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

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.

New Anticonvulsant Medication Uses in Bipolar Disorder

CNS Spectrums ◽  
2003 ◽  
Vol 8 (12) ◽  
pp. 930-947 ◽  
Author(s):  
Po W. Wang ◽  
Terence A. Ketter ◽  
Olga V. Becker ◽  
Cecylia Nowakowska
Keyword(s):  
Bipolar Disorder ◽  
Controlled Trial ◽  
Bipolar Disorders ◽  
The United States ◽  
Similar Efficacy ◽  
Acute Mania ◽  
Divalproex Sodium ◽  
Analgesic Effects ◽  
Anticonvulsant Medication ◽  
Clinical Profiles

ABSTRACTTherapy of bipolar disorders is a rapidly evolving field. Lithium has efficacy in classic bipolar disorders whereas divalproex sodium and carbamazepine may have broader spectrum efficacy that includes non-classic bipolar disorder. In the last 10 years, a series of anticonvulsants have been approved for marketing in the United States. Gabapentin has indirect γ-aminobuytric acid-ergic actions, is generally well tolerated, and appears to have anxiolytic, analgesic, and hypnotic effects. Lamotrigine has antiglutamatergic actions and is generally well tolerated (aside from rash in 1 in 10, and serious rash in 1 in 1,000 patients). Lamotrigine is indicated for maintance treatment in bipolar disorder. Emerging evidence suggests lamotrigine may have utility in bipolar disorder patients with depression and treatment-refractory rapid cycling, as well as analgesic effects. Topiramate and zonisamide may allow both weight loss, while topiramate may have specific efficacy in bulimia, binge eating disorder, and alcohol dependence. Two small studies found oxcarbazepine had similar efficacy to lithium and haloperidol in acute mania. Phenytoin, an older anticonvulsant, may have adjunctive acute mania efficacy. Levetiracetam, a newer anticonvulsant, may be worth exploring and has minimal drug-drug interactions. None of these newer agents has been shown effective in a large placebo controlled trial for acute mania. Although the clinical profiles of these newer anticonvulsants do not appear to overlap markedly with divalproex and carbamazepine (except perhaps for oxcarbazepine), these novel agents may still offer important new options in relieving a variety of specific target symptoms in patients with bipolar disorder.

Inflammation in psychiatric disorders

2014 ◽  
Vol 29 (S3) ◽  
pp. 551-552 ◽  
Author(s):  
G. Fond
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Inflammatory Diseases ◽  
Inflammatory Marker ◽  
Controlled Trial ◽  
Bipolar Disorders ◽  
Mental Illnesses ◽  
Mood Stabilizers ◽  
High Rate ◽  
Somatic Comorbidity ◽  
Anti Inflammatory

One of the most promising research fields is the inflammatory component of major psychiatric diseases (depression, bipolar disorders and schizophrenia). Multiple recent reviews clearly demonstrate that depression, schizophrenia and bipolar disorder are associated with a dysregulation of immune responses as reflected by the observed abnormal profiles of circulating pro- and anti-inflammatory cytokines in affected patients. Considering the high rate of associated somatic comorbidity, major mental illnesses, especially bipolar disorders, have been proposed as multi-systemic inflammatory diseases affecting the brain as well as other organs. In parallel, chronic inflammatory diseases are known to have a high psychiatric comorbidity rate (especially with depression). The same overlap is also found in pharmacological drugs properties as several antidepressants (especially selective serotonin reuptake inhibitors), several antipsychotics and mood stabilizers have shown intrinsic anti-inflammatory properties [1,2]. We recently conducted a systematic review of the literature regarding the efficacy of anti-inflammatory drugs (classified according to their mechanisms of action) in MDD, schizophrenia and bipolar disorders) [3]. We found that polyunsaturated fatty acids (PUFAs) have anti-inflammatory properties and are effective in major depression with a good tolerance profile. One meta-analysis based on 5 trials indicated that COX-2 specific inhibitors showed effectiveness in schizophrenia. COX-1 inhibitors like low-dose aspirin may also have potential effectiveness in the three major disorders but further studies are warranted. Minocycline, an antibiotic that penetrates central nervous system, showed also effectiveness in schizophrenia. Anti-TNFalpha drugs showed important effectiveness in resistant depression with blood inflammatory abnormalities, but in only one randomized placebo-controlled trial [4]. However, in this trial, the anti-inflammatory drug was much more effective than classical antidepressants in patients with baseline elevated hs-CRP (a inflammatory marker).

Treatment and Prevention of Depression

2002 ◽  
Vol 3 (2) ◽  
pp. 39-77 ◽  
Author(s):  
Steven D. Hollon ◽  
Michael E. Thase ◽  
John C. Markowitz
Keyword(s):  
Bipolar Disorder ◽  
Behavioral Interventions ◽  
Combined Treatment ◽  
Bipolar Disorders ◽  
Mood Stabilizers ◽  
Delayed Effect ◽  
Convulsive Therapy ◽  
Adequate Treatment ◽  
Acute Distress ◽  
Reduce Risk

Depression is one of the most common and debilitating psychiatric disorders and is a leading cause of suicide. Most people who become depressed will have multiple episodes, and some depressions are chronic. Persons with bipolar disorder will also have manic or hypomanic episodes. Given the recurrent nature of the disorder, it is important not just to treat the acute episode, but also to protect against its return and the onset of subsequent episodes. Several types of interventions have been shown to be efficacious in treating depression. The antidepressant medications are relatively safe and work for many patients, but there is no evidence that they reduce risk of recurrence once their use is terminated. The different medication classes are roughly comparable in efficacy, although some are easier to tolerate than are others. About half of all patients will respond to a given medication, and many of those who do not will respond to some other agent or to a combination of medications. Electro-convulsive therapy is particularly effective for the most severe and resistant depressions, but raises concerns about possible deleterious effects on memory and cognition. It is rarely used until a number of different medications have been tried. Although it is still unclear whether traditional psychodynamic approaches are effective in treating depression, interpersonal psychotherapy (IPT) has fared well in controlled comparisons with medications and other types of psychotherapies. It also appears to have a delayed effect that improves the quality of social relationships and interpersonal skills. It has been shown to reduce acute distress and to prevent relapse and recurrence so long as it is continued or maintained. Treatment combining IPT with medication retains the quick results of pharmacotherapy and the greater interpersonal breadth of IPT, as well as boosting response in patients who are otherwise more difficult to treat. The main problem is that IPT has only recently entered clinical practice and is not widely available to those in need. Cognitive behavior therapy (CBT) also appears to be efficacious in treating depression, and recent studies suggest that it can work for even severe depressions in the hands of experienced therapists. Not only can CBT relieve acute distress, but it also appears to reduce risk for the return of symptoms as long as it is continued or maintained. Moreover, it appears to have an enduring effect that reduces risk for relapse or recurrence long after treatment is over. Combined treatment with medication and CBT appears to be as efficacious as treatment with medication alone and to retain the enduring effects of CBT. There also are indications that the same strategies used to reduce risk in psychiatric patients following successful treatment can be used to prevent the initial onset of depression in persons at risk. More purely behavioral interventions have been studied less than the cognitive therapies, but have performed well in recent trials and exhibit many of the benefits of cognitive therapy. Mood stabilizers like lithium or the anticonvulsants form the core treatment for bipolar disorder, but there is a growing recognition that the outcomes produced by modern pharmacology are not sufficient. Both IPT and CBT show promise as adjuncts to medication with such patients. The same is true for family-focused therapy, which is designed to reduce interpersonal conflict in the family. Clearly, more needs to be done with respect to treatment of the bipolar disorders. Good medical management of depression can be hard to find, and the empirically supported psychotherapies are still not widely practiced. As a consequence, many patients do not have access to adequate treatment. Moreover, not everyone responds to the existing interventions, and not enough is known about what to do for people who are not helped by treatment. Although great strides have been made over the past few decades, much remains to be done with respect to the treatment of depression and the bipolar disorders.

scholarly journals Comorbidity Between ADHD and Symptoms of Bipolar Disorder in a Community Sample of Children and Adolescents

2005 ◽  
Vol 8 (5) ◽  
pp. 459-466 ◽  
Author(s):  
Wendy Reich ◽  
Rosalind J. Neuman ◽  
Heather E. Volk ◽  
Cynthia A. Joyner ◽  
Richard D. Todd
Keyword(s):  
Bipolar Disorder ◽  
Children And Adolescents ◽  
Latent Class ◽  
Community Sample ◽  
Control Sample ◽  
Bipolar Disorders ◽  
Adhd Subtypes ◽  
Population Prevalence ◽  
Increased Risk ◽  
Dsm Iv

AbstractThe prevalence and frequency of comorbidity of possible bipolar disorder was examined with attention-deficit hyperactivity disorder (ADHD) in a nonreferred population of twins. Children and adolescents aged 7 to 18 years with a history of manic symptoms were identified from a population-based twin sample obtained from state birth records (n = 1610). The sample was enriched for ADHD; however, there was also a random control sample (n = 466), which allowed a look at the population prevalence of the disorder. Juveniles with threshold or below threshold manic episodes were further assessed for comorbidity with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) and population-defined ADHD subtypes (from latent class analysis) using Fisher's exact test. Nine juveniles who exhibited DSM-IV manic (n = 1), hypomanic (n = 2) or below threshold episodes (n = 6) were identified. The population prevalence of broadly defined mania in the random sample was 0.2%. The possible manic episodes showed significant comorbidity with population-defined severe combined and talkative ADHD subtypes. It can be concluded that there is a significant association of bipolar symptoms with two population-defined subtypes of ADHD. Episodes of possible bipolar disorders as defined by DSM-IV are uncommon in this nonreferred sample. Children and adolescents with ADHD appear to be only modestly at increased risk for bipolar disorders.

Mood Stabilizers: Implementing Combined Treatment Regimens in Bipolar Disorder

2018 ◽  
Author(s):  
Charles Bowden ◽  
Melissa Martinez
Keyword(s):  
Bipolar Disorder ◽  
Treatment Planning ◽  
Rating Scale ◽  
Bipolar Depression ◽  
Combined Treatment ◽  
Bipolar Disorders ◽  
Maintenance Phase ◽  
Mood Stabilizers ◽  
Outcome Analysis ◽  
Treatment Regimens

Patients with bipolar disorders spend a greater proportion of their illness in a depressed or mixed state rather than experiencing either mania or hypomania. Over the past 20 years, most major pharmaceutical companies have either reduced or abandoned the research and development of novel psychiatric drugs, exiting the development of new, safe, efficacious, and tolerable treatment regimens for bipolar disorder. Therefore, optimizing the current treatments available is critical. We review studies of the last 15 years that provide guidance relevant to managing the maintenance phase of bipolar disorders. Based on these data, we provide recommendations for effective treatment planning and implementation, principally for the maintenance phase care of persons with bipolar disorder. We also discuss strategies for implementing medication regimens, differentiating strategies for maintenance phase treatment from those of acute phase treatment. Assessing key symptoms that are sensitive to change is critical for longitudinal assessments and treatment planning for patients with bipolar disorders. In most studies, only a subset of rating scale items differentiate patients with good responses from those without. Identified symptoms include racing thoughts, less need for sleep, hyperactivity, increased activity, and increased energy. We developed a procedure for using Multistate Outcome Analysis of Treatment (MOAT) in bipolar disorders. MOAT integrates efficacy and tolerability data during studies to provide information about the quantity and quality of time spent in distinct mood states. The protocol developed will be useful for assessing treatment strategies in bipolar disorder. This review contains 4 figures, 7 tables and 32 references Key words: bipolar, depression, lithium, mania, mixed, mood stabilizer, survival analysis, symptom domains, valproate

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