Pediatric Bipolar Disorder: Evidence-Based Psychopharmacological Treatments

TOPIC: Pediatric bipolar disorder can cause severe disturbances in global functioning. Diagnosing pediatric bipolar disorder is challenging due to the range of symptom expression, developmental differences as compared to adults, presence of comorbid disorders, and developing diagnostic criteria. Treating this disorder can be equally challenging due to frequent symptom relapse and the dearth of research until recently on effective psychopharmacological interventions that guide clinical prescribing practices. PURPOSE: This paper will help child psychiatric nurses have a better understanding of the unique presentation of pediatric bipolar disorder to facilitate selection of appropriate medication treatment options, taking into account symptom presentation, presence of comorbid diagnosis, drug efficacy, adverse effects, and drug-drug interactions based on research findings. SOURCES: Literature specific to assessment and psychopharmacological treatment of pediatric bipolar disorder was reviewed. CONCLUSIONS: Screening of youth with mood spectrum problems for bipolar disorder should occur in every diagnostic assessment and should be ongoing due to range of mood symptoms and the cyclical and episodic nature of this disorder. Youth with bipolar disorder may manifest symptoms and course that differ from adults. Additionally, co-occuring disorders are common in this population, which can complicate medication selection. Psychopharmacological treatment with the use of specific mood stabilizers and/or atypical antipsychotic medications is warranted depending on symptom presentation; however, monotherapy with mood stabilizers has not demonstrated effectiveness in long-term remission of pediatric bipolar symptoms. Recent research indicates that a combined treatment with two mood stabilizers or a mood stabilizer and an antipsychotic holds promising results for pediatric bipolar I, for youth with acute manic symptoms plus psychosis, and for long-term remission of symptoms.     

Lithium Therapy for Bipolar Disorder

The management of bipolar disorder (BD) may be challenging because of the disease state itself. In addition, the maintenance of the drug level of lithium plays a vital role in preventing acute manic or mixed episodes. This article reviews the drug properties of lithium, the current treatment guidelines for BD, and best practices in monitoring lithium therapy, as well as the characteristics and classification of BD.     

Self-Organization in Bipolar Disorder: Compartmentalization and Self-Complexity

The present study investigated compartmentalization and self-complexity of self-structure in people with a history of bipolar disorder. Remitted bipolar, recovered depressed and healthy control participants described aspects of themselves using experimenter-provided positive and negative traits. Compartmentalization was assessed by the partitioning of positive and negative traits between self-aspects. Complexity was assessed by both the number of self-aspects people generated and the degree of overlap between the self-aspects. The remitted bipolar and recovered depressed groups demonstrated greater compartmentalization than healthy controls and the remitted bipolar group also demonstrated greater self-complexity than healthy controls when self-aspects relating to the depressed and manic states were included. Compartmentalization may be a generic feature of mood disorder. In addition, bipolar disorder is characterized by a complex, differentiated self-concept with distinctive beliefs about the self in depressed and manic states. Therapeutic implications are discussed.

Self-Organization in Bipolar Disorder: Replication of Compartmentalization and Self-Complexity

Remitted bipolar patients were compared to remitted unipolar patients and healthy controls on a self concept task assessing degree of self-compartmentalization (clustering of self-aspects based on valence) and self-complexity (the degree of relatedness versus differentiation across self-aspects). Similar to the findings of Taylor et al. (Cognitive Therapy and Research, 31(1), 83-96, 2007) the bipolar and unipolar groups showed higher levels of self compartmentalization than healthy controls. No differences were found on the self complexity measure.     

Identifying the Complexity of Diagnosing Bipolar Disorder: A Focused Ethnography

Purpose: To identify and describe the complexity of diagnosing bipolar disorder, including the diagnostic process and patient experiences of being newly diagnosed with bipolar disorder.

Design: A mixed-methods focused ethnography was conducted, grounded in a post-positivist foundation.

Methods: Medical records (n?=?100) of patients whose diagnosis had been switched to bipolar disorder were examined. Six weeks post-hospitalization, ten outpatients with the diagnosis of bipolar disorder underwent an in-depth interview.

Findings: Four diagnostic processes were identified during the retrospective record review. Two patterns and five themes were identified from the interviews. The first pattern, living with undiagnosed bipolar disorder, demonstrated common experiences of distinguishing impulsive moods and behavior, suffering life challenges, and seeking relief. The second pattern, acclimating to a new diagnosis of bipolar disorder, demonstrated participants’ ways of understanding the diagnosis and reconciling the diagnosis. Patterns in the interviews corroborated data from the record review.

Conclusions: The rendering of an appropriate diagnosis is key. Many participants’ lives were significantly improved when diagnosis was made, and treatment recommendations for bipolar disorder (BPD) were initiated. These findings offer clinicians and researchers new ways to think about the complexity of the diagnosis of BPD including contrasting decision-making outcomes along a screening, diagnosis, and treatment continuum, as well as using the diagnostic event to instigate meaningful life change in the patient.     

Management of Bipolar Disorder During the Perinatal Period

Bipolar disorder (BPD) is a lifelong mental health condition characterized by symptoms of mania, depression, and often anxiety. BPD can have detrimental consequences for individuals during pregnancy and the postpartum period, as well as for their offspring. This is often due to underdiagnosis and/or misdiagnosis as unipolar depression. There is a high incidence of first episodes of BPD in pregnant and postpartum persons. Perinatal care providers need to routinely screen for BPD and assess for relapse among those with a previous diagnosis during the pregnancy and postpartum periods. Medication management is complex and must be considered in the context of an individual’s risk factors and perceptions about treatment as well as the limited evidence regarding fetal safety, using a shared decision-making model. Collaboration, consultation, and/or referral to mental health care providers are essential for managing acute and chronic BPD symptoms.     

非典型抗精神病药治疗少儿双相情感障碍

综述了近年来国外应用非典型抗精神病药物治疗儿童及少年双相情感障碍的研究进展。     

Bipolar spectrum disorder: differential diagnosis and treatment

Bipolar disorder commonly presents as a recurrent mood disorder characterized by frequent depressive episodes. Although manic or hypomanic phases are required for the diagnosis to be made based on current diagnostic criteria, a wider expression of mood instability and other historical features or family history may suggest the presence of a bipolar spectrum illness. This article covers the diagnostic issues related to bipolar disorder and the spectrum concept of the illness. A new definition of bipolar spectrum disorder is suggested, and treatment principles and options are discussed. Primary care providers often encounter patients who have depression and mood problems, placing them in a key position for the diagnosis and treatment of this psychiatric illness.     

Goal Appraisals and Vulnerability to Bipolar Disorder: A Personal Projects Analysis

Although studied extensively in depressed populations, the implications of goal appraisals for bipolar disorder are not well understood. Four hundred sixty-four college students completed questionnaires measuring personal goal appraisals (a modified version of B. R. Little's, 1989, Personal Projects Analysis), history of bipolar disorder symptoms, and current symptoms of hypomania and depression. Participants endorsing hypomania symptoms or current positive affect tended to construe goals in a positive manner, as likely to be attained, enjoyable, controllable, and not difficult or stressful. A history of clinically significant hypomania symptoms, however, correlated with negative, pessimistic goal appraisals. This relationship could be explained in a mediational model by higher current depression among those with previous hypomania/mania. Discussion highlights the potential of studying bipolar disorder from a goal theoretical perspective.