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Pediatric bipolar disorder

Terence A Ketter, Suresh Durgam, Ronald Landbloom, Mary Mackle, Xiao Wu, Maju Mathews
BACKGROUND: Asenapine (ASN) is approved in the United States as monotherapy and adjunctive therapy (to lithium or valproate) in adults with bipolar mania, and as monotherapy in pediatric patients with bipolar mania. This is the first long-term study evaluating safety and tolerability of ASN fixed doses in this population. METHODS: After completing a 3-week, randomized, placebo (PBO)-controlled acute trial, patients could enroll in this 26-week, fixed-dose (5 or 10mg twice daily), double-blind extension study...
October 14, 2016: Journal of Affective Disorders
M Lambert, V Niehaus, C Correll
This review aims to describe the importance of i) detecting individuals at clinical high-risk for psychosis (schizophrenia) or bipolar disorder, especially in children and adolescents, in order to enable early intervention, and ii) evaluating different intervention strategies, especially pharmacotherapy, during the subsyndromal or "prodromal" stages of these severe and often debilitating disorders. The different approaches regarding the psychotic and bipolar clinical high-risk state are discussed, including reasons and evidence for early (pharmacological) intervention and risks of treatment vs...
October 13, 2016: Pharmacopsychiatry
Terry Lee
The diagnosis of bipolar disorder (BD) in youth is confusing and controversial. Controversy notwithstanding, youth diagnosed with BD have high behavioral health needs and are at elevated risk for problematic long-term psychosocial functioning and complex psychiatric medication regimens. Pediatricians and other primary care providers (PCPs) can play an important role in the assessment and treatment of youth diagnosed with BD and the recently created and also controversial diagnosis of disruptive mood dysregulation disorder (DMDD)...
October 1, 2016: Pediatric Annals
Stewart A Shankman, Andrea C Katz, Alessandra M Passarotti, Mani N Pavuluri
No abstract text is available yet for this article.
November 15, 2016: Journal of Affective Disorders
Klaus D Jakobsen, Helle Wallach-Kildemoes, Christina H Bruhn, Nasseh Hashemi, Anne K Pagsberg, Anders Fink-Jensen, Jimmi Nielsen
Quetiapine is a low-affinity dopamine D2 receptor antagonist, approved for the treatment of bipolar disorder and schizophrenia in children and adolescents by the Food and Drug Administration, but not by European Medicine Agency. Although knowledge of adverse drug reactions in children and adolescents is scarce, quetiapine is increasingly being used for youth in Denmark. The aim of this case study is to discuss adverse drug events (ADEs) spontaneously reported to the Danish Medicines Agency on quetiapine used in the pediatric population in relation to adversive drug reactions (ADRs) reported in the European Summary of Product Characteristics (SPCs)...
September 28, 2016: International Clinical Psychopharmacology
Nataša Karas Kuželički
Preclinical Research S-adenosyl methionine (SAM) is a major methyl donor and as such exerts its influence on CNS function through methylation reactions, such as methylation of several catecholamine moiety-containing neurotransmitters, epigenetic changes through methylation of DNA, RNA, RNA-binding proteins and histones, and phospholipid methylation. Based on available evidence, SAM is currently recommended as a next-step (second-line) treatment option following inadequate treatment response to a first-line antidepressant...
September 4, 2016: Drug Development Research
Mary A Fristad
Treatment guidelines recommend that psychotherapy be used in conjunction with pharmacotherapy in children with bipolar disorder. A well-established category of psychotherapy is family skill-building plus psychoeducation; 3 examples of this are family-focused treatment, psychoeducational psychotherapy, and child- and family-focused cognitive-behavioral therapy. These treatments share several common elements that are important in pediatric populations, including being family-based, providing psychoeducation on symptoms and their management, and training patients and families in emotion regulation, communication, and problem-solving skills...
2016: Journal of Clinical Psychiatry
Kiki D Chang
Treating bipolar disorder in pediatric patients is challenging because data from rigorous trials of pharmacotherapy in this population are still not plentiful enough. Furthermore, the treatment of children and adolescents is complicated by the frequent need to combine pharmacotherapies to address all bipolar symptoms as well as this population's elevated risk for experiencing side effects. Additionally, young patients with depressive episodes who are at high risk for developing bipolar disorder need careful treatment to prevent or delay the emergence of mania...
2016: Journal of Clinical Psychiatry
Robert L Findling
Pharmacotherapy is an important component of treatment for children and adolescents with bipolar disorder. The body of evidence supporting safe and effective treatments in this population is growing. Available data provide information on the risks and benefits of pharmacologic agents used for acute manic, mixed, and depressive episodes as well as for maintenance treatment. Lithium, anticonvulsants, and antipsychotics comprise the armamentarium for treating pediatric bipolar disorder. When selecting treatment, clinicians must consider the efficacy and side effect profile of potential pharmacotherapies, as well as the patient's history, including the presence of comorbidities, in order to develop a treatment plan that will ensure optimal outcomes...
2016: Journal of Clinical Psychiatry
Robert A Kowatch
Diagnosing a pediatric patient with bipolar disorder can pose a challenge for clinicians. Children typically do not present with the full criteria for a mood episode and may have symptoms of other disorders such as attention-deficit/hyperactivity disorder, oppositional defiant disorder, anxiety disorders, and other mood disorders, which may complicate the diagnostic process. By diligently interviewing parents and children about behaviors, thoroughly reviewing family histories, and systematically ruling out other disorders, clinicians can provide an accurate diagnosis for their pediatric patients...
