Psychopharmacology of Pediatric Bipolar Disorder
This comprehensive literature review incorporates research studies evaluating the effectiveness of psychotropic medications in children and adolescents with pediatric bipolar disorder. Research articles were obtained using Medline. Open-label studies, prospective and retrospective chart reviews and randomized controlled trials evaluating the effectiveness of medication in pediatric bipolar disorder with greater than ten subjects are included in this article. Antipsychotics, anticonvulsants and lithium as monotherapy, as well as their use in combination treatment, were evaluated to determine their effectiveness in pediatric bipolar disorder. Clinical recommendations of medication and management strategies are made from a synthesis of the data. In addition, adherence concerns caused by adverse effects and nonresponse as they impact physical and mental health are addressed.
Pediatric bipolar disorder (PBD) is a severe psychiatric disorder that results in poor global functioning, reduced quality of life and high relapse rates. Research finds that many adults with bipolar disorder identify the onset of symptoms in childhood and adolescence, indicating the importance of early accurate diagnosis and treatment. A discussion of diagnostic issues regarding pediatric bipolar disorder is beyond the scope of this article. Readers are referred to reviews on the phenomenology, diagnostic presentation and controversies regarding bipolar disorder diagnosis in the pediatric population by Youngstrom et al. and Baroni et al..
Psychopharmacological treatment is considered the first-line treatment for PBD. A 2003 study found that children and adolescents with bipolar disorder were typically treated with 3.4 (± 1.5) medications and had an average of 6.3 (± 3.7) trials of psychotropic medications. In 2001, more than 100,000 children were medicated for bipolar disorder. Several factors contribute to multiple drug trials in children, including the dearth of research to guide prescribers until recently, the psychopharmacologic complexity required for stabilization of this disorder and, lastly, the fact that pediatric bipolar disorder is highly comorbid with other psychiatric disorders. This comorbidity often requires adjunctive psychopharmacologic treatment for disorders such as attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, obsessive compulsive disorder, conduct disorder, substance abuse and post-traumatic stress disorder. This review of the research hopes to educate and provide evidence-based guidance to prescribers on the appropriate choice of medication for the treatment of PBD and on the management of adverse effects of treatment.
Abstract and Introduction
Abstract
This comprehensive literature review incorporates research studies evaluating the effectiveness of psychotropic medications in children and adolescents with pediatric bipolar disorder. Research articles were obtained using Medline. Open-label studies, prospective and retrospective chart reviews and randomized controlled trials evaluating the effectiveness of medication in pediatric bipolar disorder with greater than ten subjects are included in this article. Antipsychotics, anticonvulsants and lithium as monotherapy, as well as their use in combination treatment, were evaluated to determine their effectiveness in pediatric bipolar disorder. Clinical recommendations of medication and management strategies are made from a synthesis of the data. In addition, adherence concerns caused by adverse effects and nonresponse as they impact physical and mental health are addressed.
Introduction
Pediatric bipolar disorder (PBD) is a severe psychiatric disorder that results in poor global functioning, reduced quality of life and high relapse rates. Research finds that many adults with bipolar disorder identify the onset of symptoms in childhood and adolescence, indicating the importance of early accurate diagnosis and treatment. A discussion of diagnostic issues regarding pediatric bipolar disorder is beyond the scope of this article. Readers are referred to reviews on the phenomenology, diagnostic presentation and controversies regarding bipolar disorder diagnosis in the pediatric population by Youngstrom et al. and Baroni et al..
Psychopharmacological treatment is considered the first-line treatment for PBD. A 2003 study found that children and adolescents with bipolar disorder were typically treated with 3.4 (± 1.5) medications and had an average of 6.3 (± 3.7) trials of psychotropic medications. In 2001, more than 100,000 children were medicated for bipolar disorder. Several factors contribute to multiple drug trials in children, including the dearth of research to guide prescribers until recently, the psychopharmacologic complexity required for stabilization of this disorder and, lastly, the fact that pediatric bipolar disorder is highly comorbid with other psychiatric disorders. This comorbidity often requires adjunctive psychopharmacologic treatment for disorders such as attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, obsessive compulsive disorder, conduct disorder, substance abuse and post-traumatic stress disorder. This review of the research hopes to educate and provide evidence-based guidance to prescribers on the appropriate choice of medication for the treatment of PBD and on the management of adverse effects of treatment.