Pharmacotherapy in Children and Adolescents at Clinical-High Risk for Psychosis and Bipolar Disorder

2016 ◽  
Vol 49 (06) ◽  
pp. 229-244 ◽  
Author(s):  
M. Lambert ◽  
V. Niehaus ◽  
C. Correll
Keyword(s):  
Bipolar Disorder ◽  
High Risk ◽  
Children And Adolescents ◽  
Prospective Studies ◽  
Pharmacological Intervention ◽  
Clinical High Risk ◽  
Omega 3 ◽  
Management Options ◽  
Pediatric Populations ◽  
Pharmacologic Agents

AbstractThis 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. non-treatment. Only 10 prospective studies of antipsychotics (randomized=4) and 6 prospective studies of non-antipsychotic pharmacologic agents (randomized=3, i. e., omega-3 fatty acids=2, glycine=1) for the psychotic clinical high-risk state and only 4 prospective studies of mood stabilizing medications for the bipolar clinical high-risk state (randomized=2, i. e., lithium=1, valproate=1) were detected. Based on the minimal efficacy data, adverse effect risks, especially in pediatric populations, nonspecific psychopathology, and unknown true risk for the development of either psychosis or bipolar disorder or of chronically disabling symptoms and disability, medication treatment currently remains second choice after psychosocial intervention. Additional research in this area is clearly needed in order to shed more light on the relevance and predictive value of potentially prodromal symptoms, their identification and most appropriate management options.

Structural dysconnectivity in offspring of individuals with bipolar disorder: The effect of co-existing clinical-high-risk for bipolar disorder

2021 ◽  
Vol 281 ◽  
pp. 109-116
Author(s):  
Emre Bora ◽  
Gunes Can ◽  
Nabi Zorlu ◽  
Gozde Ulas ◽  
Neslihan Inal ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
High Risk ◽  
Clinical High Risk

Update on the treatment of bipolar disorder in children and adolescents

2005 ◽  
Vol 20 (2) ◽  
pp. 87-91 ◽  
Author(s):  
Robert L. Findling
Keyword(s):  
Bipolar Disorder ◽  
High Risk ◽  
Genetic Risk ◽  
Pediatric Patients ◽  
Treatment Strategies ◽  
Pharmacological Intervention ◽  
Pediatric Bipolar Disorder ◽  
Symptom Remission ◽  
Affected Parent ◽  
Maintenance Study

AbstractAs the phenomenology of pediatric bipolar disorder has become better delineated, clinicians are now able to more accurately assess and treat young people suffering from this condition. For pediatric patients with bipolar I disorder and symptoms of mania, medication monotherapy has been shown to lead to symptom amelioration. However, this treatment modality oftentimes does not lead to full symptom remission. In an attempt to address this observation, combination treatment strategies have recently been investigated. Recently, a maintenance study has shown that in youths who achieved remission on a combination of lithium and divalproate therapy, either of these agents alone was equally effective as a treatment strategy. In youths identified as being at genetic high risk for bipolarity who also had problematic affective symptomatology, treatment with divalproate was not found to be superior to placebo; however, those with the greatest degree of genetic risk for familial psychopathology remained in the trial longer than those with more modest amounts of familial psychopathology. These data suggest that intervention in youths with only one affected parent may not be a rational prevention strategy for pharmacological intervention in bipolar disorder, and that cohorts more genetically at risk may be a more appropriate group for preventative pharmacotherapy.

