Pharmacotherapy of Child and Adolescent Psychiatric Disorders by Gershon Samuel Rosenberg David

Author:Gershon, Samuel, Rosenberg, David
Language: eng
Format: mobi
ISBN: 9781119961000
Publisher: John Wiley & Sons
Published: 2011-11-20T21:00:00+00:00

Evidence for the use of lithium in children and adolescents

Extensive research and clinical practice has demonstrated the effectiveness of lithium in adults for treating the symptoms of acute mania as well as in preventing manic and mixed episode relapse [64,65]. The FDA has established that lithium is indicated for acute mania as well as maintenance treatment in patients with bipolar disorder older than 12 years of age. Small sample size, varying assessment protocols without adequate controls and other methodologic concerns characterize much of the early literature, but more recent studies with larger samples and more rigorous methodologies suggest that lithium may be an effective treatment for youth with bipolar disorder. Questions regarding predictors of response based on clinical profile are largely unanswered or are addressed only cursorily in the literature. This may reflect ambiguity in the literature regarding how best to define bipolar phenotypes in children and adolescents other than bipolar disorder type I, for which the most evidence seems to be available.

According to recent treatment guidelines for children and adolescents with bipolar disorder, lithium is a recommended treatment for acute manic or mixed states with or without psychosis in youth with bipolar disorder based on studies conducted in youth, as well as for depression in youth with bipolar disorder based upon studies conducted in adults [66]. Recommendation for use of lithium as maintenance treatment for bipolar disorder in youth is based primarily on studies conducted in adults.

Early studies

Early evidence for the use of lithium in children and adolescents with bipolar disorder consisted mainly of case series or double-blinded cross-over studies with very small numbers or diagnostically mixed samples. An early survey of these trials suggested that the positive response rate in open trials of lithium in children with bipolar disorder was around 66%, similar to lithium-treated adults with bipolar disorder [67]. Further review of lithium's use in other diagnoses early after publication of DSM-III suggested that lithium was an effective treatment for children with bipolar disorder, emotionally unstable character disorder (a diagnosis not included in DSM-III, but which shared characteristics with borderline personality disorder, disruptive behavior disorders, and bipolar spectrum disorders), and diagnostically unclear children with parents who had responded to lithium [68].

Four early controlled trials of lithium in children and adolescents with bipolar disorder (combined N = 46) featured cross-over designs [69–72]. These studies used daily dosages ranging from 600–1200 mg/day to achieve blood levels of 0.3–1.3 mEq/L and yielded response rates ranging from 33–80%.

Mania and mixed episodes

Lithium is the oldest and possibly the most extensively studied mood stabilizer in adults for the treatment and prevention of manic and mixed episodes, with placebo controlled-studies dating back to Morgens Schou in 1954 [73], though the methodologies of many of these controlled trials limit their applicability to clinical practice. The most modern of these studies demonstrated significant improvement at day 21 for 49% of patients receiving lithium [74]. Various trials against placebo, other mood stabilizers, and neuroleptics have yielded response rates from 32–88% [75]. Monotherapy with lithium has been shown

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