Adjunctive antipsychotic treatment of adolescents with bipolar psychosis.
BACKGROUND
A combination of an antipsychotic medication and a mood stabilizer is often used for initial treatment of acute psychotic mania. However, the optimal duration of this adjunctive antipsychotic medication is unknown.


METHODS
As part of a lithium efficacy study, acutely manic adolescents with psychotic features were given open combination treatment with lithium and an adjunctive antipsychotic medication. If the psychosis resolved, the antipsychotic medication dose was gradually tapered and discontinued after 4 weeks of therapeutic lithium levels. The subject was then given a trial of maintenance lithium monotherapy for up to 4 weeks.


RESULTS
Significant improvement was seen in 64% of the sample with psychotic features after 4 weeks of combination treatment. However, few maintained their response after discontinuation of the antipsychotic medication. Successful discontinuation of antipsychotic medication in this sample was associated with first episode, shorter duration of psychosis, and the presence of thought disorder at baseline.


CONCLUSIONS
Adjunctive antipsychotic medication needs to be maintained for longer than 4 weeks in the vast majority of adolescents with psychotic mania, even though the manic and psychotic symptoms have resolved and lithium treatment is maintained. Future studies to determine the optimal duration of adjunctive antipsychotic medication treatment are warranted.
Kafantaris
V
V
Department of Psychiatry, Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY 11004, USA. kafantar@lij.edu
Coletti
D J
DJ
Dicker
R
R
Padula
G
G
Kane
J M
JM
D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D008140:Lorazepam / Q000627:therapeutic use*; D008297:Male; D011569:Psychiatric Status Rating Scales; D018967:Risperidone / Q000627:therapeutic use; D012720:Severity of Illness Index
D014150:Antipsychotic Agents; D008094:Lithium; D018967:Risperidone; D008140:Lorazepam