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Guidelines for Treatment-Resistant Mania in Children with Bipolar Disorder

Scheffer, Russell E., MD; Tripathi, Aveekshit, MBBS; Kirkpatrick, Forest G., MEd; Schultz, Tara

Journal of Psychiatric Practice®: May 2011 - Volume 17 - Issue 3 - p 186–193
doi: 10.1097/01.pra.0000398411.59491.8c

Objective To implement a treatment algorithm to operationalize treatment-resistance and improve patient outcomes in youth with pediatric bipolar disorder (PBD). The term “treatment resistance” was operationally defined as significant persistent symptoms following the application of a treatment algorithm.

Method Youth (6–17 years of age, n=120) with treatment-refractory bipolar I or II disorder, currently in a manic or mixed episode, were treated in accordance with the following 3step algorithm: (1) removal of destabilizing agents (antidepressants, gamma aminobutyric acid [GABA]-agonists, and stimulants), (2) optimization of antimanic agents, and (3) use of a limited number (E 2) of mood stabilizers. The primary efficacy measure was change in scores on the Young Mania Rating Scale (YMRS) over the 6-month treatment course. Response was defined as repeated YMRS scores E 12.

Results The sample was dichotomized into responders and non-responders. Both responders and non-responders improved significantly, with responders improving by a greater margin (d=3.2). At the end of 6 months, 75.8% of subjects demonstrated a significant and stable decrease in manic symptoms consistent with symptomatic remission (YMRS E 12). None of the subjects withdrew from the clinical process due to adverse events.

Conclusion The application of this proposed treatment algorithm allows for more accurate identification of true treatment resistance and can significantly reduce manic symptoms in patients previously described as having treatment-refractory bipolar disorder.

Department of Psychiatry, University of Kansas School of Medicine-Wichita

Please send correspondence to: Russell E. Scheffer, MD, Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS 67214.

The authors declare no conflicts of interest.

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.