Evidence-Based Reviews

Pediatric bipolar disorder: Mood swings, irritability are cues to this diagnosis

Current Psychiatry. 2003 March;2(3):40-48

References

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It is reasonable to maintain a child or adolescent who has had a single manic episode on mood-stabilizing treatment for several years and then—if the patient is euthymic and asymptomatic—to slowly taper the mood stabilizer(s) over several months. If mood symptoms recur, the agent(s) should be reintroduced.

If a child with bipolar disorder does not respond or only partially responds to a mood stabilizer, it may be necessary to add a second mood stabilizer or an atypical antipsychotic. A bipolar child or adolescent with psychotic symptoms should be maintained on an antipsychotic (typical or atypical) for at least 1 month, even if the psychosis has resolved.³⁵

Treatment of comorbid ADHD. Most children with bipolar disorder have comorbid ADHD, and mood stabilization is necessary prior to starting stimulant medications.³⁶ In bipolar patients, sustained-release psychostimulants may reduce rebound symptoms more effectively than immediate-release formulations. Typical dosages for a child with bipolar disorder and ADHD would be Concerta, 36 mg/d, or Adderall XR, 10 to 20 mg/d.

Psychosocial interventions

Most psychotherapeutic interventions have not been systematically studied in pediatric bipolar disorder but may be beneficial. In a recent study, Fristad et al reported the efficacy of multifamily psychoeducational group therapy for treating bipolar children and adolescents and their families.³⁷

Other useful psychosocial tactics include:

Minimize periods of overstimulation (for example, these patients do not do well at shopping malls).
Maintain good sleep hygiene.
Address medication nonadherence immediately.
Discuss the risk of substance abuse with the patient.
Encourage mood charting by the patient and or parent.

Related resources

Mood charts appropriate for pediatric patients.
Child and Adolescent Bipolar Foundation. www.cabf.org
Findling RF, Kowatch RA, Post RM. Pediatric bipolar disorders: a handbook for clinicians. London, Martin Dunitz Press, 2002.
Geller B, DelBello MP (eds). Child and early adolescent bipolar disorder: theory, assessment, and treatment. New York: Guilford Publications, 2002.

Drug brand names

Clozapine • Clozaril
Divalproex sodium • Depakote
Olanzapine • Zyprexa
Risperidone • Risperdal
Quetiapine • Seroquel
Ziprasidone • Geodon

Disclosure

Dr. Kowatch receives grant support from, serves as a consultant to, or is on the speakers bureau of Novartis Pharmaceuticals Corp., Abbott Laboratories, Solvay Pharmaceuticals, Eli Lilly and Co., Janssen Pharmaceutica, GlaxoSmithKline, and AstraZeneca Pharmaceuticals.

Dr. DelBello receives grant support from, serves as a consultant to, or is on the speakers bureau of Abbott Laboratories, AstraZeneca Pharmaceuticals, Eli Lilly and Co., Ortho-McNeil Pharmaceutical, Shire Pharmaceutical Group, Janssen Pharmaceutica, Pfizer Inc., and GlaxoSmithKline.