BACKGROUND: Pediatric bipolar disorder (BPD) can be misdiagnosed as a depressive, attention, conduct, or anxiety disorder and treatment with antidepressants and stimulants is common. Risk of adverse outcomes related to such treatment remains poorly defined. METHODS: We analyzed clinical records of 82 children (mean age 10.6 years) meeting modified DSM-IV diagnostic criteria for BPD to evaluate risk and timing of operationally-defined treatment-emergent mania (TEM) or increased mood-cycling following pharmacological treatment. RESULTS: Of 82 juvenile BPD patients, 57 (69%) had been given a mood-elevating agent at least once; 33/57 (58%) so-exposed met criteria for TEM, with median latency of 14 days; TEM was observed twice as often with antidepressants as stimulants (44% vs. 18%). TEM led to first-recognition of BPD in 14 cases (17%), and some drug-exposed children (4-9%) had prominent suicidal, homicidal or psychotic behavior. In addition to recent exposure to a mood-elevating agent, TEM was associated with early-onset anxiety and female gender. LIMITATIONS: Findings are retrospective in clinically diagnosed and treated outpatients, but involved otherwise unselected cases of juvenile BPD. CONCLUSIONS: TEM was reported in 58% of children with probable juvenile BPD within several weeks of new exposure to a mood-elevating agent.
BACKGROUND:Pediatric bipolar disorder (BPD) can be misdiagnosed as a depressive, attention, conduct, or anxiety disorder and treatment with antidepressants and stimulants is common. Risk of adverse outcomes related to such treatment remains poorly defined. METHODS: We analyzed clinical records of 82 children (mean age 10.6 years) meeting modified DSM-IV diagnostic criteria for BPD to evaluate risk and timing of operationally-defined treatment-emergent mania (TEM) or increased mood-cycling following pharmacological treatment. RESULTS: Of 82 juvenile BPD patients, 57 (69%) had been given a mood-elevating agent at least once; 33/57 (58%) so-exposed met criteria for TEM, with median latency of 14 days; TEM was observed twice as often with antidepressants as stimulants (44% vs. 18%). TEM led to first-recognition of BPD in 14 cases (17%), and some drug-exposed children (4-9%) had prominent suicidal, homicidal or psychotic behavior. In addition to recent exposure to a mood-elevating agent, TEM was associated with early-onset anxiety and female gender. LIMITATIONS: Findings are retrospective in clinically diagnosed and treated outpatients, but involved otherwise unselected cases of juvenile BPD. CONCLUSIONS: TEM was reported in 58% of children with probable juvenile BPD within several weeks of new exposure to a mood-elevating agent.
Authors: Robert K McNamara; Jeffrey R Strawn; Max J Tallman; Jeffrey A Welge; L Rodrigo Patino; Thomas J Blom; Melissa P DelBello Journal: J Child Adolesc Psychopharmacol Date: 2020-03-11 Impact factor: 2.576
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Authors: James Waxmonsky; William E Pelham; Elizabeth Gnagy; Michael R Cummings; Briannon O'Connor; Antara Majumdar; Jessica Verley; Martin T Hoffman; Greta A Massetti; Lisa Burrows-MacLean; Gregory A Fabiano; Daniel A Waschbusch; Anil Chacko; Frances W Arnold; Kathryn S Walker; Allison C Garefino; Jessica A Robb Journal: J Child Adolesc Psychopharmacol Date: 2008-12 Impact factor: 2.576