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Kumar R, Garzon J, Yuruk D, Hassett LC, Saliba M, Ozger C, Oztosun C, Ahern K, Athreya AP, Singh B, Croarkin PE, Vande Voort JL. Efficacy and safety of lamotrigine in pediatric mood disorders: A systematic review. Acta Psychiatr Scand 2023; 147:248-256. [PMID: 36086813 DOI: 10.1111/acps.13500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/13/2022] [Accepted: 09/03/2022] [Indexed: 12/01/2022]
Abstract
AIM To appraise the current evidence on the efficacy and safety of lamotrigine (LAM) in the treatment of pediatric mood disorders (PMD) (i.e., Major Depressive disorder [MDD], bipolar disorder [BD]). METHODS Major databases were searched for randomized controlled trials (RCTs), open-label trials, and observational studies reporting on pediatric (age < 18 years) patients treated with LAM for mood disorders. RESULTS A total of 3061 abstracts were screened and seven articles were selected for inclusion. Seven studies (319 BD and 43 MDD patients), including one RCT (n = 173), three prospective (n = 105), and three retrospective (n = 84) studies, met the study criteria with a study duration range from 8 to 60.9 weeks. The mean age of this pooled data is 14.6 ± 2.0 years. LAM daily dosage varied from 12.5 to 391.3 mg/day among the studies. In an important finding, the RCT reported favorable outcomes with LAM (HR = 0.46; p = 0.02) in 13- to 17-year-old age group as compared with 10- to 12-year-old age group (HR = 0.93; p = 0.88). In addition, time to occurrence of a bipolar event trended toward favoring LAM over placebo. All the studies identified LAM as an effective and safe drug in PMDs especially, BDs. Overall, LAM was well tolerated with no major significant side effects and no cases of Stevens-Johnson syndrome. CONCLUSIONS Most studies suggested that LAM was safe and effective in pediatric patients with mood disorders. However, the data regarding the therapeutic range for LAM are lacking. Based on the data, there is inconsistent evidence to make conclusive recommendations on therapeutic LAM dosage for mood improvement in the pediatric population. Further studies including larger sample sizes are required to address this relevant clinical question.
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Affiliation(s)
- Rakesh Kumar
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Garzon
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Deniz Yuruk
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Maria Saliba
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Can Ozger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Cinar Oztosun
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelly Ahern
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Arjun P Athreya
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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Goldstein TR, Saul M, Nagy D, Sylvester R, Rode N, Donohue J. One-Year Treatment Utilization Among Adolescents With Bipolar Spectrum Disorder. Psychiatr Serv 2022; 73:1123-1131. [PMID: 35414190 DOI: 10.1176/appi.ps.202100366] [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: 11/30/2022]
Abstract
OBJECTIVE Early-onset bipolar disorder is among the costliest psychiatric disorders; yet inpatient and outpatient service use patterns in this group are largely unknown. One-year behavioral and medical health service use was examined among adolescents diagnosed as having bipolar disorder, and rates were compared between adolescents with threshold versus subthreshold bipolar disorder. METHODS Participants included 100 adolescents (ages 12–18 years, 85% had been assigned female sex at birth) diagnosed as having bipolar disorder (type I, N=14; type II, N=28; not otherwise specified [NOS], N=58) via semistructured interviews and who consented to electronic health record (EHR) data review for enrollment in a psychosocial treatment study. Service use data were extracted in the year preceding study entry from a data repository containing all clinical and financial records (including outpatient and inpatient behavioral and medical visits) from a large western Pennsylvania health system. RESULTS EHRs indicated that 99% of adolescents used some behavioral health service, most commonly outpatient psychotherapy (60%) and medication management (43%). Use of intensive behavioral health services was common (49%), and 48% had at least one psychotropic medication noted in their EHR. General medical health services were used by 78%, most commonly outpatient (67%) and emergency department (39%) visits. No differences in service use were observed for adolescents with bipolar disorder type I or II compared with NOS for any services or medications examined. CONCLUSIONS High use of behavioral and medical health services among adolescents with bipolar spectrum disorders has important implications for health care systems, insurers, providers, and consumers. Greater coordination of health care for this high-risk, high-use population may improve outcomes.
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Affiliation(s)
- Tina R Goldstein
- Department of Psychiatry (Goldstein, Sylvester, Rode) and Department of Medicine (Saul), University of Pittsburgh Medical Center, Pittsburgh; Department of Public Health, University of Pittsburgh, Pittsburgh (Nagy, Donohue)
| | - Melissa Saul
- Department of Psychiatry (Goldstein, Sylvester, Rode) and Department of Medicine (Saul), University of Pittsburgh Medical Center, Pittsburgh; Department of Public Health, University of Pittsburgh, Pittsburgh (Nagy, Donohue)
| | - Dylan Nagy
- Department of Psychiatry (Goldstein, Sylvester, Rode) and Department of Medicine (Saul), University of Pittsburgh Medical Center, Pittsburgh; Department of Public Health, University of Pittsburgh, Pittsburgh (Nagy, Donohue)
| | - Raeanne Sylvester
- Department of Psychiatry (Goldstein, Sylvester, Rode) and Department of Medicine (Saul), University of Pittsburgh Medical Center, Pittsburgh; Department of Public Health, University of Pittsburgh, Pittsburgh (Nagy, Donohue)
| | - Noelle Rode
- Department of Psychiatry (Goldstein, Sylvester, Rode) and Department of Medicine (Saul), University of Pittsburgh Medical Center, Pittsburgh; Department of Public Health, University of Pittsburgh, Pittsburgh (Nagy, Donohue)
| | - Julie Donohue
- Department of Psychiatry (Goldstein, Sylvester, Rode) and Department of Medicine (Saul), University of Pittsburgh Medical Center, Pittsburgh; Department of Public Health, University of Pittsburgh, Pittsburgh (Nagy, Donohue)
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Bipolar Disorder in pediatric patients: A nationwide retrospective study from 2000 to 2015. J Affect Disord 2022; 298:277-283. [PMID: 34715176 DOI: 10.1016/j.jad.2021.10.113] [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] [Received: 07/12/2021] [Revised: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pediatric Bipolar Disorder (BD) has been the focus of increased attention. To date, in Portugal, there is no evidence available for pediatricBD-related hospitalization rates. This study aimed to describe and characterize all pediatric hospitalizations with a primary diagnosis of BD registered in Portugal from 2000 to 2015. METHODS A retrospective observational study was conducted. Pediatric (< 18 years) inpatient episodes with a primary diagnosis of BD were selected from a national administrative database. The ICD-9-CM codes 296.x (excluding 296.2x, 296.3x and 296.9x) identified the diagnosis of interest. Additionally, age at discharge, sex, psychiatric comorbidities, length of stay (LoS), admission type and date, in-hospital mortality and hospital charges were analyzed. RESULTS A total of 348 hospitalizations, representing 258 patients, were identified. The overall population-based rate of hospitalizations was 1.18/100 000 youths. A non-linear increase throughout the study period was found. Patients were mostly female (60.6%), with a median age of 16 years (Q1-Q3:14-17). Admissions were mostly emergent (81%), and the median LoS was 14 days (Q1-Q3:7-24). Moreover, about 26% of all episodes were readmissions. Mean estimated charges per episode were 3503.10€, totalizing 1.20M€. LIMITATIONS Limitations include the use of secondary data and the retrospective nature of the study. CONCLUSIONS Annual rates of pediatric BD hospitalizations showed a non-linear increase. These findings may contribute to better understand the pediatric BD burden. Nevertheless, more research is warranted, to better characterize sociodemographic and clinical trends in pediatric BD to prevent the high number of acute hospitalizations and readmissions of these patients.
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Aguirre L. Navigating the diagnostic challenges of bipolar disorder in youth. JAAPA 2021; 34:21-27. [PMID: 34270499 DOI: 10.1097/01.jaa.0000758200.80004.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Bipolar disorder in youth is difficult to diagnose and treat, but early detection is important to mitigate risks and improve patient outcomes. This article evaluates the unique challenges of diagnosing and treating bipolar disorder in children and adolescents. Bipolar disorder is associated with a significant personal and societal health burden and frequently is misdiagnosed and incorrectly treated. More research is needed to understand the pathophysiology of bipolar disorder and which treatment options are best throughout the lifespan.
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Affiliation(s)
- Larry Aguirre
- Larry Aguirre practices family medicine and psychiatry with an emphasis on youth populations in Mendocino County, Calif., and serves as an adjunct instructor of health sciences at Mendocino College, and an officer in the California Army National Guard. The author has disclosed no potential conflicts of interest, financial or otherwise
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Mendez I, Castro-Fornieles J, Lera-Miguel S, Picado M, Borras R, Cosi S, Valenti M, Santamarina P, Font E, Romero S. Functional Impairment and Clinical Correlates in Adolescents with Bipolar Disorder Compared to Healthy Controls. A Case-control Study. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2020; 29:149-164. [PMID: 32774398 PMCID: PMC7391870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 03/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Evidence shows that most adolescents with bipolar disorder (BD) achieve syndromic recovery after being referred to specialized treatment. However, functional recovery is reached in less than 50% of those cases. METHOD Descriptive cross-sectional case-control study, based on a clinical sample of 44 BD patients aged 12-19, matched by age and sex with 44 healthy controls (HC). Psychopathology was ascertained using the KSADS-PL, in addition to the clinical scales. Information about previous academic performance was included, as well as functional outcome based on the Children's Global Assessment Functioning Scale (CGAS). Previous exposure to stressful experiences was assessed using the Schedule for Stressful Life Events (SLES). All analyses were performed using either conditional or stepwise logistic regression models. RESULTS Once they have become stabilized, and even after controlling for socio-demographic differences, BD patients were associated with lower levels of functionality [OR 0.65 (0.46, 0.93), p=0.02], and worse performance at school [OR 0.03 (0.01, 0.67), p=0.03] compared with HC. Persistent sub-syndromal psychosis showed the strongest negative correlation with functionality (rho=-0.65, -0.57 for BD and HC respectively; p<0.001). Although BD was associated with more stressful life events, this association did not remain significant in the multivariate models. LIMITATIONS The small sample size limits our ability to detect differences between groups, and between BD subtypes. CONCLUSIONS Even when early detection and intervention is provided, BD has a significant impact on functioning and academic performance. It is important to address persistent sub-threshold symptoms and to emphasize the social and rehabilitative components of treatment.
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Affiliation(s)
- Iria Mendez
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Hospital, Barcelona, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Hospital, Barcelona, Spain
- Institute d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- CIBERSAM, Institute Carlos III, Spain
| | - Sara Lera-Miguel
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Hospital, Barcelona, Spain
| | - Marisol Picado
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Hospital, Barcelona, Spain
| | - Roger Borras
- Institute d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sandra Cosi
- Research Center for Behavior Assessment, Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
| | - Marc Valenti
- CIBERSAM, Institute Carlos III, Spain
- Department of Adult Psychiatry and Psychology, Clínic Hospital, Barcelona, Spain
| | - Pilar Santamarina
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Hospital, Barcelona, Spain
| | - Elena Font
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Hospital, Barcelona, Spain
| | - Soledad Romero
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Hospital, Barcelona, Spain
- CIBERSAM, Institute Carlos III, Spain
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Yapıcı Eser H, Taşkıran AS, Ertınmaz B, Mutluer T, Kılıç Ö, Özcan Morey A, Necef I, Yalçınay İnan M, Öngür D. Anxiety disorders comorbidity in pediatric bipolar disorder: a meta-analysis and meta-regression study. Acta Psychiatr Scand 2020; 141:327-339. [PMID: 31899546 DOI: 10.1111/acps.13146] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/26/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Anxiety disorders (AD) are known for its comorbidity and negative impact on the course of adult bipolar disorder (BD). However, there is limited research on AD comorbidity in pediatric BD (PBD). Here, we aimed to conduct a meta-analysis and meta-regression study about the comorbidity and covariates of AD and PBD. METHOD We systematically searched relevant articles published until May 2019, as defined in PRISMA guidelines. Variables for associated features and prevalence of AD were extracted. RESULTS Thirty-seven articles represented data for the analysis. Lifetime any AD comorbidity was 44.7%; panic disorder (PD) was 12.7%; generalized anxiety disorder (GAD) was 27.4%; social phobia was 20.1%; separation anxiety disorder (SAD) was 26.1%; and obsessive-compulsive disorder (OCD) was 16.7%. Childhood-onset studies reported higher GAD and SAD comorbidity, while adolescent-onset studies reported higher PD, OCD, and social phobia. Age of onset, gender, comorbidity of ADHD, substance use, oppositional defiant disorder and conduct disorder affected each anxiety disorders' comorbidity with PBD differently. CONCLUSION Anxiety disorders are highly comorbid with PBD. Early-onset PBD increases the risk of AD. Biopsychosocial aspects of this comorbidity and its course needs to be evaluated further.
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Affiliation(s)
- H Yapıcı Eser
- School of Medicine, Department of Psychiatry, Koç University, İstanbul, Turkey.,Research Center for Translational Medicine, Koç University, İstanbul, Turkey
| | - A S Taşkıran
- School of Medicine, Department of Psychiatry, Koç University, İstanbul, Turkey.,Child Mind Institute, New York, NY, USA
| | - B Ertınmaz
- School of Medicine, Koç University, İstanbul, Turkey
| | - T Mutluer
- School of Medicine, Department of Psychiatry, Koç University, İstanbul, Turkey
| | - Ö Kılıç
- Koç University Hospital, İstanbul, Turkey
| | | | - I Necef
- Koç University Hospital, İstanbul, Turkey
| | | | - D Öngür
- Harvard Medical School, Boston, MA, USA.,McLean Hospital, Belmont, MA, USA
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Estrada-Prat X, Van Meter AR, Camprodon-Rosanas E, Batlle-Vila S, Goldstein BI, Birmaher B. Childhood factors associated with increased risk for mood episode recurrences in bipolar disorder-A systematic review. Bipolar Disord 2019; 21:483-502. [PMID: 31025494 PMCID: PMC6768757 DOI: 10.1111/bdi.12785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bipolar Disorder (BD) is a recurrent illness associated with high morbidity and mortality. The frequency of mood episode recurrence in BD is highly heterogeneous and significantly impacts the person's psychosocial functioning and well-being. Understanding the factors associated with mood recurrences could inform the prognosis and treatment. The objective of this review is to summarize the literature on factors, present during childhood, that influence recurrence. METHODOLOGY A systematic review of PubMed (1946-2017) and PsycINFO (1884-2017) databases was conducted to identify candidate studies. Search terms included bipolar disorder, episodes, predictors, recurrences, and course. Study characteristics, risk for bias, and factors associated with recurrence were coded by two raters according to predetermined criteria. RESULTS Twenty child studies and 28 adult studies that retrospectively evaluated childhood variables associated with mood recurrences were included. Early age of onset, low socioeconomic status, comorbid disorders, inter-episode subsyndromal mood symptoms, BD-I/II subtypes, presence of stressors, and family history of BD were associated with higher number of recurrences. LIMITATIONS Risk factors and mood recurrences were assessed and defined in different ways, limiting generalizability. CONCLUSION Multiple factors are associated with increased risk of mood episode recurrence in BD. Interventions targeting modifiable factors could reduce the impact of BD. For example, treatment of comorbid disorders and subsyndromal mood symptoms, coupled with appropriate cognitive behavioral and family-focused therapies could ameliorate risk related to many clinical factors. When coupled with social services to address environmental factors, the number of episodes could be reduced and the course of BD significantly improved.
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Affiliation(s)
- Xavier Estrada-Prat
- Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona, Spain
| | - Anna R. Van Meter
- The Feinstein Institute for Medical Research, The Zucker Hillside Hospital, Department of Psychiatry Research, Glen Oaks, NY
| | - Ester Camprodon-Rosanas
- Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona, Spain
- Children and Adolescent Mental Health Research Group. Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Santiago Batlle-Vila
- Institut de Neuropsiquiatria i Addiccions, Centre de Salut Mental Infantil i Juvenil Sant Martí-La Mina i Ciutat Vella, Parc de Salut Mar, Barcelona, Spain
| | - Benjamin I. Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Gautam S, Jain A, Gautam M, Gautam A, Jagawat T. Clinical Practice Guidelines for Bipolar Affective Disorder (BPAD) in Children and Adolescents. Indian J Psychiatry 2019; 61:294-305. [PMID: 30745704 PMCID: PMC6345130 DOI: 10.4103/psychiatry.indianjpsychiatry_570_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Shiv Gautam
- Director Professor, Gautam Hospital and Institute of Behavioural Sciences, Jaipur, Rajasthan, India
| | - Akhilesh Jain
- HOD, Department of Psychiatry, ESI Model Hospital, Jaipur, Rajasthan, India
| | - Manaswi Gautam
- Director & Consultant Psychiatrist, Gautam Hospital & Research Center, Jaipur, Rajasthan, India
| | - Anita Gautam
- Director Clinical Operation & Consultant Psychiatrist, Gautam Hospital & Research Center, Jaipur, Rajasthan, India
| | - Tushar Jagawat
- Prof., Department of Psychiatry, NIMS Medical College, Jaipur, Rajasthan, India
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Balsan G, Corcos M. [Adolescent manic-depressive disorders: Clinical aspects]. Arch Pediatr 2016; 23:417-23. [PMID: 26790339 DOI: 10.1016/j.arcped.2015.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 11/17/2022]
Abstract
More than 50% of bipolar disorders diagnosed among adults first appeared before the age of 18. It is well established that adolescence is the high-risk period for the onset of major mood episodes associated with bipolar disorders. Even though there are few early-onset bipolar disorders, they are very severe. The most robust risk factor predicting bipolar disorder is a positive family history. Morbidity, mortality, and suicidality are high and have a severe impact on overall functioning, professional integration, family life, and affective relationships. Improving diagnosis of early symptoms should ameliorate these patients' prognosis.
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Affiliation(s)
- G Balsan
- Département de psychiatrie de l'adolescent et du jeune adulte, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
| | - M Corcos
- Département de psychiatrie de l'adolescent et du jeune adulte, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
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