This randomized, double-blind, placebo-controlled study examined the ef?cacy and tolerability of quetiapine in combination with divalproex (DVP) for acute mania in adolescents with bipolar disorder. It was hypothesized that divalproex (DVP) in combination with quetiapine would be more effective than DVP alone for treating mania associated with adolescent bipolar disorder. Furthermore, it was hypothesized that quetiapine would be well tolerated. Study by Melissa del Bello, MD, et al.
Research report that addresses what differences the age of onset of the disorder means in terms of severity of the illness. Early onset generally means that the illness is more severe overall, with greater familial risk. Early onset indicates more psychosis, greater comorbidity with panic disorder and poorer response to lithium treatment.
by Kowatch, Robert A. M.D.; Suppes, Trisha M.D., Ph.D.; Carmody, Thomas J. Ph.D.; Bucci, John P. M.A.; Hume, Judith H. M.S.; Kromelis, Michelle R.PH.; Emslie, Graham J. M.D.; Weinberg, Warren A. M.D.; Rush, A. John M.D.
Journal of the American Academy of Child & Adolescent Psychiatry Copyright 2000 © American Academy of Child and Adolescent Psychiatry, Volume 39(6), June 2000, pp. 713-720
Objective: To develop effect sizes for 3 mood stabilizers-lithium, divalproex sodium, and carbamazepine-for the acute-phase treatment of bipolar I or II disorder, mixed or manic episode, in children and adolescents aged 8 to 18 years.
Method: Forty-two outpatients with a mean age of 11.4 years (20 with bipolar I disorder and 22 with bipolar II disorder) were randomly assigned to 6 weeks of open treatment with either lithium, divalproex sodium, or carbamazepine. The primary efficacy measures were the weekly Clinical Global Impression Improvement scores and the Young Mania Rating Scale (Y-MRS).
Reprinted with permission from J Am Acad Child Adolesc Psychiatry, Volume 37(11).November 1998.1225-1227. Journal of the American Academy of Child & Adolescent Psychiatry Copyright 1998; American Academy of Child and Adolescent Psychiatry
R.J. is a 14-year-old female who was referred for severe separation anxiety, school phobia, and the recent onset of panic attacks. Despite 6 months of aggressive behavioral modification, she continued to be severely impaired by her symptoms. Pharmacotherapy with a benzodiazepine was initiated. Immediately after receiving her initial dose of 0.5 mg of clonazepam, R.J. started laughing inappropriately and was giddy, agitated, and anxious. These symptoms spontaneously abated 4 hours later. Follow-up history indicated no previous reaction in R.J. or any family member. Treatment with chlordiazepoxide was helpful in reducing her anxiety symptoms without untoward adverse effects. With the increased use of medications for emotional and behavioral disorders in youth, one of the most disturbing, nonfatal, adverse outcomes is an unpredictable and generally idiosyncratic reaction to the medication leading to rapid worsening of emotional or behavioral symptoms. Although not commonly written about, behavioral adverse effects of medication can be significantly impairing. Behavioral reactions can be traumatic to the child and family, leading to parental and youth concerns about the use of medications in general and, more specifically, the competence of the practitioner!
by Barbara Geller, M.D. and Joan Luby, M.D.
J Am Acad Child Adoles Psychiatry 36:1168-1176, 1997
Objective: To provide a review of the epidemiology, phenomenology, natural course, comorbidity, neurobiology, and treatment of child and adolescent bipolar disorder (BP) for the past 10 years. This review is provided to prepare applicants for recertification by the American Board of Psychiatry and Neurology. Method: Literature from Medline and other searches for the past 10 years, earlier relevant articles, and the authors' experience and ongoing National Institute of Mental Health-funded project "Phenomenology and Course of Pediatric Bipolarity" were used. Results: Age-specific,developmental (child, adolescent, and adult) DSM-IV criteria manifestations; comorbidity and differential diagnoses; and episode and course features are provided. Included are age-specific examples of childhood grandiosity, hypersexuality, and delusions. Differential diagnoses (e.g. specific language disorders, sexual abuse, conduct disorder [CD], schizophrenia, substance abuse), suicidality, and BP-II are discussed. Conclusion: Available data strongly suggest that prepubertal onset BP is a nonepisodic, chronic, rapid cycling, mixed manic state that may be comorbid with attention-deficit hyperactivity disorder(ADHD) and CD or have features of ADHD and/or CD as initial manifestations. Systematic research on pediatric BP is in its infancy and will require ongoing and future studies to provide developmentally relevant diagnostic methods and treatment. J Am Acad Child AdolesPsychiatry, 1997, 36(9):1168-1176.