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May 27, 2005

Bipolar Patterns in Children

There is a good article in this month's "The Brown University Child and Adolescent Behavior Letter" that focuses on new perspectives on development, prevention and treatment of Bipolar patterns in children.

In the article by Drs. Greenspan and Glovinsky it is suggested that in their book, "Bipolar Patterns in Children: New Perspectives on Developmental Pathways and a Comprehensive Approach to Prevention and Treatment" (Greenspan and Glovinsky, 2002) they describe bipolar disorder as bipolar pattern -- using the word patterns rather than disorder in discussing bipolarity in children.

"Because of the variability in the presentation of the disorder, we now know that we are not dealing with a single disorder, but rather with patterns of behavior marked by severe emotional dysregulation and difficulties in executive functioning that involve interrelated features, including genetic and biological, psychological, interactive, and family patterns."

In their Treatment Plan they describe Home, psychosocial, medication, educational approaches to dealing with children who have "bipolar patterns".

Specifically, they suggest that:

"The most important component is the home program where parents and child work on learning affective signaling, including more effective and sensitive patterns of up- and down-regulating cues. They do this as part of spontaneous play or conversations (a special type of Floor Time or "hang out time").

Parents also engage in daily problem-solving discussions where they help the child think about tomorrow and visualize and describe feelings associated with anticipated positive and negative expectations. The goal in their discussions is to help the child use more differentiated and subtle rather than polarized descriptions of feelings.

The home program also focuses on providing stable, nurturing caregiver relationships and firm, persistent, but not punitive limits and guidance. The close relationship with the same sexed parent is also important. In addition, the specific processing weaknesses need to be identified--e.g., motor planning or sequencing, or executive functioning ability--and a program to strengthen these capacities must considered.

Many children will also require psychotherapy, which has the same goals as the home program, and enables the therapist to support the family in the implementation of the home program. For some children, medication will need to be considered to help the child stabilize his or her mood and participate in the home or psychotherapeutic program. ...

The educational program needs to collaborate closely with parents and the therapeutic program. In the educational setting, the same goal of co-regulated affective interaction, firm but gentle guidance and limit-setting, and subtle differentiated (gray-area) thinking needs to be supported, while pursuing the age-expected academic goals.

If there are areas of processing challenges, the school program should work on these and also create opportunities for extra practice interacting with peers, including work with the school mental health counselor and lots of projects solving problems working with other students.

For more information go to www.ICLD.com or www.floortime.org.

For a complete version of this article and a full list of references, go to www.manisses.com/ 2newsletters/newsletters/CABL/CABL.htm.

* For a more detailed description of the developmental pathway leading to bipolar patterns, please see the new Interdisciplinary Council for Developmental Learning Disorders Diagnostic Manual for Infancy and Early Childhood, Mental Health, Developmental, Regulatory-Sensory Processing, Language and Learning Disorders in Infancy and Early Childhood (ICDL-DMIC). You can order a copy at www.ICDL.com

Posted by szadmin at 7:43 PM | Comments (0)

More Bipolar Genetic Links Identified

Bipolar Disorder Genetic linkage to chromosome 6q identified in Caucasians

It was reported this week in the American Journal of Medical Genetics that researchers have found a genetic linkage of bipolar disorder to chromosome 6q appears to be a distinctive feature of Caucasian populations.

Scientists in the United States "recently reported genome-wide significant linkage to chromosome 6q for bipolar disorder, in a study of 25 Portuguese families, using the Human Mapping Assay Xba 131 (HMA10K)."

"To further address the potential generalizability of these findings to other populations, we have also examined allelic heterozygosity in our subpopulations and in three reference populations (Caucasian, East Asian, and African-American)," according to the report. "This analysis indicated that the PIC population is highly correlated to the Caucasian reference population (r=0.86) for all of chromosome 6."

The study reports that:

"Taken together, these observations suggest a shared genetic liability among Portuguese populations for bipolar disorder on chromosome 6q and that the PIC population is likely representative of Caucasians in general," the researchers concluded.

Source: American Journal of Medical Genetics Part B - Neuropsychiatric Genetics (Genetic linkage of bipolar disorder to chromosome 6q22 is a consistent finding in Portuguese subpopulations and may generalize to broader populations. Am J Med Genet Part B, 2005;134B(1):119-121).

