Hamrin Vanya, Pachler Maryellen
Yale University School of Nursing, New Haven, USA.
J Child Adolesc Psychiatr Nurs. 2007 Feb;20(1):40-58. doi: 10.1111/j.1744-6171.2007.00083.x.
Pediatric bipolar disorder can cause severe disturbances in global functioning. Diagnosing pediatric bipolar disorder is challenging due to the range of symptom expression, developmental differences as compared to adults, presence of comorbid disorders, and developing diagnostic criteria. Treating this disorder can be equally challenging due to frequent symptom relapse and the dearth of research until recently on effective psychopharmacological interventions that guide clinical prescribing practices.
This paper will help child psychiatric nurses have a better understanding of the unique presentation of pediatric bipolar disorder to facilitate selection of appropriate medication treatment options, taking into account symptom presentation, presence of comorbid diagnosis, drug efficacy, adverse effects, and drug-drug interactions based on research findings.
Literature specific to assessment and psychopharmacological treatment of pediatric bipolar disorder was reviewed.
Screening of youth with mood spectrum problems for bipolar disorder should occur in every diagnostic assessment and should be ongoing due to range of mood symptoms and the cyclical and episodic nature of this disorder. Youth with bipolar disorder may manifest symptoms and course that differ from adults. Additionally, co-occuring disorders are common in this population, which can complicate medication selection. Psychopharmacological treatment with the use of specific mood stabilizers and/or atypical antipsychotic medications is warranted depending on symptom presentation; however, monotherapy with mood stabilizers has not demonstrated effectiveness in long-term remission of pediatric bipolar symptoms. Recent research indicates that a combined treatment with two mood stabilizers or a mood stabilizer and an antipsychotic holds promising results for pediatric bipolar I, for youth with acute manic symptoms plus psychosis, and for long-term remission of symptoms.
儿童双相情感障碍可导致整体功能严重紊乱。由于症状表现范围、与成人相比的发育差异、共病的存在以及诊断标准的不断发展，诊断儿童双相情感障碍具有挑战性。由于症状频繁复发以及直到最近关于指导临床处方实践的有效心理药物干预的研究匮乏，治疗这种疾病同样具有挑战性。
本文将帮助儿童精神科护士更好地理解儿童双相情感障碍的独特表现，以便根据研究结果，在考虑症状表现、共病诊断的存在、药物疗效、不良反应以及药物相互作用的基础上，选择合适的药物治疗方案。
回顾了有关儿童双相情感障碍评估和心理药物治疗的文献。
在每次诊断评估中都应对有情绪谱问题的青少年进行双相情感障碍筛查，并且由于情绪症状的范围以及该疾病的周期性和发作性特点，筛查应持续进行。患有双相情感障碍的青少年可能表现出与成人不同的症状和病程。此外，该人群中并发疾病很常见，这可能使药物选择复杂化。根据症状表现，使用特定的心境稳定剂和/或非典型抗精神病药物进行心理药物治疗是必要的；然而，心境稳定剂单一疗法尚未证明对儿童双相情感障碍症状的长期缓解有效。最近的研究表明，两种心境稳定剂联合治疗或一种心境稳定剂与一种抗精神病药物联合治疗对于儿童双相I型障碍、有急性躁狂症状加精神病的青少年以及症状的长期缓解具有有前景的结果。
