February 23, 2005
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Disorder More Common Among Urban Poor -Study
guidelines for kids with bipolar disorder published
for Bipolar Disorder in a Primary Care Practice
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New Treatment Guidelines for Kids With Bipolar Disorder; Parents, Researchers Urge Better Treatment.
AScribe Health News Service; 2/22/2005
Byline: Child & Adolescent Bipolar Foundation
WILMETTE, Ill., Feb. 22 (AScribe Newswire) -- Mood-stabilizing medication and psychotherapy are needed to treat mania, lift bipolar depression, and improve functioning in children with bipolar disorder, say new treatment guidelines published in the March issue of The Journal of the American Academy of Child and Adolescent Psychiatry. The guidelines were sponsored by the Child & Adolescent Bipolar Foundation (CABF), a national parent advocacy group, and were drafted by a scientific consortium led by Robert Kowatch, M.D., director of the Pediatric Mood Disorders Center at Cincinnati Children's Hospital Medical Center.
"Doctors are getting somewhat better at recognizing bipolar disorder in children, but there wasn't much to guide them in terms of treatment," says Dr. Kowatch. "It is often necessary to use several medications in combination because these kids are very ill, often suicidal or too manic and depressed to attend school. Stabilizing their moods and allowing them to return to school as soon as possible is critical if they are to lead normal lives."
The guidelines are designed to help doctors identify the classic form of the illness (called Bipolar-I) in children ages 6 to 17, and suggest strategies for treatment of mania and depression, with or without psychosis, in young patients. The recommendations are based on evidence from research studies done in children and adults, case reports published in medical journals, and consensus by a group of experts as to current clinical practices.
"Far too little research has been done on the treatment of bipolar disorder in youth," says Mina Dulcan, MD, Editor-in-Chief, Journal of the American Academy of Child and Adolescent Psychiatry. "The Guidelines represent a consensus of existing research results and clinical experience to guide clinicians and families. We hope that the guidelines will not only facilitate clinical care but also inform and enhance new research." The Academy has made the guidelines freely available to doctors who treat children and to the public at http://www.jaacap.com/ .
In addition to Dr. Kowatch, other authors of the guidelines include Mary Fristad, Ph.D., Director of Research & Psychological Services at Ohio State University; Boris Birmaher, M.D., head of the Children's Mood Disorders Center at Western Psychiatric Institute and Clinic in Pittsburgh; Karen Dineen Wagner, M.D., director of the Division of Child and Adolescent Psychiatry at the University of Texas Medical Branch in Galveston; Robert L. Findling, M.D. Professor of Psychiatry and Pediatrics at University Hospitals of Cleveland; and Martha Hellander, Research Policy Director at CABF.
Participants included sixteen other researchers and three other family representatives from CABF.
Bipolar disorder (formerly called manic-depressive illness) is a heritable illness that can be diagnosed in teenagers and even in young children. Symptoms include grandiose delusions, irritable mood often accompanied by aggression and self-injury, decreased need for sleep without daytime fatigue, pressured speech that is difficult to interrupt, racing thoughts, distractibility that varies with mood, increased goal-directed activity, hypersexuality, and in some cases, hearing voices.
"The disorder runs in families, and children with the illness are at extremely high risk of attempting suicide," says Hellander. "These kids suffer so badly, and deserve to have evidence-based treatment as early in life as possible. Many respond quickly to mood stabilizing medication, and parents tell us that 'we have our child back.'"
Like epilepsy, bipolar disorder is a lifelong condition that can often be managed with medication, psychotherapy and lifestyle changes such as stress reduction, regular sleep, accommodations at school, and avoidance of caffeine, alcohol, and drugs of abuse.
"Many children and teens with bipolar disorder have additional disorders that can complicate treatment," says Thomas K. Cummins, MD, who directs the inpatient psychiatry service at Children's Memorial Hospital in Chicago. "The sections on the treatment of comorbid psychiatric disorders are very helpful." The guidelines cover treatment of bipolar disorder that co-occurs with ADHD, oppositional-defiant disorder, conduct disorder, anxiety and tic disorders, and substance abuse. Side effects from the medications are discussed, as is the need for monitoring weight gain, cognitive effects, and hormonal changes sometimes associated with the medications.
ABOUT CABF: CABF is a national, not-for-profit organization of more than 25,000 families raising children diagnosed with, or at risk for, bipolar disorder. Its Web site, http://www.bpkids.org/ , provides information and support for parents, including online support groups, message boards, and chat rooms.
ABOUT CINCINNATI CHILDREN'S: Cincinnati Children's Hospital Medical Center is a 423-bed institution that ranks third nationally among all pediatric centers in research grants from the National Institutes of Health. The Cincinnati Children's vision is to be the leader in improving child health. Additional information can be found at www.cincinnatichildrens.org.
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