Long-Chain Omega-3 Polyunsaturated Fatty Acids in the Blood of Children and Adolescents with Juvenile Bipolar Disorder

Lipids ◽  
2008 ◽  
Vol 43 (11) ◽  
pp. 1031-1038 ◽  
Author(s):  
Edward H. Clayton ◽  
Tanya L. Hanstock ◽  
Stephen J. Hirneth ◽  
Colin J. Kable ◽  
Manohar L. Garg ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Bipolar Disorder ◽  
Polyunsaturated Fatty Acids ◽  
Children And Adolescents ◽  
Omega 3 ◽  
Long Chain

HIGHER RATES OF PSYCHOPATHOLOGY IN THE CHILDREN AND ADOLESCENTS AT GENETIC HIGH RISK OF BIPOLAR DISORDER AND SCHIZOPHRENIA COMPARED TO HEALTHY CONTROLS: PRELIMINARY RESULTS

2010 ◽  
Vol 117 (2-3) ◽  
pp. 439-440
Author(s):  
Vanessa Sanchez-Gistau ◽  
Elena de la Serna ◽  
Soledad Romero ◽  
Montse Vila ◽  
Inma Baeza ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
High Risk ◽  
Children And Adolescents ◽  
Healthy Controls ◽  
Preliminary Results

Neurocognition in young offspring of individuals with bipolar disorder: The role of co-existing familial and clinical high-risk for bipolar disorder

2019 ◽  
Vol 281 ◽  
pp. 112565
Author(s):  
Gunes Can ◽  
Emre Bora ◽  
Aysegul Ildız ◽  
Gozde Ulas ◽  
Ceren Hıdıroglu Ongun ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
High Risk ◽  
Clinical High Risk ◽  
Young Offspring

scholarly journals 23. Omega-3 Fatty Acid Versus Placebo in a Clinical High-Risk Sample From the North American Prodrome Longitudinal Studies (NAPLS) Consortium

2017 ◽  
Vol 43 (suppl_1) ◽  
pp. S16-S16 ◽  
Author(s):  
Kristin Cadenhead ◽  
Jean Addington ◽  
Tyrone Cannon ◽  
Barbara Cornblatt ◽  
Daniel Mathalon ◽  
...  
Keyword(s):  
Fatty Acid ◽  
High Risk ◽  
Longitudinal Studies ◽  
North American ◽  
Clinical High Risk ◽  
Omega 3 ◽  
Omega 3 Fatty Acid ◽  
The North ◽  
Acid Versus

Review of Risk Prediction Approaches for Bipolar Episodes in the Perinatal Period

2017 ◽  
Vol 41 (S1) ◽  
pp. S113-S113
Author(s):  
M. Casanova Dias ◽  
I. Jones ◽  
A. Di Florio ◽  
L. Jones ◽  
N. Craddock
Keyword(s):  
Decision Making ◽  
Bipolar Disorder ◽  
High Risk ◽  
Risk Prediction ◽  
Prediction Models ◽  
Perinatal Period ◽  
Management Options ◽  
Risk Prediction Models ◽  
Risk Period ◽  
The Impact

IntroductionThe perinatal period is a high-risk period for the development of illness episodes in women with bipolar disorder. Relapse rates vary between 9 and 75% depending on the study. The overall risk of a severe episode is approximately 20%. The impact on women, the relationships with their babies and their families can be devastating. In the UK costs to society are £8.1 billion per year-cohort of births. The advice currently given to women is based of general risk rates. Women's needs of information for decision-making in the perinatal period are not being met.ObjectivesTo review the risk prediction approaches used for women with bipolar disorder in the perinatal period.AimsTo understand the existing risk prediction models and approaches used for prognosis of the risk of recurrence of bipolar disorder for women in the perinatal period.MethodsSystematic literature search of public medical electronic databases and grey literature on risk prediction for bipolar episodes in the perinatal period.ResultsWe will present the existing models and approaches used for risk prediction of illness episodes in the perinatal period.ConclusionsAwareness of existing risk prediction models for recurrence of bipolar disorder in the perinatal period will allow better informed risk-benefit analysis of treatment and management options.This person-centred approach will help women and clinicians in their decision-making at this crucial high-risk period.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Clinical high risk for psychosis in children and adolescents: a systematic review

