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Pediatric bipolar disorder and pharmacotherapy: General principles

Author
David Axelson, MD
Section Editor
David Brent, MD
Deputy Editor
David Solomon, MD

INTRODUCTION

The mainstay of treatment for bipolar disorder in children and adolescents is pharmacotherapy [1]. There are several general principles for prescribing medications, and following these best practice principles may improve outcomes [2].

This topic reviews the general principles for using pharmacotherapy to treat pediatric bipolar disorder. Other aspects of pediatric bipolar disorder are discussed separately, including an overview of choosing treatment; the efficacy, administration, and side effects of second-generation antipsychotics for mania; the efficacy and core elements of adjunctive psychotherapy; assessment and diagnosis; and the epidemiology, clinical features, and course of illness:

(See "Pediatric bipolar disorder: Overview of choosing treatment".)

(See "Pediatric mania and second-generation antipsychotics: Efficacy, administration, and side effects".)

(See "Pediatric bipolar disorder: Efficacy and core elements of adjunctive psychotherapy".)

                

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Literature review current through: Nov 2016. | This topic last updated: Mon Apr 25 00:00:00 GMT 2016.
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References
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  1. McClellan J, Kowatch R, Findling RL, Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2007; 46:107.
  2. American Academy of Child and Adolescent Psychiatry. Practice parameter on the use of psychotropic medication in children and adolescents. J Am Acad Child Adolesc Psychiatry 2009; 48:961.
  3. Shain BN, COMMITTEE ON ADOLESCENCE. Collaborative role of the pediatrician in the diagnosis and management of bipolar disorder in adolescents. Pediatrics 2012; 130:e1725.
  4. Goodwin FK, Jamison KR. Treatment of children and adolescents. In: Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, Second Edition, Oxford University Press, Oxford 2007. p.907.
  5. Johnson MR, Hatzis NM, Dulcan MK, et al. Treatment of children and adolescents. In: The American Psychiatric Publishing Textbook of Psychiatry, Sixth Edition, Hales RE, Yudofsky SC, Roberts LW. (Eds), American Psychiatric Publishing, Washington, DC 2014. p.1189.
  6. Weller EB, Sheikh RM, Laracy SD, Weller RA. Mood disorders and suicidal behavior. In: Gabbard's Treatments of Psychiatric Disorders, Fourth Edition, Gabbard GO. (Ed), American Psychiatric Publishing, Inc, Washington, DC 2007. p.5.
  7. Raebel MA, Penfold R, McMahon AW, et al. Adherence to guidelines for glucose assessment in starting second-generation antipsychotics. Pediatrics 2014; 134:e1308.
  8. Goldstein BI, Strober MA, Birmaher B, et al. Substance use disorders among adolescents with bipolar spectrum disorders. Bipolar Disord 2008; 10:469.
  9. Findling RL, Nyilas M, Forbes RA, et al. Acute treatment of pediatric bipolar I disorder, manic or mixed episode, with aripiprazole: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2009; 70:1441.
  10. Haas M, Delbello MP, Pandina G, et al. Risperidone for the treatment of acute mania in children and adolescents with bipolar disorder: a randomized, double-blind, placebo-controlled study. Bipolar Disord 2009; 11:687.
  11. Tohen M, Kryzhanovskaya L, Carlson G, et al. Olanzapine versus placebo in the treatment of adolescents with bipolar mania. Am J Psychiatry 2007; 164:1547.
  12. Findling RL, Correll CU, Nyilas M, et al. Aripiprazole for the treatment of pediatric bipolar I disorder: a 30-week, randomized, placebo-controlled study. Bipolar Disord 2013; 15:138.
  13. Pathak S, Findling RL, Earley WR, et al. Efficacy and safety of quetiapine in children and adolescents with mania associated with bipolar I disorder: a 3-week, double-blind, placebo-controlled trial. J Clin Psychiatry 2013; 74:e100.
  14. Findling RL, Cavuş I, Pappadopulos E, et al. Efficacy, long-term safety, and tolerability of ziprasidone in children and adolescents with bipolar disorder. J Child Adolesc Psychopharmacol 2013; 23:545.
  15. Geller B, Luby JL, Joshi P, et al. A randomized controlled trial of risperidone, lithium, or divalproex sodium for initial treatment of bipolar I disorder, manic or mixed phase, in children and adolescents. Arch Gen Psychiatry 2012; 69:515.
  16. Pavuluri MN, Henry DB, Findling RL, et al. Double-blind randomized trial of risperidone versus divalproex in pediatric bipolar disorder. Bipolar Disord 2010; 12:593.
  17. Tramontina S, Zeni CP, Ketzer CR, et al. Aripiprazole in children and adolescents with bipolar disorder comorbid with attention-deficit/hyperactivity disorder: a pilot randomized clinical trial. J Clin Psychiatry 2009; 70:756.
  18. Biederman J, Mick E, Hammerness P, et al. Open-label, 8-week trial of olanzapine and risperidone for the treatment of bipolar disorder in preschool-age children. Biol Psychiatry 2005; 58:589.
  19. Frazier JA, Meyer MC, Biederman J, et al. Risperidone treatment for juvenile bipolar disorder: a retrospective chart review. J Am Acad Child Adolesc Psychiatry 1999; 38:960.
  20. Joshi G, Petty C, Wozniak J, et al. A prospective open-label trial of quetiapine monotherapy in preschool and school age children with bipolar spectrum disorder. J Affect Disord 2012; 136:1143.
  21. Findling RL, McNamara NK, Youngstrom EA, et al. An open-label study of aripiprazole in children with a bipolar disorder. J Child Adolesc Psychopharmacol 2011; 21:345.
  22. Thomas T, Kuich KW, Findling RL. Bipolar disorders. In: Clinical Manual of Child and Adolescent Psychopharmacology, Second Edition, McVoy M, Findling RL. (Eds), American Psychiatric Publishing, Washington, DC 2013. p.227.
  23. Kowatch RA, Fristad M, Birmaher B, et al. Treatment guidelines for children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2005; 44:213.
  24. Krieger FV, Stringaris A. Bipolar disorder and disruptive mood dysregulation in children and adolescents: assessment, diagnosis and treatment. Evid Based Ment Health 2013; 16:93.
  25. Connor DF. Electroconvulsive therapy, transcranial magnetic stimulation, and deep brain stimulation. In: Dulcan's Textbook of Child and Adolescent Psychiatry, Dulcan MK. (Ed), American Psychiatric Publishing, Inc, Washington, DC 2010. p.795.
  26. Ghaziuddin N, Kutcher SP, Knapp P, et al. Practice parameter for use of electroconvulsive therapy with adolescents. J Am Acad Child Adolesc Psychiatry 2004; 43:1521.
  27. Townsend LD, Demeter CA, Youngstrom E, et al. Family conflict moderates response to pharmacological intervention in pediatric bipolar disorder. J Child Adolesc Psychopharmacol 2007; 17:843.
  28. Drotar D, Greenley RN, Demeter CA, et al. Adherence to pharmacological treatment for juvenile bipolar disorder. J Am Acad Child Adolesc Psychiatry 2007; 46:831.
  29. DelBello MP, Hanseman D, Adler CM, et al. Twelve-month outcome of adolescents with bipolar disorder following first hospitalization for a manic or mixed episode. Am J Psychiatry 2007; 164:582.
  30. Goldstein BI, Sassi R, Diler RS. Pharmacologic treatment of bipolar disorder in children and adolescents. Child Adolesc Psychiatr Clin N Am 2012; 21:911.
  31. Potter MP, Liu HY, Monuteaux MC, et al. Prescribing patterns for treatment of pediatric bipolar disorder in a specialty clinic. J Child Adolesc Psychopharmacol 2009; 19:529.
