Stimulant Treatment in Young Boys with Symptoms Suggesting Childhood Mania: A Report from a Longitudinal Study

Abstract

This study used data from a completed longitudinal study to examine the effects of methylphenidate on 6-12-year-old boys presumably at risk for bipolar disorder. Of 75 boys referred, diagnosed with hyperkinetic reaction of childhood (minimal brain dysfunction), treated clinically with methylphenidate, and followed as young adults, 23% (the maximorbid or MAX group) had childhood symptoms of irritability and emulated DSM-IV diagnoses of attention deficit hyperactivity disorder (ADHD), plus oppositional defiant or conduct disorder (ODD/CD) and anxiety or depression or both. The remaining boys (the minimorbid or MIN group) had fewer symptoms and disorders. MAX and MIN groups did not differ in rated response to methylphenidate, duration of treatment, clinically determined maintenance doses, concurrent or subsequent treatment with other medications, or other aspects of medication experience. At ages 21-23, individuals with bipolar-related lifetime diagnoses (adult mania, hypomania, or cyclothymia) did not differ from those without bipolar-related diagnoses in any aspect of early methylphenidate treatment history. These findings indicate that ADHD boys with symptoms suggesting childhood mania do not respond differently to methylphenidate than boys without such symptoms, and there is no evidence here that methylphenidate precipitates young adult bipolar disorders in susceptible individuals.

The Efficacy and Tolerability of Methylphenidate and Behavior Modification in Children with Attention-Deficit/Hyperactivity Disorder and Severe Mood Dysregulation

“…Several retrospective analyses have found a connection between stimulant exposure and the course of BP (Delbello et al 2001;Faedda et al 2004;Reichart 2004), whereas others have not (Biederman et al 1999;Carlson et al 2000;Carlson and Mick 2003). Any retrospective observations linking stimulants and BP must control for the confounding effects of ADHD symptom severity because most children with prepubertal BP first exhibit prominent ADHD symptoms, leading to stimulant treatment at an early age.…”

Comorbidity of Social Anxiety Disorder and Attention Deficit Hyperactivity Disorder

“…[73] Diğer bir takip çalışma-sında ise DEHB'li erkek çocuklar genç erişkinliğe kadar takip edilmiş ve bu hastaların %17' si bipolar bozukluk tanısı almışlardır. [74] Ayrıca DEHB'li çocuk ve ergenlerde 10 kata kadar artmış bipolar bozukluk riski ve hem DEHB, hem de bipolar bozukluk arasında kuvvetli ailesel bağlantının bildirilmiştir. [66,73] Ama bu çalışma SAB çalışması olmasına rağmen, sadece DEHB'li hastalarda bipolar özellik görülmesi ise, araştırılması gereken önemli nokta olarak dikkati çekmiştir.…”

Diagnóstico e tratamento de transtorno bipolar e TDAH na infância: desafios na prática clínica

“…Contudo, Carlson et al (2000) encontraram baixas taxas de ativação maníaca quando estimulantes foram dados para crianças com história de mania, em tratamento para o THB. Apesar de não piorarem os sintomas maníacos, Biedermam et al (1999b) concluem que os estimulantes não são efetivos nos sintomas de TDAH até que o humor seja estabilizado.…”