Pharmacological and non-drug treatment of child bipolar I disorder during prospective eight-year follow-up.
OBJECTIVE
The Phenomenology and Course of Pediatric Bipolar Disorders study, a National Institute of Mental Health-funded study of child bipolar I disorder (BP-I) begun in 1995, is a prospective follow-up study that included collecting pharmacological and non-drug treatment data.


METHODS
There were 115 first-episode subjects who fit full DSM-IV criteria for BP-I, mixed or manic phase, with severity scores in the clinically impaired range, ascertained by consecutive new case ascertainment. Subjects were assessed with the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS), given separately to parents about their children and to children about themselves. All treatment was provided by the subjects' own community practitioners, exactly as if they had not been in the research study. Thus, families were only seen for research assessments, and research staff were not at all involved in their treatment. Data on type, dose, and duration of pharmacological and non-drug treatment were collected. During follow-up, 93.9% (n = 108) were assessed at each of the nine assessment times.


RESULTS
During the eight years, only 62.6% received any antimanic medication (antipsychotic, anticonvulsant, lithium) at any time. Percents who received non-antimanic medication included 77.4% medication for attention-deficit hyperactivity disorder and 64.3% antidepressants. A total of 67.8% of subjects were taking two or more concurrent medication classes. Subjects ascertained from psychiatric versus pediatric sites received antimanics significantly more frequently (p = 0.006). Earlier recovery during eight-year follow-up was predicted by greater percent of weeks on lithium (p = 0.017).


CONCLUSIONS
Given these findings, and the poor prognosis from prospective follow-up of this sample reported elsewhere, there is a need for further research that informs the development of effective treatment strategies.
Geller
Barbara
B
Department of Psychiatry, Washington University in St. Louis, St. Louis, MO 63110-1093, USA. gellerb@wustl.edu
Tillman
Rebecca
R
Bolhofner
Kristine
K
Zimerman
Betsy
B
D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D002648:Child; D003863:Depression / Q000188:drug therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use*; D008297:Male; D009315:National Institute of Mental Health (U.S.); D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
D000927:Anticonvulsants; D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds
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