scholarly journals CE2 Comparative Effectiveness of Monotherapy With Mood Stabilizers Versus Atypical Antipsychotics for the Treatment of Bipolar Disorder in Children and Adolescents: A Retrospective Claims-Data Study

2012 ◽  
Vol 15 (4) ◽  
pp. A5
Author(s):  
S. Mehta ◽  
A. Patel ◽  
R.R. Aparasu ◽  
M.O. Perez ◽  
H. Chen
Keyword(s):  
Bipolar Disorder ◽  
Children And Adolescents ◽  
Comparative Effectiveness ◽  
Atypical Antipsychotics ◽  
Claims Data ◽  
Mood Stabilizers

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.

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.

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.

Epidemiological and Clinical Variables Related with the Predominant Polarity on Bipolar Disorder: A Systematic Review

2017 ◽  
Vol 41 (S1) ◽  
pp. S115-S116
Author(s):  
J. García-Jiménez ◽  
A. Porras-Segovia ◽  
J.M. Gota-Garcés ◽  
J.E. Muñoz-Negro ◽  
L. Gutiérrez-Rojas
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Mood Stabilizers ◽  
Future Research ◽  
Type I ◽  
Inclusion Criteria ◽  
Clinical Correlates ◽  
History Of ◽  
Competing Interest

IntroductionType I and type II classification of bipolar disorder (BD) may not provide useful information to the clinician regarding epidemiological and clinical correlates.New classifications have recently been proposed, such as the Predominant Polarity (PP) classification, which is based on the tendency of the patient to relapse in the manic (Manic Predominant Polarity [MPP]) or the depressive (Depressive Predominant Polarity [DPP]) poles along the course of the disease.ObjectivesTo explore the epidemiological and clinical correlates of PP.MethodsWe performed a search of the PubMed and Web of Science databases up to June 1st 2016, using the keywords “bipolar disorder”, “polarity” and “predominant polarity”.ResultsThe initial search identified 1598 articles. Only 17 articles met inclusion criteria. Factors associated with MPP are manic onset, history of drug abuse and a better response to atypical antipsychotics and mood stabilizers. Meanwhile DPP is associated with depressive onset, more relapses, longer acute episodes, and a higher risk of suicide. Moreover, delay until diagnosis, mixed episodes and comorbid anxiety disorders are more prevalent in DPP patients, whose treatment often involves quetiapine and lamotrigine.LimitationsFew prospective studies. Variability of results.ConclusionsPP classification may be useful for the clinical management of BD. Further research in this field is needed. Future research should use standardized definitions and more comparable methods.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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