Guidelines Issued for Pediatric Bipolar Treatment

By Sherman, Carl | Clinical Psychiatry News, April 2005 | Go to article overview

Guidelines Issued for Pediatric Bipolar Treatment


Sherman, Carl, Clinical Psychiatry News


An independent work group of 25 psychiatrists has issued the first new guidelines for the treatment of pediatric bipolar disorder in nearly a decade.

The consensus document arose out of a need for updated information first voiced the Child and Adolescent Bipolar Foundation, a parent advocacy organization, said Robert Kowatch, M.D., professor of psychiatry and pediatrics at Cincinnati Children's Hospital/University of Cincinnati, who organized and chaired the project.

Pediatric bipolar management has changed considerably since the American Academy of Child and Adolescent Psychiatry published its 1997 Practice Parameters, but the subject remains "infused with considerable controversy, debate, and dyspepsia," Jon McClellan, M.D., of the University of Washington, Seattle, said in his accompanying commentary (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:236-9).

Although the AACAP practice parameters are currently under revision, "we wanted something different in approach and a bit more independent," Dr. Kowatch said. The goal was a "broad-based integration of what we know in the field: educational assessment and family therapy as well as medication."

The guidelines are intended for "anyone who treats these kids, diagnostically and therapeutically"--psychologists and primary care physicians along with psychiatrists--and reflect the uncertainties surrounding the disorder, he said.

The guidelines lead clinicians through a comprehensive evaluation to differentiate manic symptoms like euphoria, grandiosity, and increase in goal-directed activity from manifestations of other disorders (notably attention-deficit hyperactivity disorder) and from normal behavior (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:213-35).

"There's a lot of controversy in the field about what these kids look like. We wanted to address some of that," Dr. Kowatch said. Confronting the difficulty of fitting kids into a diagnostic protocol that was designed for adults, the guidelines attempt "to make DSM-IV criteria developmentally appropriate," he said. …

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