Safety and Effectiveness of Antidepressants in Medicaid-enrolled Pediatric Bipolar Depression PDF Download
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Author: Debajyoti Bhowmik
Publisher:
ISBN:
Category : Pharmacy management
Languages : en
Pages :
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Book Description
Pediatric bipolar disorder (I and II) patients suffer from recurrent episodes of depression and mania or hypomania (American Psychiatric Association, 1994), or mixed episodes with rapid cycling (Findling et al., 2001; Geller et al., 2002). Worldwide prevalence of bipolar disorder was 5% (Tondo et al., 2003), and in the USA was 2.6% in adults and 0-3% in adolescents (Bipolar Disorder). Early-onset bipolar disorder in childhood was associated with a higher number of lifetime episodes of manic and depressive phases, more comorbidities such as anxiety and substance abuse, rapid cycling between different phases, and higher incidence of suicide attempts compared to adulthood onset of bipolar disorder (Potter et al., 2009; Leverich et al., 2007; Perlis et al., 2004). Lifetime prevalence of the depressive phase among bipolar disorder patients is 3-fold higher than the mania phase (Post et al., 2003). Untreated bipolar depression among all the phases of bipolar disorder, particularly in children and adolescents, is associated with a high risk of suicidality (Tondo et al., 1998), substance abuse, functional disability, and poor academic and social performance among children and adolescents (Baldessarini et al., 2008; Angst et al., 2002; Frye et al., 2006; Thase, 2006; Dutta et al., 2007; Huxley and Baldessarini, 2007; Tondo and Baldessarini, 2007). Despite a higher prevalence of the depressive phase and associated risk of morbidity and mortality among bipolar disorder patients, research on the bipolar depressive phase is limited (Bhangoo et al., 2003). Although medication regimens includingmood stabilizers, antidepressants, and antipsychotics for treating bipolar depression in adults is well established (Lin et al., 2006), similar treatment guidelines for bipolar depression in younger populations are unavailable. Efficacy of different classes of medications in treating pediatric bipolar depression has been examined in several randomized trials or observational studies and documented (Kowatch et al., 2005), but psychiatric practice for children and adolescents in this regard is mostly extrapolated from adult guideline, expert consensus, or clinicians' experience. Accordingly, mood stabilizers and second-generation antipsychotics (SGA) are considered to be the 1st line therapy for pediatric bipolar depression, while antidepressants selective serotonin reuptake inhibitors (SSRI) and bupropion are recommended only as adjunct therapy when 1st line treatment is ineffective (Kowatch et al., 2005). However, the utilization pattern of medications in treating bipolar depression in pediatric population is mostly unexplored. Subsequently, real-world safety and effectiveness of psychotropic medications in pediatric bipolar depression is also limited. Controversy prevails over the safety of using antidepressants in bipolar depression patients due to the concerns about possible manic or hypomanic switching, rapid cycling, and long-term mood destabilization. Although a potential risk of mood destabilization with the use of antidepressants has been suggested historically, critical evaluation of those clinical trials suggested presence of bias and a lack of control groups to accurately address the issue. Quantitative real-world data on comparative safety of antidepressants, antipsychotics, and mood stabilizers, in terms of risk of short-term manic switch among pediatric bipolar depression patients, is limited as well. Effectiveness of psychotropic pharmacotherapy in bipolar disorder is examined for outcomes such as response, remission, recovery, and relapse of the depressive phase. Such outcomes are measured using mania and depression rating scales, such as Young's mania rating scale, Montgomery-Asberg depression rating scale, etc. Unavailability of such severity scales in administrative data hinders direct assessment of comparative effectiveness of psychotropic medications in real-world patients. Overall, numerical data on comparative effectiveness of antidepressants, antipsychotics, and mood stabilizers in pediatric bipolar depression is limited. Considering the prevalence of bipolar depression among children and adolescents and the associated risk of morbidity and mortality, and paucity of knowledge regarding drug utilization pattern, and comparative safety and effectiveness of antidepressant pharmacotherapy in this patient population, the specific aims of this study will be- Aim I: To assess adherence to psycho-pharmacotherapeutic regimens during 6 months after the initial bipolar depression diagnosis among Medicaid-enrolled children and adolescents, in terms of- (1) Continuation of antidepressant monotherapy, antipsychotic monotherapy, mood stabilizer monotherapy, antidepressant polytherapy (with antipsychotic or mood stabilizer), antipsychotic-mood stabilizer polytherapy, and 3-class polytherapy regimens during 6 months after initial bipolar depression diagnosis, (2) Augmentation pattern with a new class of medications among antidepressant, antipsychotic, and mood stabilizer monotherapy; and antidepressant, and antipsychotic-mood stabilizer polytherapy regimens during the 6 months of follow up after initial bipolar depression diagnosis, (3) Switch from initial treatment regimen including antidepressant, antipsychotic, and mood stabilizer monotherapy; and antidepressant, antipsychotic-mood stabilizer, and 3-class polytherapy to regimens inclusive of other therapeutic classes, during the 6 months of follow up after initial bipolar depression diagnosis, (4) All medication class discontinuation patterns in antidepressant, antipsychotic, and mood stabilizer monotherapy; and antidepressant, antipsychotic-mood stabilizer, and 3-class polytherapy regimens, during 6 the months of follow up after initial bipolar depression diagnosis. Aim II: To examine the risk of manic switch with the use of antidepressant in Medicaid-enrolled pediatric bipolar depression patients - (1) To assess comparative safety of antidepressant monotherapy against antipsychotic monotherapy, in terms of risk of manic switch in pediatric bipolar depression population, (2) To assess comparative safety of antidepressant monotherapy against mood stabilizer monotherapy, in terms of risk of manic switch in pediatric bipolar depression population, (3) To assess comparative safety of antidepressant polytherapy against antipsychotic-mood stabilizer polytherapy, in terms of risk of manic switch in pediatric bipolar depression population. Aim III: To evaluate the effectiveness of antidepressant pharmacotherapy among Medicaid enrolled children and adolescents with bipolar depression - (1) To assess risk of treatment augmentation in pediatric bipolar depression patients, comparing (i) Antidepressant monotherapy vs. antipsychotic monotherapy, (ii) Antidepressant monotherapy vs. mood stabilizer monotherapy, (iii) Antidepressant polytherapy vs. antipsychotic-mood stabilizer polytherapy. (2) To assess risk of mental-health related hospitalization in pediatric bipolar depression patients, comparing (i) Antidepressant monotherapy vs. antipsychotic monotherapy, (ii) Antidepressant monotherapy vs. mood stabilizer monotherapy, (iii) Antidepressant polytehrapy vs. antipsychotic-mood stabilizer polytherapy
Author: Debajyoti Bhowmik
Publisher:
ISBN:
Category : Pharmacy management
Languages : en
Pages :
Get Book Here
Book Description
Pediatric bipolar disorder (I and II) patients suffer from recurrent episodes of depression and mania or hypomania (American Psychiatric Association, 1994), or mixed episodes with rapid cycling (Findling et al., 2001; Geller et al., 2002). Worldwide prevalence of bipolar disorder was 5% (Tondo et al., 2003), and in the USA was 2.6% in adults and 0-3% in adolescents (Bipolar Disorder). Early-onset bipolar disorder in childhood was associated with a higher number of lifetime episodes of manic and depressive phases, more comorbidities such as anxiety and substance abuse, rapid cycling between different phases, and higher incidence of suicide attempts compared to adulthood onset of bipolar disorder (Potter et al., 2009; Leverich et al., 2007; Perlis et al., 2004). Lifetime prevalence of the depressive phase among bipolar disorder patients is 3-fold higher than the mania phase (Post et al., 2003). Untreated bipolar depression among all the phases of bipolar disorder, particularly in children and adolescents, is associated with a high risk of suicidality (Tondo et al., 1998), substance abuse, functional disability, and poor academic and social performance among children and adolescents (Baldessarini et al., 2008; Angst et al., 2002; Frye et al., 2006; Thase, 2006; Dutta et al., 2007; Huxley and Baldessarini, 2007; Tondo and Baldessarini, 2007). Despite a higher prevalence of the depressive phase and associated risk of morbidity and mortality among bipolar disorder patients, research on the bipolar depressive phase is limited (Bhangoo et al., 2003). Although medication regimens includingmood stabilizers, antidepressants, and antipsychotics for treating bipolar depression in adults is well established (Lin et al., 2006), similar treatment guidelines for bipolar depression in younger populations are unavailable. Efficacy of different classes of medications in treating pediatric bipolar depression has been examined in several randomized trials or observational studies and documented (Kowatch et al., 2005), but psychiatric practice for children and adolescents in this regard is mostly extrapolated from adult guideline, expert consensus, or clinicians' experience. Accordingly, mood stabilizers and second-generation antipsychotics (SGA) are considered to be the 1st line therapy for pediatric bipolar depression, while antidepressants selective serotonin reuptake inhibitors (SSRI) and bupropion are recommended only as adjunct therapy when 1st line treatment is ineffective (Kowatch et al., 2005). However, the utilization pattern of medications in treating bipolar depression in pediatric population is mostly unexplored. Subsequently, real-world safety and effectiveness of psychotropic medications in pediatric bipolar depression is also limited. Controversy prevails over the safety of using antidepressants in bipolar depression patients due to the concerns about possible manic or hypomanic switching, rapid cycling, and long-term mood destabilization. Although a potential risk of mood destabilization with the use of antidepressants has been suggested historically, critical evaluation of those clinical trials suggested presence of bias and a lack of control groups to accurately address the issue. Quantitative real-world data on comparative safety of antidepressants, antipsychotics, and mood stabilizers, in terms of risk of short-term manic switch among pediatric bipolar depression patients, is limited as well. Effectiveness of psychotropic pharmacotherapy in bipolar disorder is examined for outcomes such as response, remission, recovery, and relapse of the depressive phase. Such outcomes are measured using mania and depression rating scales, such as Young's mania rating scale, Montgomery-Asberg depression rating scale, etc. Unavailability of such severity scales in administrative data hinders direct assessment of comparative effectiveness of psychotropic medications in real-world patients. Overall, numerical data on comparative effectiveness of antidepressants, antipsychotics, and mood stabilizers in pediatric bipolar depression is limited. Considering the prevalence of bipolar depression among children and adolescents and the associated risk of morbidity and mortality, and paucity of knowledge regarding drug utilization pattern, and comparative safety and effectiveness of antidepressant pharmacotherapy in this patient population, the specific aims of this study will be- Aim I: To assess adherence to psycho-pharmacotherapeutic regimens during 6 months after the initial bipolar depression diagnosis among Medicaid-enrolled children and adolescents, in terms of- (1) Continuation of antidepressant monotherapy, antipsychotic monotherapy, mood stabilizer monotherapy, antidepressant polytherapy (with antipsychotic or mood stabilizer), antipsychotic-mood stabilizer polytherapy, and 3-class polytherapy regimens during 6 months after initial bipolar depression diagnosis, (2) Augmentation pattern with a new class of medications among antidepressant, antipsychotic, and mood stabilizer monotherapy; and antidepressant, and antipsychotic-mood stabilizer polytherapy regimens during the 6 months of follow up after initial bipolar depression diagnosis, (3) Switch from initial treatment regimen including antidepressant, antipsychotic, and mood stabilizer monotherapy; and antidepressant, antipsychotic-mood stabilizer, and 3-class polytherapy to regimens inclusive of other therapeutic classes, during the 6 months of follow up after initial bipolar depression diagnosis, (4) All medication class discontinuation patterns in antidepressant, antipsychotic, and mood stabilizer monotherapy; and antidepressant, antipsychotic-mood stabilizer, and 3-class polytherapy regimens, during 6 the months of follow up after initial bipolar depression diagnosis. Aim II: To examine the risk of manic switch with the use of antidepressant in Medicaid-enrolled pediatric bipolar depression patients - (1) To assess comparative safety of antidepressant monotherapy against antipsychotic monotherapy, in terms of risk of manic switch in pediatric bipolar depression population, (2) To assess comparative safety of antidepressant monotherapy against mood stabilizer monotherapy, in terms of risk of manic switch in pediatric bipolar depression population, (3) To assess comparative safety of antidepressant polytherapy against antipsychotic-mood stabilizer polytherapy, in terms of risk of manic switch in pediatric bipolar depression population. Aim III: To evaluate the effectiveness of antidepressant pharmacotherapy among Medicaid enrolled children and adolescents with bipolar depression - (1) To assess risk of treatment augmentation in pediatric bipolar depression patients, comparing (i) Antidepressant monotherapy vs. antipsychotic monotherapy, (ii) Antidepressant monotherapy vs. mood stabilizer monotherapy, (iii) Antidepressant polytherapy vs. antipsychotic-mood stabilizer polytherapy. (2) To assess risk of mental-health related hospitalization in pediatric bipolar depression patients, comparing (i) Antidepressant monotherapy vs. antipsychotic monotherapy, (ii) Antidepressant monotherapy vs. mood stabilizer monotherapy, (iii) Antidepressant polytehrapy vs. antipsychotic-mood stabilizer polytherapy
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
ISBN: 0309376882
Category : Medical
Languages : en
Pages : 397
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Book Description
Children living in poverty are more likely to have mental health problems, and their conditions are more likely to be severe. Of the approximately 1.3 million children who were recipients of Supplemental Security Income (SSI) disability benefits in 2013, about 50% were disabled primarily due to a mental disorder. An increase in the number of children who are recipients of SSI benefits due to mental disorders has been observed through several decades of the program beginning in 1985 and continuing through 2010. Nevertheless, less than 1% of children in the United States are recipients of SSI disability benefits for a mental disorder. At the request of the Social Security Administration, Mental Disorders and Disability Among Low-Income Children compares national trends in the number of children with mental disorders with the trends in the number of children receiving benefits from the SSI program, and describes the possible factors that may contribute to any differences between the two groups. This report provides an overview of the current status of the diagnosis and treatment of mental disorders, and the levels of impairment in the U.S. population under age 18. The report focuses on 6 mental disorders, chosen due to their prevalence and the severity of disability attributed to those disorders within the SSI disability program: attention-deficit/hyperactivity disorder, oppositional defiant disorder/conduct disorder, autism spectrum disorder, intellectual disability, learning disabilities, and mood disorders. While this report is not a comprehensive discussion of these disorders, Mental Disorders and Disability Among Low-Income Children provides the best currently available information regarding demographics, diagnosis, treatment, and expectations for the disorder time course - both the natural course and under treatment.
