Pediatric bipolar disorder: evidence-based psychopharmacological treatments.
OBJECTIVE
Pediatric bipolar disorder can cause severe disturbances in global functioning. Diagnosing pediatric bipolar disorder is challenging due to the range of symptom expression, developmental differences as compared to adults, presence of comorbid disorders, and developing diagnostic criteria. Treating this disorder can be equally challenging due to frequent symptom relapse and the dearth of research until recently on effective psychopharmacological interventions that guide clinical prescribing practices.


OBJECTIVE
This paper will help child psychiatric nurses have a better understanding of the unique presentation of pediatric bipolar disorder to facilitate selection of appropriate medication treatment options, taking into account symptom presentation, presence of comorbid diagnosis, drug efficacy, adverse effects, and drug-drug interactions based on research findings.


METHODS
Literature specific to assessment and psychopharmacological treatment of pediatric bipolar disorder was reviewed.


CONCLUSIONS
Screening of youth with mood spectrum problems for bipolar disorder should occur in every diagnostic assessment and should be ongoing due to range of mood symptoms and the cyclical and episodic nature of this disorder. Youth with bipolar disorder may manifest symptoms and course that differ from adults. Additionally, co-occuring disorders are common in this population, which can complicate medication selection. Psychopharmacological treatment with the use of specific mood stabilizers and/or atypical antipsychotic medications is warranted depending on symptom presentation; however, monotherapy with mood stabilizers has not demonstrated effectiveness in long-term remission of pediatric bipolar symptoms. Recent research indicates that a combined treatment with two mood stabilizers or a mood stabilizer and an antipsychotic holds promising results for pediatric bipolar I, for youth with acute manic symptoms plus psychosis, and for long-term remission of symptoms.
Hamrin
Vanya
V
Yale University School of Nursing, New Haven, USA. vanya.hamrin@yale.edu
Pachler
Maryellen
M
D000927:Anticonvulsants / Q000494:pharmacology / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D002648:Child; D002665:Child Psychiatry; D015897:Comorbidity; D004347:Drug Interactions; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005824:Genetics, Behavioral; D006801:Humans; D009445:Neuroanatomy; D009446:Neurobiology; D009730:Nursing Assessment; D018579:Patient Selection; D010597:Pharmacogenetics; D011568:Psychiatric Nursing; D011600:Psychopharmacology; D016896:Treatment Outcome
D000927:Anticonvulsants; D000928:Antidepressive Agents; D018692:Antimanic Agents