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Atypical Antipsychotics Effective, Safe in Preschool Bipolar Disorder: Presented at AACAP

By Paula Moyer

MIAMI BEACH, FL -- October 20, 2003 -- Preschool children with bipolar disorder can be treated safely and effectively with atypical antipsychotics, also called neuroleptics, according to findings presented here October 15^th at the 50^th Anniversary Meeting of the American Academy of Child and Adolescent Psychiatry.

"This is a new frontier because children this young with manic symptoms are difficult to treat," said principal investigator Joseph Biederman, MD, chief of clinical research in paediatric psychopharmacology, Massachusetts General Hospital, and professor of psychiatry, Harvard Medical School, Boston, Massachusetts. He noted that none of the new generation of neuroleptics are approved for use in preschool children.

He urged psychiatrists who suspect early-onset bipolar disorder to ask questions of parents that would identify characteristic age-equivalent behaviors. For example, he said, "psychiatrists need to ask the parents about proxies [to standard symptoms seen in adults with the condition]," Dr. Biederman said. "Ask about the child's behavior in a toy store. If a parent reports that a child masturbates compulsively, it would be easy to assume that the child has been sexually abused. However, the psychiatrist should include bipolar disorder in the differential [diagnosis] before diagnosing sexual abuse, he cautioned.

In an open trial, Dr. Biederman and co-investigators enrolled 12 children who were an average of 4.5 years old, and were diagnosed with early-onset bipolar disorder. During the 8-week trial, four patients received olanzapine (Zyprexa) treatment at a dose of 1.25 mg daily, with titration up to 10 mg daily allowed, and eight patients on risperidone (Risperdal) at an initial dose of 0.25 mg daily, with a maximum dose of 2.5 mg daily.

The investigators evaluated the study drugs' effect with the Young Mania Rating Scale (YMRS) and the Clinical Global Impressions scale (CGI). At baseline, the mean YMRS scores were a mean of 31.1 and at the end of the study the scores were a mean of 17.6. There was no statistically significant difference between the two drugs, Dr. Biederman said.

The improvements as measured by the CGI were also similar between the two drugs. Among olanzapine patients, 75% were either "much" or "very much" improved, as were 63% of the risperidone patients.

Dr. Biederman noted that the drugs were generally well tolerated. Among these children, 33% reported headache, and 25% each experienced insomnia and stomach ache.


[Study title: Open Trial of Atypical Neuroleptics in Preschoolers With Bipolar Disorder. Abstract A8]

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