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首页> 外文期刊>Journal of child psychology and psychiatry >Practitioner Review: Long-term pharmacological treatment of pediatric bipolar disorder
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Practitioner Review: Long-term pharmacological treatment of pediatric bipolar disorder

机译：从业者评论：小儿双相情感障碍的长期药物治疗

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Although long-term treatment is a core aspect of the management of children and adolescents with bipolar disorder (BD), most clinical recommendations are based on results from short-term studies or adult data. In order to guide clinical practice, we review the efficacy and safety profile of mood stabilizers, antipsychotics, and other pharmacological strategies for the long-term treatment of BD in pediatric patients. Methods: A MEDLINE, EMBASE, Cochrane and PsycInfo search (inception through November 2013) was performed to identify prospective studies longer than 12 weeks assessing the use of pharmacological strategies for the long-term treatment of BD in pediatric patients (0-18 years of age). Results: Four randomized controlled trials (RCT) [three placebo-controlled (assessing aripiprazole (2) and flax oil), and one head-to-head comparison of lithium vs. divalproex], and thirteen noncontrolled studies (six open-label studies assessing lithium or anticonvulsants, five assessing second-generation antipsychotics (SGAs) and four assessing combination strategies) were included in the review. Aripiprazole has shown efficacy for relapse prevention in children with pediatric bipolar disorder (PBD) 4-9 years of age in one placebo-controlled RCT. Positive results have been reported in noncontrolled studies with quetiapine and lithium for relapse prevention, as well as with lithium, quetiapine, ziprasidone, and the combination of risperidone and divalproex or lithium for long-term symptom reduction in PBD. The most frequently reported adverse events in children and adolescents treated with lithium and anticonvulsants are gastrointestinal and neurological, whereas use of SGAs is mainly related to weight gain and sedation. Conclusion: According to the limited empirical evidence, aripiprazole can be useful for relapse prevention in children with PBD. Given the lack of consistent efficacy data, clinical decision making should be based on individual clinical aspects and safety concerns.
机译：尽管长期治疗是双相情感障碍（BD）儿童和青少年管理的核心内容，但大多数临床建议均基于短期研究或成人数据。为了指导临床实践，我们回顾了情绪稳定剂，抗精神病药和其他用于长期治疗BD患儿的药理策略的疗效和安全性。方法：进行了MEDLINE，EMBASE，Cochrane和PsycInfo搜索（从2013年11月开始），以鉴定超过12周的前瞻性研究，以评估药理学策略对小儿患者（0-18岁）的BD长期治疗的使用。年龄）。结果：四项随机对照试验（RCT）[三项安慰剂对照（评估阿立哌唑（2）和亚麻油），以及一项锂与双丙戊酸钠的头对头比较）和十三项非对照研究（六项开放标签研究）评估中包括评估锂或抗惊厥药，五种评估第二代抗精神病药（SGA）和四种评估联合治疗策略。在一项安慰剂对照的RCT中，阿立哌唑已显示出对4-9岁小儿双相情感障碍（PBD）儿童预防复发的功效。在非对照研究中，喹硫平和锂用于预防复发，以及锂，喹硫平，齐拉西酮，以及利培酮和双丙戊酸钠或锂的组合用于PBD的长期减轻症状的非对照研究均报告了阳性结果。用锂和抗惊厥药治疗的儿童和青少年中最常报告的不良事件是胃肠道和神经系统疾病，而使用SGA主要与体重增加和镇静有关。结论：根据有限的经验证据，阿立哌唑可用于预防PBD儿童的复发。鉴于缺乏一致的疗效数据，临床决策应基于个体临床方面和安全性考虑。

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