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Pediatric bipolar illness

Ekaterina Stepanova, Robert L Findling
Bipolar disorder is a debilitating illness that often leads to functional impairment when untreated. Monotherapy with mood stabilizers is preferable, although combination therapy may be necessary in refractory cases. Most studies focus on the use of lithium, anticonvulsants, and second-generation antipsychotics in the treatment of acute manic or depressive phases, as well as maintaining adequate response after the episode. More research is needed in the area of psychopharmacology of pediatric bipolar disorder to bridge the gap between clinical needs and the available data...
December 2017: Pediatric Clinics of North America
James C Gay, Bonnie T Zima, Tumaini R Coker, Stephanie K Doupnik, Matthew Hall, Jonathan Rodean, Margaret O'Neill, Rustin Morse, Kris P Rehm, Jay G Berry, Naomi S Bardach
OBJECTIVES: To determine the proportion of US children hospitalized for a primary mental health condition who are discharged to postacute care (PAC); whether PAC discharge is associated with demographic, clinical, and hospital characteristics; and whether PAC use varies by state. STUDY DESIGN: Retrospective cohort study of a nationally representative sample of US acute care hospitalizations for children ages 2-20 years with a primary mental health diagnosis, using the 2009 and 2012 Kids' Inpatient Databases...
November 18, 2017: Journal of Pediatrics
Le Xiao, Stephen J Ganocy, Robert L Findling, Kiki Chang, Melissa P DelBello, John M Kane, Mauricio Tohen, Yu-Tao Xiang, Christoph U Correll
BACKGROUND: Early predictors of response and remission in pediatric mania are lacking, requiring further study. METHODS: This was a post hoc analysis of a 3-week, randomized, placebo-controlled trial of olanzapine conducted between November 2002 and May 2005 in 161 adolescents aged 13-17 years who were diagnosed with a DSM-IV acute manic or mixed episode of bipolar I disorder. Data from the olanzapine arm were analyzed to investigate the predictive power of early response or early nonresponse (≥25% or < 25% reduction in Young Mania Rating Scale [YMRS] score, respectively) at week 1 for ultimate response or nonresponse (≥ 50% or < 50% reduction in YMRS score, respectively) and for remission (YMRS total score ≤ 12 [standard definition] or ≤ 8 [stringent definition]) at week 3...
September 5, 2017: Journal of Clinical Psychiatry
V Robin Weersing, David A Brent, Michelle S Rozenman, Araceli Gonzalez, Megan Jeffreys, John F Dickerson, Frances L Lynch, Giovanna Porta, Satish Iyengar
Importance: Anxiety and depression affect 30% of youth but are markedly undertreated compared with other mental disorders, especially in Hispanic populations. Objective: To examine whether a pediatrics-based behavioral intervention targeting anxiety and depression improves clinical outcome compared with referral to outpatient community mental health care. Design, Setting, and Participants: This 2-center randomized clinical trial with masked outcome assessment conducted between brief behavioral therapy (BBT) and assisted referral to care (ARC) studied 185 youths (aged 8...
June 1, 2017: JAMA Psychiatry
Andrew D Franklin, Jenna H Sobey, Eric T Stickles
Electroconvulsive therapy is being used more frequently in the treatment of many chronic and acute psychiatric illnesses in children. The most common psychiatric indications for pediatric electroconvulsive therapy are refractory depression, bipolar disorder, schizophrenia, catatonia, and autism. In addition, a relatively new indication is the treatment of pediatric refractory status epilepticus. The anesthesiologist may be called upon to assist in the care of this challenging and vulnerable patient population...
May 2017: Paediatric Anaesthesia
Jillian Lee Wiggins, Melissa A Brotman, Nancy E Adleman, Pilyoung Kim, Caroline G Wambach, Richard C Reynolds, Gang Chen, Kenneth Towbin, Daniel S Pine, Ellen Leibenluft
OBJECTIVE: Bipolar disorder (BD) is highly heritable. Neuroimaging studies comparing unaffected youth at high familial risk for BD (i.e., those with a first-degree relative with the disorder; termed "high-risk" [HR]) to "low-risk" (LR) youth (i.e., those without a first-degree relative with BD) and to patients with BD may help identify potential brain-based markers associated with risk (i.e., regions where HR+BD≠LR), resilience (HR≠BD+LR), or illness (BD≠HR+LR). METHOD: During functional magnetic resonance imaging (fMRI), 99 youths (i...
