Pharmacological treatment of bipolar disorder among children and adolescents

Abstract

SummaryThere is growing recognition that bipolar disorder (BD) frequently first presents in adolescence. Preadolescents with volatile behavior and severe mood swings also comprise a large group of patients whose difficulties may lie within the bipolar spectrum. However, the preponderance of scientific effort and clinical trials for this condition have focused on adults. This review summarizes the BD's complexity and diagnosis among young people. It proceeds to review the principles of pharmacotherapy, to assess current treatment options, and to highlight areas where evidence-based guidance is lacking. Recent developments have enlarged the range of potential treatments for BD. Nonetheless, differences in the phenomenology, course, and sequelae of BD among young people compel greater attention to the benefits and liabilities of therapy for those affected by this illness' early onset. PHENOMENOLOGY AND DIAGNOSTIC CONSIDERATIONSBipolar disorder (BPD) describes a pattern of major mood disturbances over an extended period of time that typically crystallizes by early adulthood, although onset may occur at any time [1][2][3]. The current prototype for this illness is well-characterized for adults, and has four cardinal features: (1) episodes of major depression; interspersed, to greater or lesser degree, with (2) episodes of mania; (3) intervals between episodes whose duration, mood state and quality of functioning vary widely between patients; and (4) an overall course of psychiatric illness that is chronic [4][5][6]. "Standard" (Classic) Bipolar Disorder Based on Adult PhenomenologyBipolar I Disorder is the diagnosis, per DSM-IV, for individuals who have experienced distinct episodes of mania or an episode of major depression with a prior history of mania. Symptomatically, depression in bipolar disorder does not differ markedly from that seen in individuals without BPD (so-called "unipolar") depression, although it tends to be more persistent and refractory to treatment as our later discussion of pharmacotherapy will elaborate. The classic mood-related abnormality of a manic episode is elation or euphoria, accompanied by an unusually high energy level and the drive and enthusiasm to undertake plans and projects that are often unrealistic and poorly thought out. This frame of mind exerts a severe disinhibitory effect on behavior, which becomes impulsive, erratic, thrill-seeking, and hence AUTHOR CONTACT INFORMATION

Database analysis of children and adolescents with Bipolar Disorder consuming a micronutrient formula

“…The limited response in combination with the adverse effects associated with these medications (such as adiposity, cardiac changes, neuromuscular effects, hypokinesias, and hyperandrogenism [6]), some of which may be more substantial for youth as compared with adults [12], indicate the need to investigate other treatment options for them.…”

Treatment of Pediatric Bipolar Disorder

“…Bu nedenle çocuk ve ergenlerde, atak sırasındaki psikotik özelliklerin yatıştı-rılması dışında idame tedavisinde antipsikotiklerin kullanımı hakkında çok az şey bilinmektedir. [23] Psikotik belirtilerle seyreden bipolar I bozukluğu olan 28 yatırılarak tedavi edilmiş ergenin tedavilerinin incelendiği bir çalışmada, 4 hafta boyunca lityuma ek olarak verilen haloperidol (%54), risperidon (%21), ketiyapin (%13), tiotiksen (%6) ve klorpromazin (%6) ile stabilizasyonu sağlanan ergenlerin sadece %22.9'unda antipsikotik ilaç kesildikten sonra relaps görülmediği tespit edilmiş, antipsikotik ilaçların tekrar başlan-masıyla klinik durumun düzeldiği gözlenmiştir. [24] Psikotik belirtilerin eşlik ettiği bipolar I bozukluğu olan ergenlerin idame tedavisinde antipsikotiklerin yerini içeren kontrollü bir çalışma halen devam etmektedir.…”

Successful Treatment of Bipolar Disorder II and ADHD with a Micronutrient Formula: A Case Study

“…Side effects of mood stabilizers include adiposity, cardiac changes, neuromuscular effects, hypokinesias, and hyperandrogenism. 16,17 Adverse effects of stimulants can include nausea, cardiovascular side effects, insomnia, and weight loss. 18 These side effects, in combination with the overall difficulty in treating both conditions, indicate the need to investigate other treatment options, particularly for those with complex psychiatric presentations.…”