Clinical Manual for the Management of Bipolar Disorder in Children and Adolescents

356 Pages·2008·2.62 MB·English

by  Robert A. Kowatch

Clinical Manual for
Management of
Bipolar Disorder in
Children and
Adolescents
This page intentionally left blank
Clinical Manual for
Management of
Bipolar Disorder in
Children and
Adolescents
Edited by
Robert A. Kowatch, M.D., Ph.D.
Mary A. Fristad, Ph.D., A.B.P.P.
Robert L. Findling, M.D.
Robert M. Post, M.D.
Washington, DC
London, England
Note: The authors have worked to ensure that all information in this book is accurate
at the time of publication and consistent with general psychiatric and medical
standards, and that information concerning drug dosages, schedules, and routes of
administration is accurate at the time of publication and consistent with standards set
by the U.S. Food and Drug Administration and the general medical community. As
medical research and practice continue to advance, however, therapeutic standards may
change. Moreover, specific situations may require a specific therapeutic response not
included in this book. For these reasons and because human and mechanical errors
sometimes occur, we recommend that readers follow the advice of physicians directly
involved in their care or the care of a member of their family.
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Copyright © 2009 American Psychiatric Publishing, Inc.
ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper
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First Edition
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American Psychiatric Publishing, Inc., 1000 Wilson Boulevard,
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Library of Congress Cataloging-in-Publication Data
Clinical manual for management of bipolar disorder in children and adolescents /
edited by Robert A. Kowatch...[et al.]. — 1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-58562-291-7 (alk. paper)
1. Manic-depressive illness in children—Treatment. 2. Manic-depressive illness
in adolescence—Treatment. I. Kowatch, Robert A.
[DNLM: 1. Bipolar Disorder—diagnosis. 2. Bipolar Disorder—therapy. 3. Adolescent.
4. Child. WM 207 C641 2009]
RJ506.D4C593 2009
618.92′89506—dc22
2008042043
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xix
1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Robert A. Kowatch, M.D., Ph.D.
Prevalence of Pediatric Bipolar Disorders. . . . . . . . . 2
Age at Onset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Robert A. Kowatch, M.D., Ph.D.
Pediatric Bipolar Disorder in the Context of
DSM-IV-TR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Phenomenology and Course . . . . . . . . . . . . . . . . . . 10
Bipolar Spectrum Disorders. . . . . . . . . . . . . . . . . . . 16
The Problem of Comorbidity . . . . . . . . . . . . . . . . . . 18
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3
Course and Outcome. . . . . . . . . . . . . . . . . . . . . . .23
Robert L. Findling, M.D.
Course of Bipolar Illness in Adults. . . . . . . . . . . . . . 24
Progression of Bipolar Disorders. . . . . . . . . . . . . . . 25
Prospective Studies of Bipolar Illness in Youths. . . 26
High-Risk Offspring Studies . . . . . . . . . . . . . . . . . . . 38
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
4
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Stephanie Danner, Ph.D., and
Mary A. Fristad, Ph.D., A.B.P.P.
Using the Lifeline to Assess Pediatric
Bipolar Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Using the Lifeline to Collect Mental Health
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Collecting Family History of Mental Illness. . . . . . . 60
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
5
Etiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
Robert M. Post, M.D.
Causes and Mechanisms of Bipolar Illness. . . . . . . 71
Genetic Mechanisms in Bipolar Illness Onset . . . . 73
Importance of Stressors in the Onset and
Progression of Bipolar Illness. . . . . . . . . . . . . . . . . . 79
Sensitization Phenomena Emphasizing the
Need for Early Treatment . . . . . . . . . . . . . . . . . . . . . 94
Neurochemistry of Bipolar Illness and
Its Treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105
Convergent Physiology and Biochemistry of
Bipolar Illness: Cortical Deficits and
Limbic Hyperactivity . . . . . . . . . . . . . . . . . . . . . . . .114
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123
6
Pharmacotherapy 1: Mood Stabilizers . . . . . . .133
Robert A. Kowatch, M.D.. Ph.D.
Lithium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135
Valproate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139
Carbamazepine . . . . . . . . . . . . . . . . . . . . . . . . . . . .142
Lamotrigine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .144
Gabapentin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146
Topiramate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147
Oxcarbazepine. . . . . . . . . . . . . . . . . . . . . . . . . . . . .149
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150
7
Pharmacotherapy 2: Atypical Antipsychotics. . .157
Robert A. Kowatch, M.D., Ph.D.
Early Studies of Atypical Antipsychotics . . . . . . . .158
Management of Adverse Events
With Atypical Antipsychotics. . . . . . . . . . . . . . . . . .164
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .168
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .168
8
Pharmacotherapy 3: Medication Strategies
and Tactics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173
Robert A. Kowatch, M.D., Ph.D.
Medication Strategies and Tactics. . . . . . . . . . . . .174
Common Case Presentations. . . . . . . . . . . . . . . . .185
Clinical Pearls About Specific Medications. . . . . .193
Important Treatment Issues. . . . . . . . . . . . . . . . . .195
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198
9
Comorbidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
Robert L. Findling, M.D.
Comorbid Psychiatric Conditions:
Findings From Selected Cohorts . . . . . . . . . . . . . .202
Methodological Challenges . . . . . . . . . . . . . . . . . .208
Clinical Approach to Assessment. . . . . . . . . . . . . .208
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213
10
Working With Patients and Their Families:
Cardinal Symptom Monitoring and
Mood Charting . . . . . . . . . . . . . . . . . . . . . . . . . . .217
Matthew E. Young, M.A., and
Mary A. Fristad, Ph.D., A.B.P.P.
Psychoeducational Psychotherapy. . . . . . . . . . . . .218
Symptom Monitoring . . . . . . . . . . . . . . . . . . . . . . .228
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .234
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235
11
The Bipolar Child and the Educational System:
Working With Schools. . . . . . . . . . . . . . . . . . . . .239
Benjamin W. Fields, M.A., M.Ed., and
Mary A. Fristad, Ph.D., A.B.P.P.
Academic Problems in Pediatric Bipolar
Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240
Impairment Caused by Manic Symptoms. . . . . . .242
Impairment Caused by Depressive Symptoms. . .244
Peer Relations in School. . . . . . . . . . . . . . . . . . . . .246
Dealing With Medication Side Effects
in School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .247
Special Education and Bipolar Disorder . . . . . . . .247
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .257
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .264
Appendix: Information on Bipolar Disorder
for Schools. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .269
12
Special Treatment Issues . . . . . . . . . . . . . . . . . .273
Mary A. Fristad, Ph.D., A.B.P.P., and
Elisabeth A. Frazier, B.S.
Treatment and Medication Adherence . . . . . . . . .274
Conduct Problems. . . . . . . . . . . . . . . . . . . . . . . . . .276
Hypersexuality/Promiscuity . . . . . . . . . . . . . . . . . .278
Impaired Peer Relationships . . . . . . . . . . . . . . . . .279
Stigma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .281
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . .282
Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .283
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .285
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .287
13
Resources for Clinicians, Parents,
and Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291
Mary A. Fristad, Ph.D., A.B.P.P.
Sample Mood Charts . . . . . . . . . . . . . . . . . . . . . . .292
Books for Children . . . . . . . . . . . . . . . . . . . . . . . . .292
Children’s Literature . . . . . . . . . . . . . . . . . . . . . . . .293
Books for Adolescents . . . . . . . . . . . . . . . . . . . . . .293
Books for Parents . . . . . . . . . . . . . . . . . . . . . . . . . .294
Books for Adults . . . . . . . . . . . . . . . . . . . . . . . . . . .295
Books for Parents on Related Topics. . . . . . . . . . .297
Educational Resources . . . . . . . . . . . . . . . . . . . . . .299
National Organizations and Support Groups . . . .299
Side Effect Management. . . . . . . . . . . . . . . . . . . . .300
Complementary Treatment Information. . . . . . . .300
14
Conclusion and Future Directions . . . . . . . . . . .303
Robert A. Kowatch, M.D., Ph.D.
Appendix: K-SADS Mania Rating Scale . . . . . . .307
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .321