Medications prescribed for children with mood disorders: Effects of a family-based psychoeducation program.

Abstract

Few controlled trials have examined psychotropic medications in children with mood disorders. Multiple medications are often prescribed for these children, who frequently suffer from several comorbid conditions. However, this polypharmacy has been infrequently studied and may lead to adverse drug-drug interactions. Multi-Family Psychoeducation Groups (MFPGs) are an 8-session, manual-driven treatment for children with mood disorders, designed as an adjunct to current medications and psychotherapy. In part, MFPG teaches parents and children to be better consumers of mental health care, including medications. This study examined the effect of MFPG on medications taken by 165 children, ages 8-11, with mood disorders. The authors hypothesized that MFPG would not affect the mean number of medications taken but that the variance in number of medications would decrease from pre- to posttreatment (i.e., the number of medications prescribed for any given child should become more closely distributed around the sample mean). Approximately 70% of participants were diagnosed with bipolar spectrum disorders, and 30% were diagnosed with depressive spectrum disorders. Most had both comorbid behavioral (97%) and anxiety (69%) disorders. Information regarding medications was gathered 4 times: at baseline, 6, 12, and 18 months. Approximately half (n=78) of the participants were randomized into immediate treatment, and half (n=87) were randomized into a 1-year wait-list condition. All were encouraged to continue treatment as usual throughout the study. As hypothesized, no significant pre- to posttreatment differences were found between groups for the mean number of current medications, but variance declined significantly from pre- to posttreatment. Implications and future research goals are discussed.

Bipolar Mood Disorder in Children and Adolescents: In Search of Theoretic, Therapeutic and Diagnostic Clarity

“…Primarily, delayed recognition of the illness leads to complex difficulties as far as the stabilisation of mood is concerned (Faedda et al, 2004). Delayed recognition and intervention is also correlated with disruptions in personality development, which may manifest in disordered personality traits.…”

“…In children with the disorder, there is often a delay in time between the index episode and diagnosis of the illness. Faedda et al (2004) have noted an average delay of seven years between onset and diagnosis. The consequences of this could be highly disruptive of the child's developing sense of self.…”

“…Such interpersonal fluctuations can have an impact on the individual's sense of safety, and could be continuous relational traumataprecipitating suicidality. In addition to these features, the presence ofnon-suicidal self-harm is another possible indicator of risk (Faedda et al, 2004). With this in mind, adolescents presenting bipolar mood symptoms in conjunction with the specific personality traits of the borderline spectrum are a particular risk.…”

“…Frequently, the histories of children with bipolar disorder will reflect a range of diagnoses including (in order of frequency) Attention Deficit/ Hyperactivity Disorder (60%), Anxiety Disorders including Obsessive Compulsive Disorder (39%), Major Depressive Disorder (37%) and Oppositional Defiant and/or Conduct Disorder (2 1%) (Faedda et al, 2004).…”

“…Paediatric bipolar disorder is defined by chronic, non-episodic, ultra-rapid cycling (Faedda, Baldessarini, Glovinsky, & Austin, 2004;Vogel, 2000;Wosniak & McCallaghan 1985). This factor in particular renders paediatric bipolar disorder easily misdiagnosed as one ofthe disruptive behavioural disorders, including Oppositional Defiant Disorder (ODD), Conduct Disorder or AD/HD (Soutullo et al, 2005).…”