2016: Journal of Clinical Psychiatry
Heather A MacPherson, Sally M Weinstein, David B Henry, Amy E West
Mediation analyses can identify mechanisms of change in Cognitive-Behavioral Therapy (CBT). However, few studies have analyzed mediators of CBT for youth internalizing disorders; only one trial evaluated treatment mechanisms for youth with mixed mood diagnoses. This study evaluated mediators in the randomized trial of Child- and Family-Focused CBT (CFF-CBT) versus Treatment As Usual (TAU) for pediatric bipolar disorder (PBD), adjunctive to pharmacotherapy. Sixty-nine children ages 7-13 with PBD were randomly assigned to CFF-CBT or TAU...
October 2016: Behaviour Research and Therapy
Mariely Hernandez, Ciro Marangoni, Marie C Grant, Jezelle Estrada, Gianni L Faedda
OBJECTIVES: Objectives: Early psychopathology in children diagnosed with Bipolar Disorder (BD) remains poorly characterized. Parental retrospective reports provide helpful details on the earliest manifestations and their evolution over time. These symptoms occur early in the course of BD, often before a formal diagnosis is made and/or treatment is implemented, and are of great importance to early recognition and prevention. METHODS: Parents of pre-pubertal children and adolescents with DSM-IV diagnoses of BD attending an outpatient mood disorders clinic provided retrospective ratings of 37 symptoms of child psychopathology...
August 1, 2016: Current Neuropharmacology
Usman Hameed, Cheryl A Dellasega
The goal of this article is to describe the concept of irritability in children and youth, which has been revisited in the DSM-5. Traditionally, this behavior has been more commonly associated with mood disorders, which may account for the rising incidence of bipolar disorder diagnosis and overuse of mood-stabilizing medications in pediatric patients. While not predictive of mania, persistent nonepisodic irritability, if undetected, may escalate to violent behavior with potentially serious outcomes. It is therefore important to educate clinicians about how to accurately assess irritability in pediatric patients...
2016: Primary Care Companion to CNS Disorders
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...
July 15, 2016: Journal of Child and Adolescent Psychopharmacology
D Bailly
OBJECTIVE: To review the options for psychosocial interventions in pediatric bipolar disorders. METHODS: A comprehensive literature review of randomized clinical trials and open-label studies was conducted. RESULTS: Randomized controlled trials show that psychosocial interventions involving families (i.e. family-focused treatment) or individual and family therapy (i.e. multi- or individual-family psychoeducational psychotherapy, child- and family-focused cognitive-behavioral therapy, dialectical behavior therapy) may be effective through added benefit to pharmacotherapy...
June 28, 2016: L'Encéphale
Mian-Li Ong, Eric A Youngstrom, Jesselyn Jia-Xin Chua, Tate F Halverson, Sarah M Horwitz, Amy Storfer-Isser, Thomas W Frazier, Mary A Fristad, L Eugene Arnold, Mary L Phillips, Boris Birmaher, Robert A Kowatch, Robert L Findling
We compared 2 rating scales with different manic symptom items on diagnostic accuracy for detecting pediatric bipolar spectrum disorder (BPSDs) in outpatient mental health clinics. Participants were 681 parents/guardians of eligible children (465 male, mean age = 9.34) who completed the Parent General Behavior Inventory-10-item Mania (PGBI-10 M) and mania subscale of the Child and Adolescent Symptom Inventory-Revised (CASI-4R). Diagnoses were based on KSADS interviews with parent and youth. Receiver operating characteristic (ROC) analyses and diagnostic likelihood ratios (DLRs) determined discriminative validity and provided clinical utility, respectively...
July 1, 2016: Journal of Abnormal Child Psychology
Elisabeth A Frazier, Lance P Swenson, Tracy Mullare, Daniel P Dickstein, Jeffrey I Hunt
Depression with mixed features is poorly understood, especially in pediatric samples. This study compares symptoms and correlates of depressed adolescent inpatients with mixed features to inpatients with bipolar disorder and major depression. 407 adolescents were administered diagnostic interviews and self-reports, and 262 were categorized as Depression with Mixed Features (MXD; n = 38), Consensus Bipolar (CB; n = 79), or Depression Only (DO; n = 145). Demographic and morbidity information were collected via chart reviews...
June 27, 2016: Child Psychiatry and Human Development
Victoria A Reed, Jan K Buitelaar, Ernie Anand, Kathleen Ann Day, Tamás Treuer, Himanshu P Upadhyaya, David R Coghill, Ludmila A Kryzhanovskaya, Nicola C Savill
Atomoxetine is a noradrenergic reuptake inhibitor prescribed for attention-deficit/hyperactivity disorder (ADHD) that first gained approval in the USA in 2002 and has been authorized in 97 countries worldwide. The aim of this paper is to comprehensively review publications that addressed one or more of seven major safety topics relevant to atomoxetine treatment of children and adolescents (aged ≥6 years) diagnosed with ADHD. While the review focuses on children and adolescents, publications in which data from patients aged >18 years and from 6 to 18 years were analyzed in the same dataset were included...
July 2016: CNS Drugs
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