January 2017: Journal of the American Academy of Child and Adolescent Psychiatry
Andrea L Gold, Melissa A Brotman, Nancy E Adleman, Sara N Lever, Elizabeth R Steuber, Stephen J Fromm, Sven C Mueller, Daniel S Pine, Ellen Leibenluft
OBJECTIVE: In both children and adults, psychiatric illness is associated with structural brain alterations, particularly in the prefrontal cortex (PFC). However, most studies compare gray matter volume (GMV) in healthy volunteers (HVs) to one psychiatric group. We compared GMV among youth with anxiety disorders, bipolar disorder (BD), disruptive mood dysregulation disorder (DMDD), attention-deficit/hyperactivity disorder (ADHD), and HVs. METHOD: 3-Tesla T1-weighted magnetic resonance imaging scans were acquired in 184 youths (39 anxious, 20 BD, 52 DMDD, 20 ADHD, and 53 HV)...
December 2016: Journal of the American Academy of Child and Adolescent Psychiatry
Robert L Findling, Ronald L Landbloom, Mary Mackle, Xiao Wu, Linda Snow-Adami, Kiki Chang, Suresh Durgam
BACKGROUND: Sublingually administered asenapine was approved in March 2015 by the United States Food and Drug Administration for patients aged 10-17 years with an acute manic or mixed episode associated with bipolar I disorder (BP-1). This is the first long-term safety and tolerability study of asenapine in this population. METHODS: Following the 3-week randomized, double-blind, placebo-controlled trial of patients aged 10-17 years with an acute manic or mixed episode associated with BP-1, patients could enroll in this flexible-dose (2...
October 2016: Paediatric Drugs
Tina R Goldstein, Megan Krantz, John Merranko, Matthew Garcia, Loren Sobel, Carlos Rodriguez, Antoine Douaihy, David Axelson, Boris Birmaher
OBJECTIVE: To examine medication adherence and associated factors among adolescents with bipolar disorder (BP) using both objective and subjective methods. METHOD: Participants were 21 adolescents with a primary BP diagnosis recruited from a pediatric specialty clinic. All participants were prescribed at least one psychotropic medication. Self- and parent-reported adherence were assessed monthly over 6 months. Objective data on medication adherence were gathered through an electronic weekly pillbox...
December 2016: Journal of Child and Adolescent Psychopharmacology
C P Zeni, S Tramontina, B W Aguiar, A Salatino-Oliveira, G F Pheula, A Sharma, L Stertz, C R Moreira Maia, M Hutz, F P Kapczinski, L A Rohde
OBJECTIVE: Frontiers between pediatric bipolar disorder (PBD) and attention-deficit/hyperactivity disorder (ADHD) are not well defined. Few studies have addressed potentially different neurobiological factors between the two disorders. Brain-derived neurotrophic factor (BDNF) has been increasingly recognized for its etiologic and prognostic role in adult bipolar disorder (BD) studies. This study aimed to examine the BDNF gene polymorphism and potential alterations in BDNF serum levels in the pediatric ADHD patients with or without comorbid BD illness...
September 2016: Acta Psychiatrica Scandinavica
Snežana Urošević, Monica Luciana, Jonathan B Jensen, Eric A Youngstrom, Kathleen M Thomas
Reward/behavioral approach system hypersensitivity is implicated in bipolar disorders (BD) and in normative development during adolescence. Pediatric onset of BD is associated with a more severe illness course. However, little is known about neural processing of rewards in adolescents with BD or developmental (i.e., age) associations with activation of these neural systems. The present study aims to address this knowledge gap. The present sample included 21 adolescents with BD and 26 healthy adolescents, ages 13 to 19...
2016: NeuroImage: Clinical
Stephanie Pope, Solomon G Zaraa
INTRODUCTION: The number of long-acting injectable antipsychotics (LAIA) has increased in recent years. The safety and efficacy of that treatment are not established in children. This study aims to address this gap of information by studying such treatments in a case series. METHODS: This retrospective chart review of patients identified by the investigators at an academic acute inpatient psychiatric unit included all patients from the past 24 months who required new initial treatment with LAIA...
May 2016: Journal of Child and Adolescent Psychopharmacology
Dylan P Thibault, Adys Mendizabal, Nicholas S Abend, Kathryn A Davis, James Crispo, Allison W Willis
BACKGROUND: Reducing the burden of pediatric mental illness requires greater knowledge of mental health and substance abuse (MHSA) outcomes in children who are at an increased risk of primary psychiatric illness. National data on hospital care for psychiatric illness in children with epilepsy are limited. METHODS: We used the Kids' Inpatient Database (KID), the Healthcare Cost and Utilization Project (HCUP), and the Agency for Healthcare Research and Quality from 2003 to 2009 to examine MHSA hospitalization patterns in children with comorbid epilepsy...
