Smarty Sylvester, Findling Robert L
Child and Adolescent Psychiatry, University Hospitals of Cleveland/Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA.
Psychopharmacology (Berl). 2007 Mar;191(1):39-54. doi: 10.1007/s00213-006-0569-y. Epub 2006 Nov 9.
Pediatric bipolar disorder (PBD) is a chronic and debilitating psychiatric illness. It is associated with many short-term and long-term complications including poor academic and social performance, legal problems and increased risk of suicide. Moreover, it is often complicated by other serious psychiatric disorders including attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder and substance use disorders. For these reasons, there is a need for effective treatment for PBD.
To review available data from published reports of the treatment of PBD, highlighting those treatment practices for which there is scientific evidence. To suggest directions for future research.
A comprehensive Medline search was performed to identify published reports from 1995 to 2006. Reports with the greatest methodological stringency received greater focus.
There is limited evidence from double-blind, placebo-controlled trials regarding the treatment of PBD. Available data suggests that lithium, some anticonvulsants and second-generation antipsychotics may be equally beneficial in the acute monotherapy for youth with mixed or manic states. However, because of limited response to acute monotherapy, there is increased justification for combination therapy. There is very limited data on the treatment of the depressed phase of bipolar illness in the youth. Also, very few studies have addressed the treatment of comorbidities and maintenance/relapse prevention in PBD.
Although significant progress was made in the treatment of youth with bipolar disorder, there is a need for more methodologically stringent research to more precisely define evidence-based treatment strategies for PBD.
儿童双相情感障碍（PBD）是一种慢性且使人衰弱的精神疾病。它与许多短期和长期并发症相关，包括学业和社交表现不佳、法律问题以及自杀风险增加。此外，它常并发其他严重精神障碍，包括注意力缺陷多动障碍、对立违抗障碍、品行障碍和物质使用障碍。基于这些原因，需要对PBD进行有效治疗。
回顾已发表的PBD治疗报告中的可用数据，突出那些有科学证据的治疗方法。为未来研究提出方向。
进行全面的Medline检索，以识别1995年至2006年发表的报告。方法学严谨性最高的报告受到更多关注。
关于PBD治疗的双盲、安慰剂对照试验证据有限。现有数据表明，锂盐、一些抗惊厥药和第二代抗精神病药物在治疗混合或躁狂状态的青少年急性单药治疗中可能同样有效。然而，由于急性单药治疗反应有限，联合治疗的合理性增加。关于青少年双相情感障碍抑郁期治疗的数据非常有限。此外，很少有研究涉及PBD共病的治疗以及维持/预防复发。
尽管在双相情感障碍青少年的治疗方面取得了重大进展，但仍需要更具方法学严谨性的研究，以更精确地确定PBD基于证据的治疗策略。
