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Treatments for children

What is childhood bipolar disorder?

Bipolar disorder is a chronic psychiatric illness that can have devastating effects on individuals and their families. It is the sixth leading cause of disability worldwide, with prevalence estimated to be around 1% in the general adult population. The age of onset of bipolar disorder typically occurs during early adulthood, although onset can occur in childhood or adolescence. Bipolar disorder in childhood and adolescence is commonly associated with impairment in multiple domains, including increased risk of psychiatric hospitalisation, antisocial behaviour, addictions, and suicidal behaviour. There is a need to optimise treatments for childhood patients for whom medication use could be long-term, with concerns about potential overuse and side effects in a population who are undergoing relevant biological, psychological, and social maturational changes.

What is the evidence on pharmaceutical treatments for childhood bipolar disorder?

Moderate quality evidence suggests combined treatment with an anticonvulsant or lithium plus a second-generation antipsychotic was significantly more effective for clinical response than individual treatments.

Moderate to high quality evidence suggests a medium-sized effect of improved mania symptoms with second-generation antipsychotics aripiprazole, olanzapine, risperidone, and ziprasidone compared to placebo. Moderate quality evidence suggests no differences in depression symptoms between the antipsychotic quetiapine and placebo.

Moderate to low quality evidence finds a small effect of improved mania symptoms with mood stabilisers divalproex, lithium, oxcarbazepine, and topiramate compared to placebo.

Second generation antipsychotics may cause more weight gain and drowsiness than mood stabilisers, while mood stabilisers may cause more akathisia (inner restlessness).

Antipsychotics may cause more weight gain and drowsiness than mood stabilisers, while mood stabilisers may cause more akathisia (inner restlessness).

July 2020

Last updated at: 1:29 am, 9th July 2020
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