Author: Stephen M. Stahl
Publisher: Cambridge University Press
ISBN: 1108446566
Category : Medical
Languages : en
Pages : 525
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Book Description
Presents a user-friendly step-by-step manual on the psychotropic drugs prescribed for children and adolescents by clinicians and nurse practitioners.
Author: J. John Mann
Publisher: Cambridge University Press
ISBN: 1107024633
Category : Medical
Languages : en
Pages : 429
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Book Description
Provides a one-stop evidence-based guide to the management of all types of mood disorders.
Author: Sandra Steingard
Publisher: Springer
ISBN: 3030027325
Category : Medical
Languages : en
Pages : 225
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Book Description
This book is a guide for psychiatrists struggling to incorporate transformational strategies into their clinical work. The book begins with an overview of the concept of critical psychiatry before focusing its analytic lens on the DSM diagnostic system, the influence of the pharmaceutical industry, the crucial distinction between drug-centered and disease-centered approaches to pharmacotherapy, the concept of “de-prescribing,” coercion in psychiatric practice, and a range of other issues that constitute the targets of contemporary critiques of psychiatric theory and practice. Written by experts in each topic, this is the first book to explicate what has come to be called critical psychiatry from an unbiased and clinically relevant perspective. Critical Psychiatry is an excellent, practical resource for clinicians seeking a solid foundation in the contemporary controversies within the field. General and forensic psychiatrists; family physicians, internists, and pediatricians who treat psychiatric patients; and mental health clinicians outside of medicine will all benefit from its conceptual insights and concrete advice.
Author: Scott N. Compton
Publisher: Academic Press
ISBN: 0128130059
Category : Psychology
Languages : en
Pages : 570
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Book Description
Pediatric Anxiety Disorders provides a critical, updated and comprehensive overview of anxiety disorders in children and adolescents based on the current state of empirical research. The book provides specific clinical recommendations which integrate new knowledge from neuroscience and innovative delivery formats for interventions. This is the first reference to examine anxiety diagnoses in accordance with the latest edition of the DSM-5, including childhood onset disorders, such as Separation Anxiety Disorder, Selective Mutism, Specific Phobia, Social Anxiety Disorder, Panic Disorder, Agoraphobia and Generalized Anxiety Disorder. The book assists clinicians in critically appraising the certainty of the evidence-base and the strength of clinical recommendations. Uses the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5 Includes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach in assessing guideline development Focuses on advances in etiology, assessment and treatment Presents new advances in our understanding of the brain behind fear and anxiety Uses a stepped care approach to treatment
Author: Kenneth F. Swaiman
Publisher: Elsevier Health Sciences
ISBN: 0323374816
Category : Medical
Languages : en
Pages : 2969
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Book Description
Since 1975, Dr. Kenneth Swaiman’s classic text has been the reference of choice for authoritative guidance in pediatric neurology, and the 6th Edition continues this tradition of excellence with thorough revisions that bring you fully up to date with all that’s new in the field. Five new sections, 62 new chapters, 4 new editors, and a reconfigured format make this a comprehensive and clearly-written resource for the experienced clinician as well as the physician-in-training. Nearly 3,000 line drawings, photographs, tables, and boxes highlight the text, clarify key concepts, and make it easy to find information quickly. New content includes 12 new epilepsy chapters, 5 new cerebrovascular chapters, and 13 new neurooncology chapters, as well as new chapters on neuroimmunology and neuromuscular disorders, as well as chapters focused on clinical care (e.g., Counseling Families, Practice Guidelines, Transitional Care, Personalized Medicine, Special Educational Law, Outcome Measurements, Neurorehabilitation, Impact of Computer Resources, and Training Issues). Additional new chapters cover topics related to the developmental connectome, stem cell transplantation, and cellular and animal models of neurological disease. Greatly expanded sections to increase your knowledge of perinatal acquired and congenital disorders, neurodevelopmental disabilities, pediatric epilepsy, and nonepileptiform paroxysmal disorders and disorders of sleep. Coverage of new, emerging, or controversial topics includes developmental encephalopathies, non-verbal learning disorders, and the pharmacological and future genetic treatment of neurodevelopmental disabilities.
Author: Alan F. Schatzberg
Publisher: American Psychiatric Pub
ISBN: 1615372601
Category : Medical
Languages : en
Pages : 838
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Book Description
Schatzberg's Manual of Clinical Psychopharmacology is a meticulously researched, yet down-to-earth guide for practitioners prescribing psychotropic medications to individuals with psychiatric disorders or symptoms mandating treatment. The ninth edition offers up-to-date information on current drugs, interactions, side effects, and dosing guidelines, and retains the strengths and features that have made it a standard text for trainees and practicing clinicians. The authors also include a new chapter on important developments in laboratory-guided pharmacotherapy, including pharmacogenomic testing, neurocognitive testing, quantitative EEG, and neuroimaging. Although the book's primary purpose is to provide the reader-practitioner with basic and practical information regarding the many classes of psychiatric medications, the authors stress that understanding how to select and prescribe psychotropic medications does not obviate the basic need to comprehensively evaluate and understand psychiatric patients. Accordingly, the book draws on the authors' clinical experience, as well as on the scientific literature, resulting in an accessible, yet rigorous text. Features that have helped cement this book's reputation include: Coverage is not limited to long-standing and newly approved medications, but also includes agents that are likely to receive approval from the FDA in the near future, ensuring that the reader stays up-to-date. References are provided for key statements, and each chapter is then followed by a list of selected relevant articles and books for readers who want to go beyond the material presented, making for a leaner, more reader-friendly guide. Dozens of summary tables with key information on classes of psychotropics function as quick-reference guides, promoting learning and serving as convenient resources for overloaded clinicians. The appendix offers two kinds of suggested readings. The first, for clinicians, is invaluable to trainees, while the second, for patients and families, helps point clinicians to books aimed at a lay audience to supplement information provided to patients. Staying abreast of both new medications and promising treatment protocols is essential in this rapidly evolving field. Schatzberg's Manual of Clinical Psychopharmacology delivers authoritative information in a friendly, collegial style, ensuring that both students and practicing clinicians are equipped to provide a superior standard of care.
Author: American Psychiatric Association
Publisher: American Psychiatric Pub
ISBN: 9780890423226
Category : Medical
Languages : en
Pages : 60
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Book Description
The book provides treatment recommendations for bipolar patients, a review of evidence about bipolar disorder, and states research needs
Author: Andres Martin
Publisher: Oxford University Press
ISBN: 0199842663
Category : Medical
Languages : en
Pages : 837
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Book Description
When the first edition of Pediatric Psychopharmacology published in 2002, it filled a void in child and adolescent psychiatry and quickly establishing itself as the definitive text-reference in pediatric psychopharmacology. While numerous short, clinically focused paperbacks have been published since then, no competitors with the scholarly breadth, depth, and luster of this volume have emerged. In the second edition, Christopher Kratochvil, MD, a highly respected expert in pediatric psychopharmacology, joins the outstanding editorial team led by Dr. Martin and Dr. Scahill. In the new edition, the editors streamline the flow of information to reflect the growth in scientific data since the first edition appeared. The overall structure of the book remains the same, with major sections on underlying biology; somatic interventions; assessment and treatment; and special considerations.
