Disorders - Bipolar Disorders
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
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