Treatment Of Mania In Adolescents Research Articles

Aripiprazole: A Review of Its Use in the Treatment of Manic Episodes in Adolescents with Bipolar I Disorder

Aripiprazole (Abilify(®)) is an atypical antipsychotic that is widely used in the treatment of psychiatric conditions. Unlike other currently available atypical antipsychotics that primarily have varying degrees of dopamine D2 receptor antagonism, aripiprazole is a partial agonist at D2 and serotonin 5-HT1A receptors, which may explain differences in tolerability profiles. Recently in the EU, oral aripiprazole 10 mg once daily for 12 weeks was approved for the treatment of moderate to severe manic episodes in adolescents (aged ≥13 years) with bipolar I disorder. Approval was based on a phase 3, 30-week US trial in children and adolescents with bipolar I disorder experiencing manic or mixed episodes. Using trial data together with ancillary analyses, the European Medicines Agency concluded that aripiprazole 10 mg once daily for 12 weeks was effective in reducing symptoms of mania, but because of the high drop-out rate, efficacy over 30 weeks of treatment was not proven. Aripiprazole was generally well tolerated in the phase 3 trial. Ancillary analyses indicated that tolerability was less favourable in younger (10-12 years) than in older (≥13 years) subjects, and less favourable with the higher (30 mg/day) than the lower dosage (10 mg/day). The drug is associated with sedation, weight gain and extrapyramidal symptoms (EPS), although the incidence of EPS over 12 weeks was not significantly different between aripiprazole 10 mg/day and placebo. Data comparing the use of atypical antipsychotics in the treatment of mania in adolescents with bipolar I disorder are limited, but evidence shows that aripiprazole provides a valuable additional therapeutic option for use in this population.

Therapie mit Lithiumsalzen in der Kinder- und Jugendpsychiatrie - Klinische Wirksamkeit und praktische Empfehlungen

Lithium salts are pharmacologically classified as mood stabilizers and are medications of first choice for the treatment of manic episodes and the prevention of relapse in bipolar disorders in children and adolescents. Moreover, these drugs can be used to treat episodic impulsive aggressiveness. With regard to their use in the treatment of children and adolescents, however, there are limitations to several preparations on the market in Germany. The evidence level for the treatment of acute mania in adolescents is II, while it is only III-IV for treatment of the same disorder in children. There is only anecdotal evidence of relapse prevention in bipolar disorder in childhood (level of evidence: V), whereas the level of evidence for adolescence is higher (IV). With respect to episodic impulsive aggressiveness, there is a good evidence base (II) for treatment of the disorder in both children and adolescents. An evidence level of II indicates that at least one well designed, randomized, controlled study has been carried out; an evidence level of III is based upon non-randomized studies, an evidence level of IV upon non-experimental studies, and an evidence level of V indicates that evidence is limited to reports or opinions stated by expert circles and consensus conferences, and to clinical experience. Due to the narrow therapeutic window, the dosage should be based on serum concentrations of lithium between 0.6 and 1.2 mmol/l and should be adapted according to the clinical picture. Usually, lithium preparations are administered twice a day: in the morning and in the evening. Side effects have to be monitored very carefully. Serum concentrations higher than 1.5 mmol/l are dangerous. All potential side effects, with the exception of very infrequently occurring renal damage, are reversible by means of dose reduction or, if necessary, by discontinuation of medication with lithium.

Lithium Treatment of Acute Mania in Adolescents: A Placebo-Controlled Discontinuation Study

Lithium Treatment of Acute Mania in Adolescents: A Placebo-Controlled Discontinuation Study

Lithium for the Treatment of Acute Mania in Adolescents

This paper discusses issues around the diagnosis of mania and its acute treatment in adolescence. We review three cases of acute mania treated on an adolescent unit, highlighting some of the diagnostic difficulties. Each of these patients proved resistant to treatment with neuroleptics but responded to the addition of lithium carbonate. The clinical impression of a good response was supported by the use of the Children's Global Assessment Scale. We conclude that lithium carbonate can be useful in the treatment of acute mania in adolescence. It is an illness of which child psychiatrists need to be aware as one third of cases present in adolescence.

Open Trial of Valproate in the Treatment of Adolescent Mania

Eleven adolescent patients with bipolar disorder (ages 12 to 17 years) hospitalized for acute mania were treated prospectively with open-label valproate after failing to respond to lithium and/or a...

Lithium-resistant Adolescent Mania

Treatment of adolescent mania appears to be a neglected area in the current literature. Three cases of first episode adolescent mania that failed to respond to lithium are described and alternative treatments are discussed.