Disorders - Bipolar Disorders
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)
Janicak, P. G., Rado, J. T.
Introduction: Bipolar disorder is
characterized by mood instability, which can be challenging to manage. First-line pharmacological approaches usually involve lithium, anticonvulsants
and antipsychotics. Over the past fifteen years, several second-generation antipsychotics have demonstrated benefits for various phases of this
disorder. Areas covered: This article examines the pharmacodynamics and pharmacokinetics of quetiapine; its evidence base as an acute and maintenance
monotherapy or adjunctive therapy for bipolar manic or mixed episodes is also discussed, along with the related issues of its safety and
tolerability. Expert opinion: In the context of bipolar disorder, quetiapine is the only agent approved as a monotherapy or adjunct therapy for acute
manic/mixed episodes in adults and adolescents; as a monotherapy for acute depressive episodes in adults; and as an adjunctive maintenance therapy
for bipolar I and II disorder in adults. In addition to its antipsychotic properties, this broad mood-stabilizing potential may simplify the
management of select patients. (copyright) 2012 Informa UK, Ltd.
Expert Opinion on Pharmacotherapy, 13(11) : 1645-
1652
- Year: 2012
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Kozicky, J. M., Torres, I. J., Bond, D. J., Lam, R. W., Yatham, L. N.
Although associations between antipsychotic use and neuropsychological
impairment in bipolar I disorder have been observed, there is a lack of studies comparing the effects of specific agents used in this population. We
compared performance between patients receiving maintenance treatment with mood stabilizer monotherapy (n=15), adjunctive risperidone (n=15) or
quetiapine (n=17), and a group of demographically matched healthy controls (n=28) on tests of executive function (working memory, set shifting, and
inhibition) and verbal learning. Despite having a similar clinical profile, patients being treated with risperidone showed significantly impaired
working memory, set-shifting, and verbal learning (P<0.05) compared with those either on mood stabilizer monotherapy or adjunctive quetiapine.
Although randomized controlled trials are required to confirm the cognitive side effects of medications prescribed for maintenance treatment of
bipolar I disorder, preliminary results indicate that addition of risperidone to a mood stabilizer has a negative impact on executive function and
verbal learning, an effect not shared with quetiapine. (copyright) 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.
International Clinical Psychopharmacology, 27(2) : 91-99
- Year: 2012
- Problem: Bipolar Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Anticonvulsants/mood stabilisers (excl. lithium)
Macneil, C. A., Hasty, M., Cotton, S., Berk, M., Hallam,
K., Kader, L., McGorry, P., Conus, P.
Aim: There is a scarce literature describing psychological interventions for a young, first-episode
cohort who have experienced psychotic mania. This study aimed to assess whether a manualized psychological intervention could be effective in
reducing symptomatology and relapse, and improve functional outcome in this population. Methods: The study was an open-label design, drawn from a
larger pharmacotherapy trial. All participants in the pharmacotherapy trial were offered a manualized psychological intervention in addition to case
management. Inclusion in the psychotherapy group was based on participant's choice, and on completion of four or more of the eight modules offered.
All clinical files were audited to ensure accuracy of group allocation. Forty young people aged 15 to 25 years old who had experienced a manic
episode with psychotic features were recruited into the study, with 20 people in the combined treatment as usual plus psychotherapy group (P+TAU),
and an equal number of matched control participants who received treatment as usual (TAU) within the same service. All participants were prescribed
antipsychotic and mood-stabilizing medication. Symptomatic, functional and relapse measures were taken both at baseline and at 18-month follow-up.
Results: Manic symptoms improved significantly for both groups, with no differences between groups. Depression scores and overall symptom severity
were significantly lower in the P+TAU group. No differences were evident between groups with regard to numbers or type of relapse. The P+TAU group
had significantly better social and occupational functioning after 18months. Conclusion: This study suggests that a manualized psychological
intervention targeted to a first-episode population can be effective in reducing depression and overall symptom severity, and can improve functional
outcome following a first episode of psychotic mania. (copyright) 2012 Wiley Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 6(4) : 380-388
- Year: 2012
- Problem: Bipolar Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions