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Aripiprazole in Juvenile Bipolar Disorder Comorbid with Attention-Deficit/Hyperactivity Disorder: An Open Clinical Trial

Published online by Cambridge University Press:  07 November 2014

Abstract

Introduction

Juvenile bipolar disorder (JBD) is a highly impairing chronic mental health condition that affects children and adolescents' overall functioning. Comorbidity with attention-deficit/hyperactivity disorder (ADHD) is extremely prevalent and may determine worse response to treatment. Few investigations have addressed the use of recent atypical antipsychotics in JBD, although several guidelines suggest their use.

Methods

We conducted a 6-week open trial with aripiprazole in 10 children and adolescents with JBD comorbid with ADHD to assess impact on mania and ADHD symptoms, respectively, by means of the Young Mania Rating Scale and the Swanson, Nolan and Pelham Scale, as well as on global functioning (Clinical Global Impressions–Severity), and adverse events.

Results

Significant improvement in global functioning scores (F=3.17, P=.01, effect size=0.55), manic symptoms (F=5.63, P<.01; ES=0.93), and ADHD symptoms (t=3.42, P<.01; ES=1.05) were detected. Although an overall positive tolerability was reported, significant weight gain (F=3.07, P=.05) was observed.

Conclusion

Aripiprazole was effective in improving mania and ADHD symptoms, but neither JBD nor ADHD symptom remission was observed in most of the cases. Randomized placebo-controlled trials for JBD and ADHD are needed.

Type
Original Research
Copyright
Copyright © Cambridge University Press 2007

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References

REFERENCES

1.Wilens, TE, Biederman, J, Kwon, A, et al.Risk of substance use disorders in adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2004;43:13801386.CrossRefGoogle ScholarPubMed
2.McClellan, J, Kowatch, R, Findling, RL, Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:107125.CrossRefGoogle Scholar
3.Keck, PE, Calabrese, JR, McQuade, RD, et al.A randomized, double-blind, placebo-controlled 26-week trial of aripiprazole in recently manic patients with bipolar I disorder. J Clin Psychiatry. 2006;67:626637.CrossRefGoogle ScholarPubMed
4.Biederman, J, McDonnell, MA, Wozniak, J, et al.Aripiprazole in the treatment of pediatric bipolar disorder: a systematic chart review. CNS Spectr. 2005;10:141148.CrossRefGoogle ScholarPubMed
5.Tramontina, S, Schmitz, M, Polanczyk, G, Rohde, LA. Juvenile bipolar disorder in Brazil: clinical and treatment findings. Biol Psychiatry. 2003;53:10431049.CrossRefGoogle ScholarPubMed
6.State, RC, Frye, MA, Aftshuler, LL, et al.Chart review of the impact of attention-deficit/hyperactivity disorder comorbidity on response to lithium or divalproex sodium in adolescent mania. J Clin Psychiatry. 2004;65:10571063.CrossRefGoogle ScholarPubMed
7.Scheffer, RE, Kowatch, RA, Carmody, T, Rush, AJ. Randomized, placebo-controlled trial of mixed amphetamine salts for symptoms of comorbid ADHD in pediatric bipolar disorder after mood stabilization with divalproex sodium. Am J Psychiatry. 2005;162:5864.CrossRefGoogle ScholarPubMed
8.Burris, KD, Molski, TF, Xu, C, et al.Aripiprazole, a novel antipsychotic, is a high-affinity partial agonist at human dopamine D2 receptors. J Pharmacol Exp Ther. 2002;302:381389.CrossRefGoogle ScholarPubMed
9.Vieta, E, Bourin, M, Sanchez, R, et al.Effectiveness of aripiprazole v. haloperidol in acute bipolar mania: double-blind, randomised, comparative 12-week trial. Br J Psychiatry. 2005;187:235242.CrossRefGoogle ScholarPubMed
10.Rugino, TA, Janvier, YM. Aripiprazole in children and adolescents: clinical experience. J Child Neurol. 2005;20:603610.CrossRefGoogle ScholarPubMed
11.Orvashel, H. Psychiatric interviews suitable for use in research with children and adolescents. Psychopharmacol Bull. 1985;21:737744.Google Scholar
12.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
13.Rohde, LA. ADHD in Brazil: the DSM-IV criteria in a culturally different population. J Am Acad Child Adolesc Psychiatry. 2002;41:11311133.CrossRefGoogle Scholar
14.Biederman, J, Mick, E, Hammerness, P, et al.Open-label, 8-week trial of olanzapine and risperidone for the treatment of bipolar disorder in preschool-age children. Biol Psychiatry. 2005;58:589594.CrossRefGoogle ScholarPubMed
15.Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429435.CrossRefGoogle ScholarPubMed
16.The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry. 1999;56:10731086.CrossRefGoogle Scholar
17.Guy, W, ed. ECDEU Assessment Manual for Psychopharmacology: Publication ADM 76-338. Washington, DC: US Department of Health, Education and Welfare; 1976.Google Scholar
18.Greenhill, LL, Vitiello, B, Fisher, P, et al.Comparison of increasingly detailed elicitation methods for the assessment of adverse events in pediatric psychopharmacology. J Am Acad Child Adolesc Psychiatry. 2004;43:14881496.CrossRefGoogle ScholarPubMed
19.Barkley, RA, McMurray, MB, Edelbrock, CS, Robbins, K. Side effects of methylphenidate in children with attention deficit hyperactivity disorder: a systemic, placebo-controlled evaluation. Pediatrics. 1990;86:184192.CrossRefGoogle ScholarPubMed
20.Cohen, J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Earlbaum Associates; 1988.Google Scholar
21.Barzman, DH, DelBello, MP, Kowatch, RA, et al.The effectiveness and tolerability of aripiprazole for pediatric bipolar disorders: a retrospective chart review. J Child Adolesc Psychopharmacol. 2004;14:593600.CrossRefGoogle ScholarPubMed
22.Correll, CU. Weight gain and metabolic effects of mood stabilizers and antipsychotics in pediatric bipolar disorder: a systematic review and pooled analysis of short-term trials. J Am Acad Child Adolesc Psychiatry. 2007;46:687700.CrossRefGoogle ScholarPubMed