Disorders - Bipolar Disorders
Hamer, J. A., McIntyre, R. S., Subramaniapillai, M., Lee, Y., Brietzke, E., Mansur, R. B., Lu, W., Chen, K., Gao, Y., Xu, G., So, K. F., Lin, K.
Introduction: Identifying pre-emptive and preventative strategies for mood disorders are a priority research vista. Convergent evidence broadly suggests that aerobic exercise exerts therapeutic and preventative effects for brain-based disorders1,2. Herein, we sought to determine whether aerobic exercise reduces affective symptom burden amongst adolescents at risk for mood disorders. Method(s): 55 adolescents with sub-clinical bipolar disorder (BD) (with 2 or more DSM-4-defined symptoms of depression but not meeting criteria for diagnosis of major depressive disorder, or with 2 or more DSM-4-defined symptoms of mania but not meeting criteria for diagnosis of hypomania) and 166 healthy controls, ages 12-14, were randomized into a 12-week aerobic exercise intervention or placebo psychoeducation. Participants completed the MATRICS Consensus Cognitive Battery (MCCB), Hypomania Checklist 15 (HCL-15), and Personal Health Questionnaire 9 (PHQ-9) both pre and post. Participants were recruited from a middle school in Guangzhou, China. Result(s): There were no significant differences in baseline neurocognitive measures (P > 0.005). Both at-risk and control groups in the exercise arm improved in sustained attention and vigilance (P < 0.05). Both at-risk and control groups in the placebo arm improved in spatial spanning, executive functioning, working memory, reasoning and problem solving and overall neurocognition (P < 0.0005). All groups presented a decrease in HCL-15 (P < 0.0001), and an increase in PHQ-9 (P < 0.0001). There were no interaction effects between intervention type and risk for BP for all measures of neurocognition overtime. Conclusion(s): We conclude that a moderate aerobic exercise intervention program does not differ from psychoeducation in improving cognition or affective symptom burden for youth at-risk for mood disorders.
Bipolar Disorders, 21 (Supplement 1) : 136-137
- Year: 2019
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Physical activity, exercise
Pisano, S., Pozzi, M., Catone, G., Scrinzi, G., Clementi, E., Coppola, G., Milone, A., Bravaccio, C., Santosh, P., Masi, G.
Background: Lithium is a first-line treatment for bipolar disorder in adults, but its mechanism of action is still far from clear. Furthermore, evidences of its use in pediatric populations are sparse, not only for bipolar disorders, but also for other possible indications. Objectives: To provide a synthesis of published data on the possible mechanisms of action of lithium, as well as on its use in pediatric samples, including pharmacokinetics, efficacy, and safety data. Methods: Clinical trials in pediatric samples with at least one standardized measure of efficacy/effectiveness were included in this review. We considered: i) randomized and open label trials, ii) combination studies iii) augmentation studies iv) case series including at least 5 patients. Results: Different and non-alternative mechanisms of action can explain the clinical efficacy of lithium. Clinical studies in pediatric samples suggest that lithium is effective in managing manic symptoms/episodes of bipolar disorder, both in the acute phase and as maintenance strategy. Efficacy on depressive symptoms/phases of bipolar disorder is much less clear, while studies do not support its use in unipolar depression and severe mood dysregulation. Conversely, it may be effective on aggression in the context of conduct disorder. Other possible indications, with limited published evidence, are the acute attacks in Kleine-Levin syndrome, behavioral symptoms of X-fragile syndrome, and the management of clozapine- or chemotherapy- induced neutropenia. Generally, lithium resulted relatively safe. Conclusions: Lithium seems an effective and well-tolerated medication in pediatric bipolar disorder and aggression, while further evidences are needed for other clinical indications. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Current Neuropharmacology, 17(4) : 318-341
- Year: 2019
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Lithium
Perich, T., Mitchell, P. B.
Objectives: Several studies have recently been conducted that have explored the benefits of psychological interventions in reducing symptomatology or improving outcomes in young people at-risk of developing bipolar disorder. The aim of this review was to explore if such interventions reduce current psychiatric symptoms and prevent the development of new symptoms. Method(s): A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Databases searched were MEDLINE, EMBASE, PsychInfo, CINAHL and SCOPUS from January 1990 until August 2018. The inclusion criteria were young people aged under 30 years with a family history of bipolar disorder and any empirical studies that contained a psychological or psychoeducation intervention. Result(s): A total of 7 articles (N = 138, 55 males) were included (mean age ranged from 12 to 15 years). Interventions conducted included Family Focussed Therapy, Interpersonal and Social Rhythm Therapy, and Mindfulness-based Cognitive Therapy for Children. Significant results were found in some studies, depending on the sample's initial symptoms, with reduced time to relapse and reduced symptoms of anxiety, depression and hypo/mania being found. Limitation(s): No studies have explored if interventions may delay the time to onset of first hypo/manic episodes and only two randomised controlled trials were identified. Conclusion(s): Some significant results were noted with lower symptoms of anxiety, depression and hypo/mania being found in some studies. It is currently unclear if psychological interventions may prevent the development of bipolar disorder or other psychiatric symptoms over time; further longitudinal studies are required. Copyright © 2019
Journal of Affective Disorders, 252 : 84-91
- Year: 2019
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Family therapy, Other Psychological Interventions, Mindfulness based therapy
Cortese, S., Tomlinson, A., Cipriani, A.
Objective: Network meta-analyses (NMAs) are gaining traction as the preferred method for evidence synthesis of intervention studies. This review aimed to summarize the basics of NMAs and conduct a meta-review of available NMAs on the treatment of child and adolescent psychiatric disorders by appraising their quality. Method(s): PubMed (Medline), PsycInfo, Embase, Ovid Medline, and Web of Knowledge were systematically searched (last update January 9, 2018). The quality of each included NMA was appraised using the AMSTAR-2 tool and the PRISMA-NMA checklist, which includes specific items for NMAs. Result(s): Eighteen NMAs (6 on attention-deficit/hyperactivity disorder; 4 on psychotic disorders; 2 on depression; 2 on anxiety disorders; 1 on obsessive-compulsive disorder; 1 on disruptive behavior disorder, 1 on bipolar disorder, and 1 on antipsychotics across disorders) were retrieved. Results from the AMSTAR-2 assessment showed that only 27% of appraised NMAs were rated as moderate quality; most were rated as low (33%) or critically low (40%) quality. Only 3 of the appraised NMAs reported on all PRISMA-NMA items specific for NMAs; the network structure was graphically presented in most NMAs (80%), and inconsistency was described in only 47%. Conclusion(s): Given the paucity of head-to-head trials in child and adolescent psychiatry, NMAs have the potential to contribute to the field, because they provide evidence-based hierarchies for treatment decision making, even in the absence of trials directly comparing at least 2 treatments. However, because of important limitations in the included NMAs, additional methodologically sound NMAs are needed to inform future guidelines and clinical practice in child and adolescent psychiatry. Copyright © 2018 American Academy of Child and Adolescent Psychiatry
Journal of the American Academy of Child and Adolescent Psychiatry, 58(2) : 167-179
- Year: 2019
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Pandya, S. P.
There is a need to generate evidence on whether meditation's core aspect of building and nurturing calm and peace serves as a mood stabilizer for current and recurrent episodes of depression through the acute and maintenance phases of treating bipolar disorder II affected patients. A 2-year longitudinal multi-city randomized controlled trial experiment was conducted comprising 311 bipolar disorder II affected patients in the intervention and control group respectively across eight African and Asian cities. The Bipolar Depression Rating Scale (BDRS) was administered with the intervention and control groups that were equal at baseline. Meditation had a positive impact on the intervention group. Post intervention BDRS scores were significantly lower for patients from Asian cities, men, Hindus and Buddhists, middle class, and married patients as well as those who attended all the meditation rounds and regularly self-practiced. Within the BDRS outcome measure, depressive symptoms were impacted the most as compared with mixed symptoms. Meditation helped alleviate guilt, depressed mood, and helplessness-hopelessness. The meditation programme can be used as a combination therapy along with pharmacological treatment to treat mood instability and depression among patients with bipolar disorder II. Copyright © 2018 John Wiley & Sons, Ltd.
Clinical psychology & psychotherapy, 26(2) : 252-261
- Year: 2019
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Meditation
Findling, R.L., McNamara, N.K., Pavuluri, M., Frazier, J.A., Rynn, M., Scheffer, R., Kafantaris, V., Robb, A., DelBello, M., Kowatch, R.A., Rowles, B.M., Lingler, J., Zhao, J., Clemons, T., Martz, K., Anand, R., Taylor-Zapata, P.
Objective: This study examined the role of lithium in the maintenance treatment of pediatric patients with bipolar I disorder (BP-I). Method: Participants aged 7 to 17 years who presented with a manic or mixed episode received 24 weeks of lithium treatment in one of two multiphase studies, the Collaborative Lithium Trials (CoLT 1 and CoLT 2). Responders were randomized to continue lithium or to be cross-titrated to placebo for up to 28 weeks. The primary outcome measure was relative risk of study discontinuation for any reason. Results: A Cox regression analysis found that those who continued treatment with lithium (n = 17) had a lower hazard ratio compared to those who received placebo (n = 14) (p = .015)]. The vast majority of discontinuations were due to mood symptom exacerbations, with most of these occurring in the placebo-treated group. Discontinuation for other reasons occurred at similarly low rates across both group. Most adverse events were mild to moderate in severity, and only one study participant was discontinued from the trial owing to a serious adverse event (aggression). There was no statistically significant difference with respect to weight gain in participants receiving lithium compared to those receiving placebo. Conclusion: This randomized, double-blind, placebo-controlled Discontinuation Trial builds support for the role of lithium as a maintenance treatment in pediatric patients with bipolar disorder and for the safety and tolerability of 28 weeks of maintenance lithium treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of the American Academy of Child & Adolescent Psychiatry, 58(2) : 287-296
- Year: 2019
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Lithium, Medication dose reduction/discontinuation
Putignano, D., Clavenna, A., Reale, L., Bonati, M.
Purpose: Drug use in the pediatric population still often features off-label prescriptions, particularly for psychotropic drugs. We reviewed the registration status, scientific evidence, and recommendations from the guidelines for antipsychotics used for psychiatric disorders in children. Method(s): Antipsychotic drugs marketed in Italy, the United Kingdom (UK) and United States (US) were identified with the ATC Classification System. The licensing status and Summary of Product Characteristics (SPC) were taken from the national formularies. We analyzed reviews and guidelines on antipsychotics use in children and adolescents in the MEDLINE, EMBASE, and PsycINFO databases. Result(s): Out of 67 drugs, 19 were marketed with a pediatric license in at least one country: three in all the selected countries, and only paliperidone with the same indications. Haloperidol was the only antipsychotic authorized for autism in Italy and the UK, and as well as risperidone and aripiprazole in the US. Aripiprazole and paliperidone were licensed in all three countries for schizophrenia. Aripiprazole was licensed for bipolar disorders in all three countries. Haloperidol was licensed for Tourette syndrome in Italy and the UK, and pimozide and aripiprazole in the US. We retrieved 21 pertinent reviews and 13 guidelines for the management of neuropsychiatric disorders in pediatrics. There was a complete overlap between the authorized therapeutic indications and the available scientific evidence for autism in the US, for conduct disorders and bipolar disorders in the UK, and for Tourette syndrome and tics in the UK and Italy. Conclusion(s): These results highlight the different regulatory processes that deny to many children and adolescents the most appropriate and rational antipsychotic therapy. Copyright © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
European Journal of Clinical Pharmacology, 75(6) : 769-776
- Year: 2019
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Lithium
Miklowitz, D. J., Schneck, C. D., Walshaw, P. D., Garrett, A. S., Singh, M. K., Sugar, C. A., Chang, K. D.
Aims: Despite the considerable public health impact of bipolar disorder (BD), no psychosocial interventions have been systematically evaluated in its early prodromal stages. We describe the rationale, design and analytic methods for a 3-site randomized trial of family-focused treatment for youth at high risk (FFT-HR) for BD. Method(s): Participants (ages 9-17 years) have a diagnosis of unspecified BD or major depressive disorder, current mood symptoms and at least one first- or second-degree relative with a lifetime history of BD I or II. Participants are randomly assigned to FFT-HR (12 sessions in 4 months of family psychoeducation and skills training) or enhanced care (EC; 6 individual and family sessions over 4 months), with pharmacotherapy provided as needed. A subset of participants undergo pre- and post-treatment functional MRI (fMRI) scans while performing face-rating and family problem-solving tasks designed to activate corticolimbic circuitry. Independent evaluators assess participants' status every 4 to 6 months for up to 4 years. Result(s): We hypothesize that FFT-HR will be more effective than EC in reducing the severity of mood symptoms (primary outcome) and the hazard of a first manic episode (secondary) over 4 years. Secondarily, we will explore whether FFT-HR is associated with greater decreases in amygdala activation and increases in dorsolateral, ventrolateral or anterior medial prefrontal cortex activation from pre- to post-treatment. Clinical characteristics of 133 subjects enrolled at baseline are described. Conclusion(s): This study will test a novel intervention to reduce the early symptoms of BD, and identify neural and behavioural mechanisms that may help refine future treatments. Copyright © 2017 John Wiley & Sons Australia, Ltd
Early Intervention in Psychiatry, 13(2) : 208-216
- Year: 2019
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Family therapy, Psychoeducation, Skills training
Kazempour, V., Ebrahimi, H., Jafarabadi, M. A., Nourazar, S. G., Zamani, H.
Background and Objectives: Bipolar disorder (BD) is defined as emotion dysregulation. Since such dysregulation is also present during remission, it may be a risk factor for the development of further affective episodes. Therefore, the current study aimed at examining the impact of group cognitive behavioral therapy (GCBT), in comparison to treatment as usual (TAU), on the cognitive emotion regulation strategies of patients with BD. Patients and Methods: The current single-blind, randomized, controlled trial (RCT) was performed from 2015 to 2017 at the Psychiatric Clinic of Razi Hospital affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. A total of 70 adolescents with early-onset BD were selected by the convenience sampling method based on the diagnostic and statistical manual of mental disorders-fourth edition-text revision (DSM-IV-TR) and allocated into receive either 12 sessions of GCBT (N = 35) or TAU (N = 35). Cognitive emotion regulation strategies were evaluated by cognitive emotion regulation questionnaire (CERQ) at baseline, after the intervention, and at 3-month follow-up. Efforts were made to follow up all randomized participants even if they withdrew from the assigned treatment prior to completion of GCBT sessions. Result(s): Compliance with treatment was moderate and the mean number of GCBT sessions that the participants attended was 6.97 (2.81). The 2 groups had significant differences in terms of post-test scores for other-blame (P = 0.001), rumination (P = 0.049), positive refocus (P = 0.008), positive reappraisal (P = 0.005), and putting into perspective (P = 0.001). In the 3-month follow-up, the 2 groups were significantly different only in other-blame (P = 0.001), positive reappraisal (P = 0.001), and putting into perspective subscales (P = 0.001). Therefore, the effects of the intervention were not effectively sustained after 3 months and there was room for improvement in terms of both outcome and compliance. Conclusion(s): The GCBT is more effective when the participants are involved in the study and get instructions on emotion regulation. However, since the effects of the intervention were not sustained for most of the subscales after 3 months, booster sessions might improve and prolong the impact of psychotherapies. Copyright © 2018, Iranian Red Crescent Medical Journal.
Iranian Red Crescent Medical Journal, 20 (S1) (no pagination)(e61555) :
- Year: 2018
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Lee, E. S., Vidal, C., Findling, R. L.
Objectives: The use of atypical antipsychotic medications in pediatric patients has become more prevalent in recent years. The purpose of this review is to provide a clinically relevant update of recent selected key publications regarding the use of atypical antipsychotics in this population. Method(s): Studies reviewed included randomized, double-blind, placebo-controlled medication trials conducted within the past 5 years. A PubMed search was conducted for each of the 11 second-generation antipsychotic medications currently approved by the Food and Drug Administration for use in the United States: Clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, paliperidone, asenapine, iloperidone, lurasidone, and cariprazine. Trials published in English with subjects 18 years of age and younger were included in this review. Additional studies, chosen for their significance to clinical practice, were also included at the discretion of the authors. Result(s): This review demonstrates that more empiric data are available regarding both the acute efficacy and, to a lesser extent, the longer-term efficacy and tolerability for several of the considered antipsychotic medications. The clinical conditions for which these medications have been studied include schizophrenia, bipolar disorder, Tourette's disorder, and autism spectrum disorder. They have also been used as an adjunctive treatment for disruptive behavior disorders with aggression, which have not responded to treatment with stimulants. Conclusion(s): Evidence regarding the efficacy and tolerability of antipsychotic medications for mental health disorders in children and adolescents has expanded exponentially in recent years. However, more information is needed so that evidence-based comparisons between medications can be made. In the future, data enabling the selection of medications based upon individual patient characteristics could potentially lead to greater efficacy and efficiency in treating what are frequently debilitating medical conditions. Maladaptive aggression in children, often treated with antipsychotics, is one such area in which there is a dearth of actual information available to the clinician. It is to be hoped that additional, longer-term studies of these medications will further inform evidence-based practice in clinical settings. Copyright © 2018 Mary Ann Liebert, Inc. publishers.
