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J Affect Disord. 2004 Oct 1;82(1):149-58.

Treatment-emergent mania in pediatric bipolar disorder: a retrospective case review.

Author information

1
Lucio Bini Mood Disorders Center, New York, NY 10022, USA. gianni.faedda@moodcenter.org <gianni.faedda@moodcenter.org>

Abstract

BACKGROUND:

Pediatric bipolar disorder (BPD) can be misdiagnosed as a depressive, attention, conduct, or anxiety disorder and treatment with antidepressants and stimulants is common. Risk of adverse outcomes related to such treatment remains poorly defined.

METHODS:

We analyzed clinical records of 82 children (mean age 10.6 years) meeting modified DSM-IV diagnostic criteria for BPD to evaluate risk and timing of operationally-defined treatment-emergent mania (TEM) or increased mood-cycling following pharmacological treatment.

RESULTS:

Of 82 juvenile BPD patients, 57 (69%) had been given a mood-elevating agent at least once; 33/57 (58%) so-exposed met criteria for TEM, with median latency of 14 days; TEM was observed twice as often with antidepressants as stimulants (44% vs. 18%). TEM led to first-recognition of BPD in 14 cases (17%), and some drug-exposed children (4-9%) had prominent suicidal, homicidal or psychotic behavior. In addition to recent exposure to a mood-elevating agent, TEM was associated with early-onset anxiety and female gender.

LIMITATIONS:

Findings are retrospective in clinically diagnosed and treated outpatients, but involved otherwise unselected cases of juvenile BPD.

CONCLUSIONS:

TEM was reported in 58% of children with probable juvenile BPD within several weeks of new exposure to a mood-elevating agent.

PMID:
15465590
DOI:
10.1016/j.jad.2003.12.011
[Indexed for MEDLINE]

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