  32. Delbello MP, Schwiers ML, Rosenberg HL, Strakowski SM. A double-blind, randomized, placebo-controlled study of quetiapine as adjunctive treatment for adolescent mania. J Am Acad Child Adolesc Psychiatry 2002; 41:1216.
  33. Findling RL, McNamara NK, Gracious BL, et al. Combination lithium and divalproex sodium in pediatric bipolarity. J Am Acad Child Adolesc Psychiatry 2003; 42:895.
  34. Pavuluri MN, Henry DB, Carbray JA, et al. Open-label prospective trial of risperidone in combination with lithium or divalproex sodium in pediatric mania. J Affect Disord 2004; 82 Suppl 1:S103.
  35. Scheffer RE, Tripathi A, Kirkpatrick FG, Schultz T. Guidelines for treatment-resistant mania in children with bipolar disorder. J Psychiatr Pract 2011; 17:186.
  36. Kowatch RA, Sethuraman G, Hume JH, et al. Combination pharmacotherapy in children and adolescents with bipolar disorder. Biol Psychiatry 2003; 53:978.
  37. Goldsmith M, Singh M, Chang K. Antidepressants and psychostimulants in pediatric populations: is there an association with mania? Paediatr Drugs 2011; 13:225.
  38. Biederman J, Mick E, Spencer TJ, et al. Therapeutic dilemmas in the pharmacotherapy of bipolar depression in the young. J Child Adolesc Psychopharmacol 2000; 10:185.
  39. Family focused treatment for pediatric bipolar disorder. http://www.semel.ucla.edu/sites/all/files/champ/CHAMP_Workshop_Oct2013.pdf (Accessed on December 23, 2014).
  40. Chang KD, Singh MK, Wang PW, Howe M. Management of bipolar disorders in children and adolescents. In: Handbook of Diagnosis and Treatment of Bipolar Disorders, Ketter TA. (Ed), American Psychiatric Publishing, Inc, Washington, DC 2010. p.389.
  41. Fristad MA, Weller EB, Weller RA. The Mania Rating Scale: can it be used in children? A preliminary report. J Am Acad Child Adolesc Psychiatry 1992; 31:252.
  42. Axelson D, Birmaher BJ, Brent D, et al. A preliminary study of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children mania rating scale for children and adolescents. J Child Adolesc Psychopharmacol 2003; 13:463.
  43. Gracious BL, Youngstrom EA, Findling RL, Calabrese JR. Discriminative validity of a parent version of the Young Mania Rating Scale. J Am Acad Child Adolesc Psychiatry 2002; 41:1350.
  44. Youngstrom EA, Findling RL, Danielson CK, Calabrese JR. Discriminative validity of parent report of hypomanic and depressive symptoms on the General Behavior Inventory. Psychol Assess 2001; 13:267.
  45. Youngstrom EA, Findling RL, Calabrese JR, et al. Comparing the diagnostic accuracy of six potential screening instruments for bipolar disorder in youths aged 5 to 17 years. J Am Acad Child Adolesc Psychiatry 2004; 43:847.
  46. Pavuluri MN, Henry DB, Devineni B, et al. Child mania rating scale: development, reliability, and validity. J Am Acad Child Adolesc Psychiatry 2006; 45:550.
  47. West AE, Celio CI, Henry DB, Pavuluri MN. Child Mania Rating Scale-Parent Version: a valid measure of symptom change due to pharmacotherapy. J Affect Disord 2011; 128:112.
  48. Poznanski EO, Freeman LN, Mokros HB. Children's Depression Rating Scale - Revised. Psychopharmacol Bull 1985; 21:979.
  49. Poznanski EO, Grossman JA, Buchsbaum Y, et al. Preliminary studies of the reliability and validity of the children's depression rating scale. J Am Acad Child Psychiatry 1984; 23:191.
  50. Findling RL, Youngstrom EA, Zhao J, et al. Respondent and item level patterns of response of aripiprazole in the acute treatment of pediatric bipolar I disorder. J Affect Disord 2012; 143:231.
  51. DelBello MP, Kowatch RA, Adler CM, et al. A double-blind randomized pilot study comparing quetiapine and divalproex for adolescent mania. J Am Acad Child Adolesc Psychiatry 2006; 45:305.