Comparative effectiveness of monotherapy with mood stabilizers versus second generation (atypical) antipsychotics for the treatment of bipolar disorder in children and adolescents

2014 ◽  
Vol 23 (3) ◽  
pp. 299-308 ◽  
Author(s):  
Hua Chen ◽  
Sonam Mehta ◽  
Rajender Aparasu ◽  
Ayush Patel ◽  
Melissa Ochoa-Perez
Keyword(s):  
Bipolar Disorder ◽  
Children And Adolescents ◽  
Comparative Effectiveness ◽  
Atypical Antipsychotics ◽  
Second Generation ◽  
Mood Stabilizers

The use of second generation antipsychotics in children and adolescents with bipolar disorder and schizophrenia: A summary of the AHRQ comparative effectiveness review

2013 ◽  
Vol 2 (11) ◽  
pp. 350-352
Author(s):  
Jeani Pulsipher ◽  
Gary M. Levin
Keyword(s):  
Bipolar Disorder ◽  
Adverse Effects ◽  
Children And Adolescents ◽  
Mood Disorders ◽  
Comparative Effectiveness ◽  
Second Generation ◽  
Pediatric Patients ◽  
Healthcare Research ◽  
Second Generation Antipsychotics

Second generation antipsychotics (SGAs) can be effective in treating mood disorders in pediatric patients; however, these medications also present with a risk of serious adverse effects. A recent review by the Agency for Healthcare Research and Quality (AHRQ) evaluated the use of SGAs in pediatric patients. This article summarizes the findings of the review, with a focus on bipolar disorder and schizophrenia.

The Metabolic Impact of the Antipsychotic Drugs in Patients with Bipolar Disorder

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M. Tournier ◽  
A. Cougnard ◽  
B. Bégaud ◽  
A. Thiébaut ◽  
H. Verdoux
Keyword(s):  
Bipolar Disorder ◽  
First Generation ◽  
Second Generation ◽  
Mood Stabilizer ◽  
Care Program ◽  
Mood Stabilizers ◽  
Lipid Lowering ◽  
Study Population ◽  
Second Generation Antipsychotic ◽  
Lowering Drug

Objective:To assess the metabolic impact of adding an antipsychotic to a mood stabilizer or switching a mood stabilizer to an antipsychotic in patients with bipolar disorder.Methods:A retrospective fixed cohort study was conducted through the claims database of the French health care program for the self-employed workers. The study population consisted of 3.172 patients age 18 and over who were exposed to mood stabilizers (i.e. lithium, valproate) a 3 month-period in 2004 without dispensing of non-sedative antipsychotic, antidiabetic or lipid-lowering drugs. The outcome was the occurrence of a metabolic incident over the follow-up period, using the dispensing of an antidiabetic drug as a marker of diabetes and the dispensing of a lipid-lowering drug as a marker of hypercholesterolemia or hypertriglyceridemia. A Cox proportional hazard model was used to assess the metabolic impact of the antipsychotics; using mood stabilizers as a reference. Antipsychotic exposition was stratified in «current» and «recent» (discontinued for less than 6 months) at the time of the metabolic incident.Results:196 patients (6.2%) received a first-generation antipsychotic, 352 (11.1%) a second-generation antipsychotic, 565 (17.8%) a sedative antipsychotic and 367 patients (11.6%) presented with a metabolic incident over the study period. The recent dispensing of a second-generation antipsychotic was associated with the occurrence of a metabolic incident [HR 2.1 (95%CI 1.2-3.7) p=0.006], while current dispensing or dispensing of first-generation antipsychotics were not.Conclusion:Second-generation antipsychotics have a metabolic impact compared to classic mood stabilizers in patients with bipolar disorder.

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.

Differential Diagnosis of Borderline Personality Disorder from Bipolar Disorder

2010 ◽  
Vol 32 (3) ◽  
pp. 189-205 ◽  
Author(s):  
Gregory Hatchett
Keyword(s):  
Bipolar Disorder ◽  
Differential Diagnosis ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Atypical Antipsychotics ◽  
Treatment Approach ◽  
Borderline Personality ◽  
Mood Stabilizers ◽  
Health Counseling ◽  
Dsm V

Many psychiatrists have reconceptualized borderline personality disorder (BPD) as a variant of bipolar disorder and, consistent with the treatment of bipolar disorder, emphasize the use of mood stabilizers and atypical antipsychotics in treatment. This change in diagnostic practice is unfortunate. BPD is a distinct diagnostic construct, and clients who fit this pattern require a fundamentally different treatment approach than what is typically recommended for bipolar disorder. The purpose of this article is to update counselors on the expansion of bipolar disorder in the psychiatric literature, present evidence for the validity of BPD, discuss strategies for the differential diagnosis of it from bipolar disorder, review proposed changes in DSM-V, and integrate the literature into a mental health counseling framework.

Children and adolescents with major depressive disorders: are some second generation antidepressants better than others?

2011 ◽  
Vol 26 (S2) ◽  
pp. 1251-1251
Author(s):  
A. Kaminski ◽  
G. Gartlehner
Keyword(s):  
Children And Adolescents ◽  
Comparative Effectiveness ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Depressive Disorders ◽  
Second Generation ◽  
Young Patients ◽  
Antidepressant Drugs ◽  
Cochrane Library ◽  
Major Depressive ◽  
Increased Risk

IntroductionSince the black box warning of the FDA (Food and Drug Administration) regarding an increased risk of suicidality in children and adolescents treated with antidepressants, cautious prescription of antidepressant drugs in young patients became even more important. In the light of potentially severe side effects the comparative effectiveness and harms of antidepressants should be known to clinicians to provide optimal treatment.ObjectivesTo compare the benefits and harms of second-generation antidepressants for the treatment of Major Depressive Disorder (MDD) in children and adolescents.AimsTo provide an evidence base for clinicians and policymakers when making informed decisions regarding the prescription of Selective Serotonin Reuptake Inhibitors and other newer antidepressants.MethodsWe updated a comparative effectiveness report of the Oregon Drug Effectiveness Review Project searching MEDLINE, Embase, The Cochrane Library, and the International Pharmaceutical Abstracts up to August 2010. Two persons independently reviewed the literature, abstracted data, and rated the risk of bias.ResultsWe could not identify any head-to-head trials. There is insufficient evidence to compare one second-generation antidepressant to another in pediatric outpatients with MDD. Evidence from a systematic review of published and unpublished data indicates, that in children and adolescents only fluoxetine shows a good risk-benefit ratio.ConclusionsTo date, the evidence is insufficient to make any clear inferences about the comparative benefits and harms of second-generation antidepressants for the treatment of MDD in children. Clinicians must be aware of the small benefits and the high potential risks when prescribing antidepressant medications to children and adolescents.

Maintenance Therapies in Bipolar Disorder: Focus on Randomized Controlled Trials

2005 ◽  
Vol 39 (8) ◽  
pp. 652-661 ◽  
Author(s):  
David J. Muzina ◽  
Joseph R. Calabrese
Keyword(s):  
Bipolar Disorder ◽  
Combination Therapy ◽  
Maintenance Therapy ◽  
Atypical Antipsychotics ◽  
Mood Stabilizers ◽  
Antidepressant Effect ◽  
Controlled Trials ◽  
Research Database ◽  
Concomitant Treatment ◽  
Rapid Cycling

Objective: Lithium remains the cornerstone of maintenance therapy for bipolar disorder despite growing use of other agents, including divalproex, lamotrigine, carbamazepine and the atypical antipsychotics. Lithium has the largest body of data to support its continued use as a prophylactic agent; however, most of this data comes from early studies that did not use contemporary analytic methods. Alternatives to lithium are needed because of the relatively high rate of non-response to lithium monotherapy and the drug's frequent side-effects. This article reviews available data with an emphasis on double-blind, placebo controlled studies that examine the efficacy of lithium and other putative mood stabilizers: carbamazepine, divalproex, lamotrigine and olanzapine. Method: The authors reviewed key literature using Medline searches using key words: bipolar disorder, controlled trials, mood stabilizer, lithium, lomotrigine, divalproex, olanzapine, carbamazepine. Results: Lithium remains the gold standard for overall preventative efficacy in bipolar disorder, especially to decrease manic or hypomanic relapse. Of the mood stabilizers that have marked prophylactic antimanic properties, lithium appears to possess the greatest antidepressant effect. Divalproexmay also prevent recurrent bipolar mood episodes but the relative lack of controlled maintenance studies makes this less certain. There now exists an extensive and well-designed research database supporting the use of lamotrigine in the acute and prophylactic management of bipolar I disorder. Lamotrigine offers a spectrum of clinical effectiveness that complements lithium, in that it appears to stabilize mood ‘from below baseline’ by preventing episodes of depression and has been shown to be effective in rapid-cycling bipolar II disorder. Carbamazepine may be a useful alternative to lithium, divalproex and lamotrigine, particularly for patients with a history of mood-incongruent delusions and other comorbidities, but controlled data is more equivocal and it may lose some of its prophylactic effect over time. Emerging data continue to support the growing use of atypical antipsychotics, particularly olanzapine. Conclusions: Any monotherapy for use as a maintenance therapy of bipolar disorder appears to be inadequate for long-term use in the management of the majority of patients with bipolar disorder. Combination therapy has become the standard of care in the treatment of bipolar disorder and particularly in patients with treatment-refractory variants such as those with rapid-cycling. The emerging consensus is that patients on monotherapy, if followed for sufficiently long periods, will eventually require concomitant treatment to maintain a full remission. There exists a need for controlled trials that use random assignment to parallel arms including combination therapy followed by data analyses that include both relapse rate and survival techniques.

Sign in / Sign up

Export Citation Format

Share Document