2017 ◽  
Vol 27 (6) ◽  
pp. 683-700 ◽  
Author(s):  
Jordina Tor ◽  
Montserrat Dolz ◽  
Anna Sintes ◽  
Daniel Muñoz ◽  
Marta Pardo ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Children And Adolescents ◽  
Clinical High Risk

scholarly journals M57. NEUROCOGNITIVE HETEROGENEITY IN 7-YEAR-OLD CHILDREN AT FAMILIAL HIGH RISK OF SCHIZOPHRENIA OR BIPOLAR DISORDER - THE DANISH HIGH RISK AND RESILIENCE STUDY VIA 7

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S156-S156
Author(s):  
Nicoline Hemager ◽  
Camilla Christiani ◽  
Anne Amalie Thorup ◽  
Katrine Søborg Spang ◽  
Ditte V Ellersgaard ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
High Risk ◽  
Young Children ◽  
Hierarchical Cluster ◽  
Clinical High Risk ◽  
Neurocognitive Deficits ◽  
Polygenic Risk ◽  
Level Of Functioning ◽  
Neurocognitive Functions ◽  
Familial High Risk

Abstract Background Neurocognitive impairments are widespread in individuals with schizophrenia both premorbid and post illness onset. Although less pronounced, individuals with bipolar disorder also display various neurocognitive deficits. Owing to the impaired neurocognitive functions in first-degree relatives, neurocognitive deficits are considered endophenotypes of both disorders. Importantly, neurocognitive heterogeneity exists in both disorders. Distinct neurocognitive subgroups in young adults with clinical high risk of psychosis or familial risk of bipolar disorder have been identified with an increased risk of conversion to illness and poorer functioning in the most neurocognitively impaired subgroup. However, neurocognitive heterogeneity remains to be investigated in young children at familial high risk of schizophrenia (FHR-SZ) and bipolar disorder (FHR-BP). The aim of this study was to identify relatively homogeneous neurocognitive subgroups in a cohort of children with FHR-SZ or FHR-BP and to investigate the distribution of high risk status across the neurocognitive subgroups. Exploratively, potential differences between these subgroups on functional outcome and polygenic risk were investigated. Methods Neurocognition was assessed cross-sectionally with a comprehensive test battery in a population-based cohort of 514 children aged 7 with either FHR-SZ (N=197), FHR-BP (N=118) or no familial high risk of these disorders (N=199). A hierarchical cluster analysis of the neurocognitive data was performed using Ward’s method and followed-up by a K-means cluster analysis. The neurocognitive clusters were further compared on measures of current level of functioning and polygenic risk for educational attainment. Results Three distinct neurocognitive subgroups were derived from the hierarchical cluster analyses: a 1) significantly impaired, 2) typical, and 3) high functioning subgroup. The three subgroups performed significantly different from each other on the majority of the pairwise comparisons of the neurocognitive functions (Cohen’s d range = 0.33–2.27, p < 0.01). There was a significantly higher percentage of children with FHR-SZ in the significantly impaired subgroup (36%) compared to children with FHR-BP (20%). Importantly, 64% of the children at FHR-SZ and 80% of the children at FHR-BP displayed either typical or high neurocognitive functioning. Finally, the neurocognitive subgroups differed significantly on current level of functioning with the significantly impaired subgroup displaying the lowest level of functioning. Polygenic risk for educational attainment was non-significantly different across neurocognitive subgroups. Discussion Young children at familial high risk of severe mental disorders (SMD) are neurocognitively heterogenic with three distinct neurocognitive subgroups of varying severity. A higher percentage of children at FHR-SZ was in the significantly impaired subgroup (36%) compared to children at FHR-BP (20%). In this cross-sectional study, being in the significantly impaired neurocognitive subgroup is associated with poorer daily functioning across risk status and in other, longitudinal studies has proven predictive of transition to illness in young adults at clinical high risk. Therefore, neurocognitive profiling in high-risk offspring may guide future intervention programs targeting the neurocognitively impaired subgroup of young children at familial high risk of SMD using e.g. cognitive remediation or other potentially preemptive or ameliorating interventions.

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