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Atypical Antipsychotics for Acute Manic and Mixed Episodes in Children and Adolescents with Bipolar Disorder

Efficacy and Tolerability

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Abstract

The diagnosis of bipolar disorder (BD) in children is increasing, and often requires a comprehensive treatment plan to address a complex array of symptoms and associated morbidities. Pharmacotherapy, in combination with psychotherapeutic interventions, is essential for the treatment and stabilization of disrupted mood. Current evidence collectively demonstrates, by randomized controlled design, that atypical antipsychotics have efficacy for the treatment of acute manic or mixed symptoms in children and adolescents with BD. Additional longitudinal and biological studies are warranted to characterize the effects of atypical antipsychotics on all phases and stages of bipolar illness development in children and adolescents.

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References

  1. Moreno C, Laje G, Blanco C, et al. National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch Gen Psychiatry 2007; 64(9): 1032–9

    Article  PubMed  Google Scholar 

  2. Blader JC, Carlson GA. Increased rates of bipolar disorder diagnoses among U.S. child, adolescent, and adult inpatients, 1996–2004. Biol Psychiatry 2007; 62(2): 107–14

    Article  PubMed  Google Scholar 

  3. Perlis RH, Miyahara S, Marangell LB, et al. Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry 2004; 55(9): 875–81

    Article  PubMed  Google Scholar 

  4. Faedda GL, Baldessarini RJ, Suppes T, et al. Pediatric-onset bipolar disorder: a neglected clinical and public health problem. Harv Rev Psychiatry 1995; 3(4): 171–95

    Article  PubMed  CAS  Google Scholar 

  5. Geller B, Luby J. Child and adolescent bipolar disorder: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1997; 36(9): 1168–76

    Article  PubMed  CAS  Google Scholar 

  6. Axelson D, Birmaher B, Strober M, et al. Phenomenology of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry 2006; 63(10): 1139–48

    Article  PubMed  Google Scholar 

  7. Carter TD, Mundo E, Parikh SV, et al. Early age at onset as a risk factor for poor outcome of bipolar disorder. J Psychiatr Res 2003; 37(4): 297–303

    Article  PubMed  Google Scholar 

  8. Geller B, Tillman R, Craney JL, et al. Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Arch Gen Psychiatry 2004; 61(5): 459–67

    Article  PubMed  Google Scholar 

  9. Madaan V, Chang KD. Pharmacotherapeutic strategies for pediatric bipolar disorder. Expert Opin Pharmacother 2007; 8(12): 1801–19

    Article  PubMed  CAS  Google Scholar 

  10. McClellan J, Kowatch R, Findling RL, et al. Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2007; 46(1): 107–25

    Article  PubMed  Google Scholar 

  11. 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(3): 213–35

    Article  PubMed  Google Scholar 

  12. Physicians’ desk reference. 63rd ed. Montvale (NJ): Thomson Healthcare, Inc., 2009

  13. Keck Jr PE, Calabrese JR, McIntyre RS, et al., Aripiprazole Study Group. Aripiprazole monotherapy for maintenance therapy in bipolar I disorder: a 100-week, double-blind study versus placebo. J Clin Psychiatry 2007; 68(10): 1480–91

    Article  PubMed  CAS  Google Scholar 

  14. Chang KD. The use of atypical antipsychotics in pediatric bipolar disorder. J Clin Psychiatry 2008; 69 Suppl. 4: 4–8

    Google Scholar 

  15. Young RC, Biggs JT, Ziegler VE, et al. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978; 133: 429–35

    Article  PubMed  CAS  Google Scholar 

  16. Citrome L. Compelling or irrelevant? Using number needed to treat can help decide. Acta Psychiatr Scand 2008; 117(6): 412–9

    Article  PubMed  CAS  Google Scholar 

  17. Tohen M, Kryzhanovskaya L, Carlson G, et al. Olanzapine versus placebo in the treatment of adolescents with bipolar mania. Am J Psychiatry 2007; 164(10): 1547–56

    Article  PubMed  Google Scholar 

  18. 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(7): 687–700

    Article  PubMed  CAS  Google Scholar 

  19. DelBello MP, Findling RL, Earley WR, et al. Efficacy of quetiapine in children and adolescents with bipolar mania: a 3-week, double-blind, randomized, placebo-controlled trial. 46th Annual Meeting of the American College of Neuropsychopharmacology; 2007 Dec 9–13; Boca Raton (FL)

  20. 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(10): 1441–51

    Article  PubMed  CAS  Google Scholar 

  21. DelBello M, Findling RL, Wang PP, et al. Safety and efficacy of ziprasidone in pediatric bipolar disorder. 55th Annual Convention and Scientific Program of the Society of Biological Psychiatry; 2008 May 1-3; Washington, DC

  22. Martinez-Aran A, Vieta E, Chengappa KN, et al. Reporting outcomes in clinical trials for bipolar disorder: a commentary and suggestions for change. Bipolar Disord 2008; 10(5): 566–79

    Article  PubMed  Google Scholar 

  23. Strawn JR, Delbello MP. Olanzapine for the treatment of bipolar disorder in children and adolescents. Expert Opin Pharmacother 2008; 9(3): 467–74

    Article  PubMed  CAS  Google Scholar 

  24. Tohen M, Kryzhanovskaya L, Carlson G, et al. Olanzapine in the treatment of adolescents with bipolar mania: 26-week open-label extension [abstract]. 47th Annual Meeting of the New Clinical Drug Evaluation Unit (NCDEU); 2007 Jun 13; Boca Raton (FL)

  25. Bishop JR, Pavuluri MN. Review of risperidone for the treatment of pediatric and adolescent bipolar disorder and schizophrenia. Neuropsychiatr Dis Treat 2008; 4(1): 55–68

    PubMed  CAS  Google Scholar 

  26. DelBello MP, Schwiers ML, Rosenberg HL, et al. A double-blind, randomized, placebo-controlled study of quetiapine as adjunctive treatment for adolescent mania. J Am Acad Child Adolesc Psychiatry 2002; 41(10): 1216–23

    Article  PubMed  Google Scholar 

  27. 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(3): 305–13

    Article  PubMed  Google Scholar 

  28. Correll CU. Weight gain and metabolic effects of mood stabilizers and antipsychotics in pediatric bipolar disorder: a systematic review and pooled analysis of short-term trials. J Am Acad Child Adolesc Psychiatry 2007; 46(6): 687–700

    Article  PubMed  Google Scholar 

  29. Kongsamut S, Kang J, Chen XL, et al. A comparison of the receptor binding and HERG channel affinities for a series of antipsychotic drugs. Eur J Pharmacol 2002; 450(1): 37–41

    Article  PubMed  CAS  Google Scholar 

  30. Haddad PM, Anderson IM. Antipsychotic-related QTc prolongation, torsade de pointes and sudden death. Drugs 2002; 62(11): 1649–71

    Article  PubMed  CAS  Google Scholar 

  31. Harrigan EP, Miceli JJ, Anziano R, et al. A randomized evaluation of the effects of six antipsychotic agents on QTc, in the absence and presence of metabolic inhibition. J Clin Psychopharmacol 2004; 24(1): 62–9

    Article  PubMed  CAS  Google Scholar 

  32. Ray WA, Chung CP, et al. Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 2009; 360(3): 225–35

    Article  PubMed  CAS  Google Scholar 

  33. Heinrich TW, Biblo LA, Schneider J. Torsades de pointes associated with ziprasidone. Psychosomatics 2006; 47(3): 264–8

    Article  PubMed  Google Scholar 

  34. Elbe D, Carandang CG. Focus on ziprasidone: a review of its use in child and adolescent psychiatry. J Can Acad Child Adolesc Psychiatry 2008; 17(4): 220–9

    PubMed  Google Scholar 

  35. Blair J, Scahill L, State M, et al. Electrocardiographic changes in children and adolescents treated with ziprasidone: a prospective study. J Am Acad Child Adolesc Psychiatry 2005; 44(1): 73–9

    Article  PubMed  Google Scholar 

  36. Labellarte MJ, Crosson JE, Riddle MA. The relevance of prolonged QTc measurement to pediatric psychopharmacology. J Am Acad Child Adolesc Psychiatry 2003; 42(6): 642–50

    Article  PubMed  Google Scholar 

  37. Kowatch R, Suppes T, Gilfillan SK. Clozapine treatment of children and adolescents with bipolar disorder and schizophrenia: a clinical case series. J Child Adolesc Psychopharmacol 1995; 5: 241–53

    Article  Google Scholar 

  38. Masi G, Mucci M, Millepiedi S. Clozapine in adolescent inpatients with acute mania. J Child Adolesc Psychopharmacol 2002; 12(2): 93–9

    Article  PubMed  Google Scholar 

  39. Correll CU, Carlson HE. Endocrine and metabolic adverse effects of psychotropic medications in children and adolescents. J Am Acad Child Adolesc Psychiatry 2006; 45(7): 771–91

    Article  PubMed  Google Scholar 

  40. Klein DJ, Cottingham EM, Sorter M, et al. A randomized, double-blind, placebo-controlled trial of metformin treatment of weight gain associated with initiation of atypical antipsychotic therapy in children and adolescents. Am J Psychiatry 2006; 163(12): 2072–9

    Article  PubMed  Google Scholar 

  41. Chang K, Howe M, Gallelli K, et al. Prevention of pediatric bipolar disorder: integration of neurobiological and psychosocial processes. Ann N Y Acad Sci 2006; 1094: 235–47

    Article  PubMed  Google Scholar 

  42. DelBello MP, Adler CM, Whitsel RM, et al. A 12-week single-blind trial of quetiapine for the treatment of mood symptoms in adolescents at high risk for developing bipolar I disorder. J Clin Psychiatry 2007; 68(5): 789–95

    Article  PubMed  CAS  Google Scholar 

  43. DelBello MP, Kowatch RA. Pharmacological interventions for bipolar youth: developmental considerations. Dev Psychopathol 2006; 18(4): 1231–46

    Article  PubMed  Google Scholar 

  44. Derry S, Moore RA. Atypical antipsychotics in bipolar disorder: systematic review of randomised trials. BMC Psychiatry 2007; 7: 40

    Article  PubMed  Google Scholar 

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Acknowledgements

Dr Singh has no conflicts of interest to disclose. Dr Ketter has received grant/research support from Abbott, AstraZeneca, Bristol-Myers Squibb, Cephalon, Eli Lilly, GlaxoSmithKline, Pfizer, Repligen and Wyeth; consulting fees from Abbott, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, Jazz Pharmaceuticals, Novartis, Organon, Solvay, Valeant, Vanda, Wyeth and XenoPort; and lecture honoraria from Abbott, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Noven, Otsuka and Pfizer. Dr Chang is a consultant for GlaxoSmithKline, Eli Lilly and Company, and Bristol-Myers Squibb; receives research support from AstraZeneca Pharmaceuticals, Eli Lilly and Company, GlaxoSmithKline, National Institute of Mental Health, and National Alliance for Research in Schizophrenia and Depression; and serves on the Speakers Bureau for Bristol-Myers Squibb and Eli Lilly and Company.

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  1. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, California, 94305, USA

    Manpreet K. Singh, Terence A. Ketter & Kiki D. Chang

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  1. Manpreet K. Singh
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  2. Terence A. Ketter
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  3. Kiki D. Chang
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Correspondence to Manpreet K. Singh.

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Singh, M.K., Ketter, T.A. & Chang, K.D. Atypical Antipsychotics for Acute Manic and Mixed Episodes in Children and Adolescents with Bipolar Disorder. Drugs 70, 433–442 (2010). https://doi.org/10.2165/11534540-000000000-00000

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  • DOI: https://doi.org/10.2165/11534540-000000000-00000

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