Journal of Child and Adolescent Psychopharmacology, 28(9) : 582-605
- Year: 2018
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Fristad, M. A., Roley-Roberts, M., Myers, N., Black, S. R., Arnold, L. E.
Objective: Examine long-term outcomes for 95 youth with mood disorders who completed a 12-week randomized controlled trial (RCT) of omega3 fatty acids (OMEGA3) or placebo (PBO) and psychoeducational psychotherapy (PEP) or active monitoring (AM). Methods: Youth/parents were reassessed 2-5 years later regarding current functioning, treatment utilization and beliefs regarding utility and mechanisms of change from OATS interventions. Results: Thirty-eight youth/parents participated (40% retention); assessments were 3.4+/-0.7 years later (range: 2.2-4.7). Returners, compared to the original sample, were significantly more likely to have: completed OATS (92%); non-biracial/black caregiver; annual family income $80-100 K; and unimproved manic symptoms. The Half started or continued OMEGA3 after the RCT; over half started or continued psychotherapy. A majority believed study participation led to the continued improvement of the child (82%, parents; 68%, youth) and family (74%, parents; 68%, youth). Over 45% of parents reported ongoing improved child coping, child mood, family communication, and increased hope, which they attributed to improved understanding; for those on OMEGA3, pills; and for those in PEP, learning new skills and feeling supported. Over 45% of children reported improved mood, self-concept, coping, and family communication, which those in PEP attributed to learning new skills, a caring therapist, better self-understanding, and those on OMEGA3, pills. Conclusions: Two to five years after a 12-week RCT for mood-disordered youth, parents/youth reported ongoing improvement in mood, coping, and family communication. Increased understanding of the child was endorsed regardless of initial treatment assignment. Those in PEP frequently endorsed learning new skills and caring/supportive therapists while those on OMEGA3 believed it was beneficial.
Nutritional Neuroscience, 21 (Supplement 1) : S4
- Year: 2018
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Psychoeducation, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
Goldstein, T. R., Merranko, J., Krantz, M., Garcia, M., Franzen, P., Levenson, J., Axelson, D., Birmaher, B., Frank, E.
Objective: To conduct a pilot randomized trial of Interpersonal and Social Rhythm Therapy plus Data-Informed Referral (IPSRT + DIR) versus DIR-alone for adolescents at-risk for bipolar disorder (BP). Method: Eligible participants included youth (12-18) with a BP parent; youth with BP were excluded. Participants (n = 42) were randomized to receive IPSRT + DIR to treat any psychiatric disorders present at baseline, or DIR-alone. A blind evaluator assessed outcomes at baseline, 3- and 6-months. Participants wore an actigraph to measure sleep/wake patterns for 7 days at baseline and 6-months. Primary outcomes included mood and non-mood symptoms and sleep disturbance. Results: Youth randomized to IPSRT + DIR attended approximately half of scheduled IPSRT sessions. Although 33% of DIR-alone youth were referred for mental health services at intake (another 33% were already engaged in services), none initiated new services over follow-up. No youth developed new-onset mood disorder over follow-up. Self- and parent-reported mood and non-mood psychiatric symptoms did not distinguish the groups, although youth in DIR-alone tended to have higher baseline scores on most measures. Per clinician ratings, 1 youth receiving IPSRT + DIR displayed subthreshold hypo/manic symptoms, versus 2 receiving DIR-alone (OR = 14.7, p = 0.03), possibly signaling less subthreshold hypo/manic symptoms, and for fewer weeks (chi2 = 11.06, p = 0.0009), over 6-months with IPSRT + DIR. We found a small effect for youth in the IPSRT + DIR group to evidence more WASO at pre-treatment, but less at follow-up (cohen's d = 0.28). Limitations: Small sample size limits statistical power, and we are unable to definitively attribute group differences to IPSRT versus greater clinical contact. Ability to examine distal/rare (i.e., BP onset) outcomes was limited. Conclusions: Adolescents at-risk for BP present challenges to psychosocial treatment engagement and retention. IPSRT merits further study as an acceptable intervention for at-risk youth, though necessary frequency and intensity to affect outcomes should be examined. The potential to delay or prevent subthreshold hypo/manic symptoms via enhanced sleep continuity is an area for further examination. Future studies with larger samples and extended follow-up can help determine whether IPSRT may delay or prevent syndromal hypo/mania in youth at-risk. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Journal of Affective Disorders, 235 : 348-356
- Year: 2018
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions