Psychopharmacology of pediatric bipolar disorder: a review.
BACKGROUND
Pediatric bipolar disorder (PBD) is a chronic and debilitating psychiatric illness. It is associated with many short-term and long-term complications including poor academic and social performance, legal problems and increased risk of suicide. Moreover, it is often complicated by other serious psychiatric disorders including attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder and substance use disorders. For these reasons, there is a need for effective treatment for PBD.


OBJECTIVE
To review available data from published reports of the treatment of PBD, highlighting those treatment practices for which there is scientific evidence. To suggest directions for future research.


METHODS
A comprehensive Medline search was performed to identify published reports from 1995 to 2006. Reports with the greatest methodological stringency received greater focus.


RESULTS
There is limited evidence from double-blind, placebo-controlled trials regarding the treatment of PBD. Available data suggests that lithium, some anticonvulsants and second-generation antipsychotics may be equally beneficial in the acute monotherapy for youth with mixed or manic states. However, because of limited response to acute monotherapy, there is increased justification for combination therapy. There is very limited data on the treatment of the depressed phase of bipolar illness in the youth. Also, very few studies have addressed the treatment of comorbidities and maintenance/relapse prevention in PBD.


CONCLUSIONS
Although significant progress was made in the treatment of youth with bipolar disorder, there is a need for more methodologically stringent research to more precisely define evidence-based treatment strategies for PBD.
Smarty
Sylvester
S
Child and Adolescent Psychiatry, University Hospitals of Cleveland/Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA. jumfyy@yahoo.com
Findling
Robert L
RL
D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D000297:Psychology, Adolescent; D002666:Psychology, Child; D055502:Secondary Prevention; D016896:Treatment Outcome
D000927:Anticonvulsants; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds