title: Acute treatment of mania in children and adolescents.
abstract: OBJECTIVE
  To examine critically data concerning the efficacy and safety of acute treatments for mania in children and adolescents, in the light of considerable recent emergent evidence.
  
  
  RESULTS
  We found consistent evidence favouring the use of second-generation antipsychotics (SGAs), limited evidence favouring the use of combinations of SGA with a mood stabilizer, and no evidence supporting the use of mood stabilizer monotherapy in this context. Various SGA drugs are not clearly separated in terms of efficacy, but do differ in their side-effect profiles. There are insufficient data to comment on the benefit of alternative treatments, psychological treatments and electroconvulsive therapy. The presence of common comorbidities has an inconsistent influence on clinical effectiveness.
  
  
  CONCLUSIONS
  First-line treatment for mania in children and adolescents is a SGA, with combination therapies offering no clear advantage. Gaps in our knowledge remain about expected time to recovery, and when to augment or change treatment when there is lack of effect.
authors.affiliation: Discipline of Psychiatry, Sydney Medical School, University of New South Wales, Thomas Walker Hospital, Sydney, NSW, Australia. Philip.Hazell@sswahs.nsw.gov.au
authors.forename: Philip
authors.initials: P
authors.lastname: Hazell
authors.forename: Rajeev
authors.initials: R
authors.lastname: Jairam
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents