Bipolar Disorders in Children and Adolescents

TREATMENT

DRUG ASSISTED TREATMENT

To date, there have only been limited drug trials in treating BP disorders in children and adolescents. Monotherapy, using one of the mood stabilisers (Lithium, Tegretol, Epilim), at present is the first choice of treatment, however, only 40 to 50% improvement is achieved. If depression is a primary symptom, Lithium is the choice of mood stabiliser. To enhance improvement, atypical antipsychotics are often simultaneously used. The optimal duration of drug treatment with children and adolescents is yet to be ascertained.

Often the best response to pharmacotherapy is achieved when there is a combination of medications used. In a recent study, 80% responded to a combination of therapy after not responding to the use of a mood stabiliser alone. When co - occurring ADHD is present, the treatment of the BPD is a priority because stimulants will exacerbate the bipolar disorder, as will antidepressants in the absence of a mood stabiliser.

PSYCHO-EDUCATION

Psycho - education for the sufferer, parents, siblings and significant others is vital and should emphasise the essential use of pharmacotherapy to control symptoms, that symptom change is part of the illness, that long-term management is the norm and that suicide is a risk. It is also vital to emphasise and to attain a consensus amongst family members that those with BPDs are not naughty or defiant but they do have a neurobiological disorder, which is now viewed as a neuropsychiatric disorder of an affective dysregularity. Recent studies now indicate that BPDs sufferers have a 20 to 30% decrease of neurons in specific brain regions.

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