A Pilot Controlled Trial of Topiramate for Mania in Children and Adolescents With Bipolar Disorder

DelBello, Melissa P.; Findling, Robert L.; Kushner, Stuart; Wang, Daniel; Olson, William H.; Capece, Julie A.; Fazzio, Lydia; Rosenthal, Norman

doi:10.1097/01.chi.0000159151.75345.20

Cited by 149 publications

(40 citation statements)

References 31 publications

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“…While the change in YMRS and CDRS-R ratings was less than that seen in trials of antimanic medication in children with BP (Delbello et al 2005;Tohen et al 2007), SMD subjects exhibited clinically relevant declines in YMRS (8 points) and CDRS-R scores (11 points), suggesting that the mood dysregulation seen in SMD may be responsive to ADHD-based treatments. The design of the STP makes it difficult to determine if it was time, BMOD, or MPH that led to the improvement in these scores.…”

Section: Internalizing Symptomsmentioning

confidence: 96%

The Efficacy and Tolerability of Methylphenidate and Behavior Modification in Children with Attention-Deficit/Hyperactivity Disorder and Severe Mood Dysregulation

Waxmonsky

Pelham

Gnagy

et al. 2008

Journal of Child and Adolescent Psychopharmacology

126

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Objectives: This study examines the tolerability and efficacy of methylphenidate (MPH) and behavior modification therapy (BMOD) in children with attention-deficity/hyperactivity disorder (ADHD) and severe mood dysregulation (SMD). Methods: Children (ages 5-12) from a summer program for ADHD were screened for SMD and additional manic-like symptoms using structured assessments and direct clinical interview with the Young Mania Rating Scale (YMRS). The SMD group was comprised of 33 subjects with SMD and elevated YMRS scores (mean ϭ 23.7). They underwent weekly mood assessments plus the daily ADHD measures that are part of the program. The comparison group (n ϭ 68) was comprised of the rest of the program participants. Using a crossover design, all subjects in both groups were treated with three varying intensities of BMOD (no, low, high) each lasting 3 weeks, with MPH dose (placebo, 0.15 mg/kg t.i.d., 0.3mg/kg t.i.d., and 0.6mg/kg t.i.d.) varying daily within each behavioral treatment. Results: Groups had comparable ADHD symptoms at baseline, with the SMD group manifesting more oppositional defiant disorder/conduct disorder (ODD/CD) symptoms (p Ͻ 0.001). Both groups showed robust improvement in externalizing symptoms (p Ͻ 0.001). There was no evidence of differential treatment efficacy or tolerability. Treatment produced a 34% reduction in YMRS ratings in SMD subjects (p -0.001). However, they still exhibited elevated YMRS ratings, more ODD/CD symptoms (p Ͻ 0.001), and were more likely to remain significantly impaired at home than non-SMD subjects (p Ͻ 0.05). Conclusions: MPH and BMOD are tolerable and effective treatments for children with ADHD and SMD, but additional treatments may be needed to optimize their functioning. 573

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Section: Internalizing Symptomsmentioning

confidence: 96%

The Efficacy and Tolerability of Methylphenidate and Behavior Modification in Children with Attention-Deficit/Hyperactivity Disorder and Severe Mood Dysregulation

Waxmonsky

Pelham

Gnagy

et al. 2008

Journal of Child and Adolescent Psychopharmacology

126

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“…39 A monotherapy trial comparing topiramate vs placebo in acute manic episodes in children and adolescents was terminated prematurely due to the negative adult data. 40 However, analysis of the smaller than designed sample showed some efficacy of topiramate compared to placebo. Finally, a relatively large open-label study of adjunctive topiramate as a maintenance therapy showed efficacy in both manic and depressive phases and in overall symptom reduction.…”

Section: Anticonvulsantsmentioning

confidence: 98%

Treatment-resistant bipolar disorder

2006

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Despite the remarkable increase in medications validated as effective in bipolar disorder, treatment is still plagued by inadequate response in acute manic or depressive episodes or in long-term preventive maintenance treatment. Established first-line treatments include lithium, valproate and second-generation antipsychotics (SGAs) in acute mania, and lithium and valproate as maintenance treatments. Recently validated treatments include extended release carbamazapine for acute mania and lamotrigine, olanzapine and aripiprazole as maintenance treatments. For treatment-resistant mania and as maintenance treatments, a number of newer anticonvulsants, and one older one, phenytoin, have shown some promise as effective. However, not all anticonvulsants are effective and each agent needs to be evaluated individually. Combining multiple agents is the most commonly used clinical strategy for treatment resistant bipolar patients despite a relative lack of data supporting its use, except for acute mania (for which lithium or valproate plus an SGA is optimal treatment). Other approaches that may be effective for treatment-resistant patients include high-dose thyroid augmentation, clozapine, calcium channel blockers and electroconvulsive therapy (ECT). Adjunctive psychotherapies show convincing efficacy using a variety of different techniques, most of which include substantial attention to education and enhancing coping strategies. Only recently, bipolar depression has become a topic of serious inquiry with the dominant controversy focusing on the place of antidepressants in the treatment of bipolar depression. Other than mood stabilizers alone or the combination of mood stabilizers and antidepressants, most of the approaches for treatment-resistant bipolar depression are relatively similar to those used in unipolar depression, with the possible exception of a more prominent place for SGAs, prescribed either alone or in combination with antidepressants. Future work in the area needs to explore the treatments commonly used by clinicians with inadequate research support, such as combination therapy and the use of antidepressants as both acute and adjunctive maintenance treatments for bipolar disorder. With the first report of lithium's efficacy in 1949 by Cade, bipolar disorder has the longest record of treatment efficacy among the major Axis I disorders. Furthermore, after more than half a century of clinical research, multiple agents from many different pharmacological classes have shown at least some efficacy, while many other agents (albeit without a consistent database demonstrating their utility) are prescribed regularly by clinicians. Yet, despite this plethora of choices, treatment of bipolar disorder remains suboptimal from the points of view of clinicians and patients alike. Whether measured by recovery time from manic or depressive episodes or preventive efficacy of maintenance treatments, bipolar disorder is characterized by sluggish responses, inadequate responses, poor compliance and recurrences in controlled cli...

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“…[8] Topiramat ve okskarbamazepinin değerlendirildiği çalışmalarda çocuk ve ergenlerde topiramat ve okskarbamazepin etkin bulunmamıştır. [9,10] Yapılan çalışmalarda çocuk ve ergenlerde akut mani tedavisinde ümit vaadeden diğer ilaçlar ziprasidon, lityum ve karbamazepindir. [11][12][13][14][15] Ek olarak tedavilere dirençli vakalarda klozapin de etkin bulunmuştur ancak bu ilaçların çocuk ve ergenlerde akut mani tedavisindeki etkinliğini değerlendiren plasebo kontrollü çalışmalar henüz mevcut değil-dir.…”

Section: çOcuk Ve Ergenlerde Akut Mani Tedavisiunclassified

Treatment of Pediatric Bipolar Disorder

Erdoğan¹,

Kurban²,

Yalcin³

2014

Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychia

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ÖzetÖnceleri pediatrik bipolar bozukluk çok nadir görülen bir psikiyatrik bozukluk olarak düşünülse de, son 20 yıldaki araştırmalar bozukluğun sanılandan çok daha yaygın olduğunu ortaya koymuştur. Çocuk ve ergenlik başlangıçlı bipolar bozukluk ciddi ailesel ve akademik sorunlara, daha sık madde kullanımına, riskli cinsel ilişkilere, ergen gebeliği ve suça yatkınlığa neden olmaktadır. Erişkin başlangıçlıya göre yaşam boyu daha kötü bir işlevsellik söz konusudur. Tanı konulması daha güç olabilmekte ve tanı konulana kadar geçen süre erişkin bipolar bozukluğuna göre daha uzun olabilmektedir. Bu yaş grubunun özelliklerinden dolayı tedavi uyumu ile ilişkili problemlere daha sık rastlanmaktadır. Pediatrik bipolar bozukluktaki bu tanı ile ilgili karmaşa, tedavi konusunda da anlaşmazlıklara yol açmıştır. Bu gözden geçirmede çocuk ve ergenlik başlangıçlı bipolar bozukluktaki tedavi yaklaşımları ele alınmıştır. AbstractAlthough once pediatric bipolar disorder had been perceived as a very rarely seen psychiatric disorder, studies conducted within the last two decades revealed that this disorder is more often than assumed. Childhood and adolescent onset bipolar disorder causes and leads serious familial and academic disturbances, more frequent subtance use, precarios sexual intercourses, adolescent pregnancy and tendency to delinquency. Lifelong functionality is worse than adult onset. It could be more difficult to be diagnosed and could take longer time period for the diagnosis than adult onset. Difficulties of compliance to treatment can be seen more frequently because of the behavioural age characteristics of this group. Diagnostic controversies about the pediatric bipolar disorder also led disagreement about the treatment. In this review treatment approaches in the child and adolescent onset bipolar disorder have been discussed.

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A Pilot Controlled Trial of Topiramate for Mania in Children and Adolescents With Bipolar Disorder

Cited by 149 publications

References 31 publications

The Efficacy and Tolerability of Methylphenidate and Behavior Modification in Children with Attention-Deficit/Hyperactivity Disorder and Severe Mood Dysregulation

The Efficacy and Tolerability of Methylphenidate and Behavior Modification in Children with Attention-Deficit/Hyperactivity Disorder and Severe Mood Dysregulation

Treatment-resistant bipolar disorder

Treatment of Pediatric Bipolar Disorder

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