Disorders - Bipolar Disorders
Schneider, C., Taylor, D., Zalsman, G., Frangou, S., Kyriakopoulos, M.
Antipsychotic medications (APs) are a well-established
pharmacological treatment in adults with serious mental health problems. However, many adult mental health disorders have their origins and onset in
childhood or adolescence. The understanding that neuropsychiatric conditions of childhood are in part biologically determined, led to an increase in
the number of clinical trials supporting evidence on the efficacy of antipsychotic agents as first-line treatment for childhood psychotic disorders
and therapeutic augmentation of nonpsychotic conditions. In recent years the use of antipsychotics in children and adolescents for
neurodevelopmental, behavioural and psychiatric disorders has significantly increased while the age of prescription has decreased. These trends have
not been matched by advances in the understanding of APs' safety profile in this group of patients. It is therefore crucial that current and future
practice is informed by up-to-date synthesis of the evidence and clinical guidelines about the use and monitoring of these treatments in paediatric
populations, since the effectiveness of early therapeutic interventions in children can affect positively the long-term outcome. © The Author(s)
2014.
Journal of Psychopharmacology, 28(7) : 615-623
- Year: 2014
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Ouanes, S., Chennoufi, L., Cheour, M.
Although common and severe, mixed states are rarely the subject of
proper clinical trials. The aim of this paper is to systematically review data published in 2013 on the pharmacological treatment of mixed states.
Methods The Medline database was searched for 2013 publications using the following keywords: 'treatment'; 'mixed'; 'bipolar'. Results Medline
search returned 118 results. Manual inspection of abstracts allowed selecting six papers for further review. The first meta-analysis of the efficacy
of second-generation antipsychotics in mixed episodes, published in 2013, showed the efficacy of these agents. Other papers suggested that asenapine
and olanzapine were efficacious for mixed episodes, with olanzapine being equally effective in patients with or without substance abuse. Aripiprazole
and ziprasidone were reported to be efficacious and safe in treating manic/mixed episodes in children and adolescents. In another trial, Calcitonin
was not found to be superior to placebo in treating manic/mixed episodes. Conclusion Although data suggest that most agents efficacious for mania may
also be efficacious for mixed episodes, further studies are needed to confirm this assumption. © 2014 Elsevier B.V.
Journal of Affective
Disorders, 158 : 53-55
- Year: 2014
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Fristad, M., MacPherson, H.
Pediatric bipolar spectrum disorders (BPSDs) are serious conditions associated with morbidity and mortality. Although most
treatment research has examined pharmacotherapy for pediatric BPSDs, growing literature suggests that psychosocial interventions are also important
to provide families with an understanding of symptoms, course, and treatment of BPSDs; teach youth and parents methods for coping with symptoms
(e.g., problem solving, communication, emotion regulation, cognitive-behavioral skills); and prevent relapse. Thirteen psychosocial intervention
trials for pediatric BPSDs were identified via a comprehensive literature search and evaluated according to the Task Force on the Promotion and
Dissemination of Psychological Procedures guidelines. All interventions were examined adjunctive to pharmacotherapy and/or treatment as usual (TAU).
No well-established or questionably efficacious treatments were identified. Family psychoeducation plus skill building was probably efficacious
(i.e., Multi-Family Psychoeducational Psychotherapy, Family-Focused Treatment); cognitive-behavioral therapy (CBT) was possibly efficacious.
Dialectical behavior therapy (DBT) and interpersonal and social rhythm therapy (IPSRT) were experimental. Limited research precluded subdivision of
treatments by format and age. Only single- and multiple-family psychoeducation plus skill building and CBT were evaluated with children. Only
single-family psychoeducation plus skill building and DBT, and individual (commonly with limited familial involvement) CBT and IPSRT were evaluated
with adolescents. In conclusion, psychosocial interventions that involve families, psychoeducation, and skill building may offer added benefit to
pharmacotherapy and/or other TAU. Limitations of current research include few outcome studies, small samples, and failure to use stringent control
conditions or randomization. The review concludes with a discussion of mediators and moderators, recommendations for best practice, and suggestions
for future research. © 2014 Copyright Taylor & Francis Group, LLC.
Journal of Clinical Child & Adolescent Psychology, 43(3) : 339-
355
- Year: 2014
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Pfennig, A., Correll, C., Marx, C., Rottmann-Wolf, M., Meyer, T., Bauer, M., Leopold, K.
Aim: Accumulating data show that patients with bipolar disorder (BD) experience
substantial symptomatology months or years before full manifestation. Based on the need for early preventive interventions in BD as well as data
suggesting effectiveness of psychotherapeutic interventions for BD, we aimed to review the evidence for psychotherapeutic treatments in help-seeking
individuals considered at risk for BD (At-Risk-BD).; Methods: Searching PubMed and PsycINFO, clinical trial registries and recently published
systematic reviews, a systematic review was performed of psychoeducational and psychotherapeutic intervention studies in At-Risk-BD individuals.;
Results: Only three completed studies were identified, two of which were randomized trials (n?=?77) and one was an open pilot study (n?=?13). Two
ongoing studies (projected n?=?150 and n?=?100, respectively) were found in trial registries. The available evidence suggests potential effectiveness
of multi-family psychoeducational psychotherapy and family-focussed therapy for symptom reduction and prevention of BD conversion.; Conclusions:
Psychotherapeutic treatments are a reasonable starting point for At-Risk-BD subjects when symptom severity, distress and impairment are sufficiently
significant to initiate treatment. Ongoing studies will further clarify the effectiveness and timing of psychotherapeutic interventions for At-Risk-
BD individuals and whether or not they should be given alone or in conjunction with other treatments. Large multi-site studies with standardized
procedures/manuals are needed to advance the field.; © 2013 Wiley Publishing Asia Pty Ltd.
Early
Intervention in Psychiatry, 8(1) : 3-11
- Year: 2014
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Suttajit, S., Srisurapanont,
M., Maneeton, N., Maneeton, B.
Background: Precise estimated risks and benefits of quetiapine for acute bipolar depression are needed for clinical practice.
Objective: To systematically review the efficacy and the tolerability of quetiapine, either as monotherapy or combination therapy, for acute bipolar
depression. Methods: We included all randomized, controlled trials (RCTs) comparing quetiapine with other treatments, including placebo, in patients
with acute bipolar depression (bipolar I or II disorder, major depressive episode). Published and unpublished RCTs were identified using the Cochrane
Central Register of Controlled Trials, MEDLINE®, Web of Knowledge™, CINAHL®, PsycINFO®, the EU Clinical Trials Register database, and
ClinicalTrials.gov. The primary outcome was the change scores of depression rating scales. Results: Eleven RCTs (n=3,488) were included. Two of them
were conducted in children and adolescents. The change in depression scores was significantly greater in the quetiapine group compared with the
placebo group (mean difference, [MD] =-4.66, 95% confidence interval [CI] -5.59 to -3.73). The significant difference was observed from week 1.
Compared with placebo, quetiapine had higher incidence rates of extrapyramidal side effects, sedation, somnolence, dizziness, fatigue, constipation,
dry mouth, increased appetite, and weight gain but lower risks of treatment-emergent mania and headache. Quetiapine treatment was associated with
significant improvement of clinical global impression, quality of life, sleep quality, anxiety, and functioning. Conclusion: Quetiapine monotherapy
is effective for acute bipolar depression and the prevention of mania/hypomania switching. Its common adverse effects are extrapyramidal side
effects, sedation, somnolence, dizziness, fatigue, constipation, dry mouth, increased appetite, and weight gain. The lower risk of headache in
quetiapine-treated patients with acute bipolar depression should be further investigated. The evidence for the use of quetiapine combined with mood
stabilizers in children and adolescents with acute bipolar depression is too small to support the clinical practice. © 2014 Suttajit et al.
Drug Design, Development & Therapy, 8 : 827-
838
- Year: 2014
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Kessing, L.
V., Hansen, H. V., Christensen, E., Dam, H., Gluud, C., Wetterslev, J.
