A consecutive series of treated affected offspring of parents with bipolar disorder: is response associated with the clinical profile?
OBJECTIVE
In adults with established bipolar disorder (BD), differential response to mood stabilizers has been associated with the clinical profile. Long-term treatment studies of youth with BD are lacking. This paper provides longitudinal observations of response to mood stabilizers early in the course of illness in youth with BD.


METHODS
We report on 15 research patients who, as adolescents, met DSM-IV lifetime criteria for a bipolar spectrum disorder and required long-term treatment. These youths derived from families with one parent having BD whose course and long-term treatment response were determined in accordance with research criteria. The patients were offered lithium, and if they failed to respond or refused it, they were treated with either an anticonvulsant or an atypical antipsychotic. Using a validated scale, an independent rater retrospectively blindly scored the response to long-term treatment.


RESULTS
Those patients who stabilized on lithium derived from lithium-responsive families, whereas those who stabilized on an antipsychotic derived from lithium-nonresponsive families. The clinical course in the youths stabilized by lithium differed from that in the youths stabilized by an atypical antipsychotic.


CONCLUSIONS
Our findings suggest that the clinical profile may help in selecting effective stabilizing treatment and that a proportion of youth can be stabilized on monotherapy. This is a small case series with nonrandom treatment assignment, and the findings should be considered tentative.
Duffy
Anne
A
Department of Psychiatry, McGill University, Montreal, Quebec. anne.duffy@mcgill.ca
Alda
Martin
M
Milin
Robert
R
Grof
Paul
P
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D016241:Child of Impaired Parents / Q000523:psychology* / Q000706:statistics & numerical data*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use*; D010290:Parents / Q000523:psychology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D016651:Lithium Carbonate