The naturalistic course of pharmacologic treatment of children with maniclike symptoms: a systematic chart review.
OBJECTIVE
To assess the effectiveness of mood stabilizers in treating maniclike symptoms in children.


METHODS
Subjects were consecutively referred pediatric patients who, at initial intake, satisfied DSM-III-R criteria for mania on a structured diagnostic interview. We systematically reviewed their clinical records to assess (1) the course of maniclike symptoms and (2) all medications prescribed at each follow-up visit. Survival analysis was used to determine the effect of mood stabilizers and other medications on the course of maniclike symptoms.


RESULTS
Of the 59 subjects meeting criteria for mania, 44 (75%) exhibited evidence of maniclike symptoms during follow-up. The occurrence of manic symptoms significantly predicted the subsequent prescription of mood stabilizers (rate ratio = 2.9, 95% confidence interval [CI] = 1.6 to 5.5), and use of mood stabilizers predicted decreases in manic symptoms (rate ratio = 4.9, 95% CI = 1.2 to 20.8). However, improvement was slow and associated with a substantial risk for relapse.


CONCLUSIONS
Mood stabilizers were frequently used in children with maniclike symptoms, and their use was associated with significant improvement of maniclike symptoms, whereas use of antidepressant, antipsychotic, and stimulant medications was not.
Biederman
J
J
Pediatric Psychopharmacology Unit of the Child Psychiatry Service, Massachusetts General Hospital, Boston, USA.
Mick
E
E
Bostic
J Q
JQ
Prince
J
J
Daly
J
J
Wilens
T E
TE
Spencer
T
T
Garcia-Jetton
J
J
Russell
R
R
Wozniak
J
J
Faraone
S V
SV
D000293:Adolescent; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D002220:Carbamazepine / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D002985:Clinical Protocols; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D008499:Medical Records; D001523:Mental Disorders / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012008:Recurrence; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D016019:Survival Analysis; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use*
D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D002220:Carbamazepine; D000697:Central Nervous System Stimulants; D008094:Lithium; D017367:Selective Serotonin Reuptake Inhibitors; D014635:Valproic Acid