar disorder. More work is needed to assess the safety and efficacy of psychotropic drugs in children younger than 10 years, to further evaluate the efficacy of naturopathic compounds, and to further evaluate the effects of antimanic treatments for the management of depression and attention-deficit/hyperactivity disorder.
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Affiliation(s)
- Howard Y Liu
- University of Nebraska Medical Center, Omaha, USA
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Thomas T, Stansifer L, Findling RL. Psychopharmacology of pediatric bipolar disorders in children and adolescents. Pediatr Clin North Am 2011; 58:173-87, xii. [PMID: 21281855 DOI: 10.1016/j.pcl.2010.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pediatric bipolar disorder (PBD) is a chronic and disabling illness often leading to serious disruption in the lives of children and adolescents with this condition. Until recently, methodologically stringent data to guide pharmacologic interventions in the youth were scarce. However, clinical trials conducted recently have expanded the existing evidence base, and new data are emerging rapidly. Recent studies have examined the use of lithium, anticonvulsants, and atypical antipsychotics for acute and long-term treatment of PBD. Despite these new advances, further placebo-controlled trials investigating the efficacy and safety of pharmacologic treatment strategies for young people with bipolar disorder are still needed.
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Affiliation(s)
- Tiffany Thomas
- Division of Child and Adolescent Psychiatry, University Hospitals Case Medical Center, Cleveland, OH 44106-5080, USA.
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Toward enough of the best for all: research to transform the efficacy, quality, and reach of mental health care for youth. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2010; 37:191-6. [PMID: 20112059 DOI: 10.1007/s10488-010-0266-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Grimmer Y, Hohmann S, Banaschewski T, Holtmann M. Früh beginnende bipolare Störungen, ADHS oder Störung der Affektregulation? KINDHEIT UND ENTWICKLUNG 2010. [DOI: 10.1026/0942-5403/a000025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Die Arbeit gibt einen Überblick über die Hintergründe der Kontroverse und leitet daraus konkrete Schlussfolgerungen für die klinische Praxis ab. Bei der Diagnostik früher bipolarer Störungen ist vorrangig auf das Auftreten von abgrenzbaren Episoden mit eindeutigen Stimmungsänderungen und Veränderungen von Verhalten und Kognition zu achten. Das Mischbild aus ADHS und begleitender affektiver Dysregulation sollte nicht im Sinne einer beginnenden bipolaren Störung interpretiert werden, bedarf aber stärkerer Beachtung, insbesondere bei der Entwicklung geeigneter psycho- und pharmakotherapeutischer Ansätze. Erläutert werden zudem Gemeinsamkeiten und Unterschiede von bipolaren Störungen mit Schizophrenie, Depression, ADHS, Borderline-Persönlichkeitsstörung und Substanzmissbrauch.
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Affiliation(s)
- Yvonne Grimmer
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters am Zentralinstitut für Seelische Gesundheit Mannheim
| | - Sarah Hohmann
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters am Zentralinstitut für Seelische Gesundheit Mannheim
| | - Tobias Banaschewski
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters am Zentralinstitut für Seelische Gesundheit Mannheim
| | - Martin Holtmann
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters am Zentralinstitut für Seelische Gesundheit Mannheim
- Klinik für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik der LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum
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Abstract
OBJECTIVE The literature on bipolar in children and adolescents was reviewed to provide an update for clinicians. REVIEW PROCESS Literature of particular relevance to evidence-based practice was selected for critical review. OUTCOMES An up-to-date overview of clinical features, epidemiology, prognosis, aetiology, assessment and intervention was provided. CONCLUSIONS Bipolar disorder in children and adolescence is a relatively common, multifactorially determined and recurring problem which persists into adulthood. Psychometrically robust screening questionnaires and structured interviews facilitate reliable assessment. Multimodal chronic care programmes involving medication (notably lithium) and family-oriented psychotherapy are currently the treatment of choice.
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Affiliation(s)
- Alan Carr
- University College Dublin, Belfield, Ireland.
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Abstract
Understanding pediatric psychopharmacology often is an important part of the practice of a general psychiatrist, as a substantial number of children and adolescents are affected by a major psychiatric illness. A general psychiatrist should consider some key issues before he or she begins prescribing psychotropic medications to children and adolescents. Some agents that are effective in adults may not be effective in youths, and similarly, medications that are well tolerated in adults may be associated with accentuated or additional risks when prescribed to young people. This article is an effort to summarize the recent advances in medication therapy of the pediatric population and bring the general psychiatrist up to date on the evidence-based psychopharmacologic treatment of children and adolescents.
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Freeman AJ, Youngstrom EA, Michalak E, Siegel R, Meyers OI, Findling RL. Quality of life in pediatric bipolar disorder. Pediatrics 2009; 123:e446-52. [PMID: 19254981 DOI: 10.1542/peds.2008-0841] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Bipolar disorder is a common mood disorder associated with significant disability and impairment in quality of life in adults. Little research has examined the impact of the disorder on quality of life in children and adolescents. The current study examines the quality of life in children and adolescents with bipolar disorder compared with other physical and psychiatric illnesses. METHODS This study included 529 youth and caregiver pairs who sought services at a community mental health center or an academic medical center. Diagnoses were based on semistructured interviews of caregivers and youths, and quality of life was determined by the parent-reported Revised Children Quality of Life Questioinnaire (KINDL) questionnaire and compared with published benchmarks for many medical illnesses. RESULTS Mean age of the youths was 12.0 years, 57% were boys, 72% were black, 22% were white, and 17% had received bipolar disorder diagnoses. Youths with bipolar disorder had significantly lower quality-of-life scores than youths with asthma, atopic dermatitis, obesity, arthritis, oxygen dependence, heart surgery during infancy, depression, behavior disorders, and nonmood and nonbehavior psychiatric diagnoses. CONCLUSIONS Youths with bipolar disorder reported lower quality of life than other youths encountered in pediatric practice. Pediatricians should attend not only to the child's mood symptoms but also to the overall impairment of the disorder.
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Affiliation(s)
- Andrew J Freeman
- University of North Carolina, Department of Psychology, CB3270, Davie Hall, Chapel Hill, NC 27599-3270, USA.
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Vloet JA, Hagenah UF. [Pharmacotherapy in bipolar disorders during childhood and adolescence]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2008; 37:27-49, quiz 49-50. [PMID: 19105162 DOI: 10.1024/1422-4917.37.1.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Bipolar disorders during childhood and adolescence are rare, but serious and highly recurrent disorders, often associated with negative outcome. Pharmacotherapy, including Lithium, other mood stabilizers and typical antipsychotic agents, is the first-line treatment in bipolar disorders and often necessary for many months or years. METHOD A computerized medline-search (Pubmed) was made for prospective studies and reviews of bipolar disorder in this age-group published during the last 10 years, which were then reviewed for their relevance. RESULTS Despite the widespread use of substances whose efficacy for adults is well-established, there is a substantial lack of empirical data regarding the efficacy and safety in the treatment of bipolar disorder in children and adolescents. Placebo-controlled studies are very rare, and the interpretation of the existing data is complicated by the diagnostic controversy about bipolar disorder in children. Side-effects are more common in children and adolescents than in adults. CONCLUSIONS Combination therapy may be favoured in cases of severe and psychotic bipolar disorder. Needed are more placebo-controlled studies and long-term studies on the efficacy and safety of mood stabilizers and atypical antipsychotic agents in the treatment of children and adolescents with bipolar disorder.
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Affiliation(s)
- Jennifer A Vloet
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum, Aachen, Germany
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Abstract
PURPOSE OF REVIEW This summary of the literature published over recent years focuses on the ethical aspects of interventions with psychotropic medication in child and adolescent psychiatry. Ethical issues of pharmacotherapy concern aspects of research, safety, indicated use, enhancement, information and evidence-based practice. RECENT FINDINGS The literature on pharmacological interventions suggests changes in prescribing patterns for some substance classes owing to regulatory authorities' warnings. For most of the commonly used medications in children and adolescents no sound database about efficacy and safety is available and knowledge about adverse events and long-term safety remains poor. This is due to a general lack of clinical trials in this population. Legislative efforts have tried to improve safety and labelling of medicines for children. Ethical issues of enhancement in minors have been increasingly discussed over recent years. SUMMARY The ethical aspects of psychopharmacotherapy in minors are still rarely discussed in the literature. Practical questions of research and treatment ethics such as a need for information for children and parents are pointed out; conflicts of evocation and access to care for special populations in need are identified in a field lacking adequate ethical and clinical research.
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Abstract
PURPOSE OF REVIEW Bipolar disorder (BPD) is increasingly diagnosed in youth in both outpatient and inpatient settings. Research on BPD in youth has also increased dramatically; this paper summarizes issues of clinical relevance in primary care, advancements in the last year, and areas in which more research is needed. RECENT FINDINGS Key issues and new developments are summarized in the following areas such as epidemiology and relevance, assessment and differential diagnosis, patient and family decision support, shared decision making and triage, treatment, and monitoring and collaboration with mental health professionals. Recent practice guidelines have important implications for diagnosis and treatment. SUMMARY Early-onset BPD appears to have a more severe course and more comorbidity than later life onset, as well as longer delays in treatment seeking. Affected children show differences in cognitive functioning and neuroanatomy compared with the general population. Assessment of BPD in children needs to be comprehensive and longitudinal, as diagnosis remains a debated topic. Medications are a primary part of treatment, but more double-blind, placebo-controlled trials are needed. Psychosocial adjunctive treatment is important. Children with a family history of BPD are at risk for impaired functioning and psychopathology; high-risk studies will increase our understanding of the onset and course of BPD.
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Findling RL, Frazier JA, Kafantaris V, Kowatch R, McClellan J, Pavuluri M, Sikich L, Hlastala S, Hooper SR, Demeter CA, Bedoya D, Brownstein B, Taylor-Zapata P. The Collaborative Lithium Trials (CoLT): specific aims, methods, and implementation. Child Adolesc Psychiatry Ment Health 2008; 2:21. [PMID: 18700004 PMCID: PMC2531078 DOI: 10.1186/1753-2000-2-21] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 08/12/2008] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lithium is a benchmark treatment for bipolar illness in adults. However, there has been relatively little methodologically stringent research regarding the use of lithium in youth suffering from bipolarity. METHODS Under the auspices of the Best Pharmaceuticals for Children Act (BPCA), a Written Request (WR) pertaining to the study of lithium in pediatric mania was issued by the United States Food and Drug Administration (FDA) to the National Institute of Child Health and Human Development (NICHD) in 2004. Accordingly, the NICHD issued a Request for Proposals (RFP) soliciting submissions to pursue this research. Subsequently, the NICHD awarded a contract to a group of investigators in order to conduct these studies. RESULTS The Collaborative Lithium Trials (CoLT) investigators, the BPCA-Coordinating Center, and the NICHD developed protocols to provide data that will: (1) establish evidence-based dosing strategies for lithium; (2) characterize the pharmacokinetics and biodisposition of lithium; (3) examine the acute efficacy of lithium in pediatric bipolarity; (4) investigate the long-term effectiveness of lithium treatment; and (5) characterize the short- and long-term safety of lithium. By undertaking two multi-phase trials rather than multiple single-phase studies (as was described in the WR), the feasibility of the research to be undertaken was enhanced while ensuring all the data outlined in the WR would be obtained. The first study consists of: (1) an 8-week open-label, randomized, escalating dose Pharmacokinetic Phase; (2) a 16-week Long-Term Effectiveness Phase; (3) a 28-week double-blind Discontinuation Phase; and (4) an 8-week open-label Restabilization Phase. The second study consists of: (1) an 8-week, double-blind, parallel-group, placebo-controlled Efficacy Phase; (2) an open-label Long-Term Effectiveness lasting either 16 or 24 weeks (depending upon blinded treatment assignment during the Efficacy Phase); (3) a 28-week double-blind Discontinuation Phase; and (4) an 8-week open-label Restabilization Phase. In December of 2006, enrollment into the first of these studies began across seven sites. CONCLUSION These innovative studies will not only provide data to inform the labeling of lithium in children and adolescents with bipolar disorder, but will also enhance clinical decision-making regarding the use of lithium treatment in pediatric bipolar illness. TRIAL REGISTRATION NCT00442039.
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Affiliation(s)
- Robert L Findling
- Department of Psychiatry, University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA.
| | - Jean A Frazier
- Cambridge Health Alliance and Department of Psychiatry, Harvard Medical School, Cambridge, MA , USA
| | - Vivian Kafantaris
- The Feinstein Institute for Medical Research of the North Shore—Long Island Health System, Manhasset, NY, USA
| | - Robert Kowatch
- Division of Psychiatry, Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | - Jon McClellan
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Mani Pavuluri
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Linmarie Sikich
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stefanie Hlastala
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Stephen R Hooper
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Clinical Center for the Study of Development and Learning of the Carolina Institute of Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christine A Demeter
- Department of Psychiatry, University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Denise Bedoya
- Department of Psychiatry, University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Bernard Brownstein
- Best Pharmaceuticals for Children Act-Coordinating Center, Premier Research, Philadelphia, PA, USA
| | - Perdita Taylor-Zapata
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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Wang TY, Shiah IS, Chen CK, Yeh CB, Huang CC. Topiramate monotherapy in the maintenance treatment of juvenile bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:306-7. [PMID: 17765377 DOI: 10.1016/j.pnpbp.2007.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 07/31/2007] [Accepted: 08/06/2007] [Indexed: 11/19/2022]
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Affiliation(s)
- E Mohandas
- Department of Psychiatry, Elite Mission Hospital, Trichur, Kerala, India
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