Do We Really Know How to Treat a Child with Bipolar Disorder or One with Severe Mood Dysregulation? Is There a Magic Bullet?

Abstract

Background. Despite controversy, bipolar disorder (BD) is being increasingly diagnosed in under 18s. There is scant information regarding its treatment and uncertainty regarding the status of “severe mood dysregulation (SMD)” and how it overlaps with BD. This article collates available research on treatment of BD in under 18s and explores the status of SMD. Methods. Literature on treatment of BD in under 18s and on SMD were identified using major search engines; these were then collated and reviewed. Results. Some markers have been proposed to differentiate BD from disruptive behaviour disorders (DBD) in children. Pharmacotherapy restricted to short-term trials of mood-stabilizers and atypical-antipsychotics show mixed results. Data on maintenance treatment and non-pharmacological interventions are scant. It is unclear whether SMD is an independent disorder or an early manifestation of another disorder. Conclusions. Valproate, lithium, risperidone, olanzapine, aripiprazole and quetiapine remain first line treatments for acute episodes in the under 18s with BD. Their efficacy in maintenance treatment remains unclear. There is no validated treatment for SMD. It is likely that some children who are currently diagnosed with BD and DBD and possibly most children currently diagnosed with SMD will be subsumed under the proposed category in the DSM V of disruptive mood dysregulation disorder with dysphoria.

The developmental psychopathology of irritability

“…Such treatment is first line for bipolar disorder, and stimulants or antidepressants (for anxiety-related irritability) are contraindicated (Leibenluft, 2011). More attention has focused recently on the pharmacologic treatment of irritability (Hulvershorn, Fosselman, Dickstein & Janicak, 2012a, 2012b; Jairam, Prabhuswamy, & Dullur, 2012), as well as on the development of rating scales for irritability that can be used in treatment trials and other research (Stringaris, Goodman, et al, 2012). Such trials are of the utmost importance, given the significant metabolic side effects of the SGAs and the need for more benign and well-targeted treatments (Correll et al, 2009).…”

DSM-5: Disruptive mood dysregulation disorder

“…No specific treatment for DMDD or SMD exists currently (Jairam et al, 2012; Krieger and Stringaris, 2013). The only randomized, controlled trial in children with SMD found no benefit of lithium over placebo (Dickstein et al, 2009).…”

Chronic olanzapine administration causes metabolic syndrome through inflammatory cytokines in rodent models of insulin resistance

“…Since 1996, olanzapine has effectively improved the qualities of patients’ lives and the mental aspects of the pathology with only mild to moderate sedation 9,10 . Due to its higher clinical efficacy and decreased EPS, olanzapine has been globally used in the treatment of other mental illnesses, such as bipolar disorder and major depression disorders (MDD) 8,11,12 .…”