Management of schizophrenia and bipolar disorder in pediatric practice

Abstract

The article presents the features of diag nosis and treatment of schizophrenia and bipolar disorders (BD) with early manifestation in adolescence. Management of disorders includes the complex use of pharmacological, psychological treatment and special forms of social care. The treatment program should include the psychoeducation of the child and his parents and the mobilization of family support. The article also discusses the effi cacy of atypical antipsychotics (risperidone, aripiprazole, olanzapine) and mood stabilizers (valproate, lithium, lamotrigine, and carbamazepine) based on recommendations Food and Drug Administration (FDA) USA, European Medicines Agency (EMA) and the Expert Center of the Ministry of Health of Ukraine. The obtained results of own conducted controlled trials on the effi cacy and safety of olanzapine use are discussed by the authors. Since 2010, 22 cases of olanzapine (Zolafren®) use for adolescents with schizophrenia spectrum disorders aged 13—17 years have been registered in the department of mental disorders of children and adolescents at the Institute of Psychiatry of the Ministry of Health of Ukraine. The period of controlled administration for olanzapine at a dose of 5—20 mg per day ranged from 44 to 70 weeks. As a result of the study were highlighted clinical situations in which the characteristics of the olanzapine action profi le demonstrated its greater effi cacy compared to risperidone and conventional antipsychotics in adolescents. The aim of another controlled trial conducted by the Institute of Psychiatry of the Ministry of Health of Ukraine in 2015—2018 was to evaluate the efficacy of olanzapine at a dose of 5—20 mg per day in adolescents with fi rst time diagnosed acute manic/mixed episode of BD. Nine adolescents aged from 14 to18 years old were assigned. Olanzapine in dose 5 to 20 mg was an eff ective medication for treatment of acute/mixed affective episodes in adolescents with BD and was an acceptable alternative to conventional antipsycho tics and risperidone treatment. Various side eff ects were observed in patients receiving olanzapine therapy, the average number of side eff ects per patient was 2.86, while the most frequent side eff ect was weight gain. Keywords: schizophrenia, bipolar disorder, antipsychotic medication, pediatric practice, children and adolescents