Pediatrik Bipolar Bozukluk Tedavisi

Önceleri pediatrik bipolar bozukluk çok nadir görülen bir psikiyatrik bozukluk olarak düşünülse de, son 20 yıldaki araştırmalar bozukluğun sanılandan çok daha yaygın olduğunu ortaya koymuştur. Çocuk ve ergenlik başlangıçlı bipolar bozukluk ciddi ailesel ve akademik sorunlara, daha sık madde kullanımına, riskli cinsel ilişkilere, ergen gebeliği ve suça yatkınlığa neden olmaktadır. Erişkin başlangıçlıya göre yaşam boyu daha kötü bir işlevsellik söz konusudur. Tanı konulması daha güç olabilmekte ve tanı konulana kadar geçen süre erişkin bipolar bozukluğuna göre daha uzun olabilmektedir. Bu yaş grubunun özelliklerinden dolayı tedavi uyumu ile ilişkili problemlere daha sık rastlanmaktadır. Pediatrik bipolar bozukluktaki bu tanı ile ilgili karmaşa, tedavi konusunda da anlaşmazlıklara yol açmıştır. Bu gözden geçirmede çocuk ve ergenlik başlangıçlı bipolar bozukluktaki tedavi yaklaşımları ele alınmıştır.

Treatment of Pediatric Bipolar Disorder

Although once pediatric bipolar disorder had been perceived as a very rarely seen psychiatric disorder, studies conducted within the last two decades revealed that this disorder is more often than assumed. Childhood and adolescent onset bipolar disorder causes and leads serious familial and academic disturbances, more frequent subtance use, precarios sexual intercourses, adolescent pregnancy and tendency to delinquency. Lifelong functionality is worse than adult onset. It could be more difficult to be diagnosed and could take longer time period for the diagnosis than adult onset. Difficulties of compliance to treatment can be seen more frequently because of the behavioural age characteristics of this group. Diagnostic controversies about the pediatric bipolar disorder also led disagreement about the treatment. In this review treatment approaches in the child and adolescent onset bipolar disorder have been discussed.

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  • Demeter CA, Townsend LD, Wilson M, Findling RL. Current research in child and adolescent bipolar disorder. Dialogues Clin Neurosci 2008; 10:215–228.
  • Orhan A, Abalı O. Çocukluktan ergenliğe iki uçlu bozukluk: tanı zorlukları ve ekhastalıklar üzerine bir gözden geçirme. Journal of Mood Disorders 2011; 1:126-135.
  • Tohen M, Kryzhanovskaya L, Carlson G, Delbello M, Wozniak J, Kowatch R et al . Olanzapine versus placebo in the treatment of adolescents with bipolar mania. Am J Psychiatry 2007; 164:1547-1556.
  • Haas M, Delbello MP, Pandina G, Kushner S, Van Hove I, Augustyns I et al. Risperidone for the treatment of acute mania in in children and adolescents with bipolar disorder: a randomized, double-blind, placebo-controlled study. Bipolar Disord 2009; 11:687-700.
  • Pathak S, Findling RL, Earley WR, Acevedo LD, Stankowski J, Delbello MP. Efficacy and safety of quetiapine in children and adolescents with mania associated with bipolar I disorder: a 3-week, double-blind, placebo-controlled trial. J Clin Psychiatry 2013; 74:e100-109.
  • Findling RL, McNamara NK, Youngstrom EA, Stansbrey RJ, Frazier TW, Lingler J et al. An open-label study of aripiprazole in children with a bipolar disorder. J Child Adolesc Psychopharmacol. 2011; 21:345-351.
  • Wagner KD, Kowatch RA, Emslie GJ, Findling RL, Wilens TE, McCague K et al. A double-blind, randomized, placebocontrolled trial of oxcarbazepine in the treatment of bipolar disorder in children and adolescents. Am J Psychiatry 2006; 163:1179–1186.
  • Kowatch RA, Findling RL, Scheffer RE, Stanford K. Pediatric Bipolar Collaborative Mood Stabilizer Trial. In 54th Annual Meeting of the American Academy of Child and Adolescent Psychiatry: October 23-282007; Boston, Mass. USA, 2007.
  • DelBello MP, Findling RL, Kushner S, Wang D, Olson WH, Capece JA et al. A pilot controlled trial of topiramate for mania in children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2005; 44:539-547.
  • Wagner KD, Kowatch RA, Emslie GJ, Findling RL, Wilens TE, McCague K et al. A double-blind, randomized, placebocontrolled trial of oxcarbazepine in the treatment of bipolar disorder in children and adolescents. Am J Psychiatry 2006; 163:1179-1186.
  • Stewart M, DelBello MP, Versavel M, Keller D. Psychosocial functioning and health-related quality of life in children and adolescents treated with open-label ziprasidone for bipolar mania, schizophrenia, or schizoaffective disorder. J Child Adolesc Psychopharmacol 2009; 19:635-640.
  • Biederman J, Mick E, Spencer T, Dougherty M, Aleardi M, Wozniak J. A prospective open-label treatment trial of ziprasidone monotherapy in children and adolescents with bipolar disorder. Bipolar Disord 2007; 9:888-894.
  • Alessi N, Naylor MW, Ghaziuddin M, Zubieta JK. Update on lithium carbonate therapy in children and adolescents. J Am Acad Child Adolesc Psychiatry 1994; 33:291-304.
  • Kafantaris V, Coletti DJ, Dicker R, Padula G, Kane JM. Lithium treatment of acute mania in adolescents: a large open trial. J Am Acad Child Adolesc Psychiatry 2003; 42:1038-1045.
  • Kowatch RA, Suppes T, Carmody TJ, Bucci JP, Hume JH, Kromelis M et al. Effect size of lithium, divalproex sodium, and carbamazepine in children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2000; 39:713-720. Kowatch R, Suppes T, Gilfillan SK. Clozapine treatment of children and adolescents with bipolar disorder and schizophrenia: a clinical case series. J Child Adolesc Psychopharmacol 1995; 5:241-253.
  • Masi G, Mucci M, Millepiedi S. Clozapine in adolescent inpatients with acute mania. J Child Adolesc Psychopharmacol 2002; 12:93-99.
  • Kowatch RA, Sethuraman G, Hume JH, Kromelis M, Weinberg WA. Combination pharmacotherapy in children and adolescents with bipolar disorder. Biol Psychiatry 2003; 53:978-984.
  • DelBello MP, Schwiers ML, Rosenberg HL, Strakowski SM. A double-blind, randomized, placebo-controlled study of quetiapine as adjunctive treatment for adolescent mania. J Am Acad Child Adolesc Psychiatry 2002; 41:1216-1223.
  • Pavuluri MN, Henry DB, Carbray JA, Sampson G, Naylor MW, Janicak PG. Open-label prospective trial of risperidone in combination with lithium or divalproex sodium in pediatric mania. J Affect Disord 2004; 82(suppl 1):S103-S111.
  • Findling RL, McNamara NK, Gracious BL, Youngstrom EA, Stansbrey RJ, Reed MD et al. Combination lithium and divalproex sodium in pediatric bipolarity. J Am Acad Child Adolesc Psychiatry 2003; 42:895-901.
  • Findling RL, McNamara NK, Stansbrey R, Gracious BL, Whipkey RE, Demeter CA et al. Combination lithium and divalproex sodium in pediatric bipolar symptom restabilization. J Am Acad Child Adolesc Psychiatry 2006; 45:142-148.
  • Blader JC, Kafantaris V. Pharmacological treatment of bipolar disorder among children and adolescents. Expert Rev Neurother 2007; 7:259-270.
  • Kafantaris V, Coletti DJ, Dicker R, Padula G, Kane JM. Adjunctive antipsychotic treatment of adolescents with bipolar psychosis. J Am Acad Child Adolesc Psychiatry 2001; 40:1448-1456.
  • Singh MK, Ketter TA, Chang KD. Atypical antipsychotics for acute manic and mixed episodes in children and adolescents with bipolar disorder: efficacy and tolerability. Drugs 2010: 70:433-442.
  • Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J, Solomon DA et al. The long-term natural history of the weekly symptomatic status of Bipolar I disorder. Arch Gen Psychiatry 2002; 59:530-537.
  • Chang K. Challenges in the diagnosis and treatment of pediatric bipolar depression. Dialogues Clin Neurosci 2009; 11:73
  • Martin A, Young C, Leckman JF, Mukonoweshuro C, Rosenheck R, Leslie D. Age effects on antidepressant-induced manic conversion. Arch Pediatr Adolesc Med 2004; 158:773-780.
  • Leverich GS, Altshuler LL, Frye MA, Suppes T, McElroy SL, Keck PE et al. Risk of switch in mood polarity to hypomania or mania in patients with bipolar depression during acute and continuation trials of venlafaxine, sertraline, and bupropion as adjuncts to mood stabilizers. Am J Psychiatry 2006; 163:232-239.
  • Hammad TA, Laughren T, Racoosin J. Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry 2006; 63:332-339.
  • Suppes T, Kelly DI, Perla JM. Challenges in the management of bipolar depression. J Clin Psychiatry 2005; 66(suppl 5):11
  • Thase ME, Macfadden W, Weisler RH, Chang W, Paulsson B, Khan A et al. Efficacy of quetiapine monotherapy in bipolar I and II depression: a double-blind, placebo-controlled study (the BOLDER II study). J Clin Psychopharmacol 2006; 26:60060
  • Ghaemi SN, Hsu DJ, Soldani F, Goodwin FK. Antidepressants in bipolar disorder: the case for caution. Bipolar Disord 2003; 5:421-433.
  • Sachs GS, Nierenberg AA, Calabrese JR, Marangell LB, Wisniewski SR, Gyulai L et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med 2007; 356:1711-1722.
  • Truman CJ, Goldberg JF, Ghaemi SN, Baldassano CF, Wisniewski SR, Dennehy EB et al. Self-reported history of manic/hypomanic switch associated with antidepressant use: data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEPBD). J Clin Psychiatry 2007; 68:1472-1479.
  • Calabrese JR, Kasper S, Johnson G, Tajima O, Vieta E, Yatham LN et al. International Consensus Group on Bipolar I Depression Treatment Guidelines. J Clin Psychiatry 2004; 65:571-579.
  • Keck PE, Jr Mclntyre RS, Shelton RC. Bipolar depression: best practices for the outpatient. CNS Spectr 2007; 12(suppl 20):1–14.
  • Ketter TA, Wang P, Nowakowska C, Marsh WK. New medication treatment options for bipolar disorders. Acta Psychiatr Scand Suppl 2004; 422:18-33.
  • Craney J, Geller B. Clinical implications of antidepressant and stimulant use on switching from depression to mania in children. J Child Adolesc Psychopharmacol 2003; 13 :201-204.
  • Biederman J, Mick E, Spencer TJ, Wilens TE, Faraone SV. Therapeutic dilemmas in the pharmacotherapy of bipolar depression in the young. J Child Adolesc Psychopharmacol 2000; 10:185-192.
  • Baumer FM, Howe M, Gallelli K, Simeonova Dl, Hallmayer J, Chang KD. A pilot study of antidepressant-induced mania in pediatric bipolar disorder: characteristics, risk factors, and the serotonin transporter gene. Biol Psychiatry 2006; 60:1005– 10
  • Olfson M, Marcus SC, Druss BG. Effects of Food and Drug Administration warnings on antidepressant use in a national sample. Arch Gen Psychiatry 2008; 65:94-101.
  • Chang K, Saxena K, Howe M. An open-label study of lamotrigine adjunct or monotherapy for the treatment of adolescents with bipolar depression. J Am Acad Child Adolesc Psychiatry 2006; 45:298-304.
