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Acute and continuation pharmacological treatment of children and adolescents with bipolar disorders; a summary of two previous studies

Published online by Cambridge University Press:  18 September 2015

R.A. Kowatch ,
Th.J. Carmody ,
T. Suppes ,
J.H. Hume ,
M. Kromelis ,
G.J. Emslie  and
W.A. Weinberg
R.A. Kowatch*
Affiliation:
The University of Texas Southwestern. Dallas, U.S.A
T. Suppes
Affiliation:
Medical Center, Dallas, U.S.A
J.H. Hume
Affiliation:
Medical Center, Dallas, U.S.A
M. Kromelis
Affiliation:
Medical Center, Dallas, U.S.A
G.J. Emslie
Affiliation:
Childrens Medical Center, Dallas, U.S.ADepartments of Psychiatry
W.A. Weinberg
Affiliation:
Childrens Medical Center, Dallas, U.S.ADepartments of Psychiatry
*
The University of Texas, Southwestern Medical Center at Dallas, Department of Psychiatry, 5323 Harry Hines Blvd, Dallas, TX 75390-9070, United StatesTel 214-648-4978, Fax 214-648-4979, E-mail kowatch@utsw.swrned.edu
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Abstract

We report the results of an acute-phase and continuation-phase study of the pharmacological treatment of children and adolescents with bipolar disorders. The acute phase study, with a duration of 6-8 weeks, aimed at developing effect sizes (ES) for lithium, divalproex sodium, and carbamazepine, in the acute phase treatment of Bipolar I or II children and adolescents during a mixed or manic episode. During the acute-phase of treatment, 42 outpatients with a mean age of 11.4 yr. (20 with Bipolar I Disorder and 22 with Bipolar II Disorder) were randomly assigned to 6-8 weeks of open treatment with either lithium, divalproex sodium, or carbamazepine. The primary efficacy measures were the weekly CGI Improvement scores and the Young Mania Rating Scale. Using a ≥ 50% change from baseline to exit in the Y-MRS scores to define response, the effect size for divalproex sodium was 1.63,1.06 for lithium, and 1.00 for carbamazepine. Using this same response measure with the intent-to-treat sample, the response rates were: sodium divalproex 53%; lithium 38%; and carbamazepine 38% (x 2=0.85, 2 d.f., p=0.60). Thirty-five subjects continued in open, treatment for another 16-18 weeks, for a total of 24 weeks of prospective treatment. Overall, of the thirty-five continuation phase subjects, thirty (85%) were categorized as responders at the end of the continuation phase of treatment. Of these thirty-five subjects, 13 (37%) were only on a single mood stabilizer and no other psychotropic agents at the end of the continuation phase. Thirty-one percent of subjects in continuation were also treated with a stimulant medication in addition to mood stabilizers.

Keywords

bipolar disorderchildrenadolescentslithiumcarbamazepineand divalproex sodium
Type
Research Article
Information
Acta Neuropsychiatrica , Volume 12 , Issue 3 , September 2000 , pp. 145 - 149
Copyright
Copyright © Scandinavian College of Neuropsychopharmacology 2000

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