Research Paper: Bipolar Disorder Symptoms

Pages: 8 (3835 words)  ·  Bibliography Sources: 8  ·  Level: Master's  ·  Topic: Psychology  ·  Buy This Paper

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[. . .] Besides this, due to the CYP450 drug interactions, carbamazapine in combination with sodium divalproex are not suggested for use in combination (Kowatch & Delbello, 2005). Researchers have said about a reduction in manic or depressed symptoms in studies evaluating monotherapy with lithium (only or in comparison to divalproex sodium at the periods of 20 months, then 14 weeks and finally 6 weeks) that these specific mood stabilizers could not uphold over the longer period of time and a second medication was defensible to get reduction in symptoms in some studies (Calabrese et al. 2005; Findling et al., 2005a and 2005b; Geller, Williams, et al., 1998).

In addition to this, for managing a short-term and severe bipolar disorder in children, the use of risperidone, olanzapine as monotherapy and quetapine is strongly supported by the evidence. The rate of response had been between 53 to 82%. Since some studies are double-blind placebo-controlled and others are retrospective chart reviews or open label, therefore it is not easy to compare head-to head. However, for the treatment of pediaratic bipolar disorder, it is recommended by the research data that atypical antipsychotics can be a fine first-line treatment, mainly in youth facing psychotic symptoms. According to the findings of Findling and colleagues' (2003), youth taking divalproex sodium monotherapy and lithium for psychotic symptoms and bipolar disorder did not get reduction in symptoms. Only a single double-blind randomized study of 28 days has been done with children which compares antipsychotic (seroquel) and a mood stabilizer (divalproex sodium) (DelBello et al., 2006). As examined by the YMRS, both of the drugs were equally good in getting quick immediate stabilization of bipolar symptoms. As far as scores are concerned on the Clinical Global Inventory for Bipolar Disorder, quetapine performed in an effective way, which resulted in quick action, enhanced reduction and response rate in comparison to divalproex sodium.

Much more convincing treatments include combined treatments of a mood stabilizer (divalproex sodium or lithium) and an antipsychotic (quetiapine or risperidone). These treatments give assurance of lasting reduction in the symptoms. It is imperative that clinicians must compare the benefit of drug with the negative effects. With the usage of mood stabilizers and antipsychotics, certain things should be examined carefully such as sedation, gain of weight, metabolic problems that cause diabetics, enhanced lipid and cholesterol levels. In order to prevent enhanced lipid and cholesterol levels and obesity, it is imperative to give education on exercise and nutrition. In spite of these interventions other drug choices should be evaluated for those children who face a five percent gain in body weight.

Both, a sustained-release stimulant medication and a mood stabilizer is an essential requirement of those children who face ADHD and bipolar disorder; if both of them can be tolerated without side effects at once. Secure and efficient use of anticonvulsants or antipsychotics combined with stimulants has been shown by a number of studies as an effective method of treatment (Pavuluri, Henry, Devineni, et al., 2004a and 2004b; Pavuluri et al., 2005a and 2005b; Scheffer et al., 2005). Close monitoring for the side effects is very important for all these drugs and these side effects vary according to the type of drug. Stabilizing mania or psychosis is given the precedence and then the next issue is addressing a few depressive symptoms. The use of selective serotonin reuptake inhibitors (SSRIs) use in treating the depressive symptoms of pediatric bipolar disorder is cautioned because there is not much guidance or evidence about the efficiency and safety for them in the pediatric literature. A study was conducted by Leverich et al. (2006) with the adults facing bipolar illness placed on trials of sertraline, venlafaxine, bupropion as appendages to their mood stabilizer. In the acute trials, the conversion to hypomania caused by the antidepressants was 11.4% and that to mania were 7.9% and in the continuation trial 21.8% and percent respectively. In addition to this, according to a recent study (Hamrin & Scahill, 2005), researchers conducted a review of six studies that evaluate the SSRIs in the children with main depression, and asserted that the switching rate in children diagnosed with unipolar depression was between 2 and 6% with mania/hypomania. So, it is necessary for the clinicians to be careful in using SSRIs for adults as well as children that have bipolar disorder because it can result in agitation, mania, activation or hypomania. As compared with adults, children can be more responsive to switches.

Implications for Future Research

Major portion of studies in pediatric bipolar disorder consist of retrospective chart views or open label, which determine severe responses to pharmacological involvement. While significant information is given by them, most of the studies were of eight weeks in duration and lacks the severity of randomized controlled trials. For enhancing the efficiency in treating pediatric bipolar disorder randomized controlled trials are very necessary. They compare many drugs as well as adjunctive pills responses. Besides this, for evaluating the influences on remission results, mood stabilization and ramifications of adverse effects, detailed studies are required.

The beginning of an acute and constant mental sickness which affects global performance is shown by the pediatric bipolar disorder. Though it is extremely genetic, but performance can be improved with the detection at an earlier stage and treatment. The presentation of symptoms is different between adults and children with respect to additional refinements of the problem-solving criteria and route of disease which remain ongoing. For the lasting remission of pediatric bipolar symptoms, the use of the process of Monotherapy alongside mood stabilizers has not shown good results.

According to the current research collective treatment of bipolar disorder with an antipsychotic and mood stabilizer or with two mood stabilizers may assure lasting reduction of this disorder in children as well as youngsters who have weird symptoms and psychosis. Since, in this population the rate of relapse is quite high therefore placebo-controlled and rigorous double-blind randomized studies are required in order to estimate lasting results of medication trials.

References

American Psychiatric Association. (2000). Dignostic and statistical manual of mental disorders (4th ed., Text Rev.). Washington, DC: American Psychiatric Association.

Biederman, J., Farone, S., Mick, E., Wozniak, J., Chen, L., Ouellette, C., et al. (1996). Attention deficit hyperactivity disorder and juvenile mania: An overlooked comorbidity? Journal of Child and Adolescent Psychiatry, 35(8), 997-1008.

Birmaher, B., Axelson, D., Srrober, M., Gill, M., Valeri, S., Chiappetta, L, et al. (2006). Clinical course of children and adolescents with bipolar spectrum disorders. Archives of General Psychiatry, 63, 175-183.

Blumberg, H., Fredricks, C., Wang, F. Kalmar, J., Spencer, L., Papademetris, X., et al. (2005). Preliminary evidence for persistent abnormalities in amygdale volumes in adolescents and young adults with bipolar disorder. Bipolar Disorders, 7, 570-576.

Calabrese, J., Shelton, M., Rapport, D., Youngstrom, E., Jackson, D., Jackson, K., et al. (2005). A 20-month, double blind, maintenance study of lithium vs. divalproex monotherapy in bipolar I and II disorder accompanied by rapid cycling. American Journal of Psychiatry, 162, 2152-2161.

Chang, A., Li, P., & Warsh, J. (2003). Altered cAMP-dependent protein kinase subunit immunolabeling in post-mortem brain from patients with bipolar affective disorder. Journal of Neurochemistry, 84(4), 781-791.

Chang, K., Karchemsky, A., Barnea-Goraly, N., Garrett, A., Simeonova, D., & Reiss, A. (2005). Reduced amygdalar grey matter volume in familial pediatric bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 44(6), 565-573.

Chang, K., Steiner, H., & Ketter, T. (2000). Psychiatric phenomenology of child and adolescent bipolar offspring. Journal of the American Academy of Child and Adolescent Psychiatry, 39(4), 453-60.

Davanzo, P., Gunderson, B., Belin, T., Mintz, J., Pataki, C., Ott, D., et al. (2003). Mood stabilizers in hospitalized children with bipolar disorder: A retrospective chart review. Psychiatry and Clinical Neurosciences, 57(5), 504-513.

Dean, B. (2004). The neurobiology of bipolar disorder: Findings using human postmortem central nervous system tissue. Australian and New Zealand Journal of Psychiatry, 38(3), 135-140.

DelBello, M., Kowatch, R., Caleb, A., Stanford, K., Welge, J., Barzman, D., et al. (2006). A double-blind randomized pilot study comparing quetiapine and divalproex sodium for adolescent mania. Journal of the American Academy of Child and Adolescent Psychiatry, 45(3), 305-313.

Dickstein, D., Milham, M., Nugent, A., Drevets, W., Charney, D., Pine, D., et al. (2005). Frontotemporal alterations in pediatric bipolar disorder. Results of a voxel-based morphometry study. Archives of General Psychiatry, 62(7), 734-741.

DuVal, S. (2005). Six-year-old Thomas diagnosed with pediatric onset bipolar disorder: A case study. Journal of Child and Adolescent Psychiatric Nursing, 18, 38-42.

Emamghoreishi, M., Li, P., Schlichter, L., Parikh, S., Cooke, R., & Warsh, J. (2000). Associated disturbances in calcium homeostasis and G. protein-mediated cAMP signaling in bipolar I disorder. Biological Psychiatry, 48(7), 665-673.

Findling, R., Calabrese, J., & Youngstrom, E. (2003). Divalproex sodium vs. placebo in the treatment of youth at genetic high risk for developing bipolar disorder. Bipolar Disorder, 5, 47.

Findling, R., McNamara, N., Stansbrey, R., Gracious, E., Whipkey, R., Demeter, C., et al. (2005a). Combination lithium and divalproex sodium in pediatric bipolarity. Journal of the American Academy… [END OF PREVIEW]

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