Portal de Periódicos da CAPES

Drs. Freeman and Stoll Reply

1999; American Psychiatric Association; Volume: 156; Issue: 6 Linguagem: Inglês

10.1176/ajp.156.6.980b

1535-7228

Marlene P. Freeman, Andrew L. Stoll,

Genetics and Neurodevelopmental Disorders

Back to table of contents Previous article Next article Letter to the EditorFull AccessDrs. Freeman and Stoll ReplyMARLENE P. FREEMAN, M.D., and ANDREW L. STOLL, M.D., MARLENE P. FREEMANSearch for more papers by this author, M.D., and ANDREW L. STOLLSearch for more papers by this author, M.D., Boston, Mass.Published Online:1 Jun 1999https://doi.org/10.1176/ajp.156.6.980bAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We would like to thank R. Walter Lovell, M.D., for his important comments. As he indicated, the risk of serious rashes is much higher in the pediatric population than in adults. The topic of bipolar disorder in children and adolescents deserves substantial consideration, and we feel that we could not have adequately covered this information in our article. But because Dr. Lovell drew our attention to it, we would like to discuss a few other relevant matters regarding bipolar disorder in children and adolescents.First, diagnosis itself is generally quite challenging in this population. Presentations may be atypical, are commonly confused with other disorders, and are often seen in the context of significant comorbidity (1–3). As a result, bipolar disorder in children and adolescents is most likely underdiagnosed or inappropriately treated or both.Mood stabilizers have not been well studied in the treatment of children and adolescents. Moreover, adequate research has not been conducted regarding combinations of mood stabilizers in children with bipolar disorder. Much of what we know about anticonvulsants in this population is based on studies of epilepsy. In addition to the increased risk of rashes with lamotrigine, other mood stabilizers may pose distinct risks in the pediatric population. For instance, val­proic acid may cause a higher risk of liver failure (4) and thrombocytopenia (5) in children. Also, gabapentin has been reported to cause behavioral side effects (6, 7) Carbamazepine has been reported to be well tolerated in children (8), but cases have been reported that suggest that it may unmask a Tourette’s-like syndrome (9). Lithium has been reported to be effective in the acute treatment of bipolar disorder in children (10) but has also been shown to cause frequent side effects, especially neurologic, including tremor, drowsiness, ataxia, and confusion (11).We hope that more information becomes available regarding the safety and efficacy of mood stabilizers in children and adolescents. Many aspects of bipolar disorder in the pediatric population, including diagnosis and treatment, deserve our attention.References1. Bowring MA, Kovacs M: Difficulties in diagnosing manic disorders among children and adolescents. J Am Acad Child Adolesc Psychiatry 1992; 31:611–614Crossref, Medline, Google Scholar2. Weller EB, Weller RA, Fristad MA: Bipolar disorder in children: misdiagnosis, underdiagnosis, and future directions. J Am Acad Child Adolesc Psychiatry 1995; 34:709–714Crossref, Medline, Google Scholar3. Akiskal HS, Downs J, Jordan P, Watson S, Daugherty D, Pruitt DB: Affective disorders in referred children and younger siblings of manic-depressives. Arch Gen Psychiatry 1985; 42:996–1002Google Scholar4. Scheffner D, Konig S, Rauterberg-Ruland I, Kochen W, Hofmann WJ, Unkelbach S: Fatal liver failure in 16 children with valproate therapy. Epilepsia 1988; 29:530–542Crossref, Medline, Google Scholar5. Delgado MR, Riela AR, Mills J, Browne R, Roach ES: Thrombocytopenia secondary to high valproate levels in children with epilepsy. J Child Neurol 1994; 9:311–314Crossref, Medline, Google Scholar6. Wolf SM, Shinnar S, Kang H, Gil KB, Moshe SL: Gabapentin toxicity in children manifesting as behavioral changes. Epilepsia 1995; 36:1203–1205Google Scholar7. Lee DO, Steingard RJ, Cesena M, Helmers SL, Riviello JJ, Mikati MA: Behavioral side effects of gabapentin in children. Epilepsia 1996; 37:87–90Crossref, Medline, Google Scholar8. Schain RJ, Ward JW, Guthrie D: Carbamazepine as an anticonvulsant in children. Neurology 1997; 27:476–480Crossref, Google Scholar9. Neglia JP, Glaze DG, Zion TE: Tics and vocalizations in children treated with carbamazepine. Pediatrics 1984; 73:841–844Medline, Google Scholar10. Varanka TM, Weller RA, Weller EB, Fristad MA: Lithium treatment of manic episodes with psychotic features in prepubertal children. Am J Psychiatry 1988; 145:1557–1559Google Scholar11. Hagino OR, Weller EB, Weller RA, Washing D, Fristad MA, Kontras SB: Untoward effects of lithium treatment in children aged four through six years. J Am Acad Child Adolesc Psychiatry 1995; 34:1584–1590Google Scholar FiguresReferencesCited byDetailsCited byAspects of Mental Health Care in the Gynecological Setting1 May 2014 | Women's Health, Vol. 10, No. 3Trials, Vol. 15, No. 1Journal of Clinical Psychology in Medical Settings, Vol. 19, No. 3Reproductive Health, Vol. 8, No. 1The International Journal of Neuropsychopharmacology, Vol. 12, No. 08Menopause, Vol. 16, No. 4Expert Opinion on Pharmacotherapy, Vol. 9, No. 3Expert Opinion on Pharmacotherapy, Vol. 9, No. 4Factors Associated With The Prophylactic Effect of Placebo Injections in Subjects Enrolled in a Study of Botulinum Toxin For Migraine26 June 2016 | Cephalalgia, Vol. 27, No. 6Gynecological Endocrinology, Vol. 23, No. 5Journal of Reproductive and Infant Psychology, Vol. 24, No. 4The Journal of Alternative and Complementary Medicine, Vol. 11, No. 2Journal of the Korean Medical Association, Vol. 48, No. 5Science and Engineering Ethics, Vol. 10, No. 1Management of premenstrual dysphoric disorderHospital Medicine, Vol. 64, No. 6BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 109, No. 1BMC Women's Health, Vol. 2, No. 1Journal of Women's Health & Gender-Based Medicine, Vol. 10, No. 6SSRN Electronic Journal Volume 156Issue 6 June 1999Pages 980b-981 Metrics History Published online 1 June 1999 Published in print 1 June 1999