  • Patel NC, DelBello MP, Bryan HS, Adler CM, Kowatch RA, Stanford K et al. Open-label lithium for the treatment of adolescents with bipolar depression. J Am Acad Child Adolesc Psychiatry 2006; 45:289-297.
  • Lin PY, Su KP. A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. J Clin Psychiatry 2007; 68:1056-1061.
  • Brumback RA, Weinberg WA. Mania in childhood. Therapeutic trial of lithium carbonate and further description of manicdepressive illness in children. Am J Dis Child 1977; 131:1122-1126.
  • Tohen M, Kryzhanovskaya L, Carlson G, Delbello M, Wozniak J, Kowatch R et al. Olanzapine versus placebo in the treatment of adolescents with bipolar mania. Am J Psychiatry 2007; 164:1547-1556.
  • Wagner KD, Redden L, Kowatch R, Wilens TE, Segal S, Chang K et al. A double-blind, randomized, placebo-controlled trial of divalproex ER in the treatment of bipolar disorder in children and adolescents. J Am Acad Child Adolesc Psychiatry 2009; 19:83-89.
  • Wagner KD, Kowatch RA, Emslie GJ, Findling RL, Wilens TE, McCague K et al. A double-blind, randomized, placebocontrolled trial of oxcarbazepine in the treatment of bipolar disorder in children and adolescents. Am J Psychiatry 2006; 163:1179-1186.
  • Lish JD, Dime-Meenan S, Whybrow PC, Price RA, Hirschfeld RM. The National Depressive and Manic-depressive Association (DMDA) survey of bipolar members. J Affect Disord 1994; 31:281-294.
  • Perlis RH, Miyahara S, Marangell LB, Wisniewski SR, Ostacher M, DelBello MP et al. Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry 2004; 55:875-881.
  • Leverich GS, Post RM, Keck PE Jr, Altshuler LL, Frye MA, Kupka RW et al. The poor prognosis of childhood-onset bipolar disorder. J Pediatr 2007; 150:485-490.
  • Geller B, Cooper TB, Zimerman B, Frazier J, Williams M, Heath J et al. Lithium for prepubertal depressed children with family history predictors of future bipolarity: a double-blind, placebo-controlled study. J Affect Disord 1998; 51:165-175. Chang KD, Dienes K, Blasey C, Adleman N, Ketter T, Steiner H. Divalproex monotherapy in the treatment of bipolar offspring with mood and behavioral disorders and at least mild affective symptoms. J Clin Psychiatry 2003; 64:936-942. Findling RL, Frazier TW, Youngstrom EA, McNamara NK, Stansbrey RJ, Gracious BL et al. Double-blind, placebo controlled trial of divalproex monotherapy in the treatment of symptomatic youth at high risk for developing bipolar disorder. J Clin Psychiatry 2007; 68:781-788.
  • Weisler RH, Calabrese JR, Thase ME, Arvekvist R, Stening G, Paulsson B et al. Efficacy of quetiapine monotherapy for the treatment of depressive episodes in bipolar I disorder: a post hoc analysis of combined results from 2 double-blind, randomized, placebo-controlled studies. J Clin Psychiatry 2008; 69:769-782.
  • DelBello MP, Adler CM, Whitsel RM, Stanford KE, Strakowski SM. A 12 week single-blind trial of quetiapine for the treatment of mood symptoms in adolescents at high risk for developing bipolar I disorder. J Clin Psychiatry 2007; 68:7897
  • Goldstein TR, Birmaher B, Axelson D, Ryan ND, Strober MA, Gill MK et al. History of suicide attempts in pediatric bipolar disorder: Factors associated with increased risk. Bipolar Disord 2005; 7:525-535.
  • Lewinsohn PM, Seeley JR, Klein DN. Bipolar disorders during adolescence. Acta Psychiatr Scand Suppl 2003; (418):47-50. Wilcox HC, Anthony JC. Child and adolescent clinical features as forerunners of adult-onset major depressive disorder: Retrospective evidence from an epidemiological sample. J Affect Disord 2004; 82:9-20.
  • Axelson D, Birmaher B, Strober M, Gill MK, Valeri S, Chiappetta L et al. Phenomenology of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry 2006; 63:1139-1148.
  • Salvadore G, Drevets WC, Henter ID, Zarate CA, Manji HK. Early intervention in bipolar disorder, part I: clinical and imaging findings. Early Interv Psychiatry 2008; 2:122-135.
  • Kafantaris V, Coletti DJ, Dicker R, Padula G, Pleak RR, Alvir JMJ. Lithium treatment of acute mania in adolescents: A placebo-controlled discontinuation study. J Am Acad Child Adolesc Psychiatry 2004; 43:984-993.
  • Birmaher B, Axelson D, Strober M, Gill MK, Valeri S, Chiappetta L et al. Clinical course of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry 2006; 63:175-183.
  • Salvadore G, Drevets WC, Henter ID, Zarate CA, Manji HK. Early intervention in bipolar disorder, part II: therapeutics. Early Interv Psychiatry 2008; 2:136-146.
  • Oral T. Duygudurum düzenleyicileri. Klinik Psikofarmakoloji Bülteni 1999; 9:14-20.
  • Blader C, Carlson GA. Increased rates of bipolar disorder diagnoses among U.S. child, adolescent, and adult inpatients, 1996-2004. Biol Psychiatry 2007; 62:107-114.
  • Bowden CL, Calabrese JR, Sachs G, Yatham LN, Asghar SA, Hompland M, Lamictal 605 Study Group et al. A placebocontrolled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Arch Gen Psychiatry 2003; 60:392-400.
  • Geller B, Cooper TB, Sun K, Zimerman B, Frazier J, Williams M et al. Double-blind and placebo-controlled study of lithium for adolescent bipolar disorders with secondary substance dependency. J Am Acad Child Adolesc Psychiatry 1998; 37:1711
  • Chengappa KN, Gershon S, Levine J. The evolving role of topiramate among other mood stabilizers in the management of bipolar disorder. Bipolar Disord 2001; 3:215-232.
  • Rakofsky JJ, Dunlop BW. Treating nonspecific anxiety and anxiety disorders in patients with bipolar disorder: a review.J Clin Psychiatry 2011; 72:81-90.
  • Goldstein TR, Birmaher B, Axelson D, Ryan ND, Strober MA, Gill MK et al. History of suicide attempts in pediatric bipolar disorder: Factors associated with increased risk. Bipolar Disord 2005; 7:525-535.
  • Miklowitz DJ, George EL, Axelson DA, Kim EY, Birmaher B, Schneck C et al. Family-focused treatment for adolescents with bipolar disorder. J Affect Disord 2004; 82(suppl 1): S113-S128.
  • Fristad MA. Psychoeducational treatment for school-aged children with bipolar disorder. Dev Psychopathol 2006; 18:1289130
  • Hlastala SA, Frank E. Adapting interpersonal and social rhythm therapy to the developmental needs of adolescents with bipolar disorder. Dev Psychopathol 2006; 18:1267-1288.
  • Marangell LB, George MS, Callahan AM, Ketter TA, Pazzaglia PJ, L'Herrou TA et al. Effects of intrathecal thyrotropin releasing hormone (protirelin) in refractory depressed patients. Arch Gen Psychiatry 1997; 54:214-222.
  • Post RM. Promising avenues of therapeutics for bipolar illness. Dialogues Clin Neurosci 2008; 10:193-201.
  • Richieri R, Adida M, Dumas R, Fakra E, Azorin JM, Pringuey D et al. Affective disorders and repetitive transcranial magnetic stimulation: therapeutic innovations. Encephale 2010; 36(suppl 6):s197-s201.
  • Berton O, McClung CA, Dileone RJ, Krishnan V, Renthal W, Russo SJ et al. Essential role of BDNF in the mesolimbic dopamine pathway in social defeat stress. Science 2006; 311(5762):864-868.
  • Willoughby CL, Hradek EA, Richards NR. Use of electroconvulsive therapy with children: an overview and case report. J Child Adolesc Psychiatr Nurs1997; 10:11-17.
  • Shoirah H, Hamoda HM. Electroconvulsive therapy in children and adolescents. Expert Rev Neurother 2011; 11:127-137. Wachtel LE, Dhossche DM, Kellner CH. When is electroconvulsive therapy appropriate for children and adolescents? Med Hypotheses 2011; 76:395-399.
  • Sackeim HA, Prudic J. Length of the ECT course in bipolar and unipolar depression. J ECT 2005; 21:195-197.
  • Cohen D, Paillère-Martinot ML, Basquin M. Use of electroconvulsive therapy in adolescents. Convuls Ther 1997; 13:25-31. Cohen D, Dubos PF, Basquin M. Use of electroconvulsive therapy in the adolescent. Encephale 1997; 23:308-311.
  • McLean MJ, Holcomb RR, Wamil AW, Pickett JD, Cavopol AV. Blockade of sensory neuron action potentials by a static magnetic field in the 10 mT range. Bioelectronmagnetics 1995; 16:20-32.
  • Kennaway DJ, Moyer RW. Serotonin 5HT2C agonists mimic the effect of light pulses on circadian rhythms. Brain Res 1998; 806:257-270.
  • Coppen A, Bolander-Gouaille C. Treatment of depression: time to consider folic acid and vitamin B12. J Psychopharmacol 2005; 19:59-65.
  • Coppen A, Bailey J. Enhancement of the antidepressant action of fluoxetine by folic acid: a randomised, placebo controlled trial. J Affect Disord 2000; 60:121-130.
  • Nemets B, Stahl Z, Belmaker RH. Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. Am J Psychiatry 2002; 159:477-479.
  • Keck PE Jr, Mintz J, McElroy SL, Freeman MP, Suppes T, Frye MA et al. Double-blind, randomized, placebo-controlled trials of ethyl-eicosapentanoate in the treatment of bipolar depression and rapid cycling bipolar disorder. Biol Psychiatry 2006; 60:1020-1022.
  • Frye MA, Grunze H, Suppes T, McElroy SL, Keck PE Jr, Walden et al. A placebo-controlled evaluation of adjunctive modafinil in the treatment of bipolar depression. Am J Psychiatry 2007; 164:1242-1249.
  • Zarate CA Jr, Singh JB, Carlson PJ, Brutsche NE, Ameli R, Luckenbaugh DA et al A randomized trial of an N-methyl-Daspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry 2006; 63:856-864.
  • Zarate CA Jr, Quiroz JA, Singh JB, Denicoff KD, De Jesus G, Luckenbaugh DA et al. An open-label trial of the glutamate modulating agent riluzole in combination with lithium for the treatment of bipolar depression. Biol Psychiatry 2005; 57:430-432.
  • Akpınar F, Narin F, Özsoy SD. Lityum ve valproat alan bipolar hastalarda protein oksidasyonunun değerlendirilmesi. Sağlık Bilimleri Dergisi 2013; 22:223-226.
  • Kılınçaslan A, Savaş HA. Çocuk ve ergenlerde iki uçlu bozukluğun tedavisinde yeni gelişmeler. Güncel Psikiyatri ve Psikonörofarmakoloji 2011; 1:24-36. Ayten Erdoğan, Prof.Dr., Bakırköy Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi,İstanbul; Sema Kurban, Dr., Bakırköy Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi,İstanbul; Özhan Yalçın,Uzm. Dr., Bakırköy Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi,İstanbul. Yazışma Adresi/Correspondence: Özhan Yalçın, Bakırköy Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi,İstanbul, Turkey. E-mail: cpozhan@gmail.com Yazar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemiştir. The author reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol6/no2/ Çevrimiçi yayım / Published online 01 Ağustos/August 01, 2013; doi: 10.5455/cap.20130707024051