Treatment-emergent mania in pediatric bipolar disorder: a retrospective case review

被引:82
作者
Faedda, GL
Baldessarini, RJ
Glovinsky, IP
Austin, NB
机构
[1] Lucio Bini Mood Disorders Ctr, New York, NY 10022 USA
[2] Harvard Univ, Sch Med, Dept Psychiat, Boston, MA 02115 USA
[3] Harvard Univ, Sch Med, Program Neurosci, Boston, MA 02115 USA
[4] McLean Hosp, Bipolar & Psychot Disorders Program, Belmont, MA 02478 USA
[5] McLean Hosp, Psychiat Res Labs, Belmont, MA 02478 USA
[6] Village Educ Ctr, Beverly Hills, MI 48301 USA
关键词
antidepressants; bipolar disorder; children; mania; stimulants;
D O I
10.1016/j.jad.2003.12.011
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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. (C) 2004 Elsevier B.V. All rights reserved.
引用
收藏
页码:149 / 158
页数:10
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