Combination lithium and Divalproex sodium in pediatric bipolarity

ABSTRACT Objective: It has been reported that bipolar disorder may become less responsive to previously effective treatment with each symptomatic relapse. The primary goal of this study was to assess the rate of restabilization after the resumption of lithium (L

An Open-Label Study of Aripiprazole in Children with a Bipolar Disorder

Abstract Objective: The purpose of this open-label study was to describe the effectiveness of aripiprazole (APZ) in the treatment of children with bipolar disorders suffering from manic symptomatology. Method: Symptomatic outpatients (Young Mania Rating Scale [YMRS] score !15) meeting strict, unmodified, Diagnostic and Statistical Manual of Mental Disorders, 4th edition, diagnostic symptom criteria for a bipolar disorder, ages 4-9 years, were eligible. Subjects were treated prospectively with flexible doses of APZ (maximum daily dose of 15 mg/day), for up to 16 weeks or until a priori response criteria were met. Outcome measures included the YMRS, Clinical Global Impressions ScaleSeverity, Children's Global Assessment Scale (CGAS), and the Children's Depression Rating Scale-Revised (CDRS-R). A priori response criteria consisted of 3 of 4 consecutive weeks with (1) CDRS-R <29; (2) YMRS <10; and (3) CGAS >50. Results: Ninety-six children (62 males; mean age of 6.9 (SD ¼ 1.7), received APZ for an average length of treatment of 12.5 (SD ¼ 3.9) weeks. Significant improvements in YMRS, CDRS-R, CGAS, and Clinical Global Impressions Scale-Severity scores ( p < 0.001) were noted at the end of study participation. Sixty of the subjects (62.5%) met a priori response criteria at study's end. The most common side effects noted were stomachache, increased appetite, and headache. Two subjects were removed from the study due to side effects [epistaxis (n ¼ 1); akathisia (n ¼ 1)]. Subjects experienced an average weight gain of 2.4 (SD ¼ 1.9) kg. Conclusion: APZ may be effective in the acute treatment of symptoms of children with bipolar illnesses