April 2016: Epilepsy & Behavior: E&B
Janet Wozniak, Stephen V Faraone, James Chan, Laura Tarko, Mariely Hernandez, Jacqueline Davis, K Yvonne Woodworth, Joseph Biederman
OBJECTIVE: We conducted a 12-week, randomized, double-blind, controlled clinical trial to evaluate the effectiveness and tolerability of high eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) omega-3 fatty acids and inositol as monotherapy and in combination in children with bipolar spectrum disorders. METHOD: Participants were children 5-12 years of age meeting DSM-IV diagnostic criteria for bipolar spectrum disorders (bipolar I or II disorder or bipolar disorder not otherwise specified [NOS]) and displaying mixed, manic, or hypomanic symptoms...
November 2015: Journal of Clinical Psychiatry
Michal Goetz, Tomas Novak, Marie Vesela, Zdenek Hlavka, Martin Brunovsky, Michal Povazan, Radek Ptacek, Antonin Sebela
BACKGROUND: Approximately 30%-60% of adults diagnosed with bipolar disorder (BD) report onset between the ages 15 and 19 years; however, a correct diagnosis is often delayed by several years. Therefore, investigations of the early features of BD are important for adequately understanding the prodromal stages of the illness. METHODS: A complete review of the medical records of 46 children and adolescents who were hospitalized for BD at two psychiatric teaching centers in Prague, Czech Republic was performed...
2015: Neuropsychiatric Disease and Treatment
Prabha S Chandra, Geetha Desai, Dharma Reddy, Harish Thippeswamy, Gayatri Saraf
BACKGROUND: Several Western countries have established mother-baby psychiatric units for women with mental illness in the postpartum; similar facilities are however not available in most low and medium income countries owing to the high costs of such units and the need for specially trained personnel. MATERIALS AND METHODS: The first dedicated inpatient mother-baby unit (MBU) was started in Bengaluru, India, in 2009 at the National Institute of Mental Health and Neurosciences in response to the growing needs of mothers with severe mental illness and their infants...
July 2015: Indian Journal of Psychiatry
Robert L Findling, Kiki Chang, Adelaide Robb, Vicki J Foster, Joseph Horrigan, Alok Krishen, Art Wamil, John E Kraus, Melissa DelBello
OBJECTIVE: This study aimed to compare the efficacy of lamotrigine versus placebo in 10- to 17-year-olds with bipolar I disorder (BP-I) who were receiving conventional bipolar disorder treatment. METHOD: In this randomized withdrawal trial, patients with BP-I of at least moderate severity received lamotrigine during an ≤18-week open-label phase. Patients who maintained a stable lamotrigine dose for ≥2 weeks and Clinical Global Impression-Bipolar Severity of Illness (CGI-BP[S]) score of ≤3 for ≥6 consecutive weeks were randomized to double-blind lamotrigine or placebo for ≤36 weeks...
December 2015: Journal of the American Academy of Child and Adolescent Psychiatry
Snežana Urošević, Eric A Youngstrom, Paul Collins, Jonathan B Jensen, Monica Luciana
OBJECTIVES: Bipolar disorders' (BD) onset before age 18 is a potential marker for a more severe illness course. Adolescence is also a period of significant normative maturation of inhibitory control and reward-relevant decision-making processes, such as decreased delay discounting (i.e., decreased preference for smaller, immediate versus larger, delayed rewards). Adults with BD exhibit elevated delay discounting rates. Very little is known about developmental changes in delay discounting in adolescents with BD, or about associations between inhibitory control and delay discounting in BD...
January 15, 2016: Journal of Affective Disorders
La Vonne A Downey, Leslie S Zun
BACKGROUND: Frequent users of the emergency department (ED) contribute to the problem of overcrowding and are more likely to have psychiatric problems and a higher than average 90-day readmission rate. In addition, ED visits due to mental health problems have increased in recent years, thus driving up 90-day readmission rates. OBJECTIVES: The objective of the study is to determine the reasons for readmissions of psychiatric patients who have previously presented to the ED...
October 2015: American Journal of Emergency Medicine
Daniel P Dickstein, Grace K Cushman, Kerri L Kim, Alexandra B Weissman, Ezra Wegbreit
Bipolar disorder (BD) is among the most impairing psychiatric disorders affecting children and adolescents, despite our best psychopharmacological and psychotherapeutic treatments. Cognitive remediation, defined as a behavioral intervention designed to improve cognitive functions so as to reduce psychiatric illness, is an emerging brain-based treatment approach that has thus far not been studied in pediatric BD. The present article reviews the basic principles of cognitive remediation, describes what is known about cognitive remediation in psychiatric disorders, and delineates potential brain/behavior alterations implicated in pediatric BD that might be targets for cognitive remediation...
August 2015: CNS Spectrums
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