A Double-Blind and Placebo-Controlled Trial of Aripiprazole in Symptomatic Youths at Genetic High Risk for Bipolar Disorder

Findling, Robert L.; Youngstrom, Eric A.; Rowles, Brieana M.; Deyling, Elizabeth; Lingler, Jacqui; Stansbrey, Robert J.; McVoy, Molly; Lytle, Sarah; Calabrese, Joseph R.; McNamara, Nora

doi:10.1089/cap.2016.0160

Cited by 24 publications

(10 citation statements)

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“…Guanfacine and clonidine can be effective in individuals with co-existing impulse control disorder [90]. Aripiprazole and risperidone are useful for co-existing irritability and aggressive behaviors [183][184][185][186].…”

Section: Other Co-existing Psychiatric Conditionsmentioning

confidence: 99%

European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part III: pharmacological treatment

Roessner

Eichele

Stern

et al. 2021

Eur Child Adolesc Psychiatry

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In 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). We now present an update of the part on pharmacological treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients’ self-regulatory control and thus his/her autonomy. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. Overall, treatment of TS should be individualized, and decisions based on the patient’s needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician’s preferences, experience, and local regulatory requirements.

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Section: Other Co-existing Psychiatric Conditionsmentioning

confidence: 99%

European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part III: pharmacological treatment

Roessner

Eichele

Stern

et al. 2021

Eur Child Adolesc Psychiatry

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“…Four double-blind, randomized, controlled trials (RCTs) investigated aripiprazole in child and adolescent bipolar disorder and included 458 children and adolescents (Tramontina et al 2009;Findling et al 2012Findling et al , 2013Findling et al , 2017. Most studies found a significant improvement in the manic symptoms, leading to the authorizations listed in Table 1.…”

Section: Efficacy Datamentioning

confidence: 99%

Aripiprazole in Children and Adolescents

Coustals

Ménard

Cohen

2021

Journal of Child and Adolescent Psychopharmacology

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Objective: To review the use of aripiprazole in children and adolescents. Methods: Medline and Embase databases were systematically searched using the keywords aripiprazole and child or adolescent over the period from 2000 to 2019. The initial screen yielded 163 publications, from which 99 studies were reviewed. Results: Aripiprazole is one of the most widely prescribed atypical antipsychotics. Like others, its use in children and adolescents is becoming commonplace and occurs in off-label indications. Aripiprazole has proven efficacy for several indications in children and adolescents, including schizophrenia, bipolar disorder, Tourette's syndrome, and behavioral impairments associated with autism and intellectual disability. Adverse effects are more important in children and adolescents than adults, particularly weight gain, drowsiness, extrapyramidal effects, and metabolic effects, even though the latter may appear less important than with other atypical antipsychotics. Severe adverse effects often occur in multiple-prescription settings. At present, postprescription monitoring is very poor. Conclusion: Aripiprazole has proven efficacy for several indications in children and adolescents. However, its use requires clinical and paraclinical monitoring to assess the occurrence of adverse events that may challenge the benefit/risk ratio. In addition, off-label prescriptions should be limited, as they appear to account for a significant proportion of aripiprazole use worldwide.

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“…Thus, it is possible that we still do not have a good answer for the efficacy of lithium in high‐risk youth based on this single study. A recent randomized controlled trial suggests that in high‐risk youth with subthreshold mania symptoms, aripiprazole may be an effective first‐line treatment option . In this study, high‐risk youth aged 5‐7 who met criteria for either cyclothymia or bipolar disorder‐not otherwise specified showed significant improvement in mood symptoms in the treatment compared to placebo group, but experienced some treatment‐emergent weight gain.…”

Section: Discussionmentioning

confidence: 76%

Clinical Conundrum: How do you treat youth with depression and a family history of bipolar disorder?

et al. 2019

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KEYWORDS: antidepressant-induced mania, family history of bipolar disorder, pediatric depression and anxiety, pharmacotherapy, psychotherapy, treatment | C A S E"John" is a 14-year-old boy who presents with symptoms of depressed mood and anxiety. His mother describes him as a sociable child who participates in several extracurricular activities. However, over the past 2 years, he has become increasingly socially withdrawn. In the past 6 months, other symptoms developed, including difficulties falling asleep, academic decline, and feelings of worthlessness. During this time, John's family reports significant psychosocial stressors: John's brother is diagnosed with schizophrenia, and his father, who has lived with bipolar I disorder for years, is hospitalized for a suicide attempt.Indeed, John's symptoms significantly interfere with his social and academic functioning. With these concerns, he initially presents to his pediatrician seeking treatment for sustained depressive symptoms lasting at least 2 weeks for most of the day, every day.He shares with his pediatrician that he had been experiencing daily challenges trying to fall asleep due to low mood and worries, some anhedonia, decreased energy, difficulty concentrating in school, and psychomotor retardation. He also reports several weeks of hypersomnia, increased appetite, and eating, especially during times of stress, like studying for exams. Though he endorses passive suicidal thoughts in dark moments of hopelessness, he denies any specific plans, means, or intent to harm himself, and does not report a history of any prior suicide attempts or self-injurious behaviors.Importantly, John denies any current or lifetime manic or psychotic symptoms. After being diagnosed with major depressive disorder, it is recommended that he receive psychotherapy to address his mood symptoms. John completes 4 months of family focused therapy (FFT) for youth at risk for bipolar disorder, after which he reported mild improvement in anxiety but no significant improvement of his mood symptoms. His baseline and 4-month depression and mania severity scores are as follows: Children's Depression Rating Scale-Revised Raw score went from 59 to 52 and the Young Mania Rating Scale score went from 1 to 0.Given the persistence of his mood symptoms in spite of FFT, John's therapist recommends that he speak to his pediatrician about the possibility of starting an antidepressant. After reviewing risks, benefits, and alternatives, his pediatrician starts John on 5 mg of escitalopram. Within hours, John notices that his mood had improved.However, on the third day of treatment on 5 mg of escitalopram, John's experiences increased anxiety to a level of a full-blown panic attack. While he was sitting in class, he reports suddenly feeling restless, a sense of doom, and palpitations. He worries that these intense symptoms were due to escitalopram so he discontinues the medication the next day with full resolution of his anxiety and agitation. A life chart illustrating his transition from psychotherapy t...

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A Double-Blind and Placebo-Controlled Trial of Aripiprazole in Symptomatic Youths at Genetic High Risk for Bipolar Disorder

Abstract: This double-blind trial found that APZ was significantly more efficacious than placebo in reducing symptoms of mania in children and adolescents with cyclotaxia.

Cited by 24 publications

References 55 publications

European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part III: pharmacological treatment

European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part III: pharmacological treatment

Aripiprazole in Children and Adolescents

Clinical Conundrum: How do you treat youth with depression and a family history of bipolar disorder?

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