Disorders - Bipolar Disorders
Miklowitz, D. J., Schneck, C. D., Singh, M. K., Taylor, D. O., George, E. L., Cosgrove, V. E., Howe, M. E., Dickinson, L. M., Garber, J., Chang, K. D.
Objective: Depression and brief periods of (hypo)mania are linked to an increased risk of progression to bipolar I or II disorder (BD) in children of bipolar parents. This randomized trial examined the effects of a 4-month family-focused therapy (FFT) program on the 1-year course of mood symptoms in youth at high familial risk for BD, and explored its comparative benefits among youth in families with high versus low expressed emotion (EE). Method: Participants were 40 youth (mean 12.3 ± 2.8 years, range 9 - 17) with BD not otherwise specified, major depressive disorder, or cyclothymic disorder who had a first-degree relative with BD I or II and active mood symptoms (Young Mania Rating Scale [YMRS] >11 or Child Depression Rating Scale >29). Participants were randomly allocated to FFT - High Risk version (FFT-HR; 12 sessions of psychoeducation and training in communication and problem-solving skills) or an education control (EC; 1 - 2 family sessions). Results: Youth in FFT-HR had more rapid recovery from their initial mood symptoms (hazard ratio = 2.69, p = .047), more weeks in remission, and a more favorable trajectory of YMRS scores over 1 year than youth in EC. The magnitude of treatment effect was greater among youth in high-EE (versus low-EE) families. Conclusions: FFT-HR may hasten and help sustain recovery from mood symptoms among youth at high risk for BD. Longer follow-up will be necessary to determine whether early family intervention has downstream effects that contribute to the delay or prevention of full manic episodes in vulnerable youth. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)
Journal of the American Academy of Child & Adolescent Psychiatry, 52(2) : 121-131
- Year: 2013
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Family therapy
Pathak, S., Findling, R. L., Earley, W. R., Acevedo, L. D., Stankowski, J., DelBello, M. P.
Objective: To evaluate the efficacy and safety of quetiapine monotherapy in children and adolescents with mania associated with bipolar I disorder. Method: Patients aged 10 to 17 years, with a DSM-IV-TR diagnosis of a manic episode associated with bipolar I disorder and Young Mania Rating Scale (YMRS) total score ≥ 20 were randomized to 3 weeks of quetiapine (400 or 600 mg/d) or placebo. The primary efficacy measure was change in YMRS total score. The study was conducted at 34 centers in the United States between August 2004 and July 2006. Results: The intent-to-treat population included 277 patients. Least squares mean change in YMRS score from baseline to end point by mixed-model, repeated-measures analysis was −14.25, −15.60, and −9.04 for quetiapine 400 mg/d, quetiapine 600 mg/d, and placebo, respectively (P < .001, each quetiapine dose vs placebo). Significant improvement in YMRS score versus placebo was first observed at day 4 (P = .015) with quetiapine 400 mg/d and day 7 (P < .001) with quetiapine 600 mg/d. Mean changes in body weight at day 21 (observed cases) were 1.7 kg for both quetiapine doses and 0.4 kg for placebo. Numerically larger mean increases in total cholesterol, low-density lipoprotein cholesterol, and triglycerides were observed with quetiapine than placebo. Adverse events associated with quetiapine were mostly mild to moderate in intensity. Conclusions: In this 3-week study, quetiapine was significantly more effective than placebo in improving manic symptoms in youth with mania associated with bipolar disorder. Treatment was generally well tolerated and adverse events were broadly consistent with the known profile of quetiapine in adults with bipolar disorder. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)
Journal of Clinical Psychiatry, 74(1) : e100-e109
- Year: 2013
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
West, A. E., Weinstein, S. M., Peters, A.
Objective: Psychosocial treatment has been indicated as an essential component of effective treatment for pediatric bipolar disorder (PBD). However, patients demonstrate variable response to current evidence-based psychosocial interventions, implying that certain patient and family characteristics may moderate treatment outcomes. In particular, poor family functioning has emerged as a potential moderator of treatment outcome for youth with bipolar disorder (Miklowitz et al., 2009), with families demonstrating lower functioning showing poorer response to treatment. Methods: Data presented is from a randomized clinical trial of child- and family-focused cognitive-behavioral therapy (CFFCBT) versus treatment as usual (TAU) for PBD youth aged 7-13 (n = 60). Participants were recruited from a specialty pediatric mood disorders clinic in a large Midwestern medical center. All participants were diagnosed with bipolar disorder (I, II, or NOS) via the WASH-U-KSADS and randomly assigned to receive 12 weeks of CFF-CBT or TAU sessions. Participants were assessed (via a blinded rater) on a range of symptom, global functioning, child, parent, and family psychosocial functioning measures at baseline, weeks 4 and 8, post-treatment, and a 6-month follow-up. Family functioning was assessed using the Family Adaptability and Cohesion Evaluation Scale (FACES); family coping was assessed by the Family Crisis Oriented Personal Evaluation Scales (F-COPES). Results: Results demonstrate strong overall efficacy for CFF-CBT versus TAU; however, family characteristics at baseline emerged as a powerful moderator of outcomes in the CFF-CBT group (n = 26). Random intercept mixed-effects regression models demonstrated that families with low coping at baseline demonstrated a significantly worse treatment response as compared to those with higher coping across numerous child and family outcomes, including less improvement in: child symptom severity (CGI) (d = -1.08), child global functioning (CGAS) (d = 1.03), and child social skills (d = 1.05); all ps < 0.05. Families with lower functioning at baseline showed similar robust patterns of worse child and family outcomes versus families with higher functioning (ps < 0.05), including less improvement in: child CGI scores (d = -1.13) and CGAS scores (d = 1.04); child social skills (d = 0.99); and family satisfaction (d = -0.89). Discussion: Baseline family characteristics exerted a robust influence on CFF-CBT treatment effects, with consistently large effect sizes for high versus low functioning families. Families with lower coping and cohesion at baseline showed a poorer response to CFFCBT across a variety of child and family outcomes. These data strongly argue for the need to tailor CFF-CBT to better meet the needs of such families to optimize treatment outcomes. In particular, these families may benefit from an enhanced focus on coping and cohesion - which is currently one component of CFF-CBT - but could be expanded for indicated families to maximize treatment efficacy. This line of research is consistent with the overall NIMH Strategic Plan objective to examine how baseline patient characteristics can inform nullpersonalizednull treatment approaches to enhance treatment outcomes.
Bipolar Disorders, 15 : 150
- Year: 2013
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Peruzzolo, T. L., Tramontina, S., Rohde, L. A., Zeni, C. P.
Objective: To review the options for acute and maintenance pharmacological treatment of bipolar disorder in children and adolescents, including the treatment of bipolar depression and comorbid attention deficit/hyperactivity disorder (ADHD). Methods: Narrative review of randomized clinical trials and open-label studies published from 2000 to 2012. The PubMed and PsycINFO websites were queried. Case series were included when a higher level of evidence was not available. Results: Published data from randomized controlled trials (RCTs) in acute mania/hypomania with significant responses are available for lithium, topiramate, risperidone, olanzapine, and aripiprazole. Open trials of lithium and lamotrigine show that these drugs may be effective in the treatment of depressive episodes. No trials of selective serotonin reuptake inhibitors (SSRIs) have been conducted. In the treatment of comorbid ADHD, there are encouraging findings with mixed amphetamine salts and atomoxetine; conflicting results are observed with methylphenidate. Conclusions: Published RCTs of traditional mood stabilizers are scarce, but the best available evidence (results from meta-analytic regression) suggests that second-generation antipsychotics (SGAs) as a group are more effective in reducing manic symptoms. Risperidone was the only one included in head-to-head comparisons (vs. lithium and divalproex), showing superiority in terms of efficacy, but with more metabolic side effects, which were also more common in most of the SGAs. There are few studies addressing the treatment of ADHD and depression. Brazilian guidelines for the treatment of pediatric bipolar disorder should also include some SGAs (especially risperidone and aripiprazole) as first-line treatment, and these drugs should be provided by the public health services. (copyright) 2013 Associacao Brasileira de Psiquiatria.
Revista Brasileira De Psiquiatria, 35(4) : 393-405
- Year: 2013
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
Salpekar, J.
This session will review recent results from the TEAM (Treatment of Early Age Mania) study, which examined efficacy and tolerability of medications for pediatric bipolar disorder. The TEAM study is a large federally funded, multisite, controlled medication trial comparing lithium, divalproex sodium, and risperidone. Medications were selected as representative of individual classes of treatment, traditional mood stabilizer (divalproex sodium), antipsychotic (risperidone), and lithium. A total of 279 medication-naive patients aged 6-15 were enrolled and randomized to one of the three medications. Titration according to a predetermined schedule was implemented; dosages were increased based upon tolerability and symptom resolution. Primary outcome measures were the Clinical Global Impressions for Bipolar Illness Improvement-Mania and the Modified Side Effects Rating Form for Children and Adolescents. Raters at baseline and at study endpoint were blinded to treatment assignment. The TEAM study demonstrated that risperidone was superior to lithium and divalproex sodium in treatment naive patients with bipolar disorder. All three medications were found to be effective in improving symptoms and overall treatment of bipolar disorder. Response to lithium compared to divalproex sodium was similar. The dropout rate was higher for lithium than for risperidone Additionally, side effects of increased weight gain, body mass index, and prolactin level occurred with risperidone more than lithium. The session will review detailed findings from the TEAM study and discuss treatment implications for pediatric bipolar disorder.
European Child & Adolescent Psychiatry, 22(2) : S164
- Year: 2013
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Lithium, Other biological interventions
Seida, J. C., Schouten, J. R., Boylan, K., Newton, A. S., Mousavi, S. S., Beaith, A., Vandermeer, B., Dryden, D. M., Carrey, N.
BACKGROUND AND OBJECTIVE: Despite increasing on-label and offlabel use of antipsychotics, prescribing antipsychotics to children remains controversial due to uncertainty of their relative benefits and safety. We systematically reviewed the effectiveness and safety of first- (FGA) and second-generation antipsychotics (SGA) for patients aged (less-than or equal to)24 years with psychiatric and behavioral conditions. METHODS: We searched 10 databases from January 1987 to February 2011, gray literature, trial registries, and reference lists. Two reviewers independently selected studies, assessed methodologic quality, and graded the evidence. One reviewer extracted, and a second verified, data. We summarized findings qualitatively and conducted metaanalyses when appropriate. RESULTS: Sixty-four trials and 17 cohort studies were included. Most trials had a high risk of bias; cohort studies had moderate quality. All comparisons of FGAs versus SGAs, FGAs versus FGAs, and FGAs versus placebo had low or insufficient strength of evidence. There was moderate strength of evidence for the following comparisons. Olanzapine caused more dyslipidemia and weight gain, but fewer prolactin-related events, than risperidone. Olanzapine caused more weight gain than quetiapine. Compared with placebo, SGAs improved clinical global impressions (schizophrenia, bipolar and disruptive behavior disorders) and diminished positive and negative symptoms (schizophrenia), behavior symptoms (disruptive behavior disorders), and tics (Tourette syndrome). CONCLUSIONS: This is the first comprehensive review comparing the effectiveness and safety across the range of antipsychotics for children and young adults. The evidence on the comparative benefits and harms of antipsychotics is limited. Some SGAs have a better side effect profile than other SGAs. Additional studies using head-to-head comparisons are needed. Copyright (copyright) 2012 by the American Academy of Pediatrics.
Pediatrics, 129(3) : e771-e784
- Year: 2012
- Problem: Bipolar Disorders, Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Pavuluri, Mani N., Ellis, James A., Wegbreit, Ezra, Passarotti, Alessandra M., Stevens, Michael C.
Objective: The aim of the current study was to determine the influence of implicated affective circuitry disturbance in pediatric bipolar disorder (PBD) on behavioral inhibition. The differential influence of an antipsychotic and an anti-epileptic medication on the functional connectivity across affective and cognitive neural operations in PBD was examined. Methods: This was a six-week double blind randomized fMRI trial of risperidone plus placebo vs. divalproex plus placebo for patients with mania (n = 22; 13.6 ± 2.5 years). Healthy controls (HC; n = 14, 14.5 ± 2.8 years) were also scanned for normative comparison. Participants performed a response inhibition fMRI task where a motor response, already 'on the way' to execution, had to be voluntarily inhibited on trials where a stop signal was presented. Independent component analysis was used to map functional connectivity across the whole brain. Results: While there were no behavioral differences between the groups at pre- or post-drug trial, there was significant improvement on manic symptoms in the patient groups. All participants engaged an evaluative affective circuit (EAC: bilateral inferior frontal gyrus, middle frontal gyrus, anterior cingulate cortex (ACC), middle temporal gyrus, insulae, caudate and putamen) and a reactive affective circuit (RAC: bilateral occipital cortex, amygdala, medial frontal gyrus and insula) during task performance. Within the EAC, post-treatment and relative to HC, greater engagement was seen in left insula in risperidone group and left subgenual ACC in divalproex group. Within the RAC, greater baseline amygdala connectivity in patients did not alter with treatment. Conclusion: EAC and RAC are two key circuits that moderate emotional influence on response inhibition in PBD. Risperidone and divalproex differentially engage the EAC. Limited change in amygdala activity with treatment in all patients indicates a likely trait deficit in PBD. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)
Behavioural Brain Research, 226(2) : 493-503
- Year: 2012
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Anticonvulsants/mood stabilisers (excl. lithium)
McMurrich, Stephanie, Sylvia, Louisa G., Dupuy, Jamie M., Peckham, Andrew D., Peters, Amy T., Deckersbach, Thilo, Perlis, Roy H.
Objectives: The course of bipolar disorder tends to worsen over time, highlighting the importance of early intervention. Despite the recognized need for adjunctive psychosocial treatments in first-episode mania, very few studies have evaluated psychological interventions for this period of significant risk. In this empirical review, we evaluate existing research on first-episode bipolar disorder, compare this body of research to parallel studies of first-episode schizophrenia, and identify strategies for future research.; Methods: A comprehensive literature search of the MEDLINE and PsychINFO databases was conducted to identify studies of first-episode mania, as well as first-episode schizophrenia. Recovery and relapse rates were compared across studies.; Results: In contrast to a number of studies of first-episode schizophrenia, the authors identified only seven independent programs assessing first-episode mania. Findings from these studies suggest that, while pharmacological treatment helps patients achieve recovery from acute episodes, it fails to bring patients to sustained remission. Early psychosocial intervention may be imperative in reducing residual symptoms, preventing recurrence of mood episodes, and improving psychosocial functioning. However, very few studies of psychosocial interventions for first-episode mania have been systematically studied.; Conclusions: Studies of first-episode mania indicate a gap between syndromal/symptomatic and functional recovery. Novel psychosocial interventions for first-episode mania may help bridge this gap, but require controlled study.; © 2012 John Wiley and Sons A/S.
Bipolar Disorders, 14(8) : 797-808
- Year: 2012
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Olsen, B. T., Ganocy, S. J., Bitter, S. M., Findling, R. L., Case, M., Chang, K., Tohen, M., Delbello, M. P.
Aim: To examine health-related quality of life (HRQoL) in adolescents with bipolar disorder before and after double-blind treatment with olanzapine or placebo. Methods: Parents or legal guardians of 160 adolescents with a manic or mixed episode associated with bipolar I disorder were asked to rate their child's health using the Child Health Questionnaire-Parental Form 50 at baseline, before receiving medication, and then again at the end of participation in a 3-week double-blind placebo-controlled study of olanzapine. Results: Adolescents in both treatment groups began and ended the study with significantly lower scores than normalized values of healthy peers on several HRQoL subscales (lower ratings indicate more impaired functioning), especially those assessing psychosocial factors. However, participants receiving olanzapine exhibited greater improvement than those in the placebo group across multiple HRQoL subscales, including the Behavior, Family activities, and Mental health subscales. Reduction in manic symptoms was associated with improvement in HRQoL values. Conclusions: As expected, manic adolescents with bipolar disorder exhibit abnormalities in psychosocial, rather than physical factors associated with HRQoL. Treatment with olanzapine had a greater effect on multiple domains of psychosocial functioning compared with placebo, suggesting that in addition to improving manic symptoms, pharmacologic interventions may lessen some of psychosocial deficits experienced by adolescents with bipolar disorder. However, following 3 weeks of treatment, adolescents with bipolar disorder continued to exhibit deficits in several aspects of psychosocial functioning, indicating that additional pharmacologic and psychosocial interventions may be necessary to further improve functional outcome. (copyright) 2012 Elsevier Inc.
Comprehensive Psychiatry, 53(7) : 1000-1005
- Year: 2012
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Kusel, J., Brooks-Rooney, C., Wilson, T., Pitsi, D., Mehta, R., Lister, S.
Background: In Europe there is an increasing need for licensed medication to treat children and adolescents presenting with manic or mixed episodes of bipolar disorder, as lithium is currently the only licensed agent. In the US, the situation is different as aripiprazole, risperidone, quetiapine and olanzapine are also licensed for this indication. A previous high-quality systematic review was conducted in 2005 that identified six randomised controlled trials (RCTs) of pharmacological agents for the treatment of children and adolescents with manic/mixed episodes of bipolar disorder [1]. Following a recent surge in research in this area, an update of the review is necessary. Objective: To identify all literature published since 2005 on trials of pharmacological treatments for manic/mixed episodes of bipolar I disorder in patients aged <18 years. Methods: EMBASE, MEDLINE, PsychINFO, CINAHL and the Cochrane Library were systematically searched from 2005 to January 2012. Two independent reviewers assessed the search results for randomised and non-randomised trials (prospective, longitudinal studies only) that included patients <18 years with manic/mixed episodes of bipolar disorder at baseline and investigated the outcomes of a pharmacological agent (atypical antipsychotic, lithium or divalproex). Full texts of potentially relevant articles were assessed by two reviewers against the same inclusion criteria. Reference lists, clinical trials databases and congress abstracts were also searched. Results: Of 3636 search results obtained, 270 articles were deemed potentially relevant. After review of the full texts, 35 were included as relevant RCTs (relating to 15 different trials) and 12 were included as relevant non-RCTs. 103 did not exclusively include patients with bipolar I disorder with manic/mixed episodes, 73 did not include only patients <18, 18 did not assess a pharmacological agent of interest and 29 were not primary studies or did not have a suitable trial design. The majority of RCTs (10 of 15) assessed at least one atypical antipsychotic, none of which were in combination with another agent. The remaining RCTs assessed only a mood stabiliser (lithium n = 2; divalproex n = 2; both n = 1). The non-RCTs mainly investigated mood stabilisers. Although many of the RCTs were of a small size, they were largely of medium to high quality. The non-RCTs were also often limited by their small sample sizes, but some did provide longterm data to supplement the short-term RCTs. Conclusion: Despite the availability of numerous studies on treatments for manic/mixed episodes of paediatric bipolar disorder, there are very few licensed treatments available in Europe. The atypical antipsychotics have been frequently studied in this indication and seem to be highly effective; safety profile is likely to be the main differentiator between them. A network meta-analysis is now required to assess the relative effectiveness of the different treatments for manic and mixed episodes of bipolar disorder in children and adolescents.
European Neuropsychopharmacology, 22 : S425
- Year: 2012
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Anticonvulsants/mood stabilisers (excl. lithium), Lithium
Lolich, Maria, Vazquez, Gustavo H., Alvarez, Lina M., Tamayo, Jorge M.
Introduction: Multiple psychosocial interventions for bipolar disorder have been proposed in recent years. Therefore, we consider that a critical review of empirically validated models would be useful.; Methods: A review of the literature was conducted in Medline/PubMed for articles published during 2000-2010 that respond to the combination of "bipolar disorder" with the following key words: "psychosocial intervention", "psychoeducational intervention" and "psychotherapy".; Results: Cognitive-behavioral, psychoeducational, systematic care models, interpersonal and family therapy interventions were found to be empirically validated. All of them reported significant improvements in therapeutic adherence and in the patients' functionality.; Conclusions: Although there are currently several validated psychosocial interventions for treating bipolar disorder, their efficacy needs to be specified in relation to more precise variables such as clinical type, comorbid disorders, stages or duration of the disease. Taking into account these clinical features would enable a proper selection of the most adequate intervention according to the patient's specific characteristics.;
Actas Espanolas De Psiquiatria, 40(2) : 84-92
- Year: 2012
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Malhi, Gin S., Bargh, Danielle M., Cashman, Emma, Frye, Mark A., Gitlin, Michael
Objective: To provide practical and clinically meaningful treatment recommendations that amalgamate clinical and research considerations for several common, and as yet understudied, bipolar disorder complex presentations, within the framework of a proposed stratified model.; Methods: A comprehensive search of the literature was undertaken using electronic database search engines (Medline, PubMed, Web of Science) using key words (e.g., bipolar disorder, anxiety, rapid cycling, and subsyndromal). All relevant randomised controlled trials were examined, in addition to review papers, meta-analyses, and book chapters known to the authors. The findings formed the basis of the treatment recommendations within this paper.; Results: In light of the many broad presentations of bipolar disorder, a stratified model of bipolar disorder complexity was developed to facilitate consideration of the myriad of complexities that can occur during the longitudinal course of illness and the appropriate selection of treatment. Evidence-based treatment recommendations are provided for the following bipolar disorder presentations: bipolar II disorder, subsyndromal symptoms, mixed states, rapid cycling, comorbid anxiety, comorbid substance abuse, and for the following special populations: young, elderly, and bipolar disorder around the time of pregnancy and birth. In addition, some key strategies for countering treatment non-response and alternative medication recommendations are provided.; Conclusions: Treatment recommendations for the more challenging presentations of bipolar disorder have historically received less attention, despite their prevalence. This review acknowledges the weaknesses in the current evidence base on which treatment recommendations are generally formulated, and additionally emphasises the need for high-quality research in this area. The stratified model provides a means for conceptualizing the complexity of many bipolar disorder presentations and considering their management.; © 2012 John Wiley and Sons A/S.
Bipolar Disorders, 14 Suppl 2 : 66-89
- Year: 2012
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)