Bipolar Disorder in Children and Adolescents: Current Challenges

1997 ◽  
Vol 42 (6) ◽  
pp. 632-636 ◽  
Author(s):  
Margaret Steele ◽  
Sandra Fisman
Keyword(s):  
Bipolar Disorder ◽  
Children And Adolescents ◽  
Lithium Carbonate ◽  
Mood Stabilizers ◽  
Disruptive Behaviour ◽  
Juvenile Onset ◽  
Case Examples ◽  
Developmental Factors ◽  
Disruptive Behaviour Disorders ◽  
Case Vignettes

Objective: To demonstrate the diagnostic and treatment challenges in juvenile-onset bipolar disorder. Method: Three case vignettes are outlined to demonstrate different bipolar presentations in children and adolescents. Results: These case examples illustrate important issues in the diagnosis and management of juvenile-onset bipolar disorder. These issues include diagnostic confusion with atypical initial presentation and the effect of developmental factors on symptom expression. The relationship among genetic risk, early affective instability, and the stress generated by affectively ill family members is complex and circular. Comorbidity with disruptive behaviour disorders, as well as anxiety disorders, is demonstrated by the cases discussed. Comorbid disorders may affect outcome and require separate treatment intervention. There is evidence for the prophylactic antimanic effect of lithium carbonate in children and adolescents, but its specificity as an antimanic agent is still uncertain. There is less evidence, at present, for effectiveness of other mood stabilizers in this age group, although sodium valproate may prove more effective in mixed mania and rapid cycling, which are so often seen with early-onset bipolar disorder. Conclusions: While the existence of juvenile-onset bipolar disorder is no longer in dispute, several outstanding issues related to diagnosis and long-term management remain. Careful prospective research will be necessary to sort out these issues definitively.

scholarly journals Do We Really Know How to Treat a Child with Bipolar Disorder or One with Severe Mood Dysregulation? Is There a Magic Bullet?

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Rajeev Jairam ◽  
Mukesh Prabhuswamy ◽  
Pravin Dullur
Keyword(s):  
Bipolar Disorder ◽  
Maintenance Treatment ◽  
Mood Stabilizers ◽  
Disruptive Behaviour ◽  
Magic Bullet ◽  
Dsm V ◽  
Disruptive Behaviour Disorders ◽  
The Status ◽  
Severe Mood Dysregulation ◽  
Mood Dysregulation

Background. Despite controversy, bipolar disorder (BD) is being increasingly diagnosed in under 18s. There is scant information regarding its treatment and uncertainty regarding the status of “severe mood dysregulation (SMD)” and how it overlaps with BD. This article collates available research on treatment of BD in under 18s and explores the status of SMD.Methods. Literature on treatment of BD in under 18s and on SMD were identified using major search engines; these were then collated and reviewed.Results. Some markers have been proposed to differentiate BD from disruptive behaviour disorders (DBD) in children. Pharmacotherapy restricted to short-term trials of mood-stabilizers and atypical-antipsychotics show mixed results. Data on maintenance treatment and non-pharmacological interventions are scant. It is unclear whether SMD is an independent disorder or an early manifestation of another disorder.Conclusions. Valproate, lithium, risperidone, olanzapine, aripiprazole and quetiapine remain first line treatments for acute episodes in the under 18s with BD. Their efficacy in maintenance treatment remains unclear. There is no validated treatment for SMD. It is likely that some children who are currently diagnosed with BD and DBD and possibly most children currently diagnosed with SMD will be subsumed under the proposed category in the DSM V of disruptive mood dysregulation disorder with dysphoria.

Bipolar Disorder in Children and Adolescents

CNS Spectrums ◽  
2003 ◽  
Vol 8 (12) ◽  
pp. 954-959 ◽  
Author(s):  
Dwight V. Wolf ◽  
Karen Dineen Wagner
Keyword(s):  
Bipolar Disorder ◽  
Children And Adolescents ◽  
Psychosocial Development ◽  
Age Of Onset ◽  
Mood Stabilizers ◽  
Diagnostic Challenge ◽  
Open Label ◽  
Double Blind ◽  
Hyperactivity Disorder ◽  
Combination Treatments

AbstractThere is increased recognition that bipolar disorder has an early age of onset. The prevalence of bipolar disorder in prepubertal children has not been determined, however the prevalence in adolescence is ˜1%. Bipolar disorder in children poses a diagnostic challenge since the symptoms may differ from those in late adolescence and adulthood. Comorbid disorders, such as attention-deficit/hyperactivity disorder, further complicate both the diagnosis and course of the disorder. There is increasing evidence of the chronicity and severity of this disorder in youths. Bipolar disorder significantly disrupts a child's psychosocial development including impairments in academic functioning, family functioning, and relationship with peers. Although this disorder has significant morbidity in children and adolescents, there is a paucity of controlled studies to assess the efficacy and safety of mood stabilizers in the treatment of this disorder in youths. The treatment literature consists largely of case studies, retrospective chart reviews, and open-label studies. There is a compelling need for double-blind, placebo-controlled trials to determine whether commonly used medications to treat this disorder are significantly superior to placebo. Since many children in clinical practice require more than one psychotropic medication to adequately manage this disorder, studies of combination treatments are warranted. This review will provide an overview of the literature of bipolar disorder in children and adolescents, including discussion of the prevalence, diagnosis, epidemiology, course of the illness, and treatment issues.

scholarly journals Comparative efficacy and acceptability of psychosocial treatments for disruptive behaviour disorders in children and adolescents: study protocol for a systematic review and network meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e046091
Author(s):  
Lin Zhang ◽  
Zhihong Ren ◽  
Xueyao Ma ◽  
Dilana Hazer-Rau ◽  
Guangrong Jiang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Children And Adolescents ◽  
Treatment Efficacy ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Disruptive Behaviour ◽  
Comparative Efficacy ◽  
Psychosocial Treatments ◽  
Disruptive Behaviour Disorders ◽  
Meta Analyses

IntroductionDisruptive behaviour disorders are common among children and adolescents, with negative impacts on the youths, their families and society. Although multiple psychosocial treatments are effective in decreasing the symptoms of disruptive behaviour disorders, comprehensive evidence regarding the comparative efficacy and acceptability between these treatments is still lacking. Therefore, we propose a systematic review and network meta-analysis, integrating both direct and indirect comparisons to obtain a hierarchy of treatment efficacy and acceptability.Methods and analysisThe present protocol will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Ten databases, including Web of Science, PubMed, PsycINFO, MEDLINE, APA PsycArticles, Psychology and Behavioral Sciences Collection, OpenDissertations, The Cochrane Library, Embase and CINAHL, will be searched from inception for randomised controlled trials of psychosocial treatments for children and adolescents with disruptive behaviour disorders, without restrictions on language, publication year and status. The primary outcomes will be efficacy at post-treatment (severity of disruptive behaviour disorders at post-treatment) and acceptability (dropout rate for any reason) of psychosocial treatments. The secondary outcomes will involve efficacy at follow-up, severity of internalising problems and improvement of social functioning. Two authors will independently conduct the study selection and data extraction, assess the risk of bias using the revised Cochrane Collaboration’s Risk of Bias tool and evaluate the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation framework to network meta-analysis. We will perform Bayesian network meta-analyses with a random effects model. Subgroup and sensitivity analyses will be performed to evaluate the robustness of the findings.Ethics and disseminationThe research does not require ethical approval. Results are planned to be published in journals or presented at conferences. The network meta-analysis will provide information on a hierarchy of treatment efficacy and acceptability and help make a clinical treatment choice.PROSPERO registration numberCRD42020197448.

scholarly journals Profile of stress factors associated with mental disorders in children and adolescents referred for evaluation and treatment to the Free State Psychiatric Complex, 2007

2012 ◽  
Vol 18 (2) ◽  
pp. 7
Author(s):  
H Heckler ◽  
C E Taute ◽  
G H J Krüger ◽  
D De Wet ◽  
F J W Calitz ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Children And Adolescents ◽  
Developmental Disorders ◽  
Depressive Disorders ◽  
Conduct Disorders ◽  
Stress Factors ◽  
Free State ◽  
Disruptive Behaviour ◽  
State Psychiatric ◽  
Disruptive Behaviour Disorders

<p><strong>Introduction.</strong> South African children and adolescents face serious challenges. Over the past decades children have been exposed to rapid and stressful changes in their environment, including increased crime and violence. <strong></strong></p><p><strong>Aim of study.</strong> The aim of the study was to determine the profile of stress factors leading to mental disorders in children and adolescents referred to the Child and Adolescent Unit at the Free State Psychiatric Complex, Bloemfontein, from January 2006 to December 2007. <strong></strong></p><p><strong>Methods.</strong> A total of 669 children (0 - 12 years) and adolescents (13 - 18 years) referred to the unit for evaluation and treatment were included in the study.<strong> </strong></p><p><strong>Results.</strong> Thirty per cent were diagnosed with attention deficit and disruptive behaviour disorders, followed by major depressive disorders (22.7%), anxiety disorders (18.5%), conduct disorders (16.1%), mild mental retardation (15.7%), adjustment disorders (9.6%), elimination disorders (8.8%), developmental disorders (7.6%) and bereavement (7.0%). Social stressors were identified in 64.1% of participants, and psychological stressors in 19%.</p><p><strong>Conclusions.</strong> Stress plays an important role in the lives of children and adolescents, which could lead to emotional problems if not well managed. The functioning of children and adolescents should be monitored continuously. Schools are in a favourable position to identify stressors affecting children and adolescents. Educators therefore need training and opportunities to consult on mental health matters. Furthermore, religious organisations should be enlisted to identify stressors manifesting as spiritual dysfunction. School health services can play a role in the recognition of biological stressors such as epilepsy, pregnancy, enuresis, illness, speech problems and sensory dysfunction.</p>

scholarly journals Management of schizophrenia and bipolar disorder in pediatric practice

2019 ◽  
Vol 27 (2 (99)) ◽  
pp. 38-47
Author(s):  
Igor Martsenkovsky ◽  
Inna Martsenkovska
Keyword(s):  
Bipolar Disorder ◽  
Children And Adolescents ◽  
Psychological Treatment ◽  
Controlled Trial ◽  
Bipolar Disorders ◽  
Mood Stabilizers ◽  
European Medicines Agency ◽  
Schizophrenia Spectrum Disorders ◽  
Pediatric Practice ◽  
Ministry Of Health

The article presents the features of diag nosis and treatment of schizophrenia and bipolar disorders (BD) with early manifestation in adolescence. Management of disorders includes the complex use of pharmacological, psychological treatment and special forms of social care. The treatment program should include the psychoeducation of the child and his parents and the mobilization of family support. The article also discusses the effi cacy of atypical antipsychotics (risperidone, aripiprazole, olanzapine) and mood stabilizers (valproate, lithium, lamotrigine, and carbamazepine) based on recommendations Food and Drug Administration (FDA) USA, European Medicines Agency (EMA) and the Expert Center of the Ministry of Health of Ukraine. The obtained results of own conducted controlled trials on the effi cacy and safety of olanzapine use are discussed by the authors. Since 2010, 22 cases of olanzapine (Zolafren®) use for adolescents with schizophrenia spectrum disorders aged 13—17 years have been registered in the department of mental disorders of children and adolescents at the Institute of Psychiatry of the Ministry of Health of Ukraine. The period of controlled administration for olanzapine at a dose of 5—20 mg per day ranged from 44 to 70 weeks. As a result of the study were highlighted clinical situations in which the characteristics of the olanzapine action profi le demonstrated its greater effi cacy compared to risperidone and conventional antipsychotics in adolescents. The aim of another controlled trial conducted by the Institute of Psychiatry of the Ministry of Health of Ukraine in 2015—2018 was to evaluate the efficacy of olanzapine at a dose of 5—20 mg per day in adolescents with fi rst time diagnosed acute manic/mixed episode of BD. Nine adolescents aged from 14 to18 years old were assigned. Olanzapine in dose 5 to 20 mg was an eff ective medication for treatment of acute/mixed affective episodes in adolescents with BD and was an acceptable alternative to conventional antipsycho tics and risperidone treatment. Various side eff ects were observed in patients receiving olanzapine therapy, the average number of side eff ects per patient was 2.86, while the most frequent side eff ect was weight gain. Keywords: schizophrenia, bipolar disorder, antipsychotic medication, pediatric practice, children and adolescents

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