Department of Geriatrics, Institute of Psychiatry and Psychology, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Largo Francesco Vito 1, Rome, 00168, Italy.
Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, Rome, 00168, Italy.
Curr Neuropharmacol. 2023;21(6):1329-1342. doi: 10.2174/1570159X21666230126153105.
Lithium is the standard treatment for bipolar disorders (BD) in adults. There is a dearth of data on its use in the pediatric age. This review aimed to investigate the use of lithium in pediatric bipolar disorder (BD) and other externalizing childhood-related disorders.
We applied the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria (PRISMA) to identify randomized controlled trials evaluating the use of lithium in pediatric (BD), conduct disorder (CD), attention deficit hyperactivity disorder, oppositional defiant disorder, and disruptive mood dysregulation disorder. The primary outcome of our study was to evaluate the efficacy of lithium compared to a placebo or other pharmacological agents. The secondary outcomes were acceptability and tolerability.
Twelve studies were eligible, 8 on BD and 4 on CD. Overall, 857 patients were treated with lithium. No studies for externalizing disorder diagnoses were identified. Regarding BD patients (n = 673), efficacy results suggested that lithium was superior to placebo in manic/mixed episodes but inferior to antipsychotics. Lithium efficacy ranged from 32% to 82.4%. Results on maintenance need to be expanded. Comorbidity rates with other externalizing disorders were extremely high, up to 98.6%. Results in CD patients (n= 184) suggested the efficacy of lithium, especially for aggressive behaviors. No severe adverse events directly related to lithium were reported in BD and CD; common side effects were similar to adults.
This systematic review supports the use of lithium in BD and CD as an efficacious and generally well-tolerated treatment in the pediatric age. However, evidence is limited due to the paucity of available data.
锂是成人双相情感障碍（BD）的标准治疗方法。关于其在儿科年龄的应用数据匮乏。本综述旨在研究锂在儿科双相情感障碍（BD）和其他外化儿童相关障碍中的应用。
我们应用系统评价和荟萃分析的首选报告项目（PRISMA）标准来确定评估锂在儿科（BD）、品行障碍（CD）、注意缺陷多动障碍、对立违抗性障碍和破坏性情绪失调障碍中应用的随机对照试验。我们研究的主要结果是评估锂与安慰剂或其他药物相比的疗效。次要结果是可接受性和耐受性。
12 项研究符合条件，其中 8 项关于 BD，4 项关于 CD。共有 857 名患者接受了锂治疗。没有发现针对外化障碍诊断的研究。对于 BD 患者（n = 673），疗效结果表明，锂在躁狂/混合发作中优于安慰剂，但逊于抗精神病药物。锂的疗效范围为 32%至 82.4%。需要扩大维持治疗的研究结果。与其他外化障碍的合并症发生率极高，高达 98.6%。CD 患者（n= 184）的结果表明锂的疗效，尤其是对攻击性行为。BD 和 CD 中未报告与锂直接相关的严重不良事件；常见的副作用与成人相似。
本系统评价支持在儿科年龄使用锂治疗 BD 和 CD，因为它是一种有效且普遍耐受良好的治疗方法。然而，由于可用数据有限，证据有限。
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