Posted by szadmin at 7:32 PM | Comments (4)

Bipolar Continuing Education

This announcement on new training classes for doctors on Bipolar Disorder looks like the sort of thing that might be of value to others trying to learn about the disorder:

New Continuing Education program for Primary Care Physicians the Latest Insights on Bipolar Disorder; Lifelong Learning Initiative Provides New Tools and Insights for Earlier Diagnosis, Collaborative Care

CME LLC announced today the launch of the Lifelong Learning Initiative on Bipolar Disorder, a full curriculum of continuing medical education programs, running nationwide through December. The Lifelong Learning Initiative is geared toward primary care physicians and addresses the importance of a collaborative approach to the diagnosis and management of bipolar disorder along with the latest findings in screening and best practices regarding treatment. Each educational activity highlights a particular aspect of bipolar disorder and provides clinicians with a complete overview of this pervasive, highly misdiagnosed illness. The need for such education is evident by the fact that 69 percent of bipolar patients are misdiagnosed-usually with major depression-which can have life-altering consequences.(1)

"Research clearly shows that bipolar disorder is among the most difficult illnesses to diagnose," said Marsha Meyer, RPh, senior vice president of clinical information for CME LLC. "Patients frequently seek a physician's care when they're in a state of depression, not elated with mania-the other hallmark of bipolar disorder-so without careful assessment to uncover the full spectrum of patients' histories, physicians often misdiagnose them as suffering solely from major depressive disorder rather than bipolar disorder."

Recent studies show that approximately five percent of the U.S. population struggles with bipolar disorder (2), a much higher incidence than previously estimated, but strides have been made that make efforts to diagnose this disorder much more effective. CME's Lifelong Learning Initiative on Bipolar Disorder fills a critical void in medical education, bringing primary care clinicians the latest psychiatric findings on this disorder, as they are usually a patient's first point of contact.

The Lifelong Learning Initiative on Bipolar Disorder shares vital new findings with primary care physicians around the country by focusing primarily on two components: methods for identifying and diagnosing bipolar disorder and emerging best practices for treating the illness. The curriculum also provides insights on the benefits of collaboration between primary care and mental health specialists in treating this complex illness. While primary care physicians are often the first to recognize depression in their patients, symptoms of bipolar disorder can resemble those related to schizophrenia, borderline personality or even ADHD. Consequently, 35 percent of bipolar patients have to wait 10-12 years before receiving an accurate diagnosis.(3) CME designed this learning initiative to positively impact earlier diagnoses and ultimately help patients suffering from the disorder get the care they need.

Clinicians are encouraged to participate in as many activities as possible to receive the full educational benefit of this curriculum, while earning as many as 29.75 credits. Individual events include half-day meetings and dinner meetings, teleconferences, online programs, enduring supplements and other multimedia activities that cover such critical issues as diagnostic strategies for bipolar disorder, safety and efficacy of available therapies, collaborative care, and many others. An ongoing outcomes study will be conducted prior to, immediately after and three to six months following the completion of the full curriculum. Primary care physicians and other healthcare professionals can register for events, participate in each "Activity of the Month," track credits and learn more about these important patient care issues at http://bipolar.cmellc.com/ .

CME's Lifelong Learning Initiative on Bipolar Disorder is supported by an unrestricted educational grant from AstraZeneca.

About CME LLC

CME LLC is a leading ACCME-accredited provider of continuing medical education programs and offers a wide range of informational and educational resources for healthcare professionals. Based in Irvine, California, CME produces a variety of conferences, multimedia home-study products and Web sites and is the sponsor of the U.S. Psychiatric & Mental Health Congress and the Issues in Aging Medical Congress. For additional information, visit CME online at http://www.cmellc.com

Posted by szadmin at 7:23 PM | Comments (5)

Bipolar Disorder Harder for Children than Adults

A report from the American Psychological Association:

Bipolar disorder is a more severe illness for children than adults during the first few years after diagnosis, a landmark study suggested Monday.

The first research tracking a large group of bipolar children and teenagers over time finds that 2 1/2 years after diagnosis:

*Nearly one-third of them still have not recovered.

*It takes the rest about 17 months to recover.

*Four out of five have at least one recurrence.

During the study, children experienced serious symptoms about two-thirds of the time, says study leader Boris Birmaher of the University of Pittsburgh Medical School. "They spend more time ill than adults with the same disease."

The study of 300 children ages 7 to 18 was released at the American Psychiatric Association meeting in Atlanta.