Background
It is unknown whether young adults with bipolar disorder are able to benefit from early intervention combining optimised pharmacological treatment
and group psychoeducation. The aim of the present report was to compare the effects of early intervention among patients with bipolar disorder aged
18-25 years to that of patients aged 26 years or older. Methods Patients were randomised to early treatment in a specialised outpatient mood disorder
clinic versus standard care. The primary outcome was risk of psychiatric re-hospitalisation. Results A total of 158 patients with mania/bipolar
disorder were included among whom 29 (18.4%) were between 18 and 25 years and 129 patients were 26 years or older. For both age groups, the point
estimate of the hazard ratio of re-hospitalisation was insignificantly decreased for patients treated in the mood disorder clinic versus standard
treatment but more so for patients between 18 and 25 years (HR 0.33, 95% CI 0.10-1.07; p=0.064) than for patients 26 years or older (HR 0.68, 95% CI
0.40-1.14, p=0.14). Younger adults treated in the mood disorder clinic used mood stabilisers and antipsychotics more in contrast to those treated in
standard care. The differences between the estimates of effects did not reach significance in tests of interactions (p>0.2). Limitations The study
was based on a post hoc subgroup analysis and due to the small number of patients aged 18-25 years, type II errors cannot be excluded. Conclusions
Although not statistically different, the observed differences of the point estimates was surprisingly larger for young adults suggesting that young
adults with bipolar disorder may benefit even more than older adults from early intervention combining pharmacological treatment and group
psychoeducation. © 2013 Elsevier B.V.
Journal of Affective
Disorders, 152-154(1) : 403-408
- Year: 2014
- 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), Lithium, Psychological Interventions
(any), Psychoeducation
Moosavi, S., Ahmadi, M., Monajemi, M.
OBJECTIVE: This study compared the efficacy of risperidone monotherapy with risperidone plus
valproate in bipolar I disorder, manic phase. Some studies showed the efficacy of risperidone monotherapy in the treatment of bipolar disorder, so we
examined this effectiveness in this clinical-trial study.\rMETHOD: This 7-week, randomized, single-blind study included 48 bipolar I inpatients manic
phase without psychotic features divided in risperidone group (n = 23) and risperidone plus sodium valproate group (n = 25). According to clinical
symptoms, 3 categories: complete remission, partial remission and no remission were mentioned in weekly follow-up. Remission rate compared with
survival analysis.\rRESULTS: The results showed a significant difference in remission rate between risperidone monotherapy and risperidone plus
sodium valproate at the 1st, 2nd and the 3rd week (p = 0.012, 0.023, 0.027 respectively), It means the remission rate in risperidone plus valproate
group was higher in the first three weeks, but at the end of the seventh week, the difference was not statistically significant. There was no
significant difference between the two groups in the development of adverse effects.\rCONCLUSIONS: Risperidone can be effective and well tolerated in
both acute manic episodes of bipolar mood disorders.
Global Journal of Health Science, 6(6) : 163-167
- Year: 2014
- 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)
McKeage, K.
Aripiprazole (Abilify®) is an atypical antipsychotic that is widely used in the treatment of psychiatric conditions. Unlike other
currently available atypical antipsychotics that primarily have varying degrees of dopamine D2 receptor antagonism, aripiprazole is a partial agonist
at D2 and serotonin 5-HT1A receptors, which may explain differences in tolerability profiles. Recently in the EU, oral aripiprazole 10 mg once daily
for 12 weeks was approved for the treatment of moderate to severe manic episodes in adolescents (aged =13 years) with bipolar I disorder. Approval
was based on a phase 3, 30-week US trial in children and adolescents with bipolar I disorder experiencing manic or mixed episodes. Using trial data
together with ancillary analyses, the European Medicines Agency concluded that aripiprazole 10 mg once daily for 12 weeks was effective in reducing
symptoms of mania, but because of the high drop-out rate, efficacy over 30 weeks of treatment was not proven. Aripiprazole was generally well
tolerated in the phase 3 trial. Ancillary analyses indicated that tolerability was less favourable in younger (10-12 years) than in older (=13 years)
subjects, and less favourable with the higher (30 mg/day) than the lower dosage (10 mg/day). The drug is associated with sedation, weight gain and
extrapyramidal symptoms (EPS), although the incidence of EPS over 12 weeks was not significantly different between aripiprazole 10 mg/day and
placebo. Data comparing the use of atypical antipsychotics in the treatment of mania in adolescents with bipolar I disorder are limited, but evidence
shows that aripiprazole provides a valuable additional therapeutic option for use in this population. © 2014 Springer International Publishing
Switzerland.
CNS
Drugs, 28(2) : 171-183
- Year: 2014
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Miklowitz, D., Schneck, C., George, E., Taylor, D., Sugar, C., Birmaher, B., Kowatch, R., DelBello, M., Axelson, D.
Objective: Previous studies
have found that family-focused treatment is an effective adjunct to pharmacotherapy in stabilizing symptoms in adult bipolar disorder. The authors
examined whether pharmacotherapy and family-focused treatment for adolescents with bipolar disorder was more effective than pharmacotherapy and brief
psychoeducation (enhanced care) in decreasing time to recovery from a mood episode, increasing time to recurrence, and reducing symptom severity over
2 years. Method: A total of 145 adolescents (mean age, 15.6 years) with bipolar I or II disorder and a DSM-IV-TR manic, hypomanic, depressive, or
mixed episode in the previous 3 months were randomly assigned, with family members, either to pharmacotherapy and family-focused treatment,
consisting of psychoeducation (i.e., recognition and early intervention with prodromal symptoms), communication enhancement training, and problem-
solving skills training, delivered in 21 sessions over 9 months; or to pharmacotherapy and three weekly sessions of enhanced care (family
psychoeducation). Independent evaluators assessed participants at baseline, every 3 months during year 1, and every 6 months during year 2, using
weekly ratings of mood. Results: Twenty-two participants (15.2%) withdrew shortly after randomization. Time to recovery or recurrence and proportion
of weeks ill did not differ between the two treatment groups. Secondary analyses revealed that participants in family-focused treatment had less
severe manic symptoms during year 2 than did those in enhanced care. Conclusions: After an illness episode, intensive psychotherapy combined with
best-practice pharmacotherapy does not appear to confer advantages over brief psychotherapy and pharmacotherapy in hastening recovery or delaying
recurrence among adolescents with bipolar disorder.
American Journal of Psychiatry, 171(6) : 658-667
- Year: 2014
- 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), Psychological Interventions
(any), Family therapy, Psychoeducation
McNamara, R., Strawn, J., Stahl, L., Weber, W., Welge,
J., Patino, R., Strakowski, S., DelBello, M.
Background: When offspring of parents with bipolar disorder develop major depressive disorder they are
at increased risk for developing mania (and by definition bipolar I disorder). Antidepressant medications that are commonly used to treat depressive
symptoms may further increase risk of developing manic symptoms. Therefore, treatments for mood symptoms in ultra-high risk youth are urgently needed
to establish early intervention and ultimately prevention strategies. Long-chain omega-3 (LCn-3) fatty acids are anti-inflammatory and have
neurotrophic and neuroprotective properties, and increasing LCn-3 fatty acid status with fish oil (FO) has antidepressant actions. However, the
central mechanisms mediating this effect remain poorly understood. This study investigated the effects of increasing LCn-3 fatty acid status on
corticolimbic activation patterns elicited by emotional images in depressed adolescent bipolar offspring by functional magnetic resonance imaging
(fMRI). Methods: Sixty medication-free youth (ages 9-20 years) with a current diagnosis of MDD or Depressive Disorder NOS and a biological parent
with bipolar I disorder were randomized to 12 week treatment with FO supplements (2,100 mg/d) or placebo (olive oil). At baseline and endpoint, fMRI
scans were obtained while performing a continuous performance task with emotional and neutral distractors (CPT-END). Standard event-related voxel-
wise fMRI analysis was performed. Symptom ratings were performed weekly using the Children's Depression Rating Scale-Revised CDRS-R, Young Mania
Rating Scale (YMRS), Clinical Global Impression-Severity Scale (CGI-S), and CGIImprovement Scale (CGI-I). Erythrocyte fatty acid levels were obtained
at baseline and endpoint. Results: Baseline-endpoint RBC LCn-3 fatty acid (EPA+ DHA) levels increased, and the ratio of arachidonic acid to EPA+DHA
(AA/EPA+DHA) decreased, significantly following FO supplementation but not placebo. Both treatment groups demonstrated significant reductions over
time in symptoms of depression (p<0.0001) and mania (p<0.0001). Response rates (mean CDRS % improvement) were 61% (FO) and 55% (Placebo) (p=0.39),
and remission (CDRS< 28) rates were 46% (FO) and 54% (Placebo)(p=0.1). The rates of CGI-I response (defined as = 2, i.e., very much improved or much
improved) were significantly greater in the FO group than placebo group (64% vs. 36%, p=0.04). The FO group had a significantly greater CGI-S
reduction than the placebo group (-1.8 vs. -1.0, p<0.01). Baseline-endpoint activation in the left parahippocampal gyrus and fusiform gyrus in
response to emotional images decreased, and activation in bilateral cerebellar tonsils increased, following FO supplementation but not placebo.
Conclusions: Increases in LCn-3 fatty acid status and reductions in depressive symptoms in bipolar offspring following FO supplementation are
associated with reduced activation of limbic structures in response to emotional stimuli.
Neuropsychopharmacology, 39 : S228
- Year: 2014
- Problem: Bipolar Disorders, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil)
Moreno, C., Llorente, C., Espliego, A., Arango, C., Moreno, D.
Background Although long-term treatment is a core aspect of the management of children and
adolescents with bipolar disorder (BD), most clinical recommendations are based on results from short-term studies or adult data. In order to guide
clinical practice, we review the efficacy and safety profile of mood stabilizers, antipsychotics, and other pharmacological strategies for the long-
term treatment of BD in pediatric patients. Methods A MEDLINE, EMBASE, Cochrane and PsycInfo search (inception through November 2013) was performed
to identify prospective studies longer than 12 weeks assessing the use of pharmacological strategies for the long-term treatment of BD in pediatric
patients (0 - 18 years of age). Results Four randomized controlled trials (RCT) [three placebo-controlled (assessing aripiprazole (2) and flax oil),
and one head-to-head comparison of lithium vs. divalproex], and thirteen noncontrolled studies (six open-label studies assessing lithium or
anticonvulsants, five assessing second-generation antipsychotics (SGAs) and four assessing combination strategies) were included in the review.
Aripiprazole has shown efficacy for relapse prevention in children with pediatric bipolar disorder (PBD) 4 - 9 years of age in one placebo-controlled
RCT. Positive results have been reported in noncontrolled studies with quetiapine and lithium for relapse prevention, as well as with lithium,
quetiapine, ziprasidone, and the combination of risperidone and divalproex or lithium for long-term symptom reduction in PBD. The most frequently
reported adverse events in children and adolescents treated with lithium and anticonvulsants are gastrointestinal and neurological, whereas use of
SGAs is mainly related to weight gain and sedation. Conclusion According to the limited empirical evidence, aripiprazole can be useful for relapse
prevention in children with PBD. Given the lack of consistent efficacy data, clinical decision making should be based on individual clinical aspects
and safety concerns. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
Journal
of Child Psychology & Psychiatry, 55(9) : 959-980
- Year: 2014
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)
Findling, R., Pathak,
S., Earley, W., Liu, S., DelBello, M.
Objective: Quetiapine is an atypical antipsychotic with demonstrated efficacy in the treatment of adolescent schizophrenia and pediatric
bipolar mania. Large, placebo-controlled studies of interventions in pediatric bipolar depression are lacking. The current study investigated the
efficacy and safety of quetiapine extended-release (XR) in patients 10-17 years of age, with acute bipolar depression. Methods: This multicenter,
double-blind, randomized, placebo-controlled study investigated quetiapine XR (dose range, 150-300 mg/day) in pediatric outpatients with an American
Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR) diagnosis of bipolar I or bipolar
II disorder (current or most recent episode depressed) treated for up to 8 weeks (ClinicalTrials.gov identifier: NCT00811473). The primary study
outcome was mean change in Children's Depression Rating Scale-Revised (CDRS-R) total score. Secondary efficacy outcomes included CDRS-R-based
response and remission rates. Results: Of 193 patients randomized to treatment, 144 patients completed the study (75.3% of quetiapine XR group
[n=70]; 74.0% of placebo group [n=74]). Least squares mean changes in CDRS-R total score at week 8 were: -29.6 (SE, 1.65) with quetiapine XR and -
27.3 (SE, 1.60) with placebo, a between-treatment group difference of -2.29 (SE, 1.99; 95% CI, -6.22, 1.65; p=0.25; mixed-model for repeated measures
analysis). Rates of response and remission did not differ significantly between treatment groups. The safety profile of quetiapine XR was broadly
consistent with the profile reported previously in adult studies of quetiapine XR and pediatric studies of quetiapine immediate-release (IR).
Potentially clinically significant elevations in clinical chemistry values included triglycerides (9.3%, quetiapine XR; 1.4%, placebo group) and
thyroid stimulating hormone (4.7%, quetiapine XR; 0%, placebo group). An adverse event potentially related to diabetes mellitus occurred in 3.3% of
the quetiapine XR versus no adverse events in the placebo group. Conclusions: Quetiapine XR did not demonstrate efficacy relative to placebo in this
8 week study of pediatric bipolar depression. Quetiapine XR was generally safe and well tolerated. Copyright © 2014, Mary Ann Liebert, Inc.
Journal of Child & Adolescent
Psychopharmacology, 24(6) : 325-335
- Year: 2014
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)