Department of Psychiatry, Creighton University.
Department of Psychiatry, The Ohio State University Wexner Medical Center.
J Clin Child Adolesc Psychol. 2021 Jul-Aug;50(4):464-477. doi: 10.1080/15374416.2020.1772082. Epub 2020 Jun 17.
: We review the current limited research on pediatric bipolar spectrum disorder (BPSD) treatment moderators.. Four pharmacotherapy and nine psychotherapy moderator studies in youth with pediatric BPSD is summarized. Two pharmacotherapy studies suggest that younger children and those with more aggression fare worse. Regarding preferential outcomes, one study found that older youth respond better to lithium than younger youth; all youth, regardless of age, respond similarly to valproate. One study found non-obese youth and those with comorbid attention deficit hyper-activity disorder respond better to risperidone than lithium. Results are mixed for psychosis and disruptive behavior disorders on risperidone compared to divalproex. Tentatively, youth with generalized anxiety are more likely to respond to valproate while youth with panic preferentially respond to lithium. Psychotherapy findings from two studies suggest that sex, age, race, baseline mania, and past-month suicidal ideation/non-suicidal self-injury do not moderate outcomes. Although not replicated, higher baseline inflammatory markers are associated with greater decreases in depressive symptoms; baseline higher self-esteem and comorbid attention deficit hyperactivity disorder are associated with steeper decreases in (hypo)manic symptoms. Findings are mixed on the role of baseline mood severity, other comorbid disorders, parental depression, family income, and expressed emotion in moderating treatment outcomes. Replication of these possible moderators is needed for both pharmacotherapy and psychotherapy interventions before conclusive results can be determined. Examination of larger samples of youth with BPSD and longer duration follow-up are needed to clarify meaningful treatment moderators.
我们回顾了目前关于儿童双相谱系障碍（BPSD）治疗调节剂的有限研究。总结了四项儿科 BPSD 青年药理学治疗和九项心理治疗调节剂研究。两项药理学研究表明，年龄较小的儿童和攻击性较强的儿童预后较差。关于优先结果，一项研究发现，年龄较大的青少年对锂的反应优于年龄较小的青少年；无论年龄大小，所有青少年对丙戊酸盐的反应相似。一项研究发现，非肥胖青少年和伴有注意力缺陷多动障碍的青少年对利培酮的反应优于锂。与丙戊酸钠相比，利培酮治疗精神病和破坏性行为障碍的结果喜忧参半。初步研究表明，广泛性焦虑的青少年更有可能对丙戊酸盐有反应，而惊恐障碍的青少年更倾向于对锂有反应。两项研究的心理治疗结果表明，性别、年龄、种族、基线躁狂症和过去一个月的自杀意念/非自杀性自伤并不影响治疗结果。尽管没有得到复制，但较高的基线炎症标志物与抑郁症状的更大减轻有关；基线较高的自尊和共患注意缺陷多动障碍与（低）躁狂症状的急剧减轻有关。基线情绪严重程度、其他共患疾病、父母抑郁、家庭收入和表达情绪在调节治疗结果中的作用存在分歧。在确定结论之前，需要对药理学和心理治疗干预措施的这些可能调节剂进行复制，以得出明确的结果。需要对患有 BPSD 的更大样本的青少年进行更长期的随访，以澄清有意义的治疗调节剂。