Full story

Posted by szadmin at 3:43 AM | Comments (0)

May 26, 2005

Fatty Acid levels in Brain Linked to Depression

New Study Links Levels Fatty Acid Levels To Depression

Bethesda, MD -- A group of researchers from Israel has discovered that rats exhibiting the signs of depression have increased levels of the omega-6 fatty acid, arachidonic acid, in their brains. The details of their findings appear in the June issue of the Journal of Lipid Research, an American Society for Biochemistry and Molecular Biology journal.

During recent years, omega-3 fatty acids have enjoyed increased popularity as numerous studies have shown that supplementing diets with fish oil (a natural source of this polyunsaturated fatty acid) does everything from reducing the risk of heart disease to preventing arthritis. There is also evidence that depression may be associated with a dietary deficiency in omega-3 fatty acids. This "phospholipid hypothesis" of depression has been supported by research showing that omega-3 fatty acid concentration in the blood of depressed patients is lower than that in control patients.

"The "phospholipid hypothesis" of depression postulates that decreased omega-3 fatty acid intake, and hence, perhaps decreased brain omega-3 fatty acid content, could be responsible for the disease," explains Dr. Pnina Green of Tel Aviv University. "In humans, because of high dietary variability and the obvious inability to examine brain tissue, the theory is backed up mainly by indirect evidence. The availability of the Flinders Sensitive Line rat, an animal model of depression, overcomes both these obstacles."

In the Journal of Lipid Research study, Dr. Green in collaboration with Dr Gal Yadid of Bar-Ilan University, Ramat Gan, used the Flinders Sensitive Line rats to investigate the link between omega-3 fatty acids and depression. They examined the brains of the depressed rats and compared them with brains from normal rats. Surprisingly, they found that the main difference between the two types of rats was in omega-6 fatty acid levels and not omega-3 fatty acid levels. Specifically, they discovered that brains from rats with depression had higher concentrations of arachidonic acid, a long-chain unsaturated metabolite of omega-6 fatty acid.

Arachidonic acid is found throughout the body and is essential for the proper functioning of almost every body organ, including the brain. It serves a wide variety of purposes, from being a purely structural element in phospholipids to being involved in signal transduction and being a substrate for a host of derivatives involved in second messenger function.

"The finding that in the depressive rats the omega-3 fatty acid levels were not decreased, but arachidonic acid was substantially increased as compared to controls is somewhat unexpected," admits Dr. Green. "But the finding lends itself nicely to the theory that increased omega-3 fatty acid intake may shift the balance between the two fatty acid families in the brain, since it has been demonstrated in animal studies that increased omega-3 fatty acid intake may result in decreased brain arachidonic acid."

Although far less attention has been paid to dietary requirements for omega-6 fatty acids, which can be found in most edible oils and meat, perhaps in the future depression may be controlled by increasing omega-3 fatty acid intake and decreasing omega-6 fatty acid intake.

Posted by szadmin at 9:02 PM | Comments (1)

May 21, 2005

Cannabis in bipolar

Cannabinoids in Bipolar disorder

The role of cannabis (marijuana) in psychiatric disorders remains controversial. In bipolar disorder, it is known that many people use cannabis for various reasons. There are some reports that people use cannabis for help in alleviating mania and others report its use for relieving depression. However, these reports are anecdotal and no systematic research has ever been done to see if these effects apply to the population in general. Additionally, there are reports that indicate that cannabis can have a detrimental and potentially causative role in the development of psychosis and paradoxically, can induce mania. The authors of this paper conducted a literature search to identify what has been published regarding the relationship between cannabis and bipolar disorder. Additionally, they looked at other ways of ingesting cannabinoids (the type of molecule that is the active ingredient in marijuana). The active ingredient in marijuana is called delta-9 tetrahydracannabinol but there are other similar cannabinoid molecules that can be utilized to harbor similar effects.

When marijuana is ingested, the active ingredient triggers a receptor in the brain called the CB-1 receptor. CB-1 receptors are part of what is called the "endocannabinoid" system which broken down means "endo" or endogenous (naturally present in the body) cannabinoid system. The evolution of this system indicates that our bodies naturally produce cannabinoid-type molecules, which in fact is the case. CB-1 receptors are plentiful in the areas of the brain considered to be involved with bipolar disorder with the highest levels in the basal ganglia, cerebellum and hippocampus. There are similar receptors in the peripheral body, called CB-2 receptors. They are seen primarily in immune cells. It is not known precisely what effect the CB-2 receptors have with the effects of cannabis.

Unfortunately, no controlled trials of THC have been done in bipolar disorder. Anecdotal evidence is fraught with peril in terms of making major judgments because it is not controlled and there is no objective comparison to understand the benefit due to the drug itself versus other effects associated with taking the drug or placebo effect. Additionally, it is seen that the effects of THC are often "bidirectional" which means that it is possible that in some people THC will relax, often in similar effectiveness as benzodiazepine (valium for example) medications, but in other people will cause anxiety and change physiologic parameters that leads to furthering of anxiety. It may make people tired or in others increase alertness and in some it may lead to depressed feelings while others feel a high and levels of euphoria.

Because there is evidence, particularly in certain genetically susceptible individuals, of psychosis being related to usage of cannabis, it should be with extreme caution that one uses such a drug if they have a diagnosis of bipolar disorder. Additionally, as it can provoke mania in some people, extreme caution should be used before one takes this drug if they have a diagnosis of bipolar disorder. THC also can interfere with the action of psychiatric medications, primarily the atypical antipsychotics which are frequently used as anti-manic agents. Lastly, it has been shown that the effects of marijuana are often more severe in people already diagnosed with psychiatric disorders.

However, given the anecdotal evidence, it does appear that for some people marijuana is beneficial. Any decision to use it should be well considered and best discussed with physician and should be done under very careful supervision. Before an evidence-based recommendation can be made regarding marijuana, a double-blind, randomized controlled trial will need to be conducted both for safety and effectiveness. The authors are advocating for such research to be conducted and one can only feel that to know the results of this kind of research would be beneficial. Additionally, if such research were to show a positive benefit, more standardized methods of taking the THC, such as a sublingual spray, could be created such that it could be given in a therapeutic dose. Inhalational THC, smoked marijuana for example, varies in potency and in the depth of inhalation by the consumer and can lead to different effects even with the same product. Standardized dosing would also allow for a lower dose to be taken which may be equally effective but with fewer risks, (psychosis, mania, or hypomania in particular) than conventional inhalational means allow for. Additionally, a commercially prepared medication could include a similar cannabinoid called cannabidiol to further help temper the drug to lower side effects.

Ashton CH, Moore PB, Gallagher P, Young AH.
Cannabinoids in bipolar affective disorder: a review and discussion of their therapeutic potential.
J Psychopharmacol. 2005 Sep;19(3):293-300.

Click here for the article on PubMed

Posted by at 12:31 AM | Comments (72)

May 9, 2005

Bipolar Disorder & Care-giver Coping

Caregiver strategies in bipolar disorder

This is a paper that is looking at what it is like for a caregiver of someone with a chronic mental illness. They cite many references of other diseases, but in this paper they focus more on bipolar affective disorder. Specifically, the authors wanted to compare and contrast the coping styles of people who took care of people with bipolar vs. people with schizophrenia. They also looked at demographic characteristics to see what factors impacted the styles of care given by the person responsible.

The authors looked at 50 patients with schizophrenia and 50 with bipolar disorder. They asked questions of both the patient and the caregiver. They wanted to assess the level of functioning of the patient and the extent to which they needed care. Caregivers were defined as people with whom the patients lived and they had to have some responsibility with respect to the patient's treatment but also to their daily living needs. They looked at several stressors including financial, family structure, and physical health demands amongst many others. As the study was conducted in India, the investigators created many of their own scales or adapted English assessments and translated them into Hindi for more widespread understanding. Patients were also assessed for level of psychopathology using common rating scales (PANSS and YMRS/HDRS).

The researchers assessed care giving style by asking if the caregiver remembered ever using particular techniques for coping. The most common techniques used were consulting with physicians, consulting family/friends and other supportive people. Over 96% of caregivers mentioned utilizing these types of resources in both the bipolar and schizophrenia groups. Approximately 80% of caregivers in both groups "hoped for miracles/prayed for good times" as a coping strategy. Nearly all caregivers utilized a mixture of techniques that were considered both adaptive and some more maladaptive. For the most part, the groups coped similarly but in the schizophrenia caregiver group there was a significantly greater proportion of caregivers that coped by "trying to take one's mind off things by smoking/drinking/ taking pills to relax" and also that used coercion to achieve what they wanted. There were differences noticed in coping styles between men and women with women more likely to use "problem-focused" strategies though it was a small difference between the groups. Women were also more likely to seek social support for their issues and were less likely to use the maladaptive avoidant behaviors.

There are a few methodological limitations to this study. The populations studied were very similar to each other and were both chronic patients with a long history of illness behind them. Their caregivers had been with the patients generally for a long time and many were spouses. There was a high proportion of married patients in this study as well. Because the patients were of such a chronic nature, the findings may not necessarily be applicable to a population of more recently diagnosed patients in which the coping of caregivers may be more difficult as they adjust to the changes in their loved ones.

It should also be noted that caregivers tend to change their coping techniques over time and this study focused on a snapshot in time. Therefore, it may not necessarily predict how people cope over the length of their care giving. Ultimately, more long term and longitudinal research designs will be helpful to ascertain the coping strategies people use over the many years they take care of patients. Ultimately, this type of research can be helpful in finding out the useful and less useful ways that people cope and that way more specific recommendations can be make to help people who are involved in the difficult work of taking care of the chronically mentally ill.

Nehra R, Chakrabarti S, Kulhara P, Sharma R.
Caregiver-coping in bipolar disorder and schizophrenia: A re-examination.
Soc Psychiatry Psychiatr Epidemiol. 2005 Apr;40(4):329-36.

Click here to access this article on PubMed

Posted by at 10:52 PM | Comments (0)

May 4, 2005

Avoid Army Recruiters

In the New York Times this afternoon it was reported that Army recruiters are bending the rules significantly to meet recruitment goals. A quote from the New York Times demonstrates this "bending of the rules", see below:

"It was late September when the 21-year-old man, fresh from a three-week commitment in a psychiatric ward, showed up at an Army recruiting station in southern Ohio. The two recruiters there wasted no time signing him up, and even after the man's parents told them he had bipolar disorder - a diagnosis that would disqualify him - he was all set to be shipped to boot camp, and perhaps Iraq after that, before senior officers found out and canceled the enlistment.

Despite an Army investigation, the recruiters were not punished and were still working in the area late last month."

Full Story: (Free Registration Required): Army Recruiters Say They Feel Pressure to Bend Rules

Posted by szadmin at 3:16 AM | Comments (4)

May 3, 2005

Community Intervention for BP?

Population-based care for Bipolar Disorder

This is an article that is a preliminary report from a large trial that is looking to see if a community based intervention has a positive impact on the lives of people with bipolar disorder. Specifically, the authors of the study have set up a program in which people are randomly assigned either to the group that receives special attention from a psychiatric nurse/case manager or a group that receives the regular treatment and follow-up from the clinic. Both groups are allowed to be on whatever medication regimen is needed and receive a full treatment regimen, but the group that receives the intervention has an extra bit of help in maintaining appointments, reminders about medication and symptom surveillance.

The authors calculated that to show a 15% improvement they would need to have 250 people in both groups. They were able to recruit 500 subjects and over 400 joined the study and were randomized (assigned randomly) to one group or the other. The study is to last for 24 months; however this report is of the first 12 month’s worth of data.

The authors found that as of the first 12 months, there was not a lot of difference between the groups. The number of emergency room visits, hospital days and adherence to medication regimen was statistically even between the groups though there was a trend towards less hospital usage in the group with the extra intervention. The authors point out though that hospitalizations are uncommon and therefore would require either a longer duration of study or greater number of patients to show a statistical difference and so perhaps at the 24 month end point of the study there may be a measurable difference. The cost of the extra intervention was $512/subject and so would cost less than viruatlly any hospitalization. This is important because if in fact the data ultimately shows a benefit with respect to hospitalizations the intervention will save money in the long run as well as improve quality of life. The only statically significant differences between the groups were in the number of medication management visits and in the number of patients who were on atypical antipsychotics (also useful for anti-mania properties in bipolar disorder.) The extra intervention group was higher in both of those categories than the standard treatment group. There was also a significantly different decrease in the amount of mania symptoms experienced by the group who received the extra intervention so it remains to be seen how that will impact the ultimate utilization of resources. However, at the very least that should indicate an improvement in quality of life and decreased risk of a full blown manic episode which can be potentially life altering.

As this is preliminary data, it will be interesting to see how the study turns out upon its completion. The authors point out that bipolar disorder is a complicated disorder that does not always follow a predictable timeline. Long term data is scant in bipolar disorder so hopefully this NIMH funded study will be able to provide some answers that will help improve symptoms and decrease hospitalizations. However, for right now, the data does not show a definite improvement with this intervention.

Funded by grant R01 MH59125 from the National Institute of Mental Health. The funding agency provided consultation regarding study design, but was not involved in data collection, data analysis and interpretation, or preparation of this manuscript.

Simon GE, Ludman EJ, Unutzer J, Bauer MS, Operskalski B, Rutter C.
Randomized trial of a population-based care program for people with bipolar disorder.
Psychol Med. 2005 Jan;35(1):13-24.

Click here for this article on PubMed

Posted by at 12:47 AM | Comments (0)

May 2, 2005

Lithium vs Depakote in child bipolar

Lithium Vs. Depakote for Long-term Maintenance treatment in Pediatric Bipolar Disorder

This study purports to be the first to look at maintenance treatments in pediatric bipolar disorder in a double-blind, randomized and controlled fashion. It is difficult to do clinical trials in children for many reasons. First, it is costly to do clinical trials and once drugs are approved, they can be used "off-label" (meaning without FDA approval) in children as long as there isn't evidence that they are unsafe in children. Also, it can be difficult to do experiments on children because of parental concerns and concerns over possible long-term effects that are of less consequence potentially in adults.

However, this study looked at two medications that were commonly used in pediatric bipolar disorder, Lithium and Diavalproex sodium (Depakote, Depakene). The authors selected potential subjects who were diagnosed with bipolar disorder at an early age. They were then given both Lithium and Divalproex until such time that their symptoms waned (avg of 10 weeks.) After that, they were randomly assigned to either receive Divalproex or Lithium for up to the next 76 weeks. Nearly 300 patients were initially screened for the research and based on inclusion/exclusion criteria, 30 patients entered the second phase in each group. They were monitored for side effects by a doctor who was not involved in the research and could remove them from the study if there were side effects that became problematic.

Overall, it was shown that there was little to no difference statistically between the groups. Nearly 75% of patients reported side effects with subjects having to withdraw from the study for alopecia (hair loss) in both groups (1 in each group.) Other main side effects were headache and abdominal pain in the divalproex group and enuresis (bed-wetting) and vomiting in the Lithium group. One patient from the Lithium group dropped out of the study for enuresis and one dropped from the divalproex group for a low platelet count and another dropped out for a change in thyroid hormone tests. When the authors looked at the length of time to relapse, there was no difference between the groups. Based on the statistics, they would have needed nearly 100x more patients in the study in order to be able to show a difference. This means that the difference was so small as to not have matter clinically.

One methodological advantage to this study is that it allowed patients who were also diagnosed and treated for other psychiatric conditions to be in the study. For example, if a patient had ADHD and was on a stimulant for that disorder, they could be part of this study. That helps to replicate what real life is like instead of only taking patients that have no complicating factors which is different from what a "typical" patient will present like. This study also had a long followup duration which helped to improve the quality of the data.

Limitations of the study are that it was a small cohort of patients. Only 30/group is not a lot and based on how close the results were to each other, it would have taken over 3000 patients to notice a difference between the groups. Also, they mention that it would have been helpful to have had a combo lithium/divalproex group to further compare if the combo therapy is better than either individually. The authors also mention that they would like to have a placebo group to compare against, but also that is difficult ethically as it would mean that some subjects would not receive medication despite our feeling that it is helpful.

Overall, given that lithium is significantly less expensive than divalproex, it makes sense that it would be a logical first choice if all other things are equal. However, individual circumstances may dictate that divalaproex is better to start with. Also, if one doesn't work, it is reasonable to try the other drug before going to other medications. Not all drugs work for any particular individual so it is always helpful to work closely with a psychiatrist to determine the best medication regimen for an individual patient, but these data indicate that for a population of people on average, lithium and divalproex are equally effective.

The Stanley Medical Research Institute primarily supported this study. It was also supported in part by an NIMH Developing Centers for Interventions and Services Research Grant (P 20 MH-66054). Nursing and pharmacy activities were supported in part by NICHD Pediatric Pharmacology Research Unit (PPRU) contract HD 31323-05. Medications were provided in part by Abbott Laboratories.

Findling RL, McNamara NK, Youngstrom EA, Stansbrey R, Gracious BL, Reed MD, Calabrese JR.
Double-Blind 18-Month Trial of Lithium Versus Divalproex Maintenance Treatment in Pediatric Bipolar Disorder.
J Am Acad Child Adolesc Psychiatry. 2005 May;44(5):409-417.


Click here for the article on PubMed

Posted by at 7:40 PM | Comments (2)