Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Bipolar Affective Disorder Workup

  • Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD  more...
 
Updated: Apr 08, 2015
 

Approach Considerations

Initial tests for substance and alcohol abuse are usually necessary to exclude drugs and alcohol as causative agents for behavior. No specific blood or other laboratory tests aid in diagnosing bipolar disorder.

Go to Bipolar Affective Disorder for complete information on this topic.

Next

Blood Studies

Thyroid hormones

Thyroid studies may help to rule out a thyroid disorder as a cause of an altered mood. Triiodothyronine (T3) levels may be elevated in agitated patients who have normal thyroid function. Additional thyroid tests, such as thyroid-stimulating hormone (TSH) and thyroxine (T4) studies, can be helpful, as well as consultation with an endocrinologist.

Serum blood chemistries

Serum blood chemistries, such as basic metabolic panels and liver function tests, may help assess renal and hepatic health before certain medications are started or continued to help regulate or ameliorate bipolar symptoms.

Mania and depression may both involve states of malnutrition secondary to the psychiatrically diminished awareness of or ability to maintain one’s health and well-being. Thus, a metabolic panel, in addition to thiamine, albumin, and prealbumin studies (in extreme cases), may help determine the extent of self-neglect and compromised nutritional state. levels of vitamin D, folate, vitamin B-12, vitamin B-6, and total protein can also be abnormal and should be checked, especially in the presence of acute mania or hypomania.

Other tests

Routine screening for substance misuse is not indicated; however, clinical history of substance misuse or pregnancy may indicate the need for such screening such as urine or blood testing for substances of abuse and alcohol. In patients with known hypersexuality, a very careful sexual history should be taken. An HIV test should also be administered, as well as HIV prevention counseling.

Serum cortisol levels may be elevated, but this is neither of diagnostic nor clinical value.

Previous
Next

Drug Level Monitoring

After pharmacotherapy is implemented, periodic laboratory tests may be required to monitor drug levels and to ensure that no adverse response to the medication is harming renal or hepatic function or bone marrow. Medications that are strong CYP2D6 inhibitors such as fluoxetine, bupropion, and lamotrigine may cause increases in risperidone concentration and increased risk of adverse side effects, such as elevated prolactin, especially in individuals who are poor metabolizers.[47, 48]

Previous
Next

Neuroimaging

Initial studies suggest that developmental changes with maturity in children and adolescents with bipolar disorder differ from those in healthy peers. Neuroimaging modalities are not yet diagnostically helpful in diagnosing bipolar disorder in individuals, but studies are ongoing to determine if they would be helpful in diagnosis.

In some studies, neuroimaging (ie, functional magnetic resonance imaging [fMRI]) in child and adolescent patients with bipolar disorder has shown abnormal neural activation for faces with negative emotions along with face-processing deficits.[49] Adolescent patients failed to show normal developmental maturity changes with respect to total hippocampal volume in comparison to healthy controls.

Other studies have shown abnormal corpus callosum myelination and enlarged ventricles with an increased number of hyperintensities compared with healthy control subjects.[27]

Previous
Next

Electrocardiography and Echocardiography

Before a psychotropic medication is started, baseline electrocardiography (ECG) and echocardiography, with measures of cardiac contractility, should be performed; many medications (lithium, trazodone, ziprasidone, risperidone, quetiapine, verapamil) may alter QT intervals or other features of the cardiac rhythm, thereby affecting cardiac contractility and output. This is especially critical if the patient has a family history of a structural or electrical heart abnormality.

Previous
 
 
Contributor Information and Disclosures
Author

Bettina E Bernstein, DO Distinguished Fellow, American Academy of Child and Adolescent Psychiatry; Distinguished Fellow, American Psychiatric Association; Clinical Assistant Professor of Neurosciences and Psychiatry, Philadelphia College of Osteopathic Medicine; Clinical Affiliate Medical Staff, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia; Consultant to theVillage, Private Practice; Consultant PMHCC/CBH at Family Court, Philadelphia

Bettina E Bernstein, DO is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References
  1. Hamshere ML, O'Donovan MC, Jones IR, et al. Polygenic dissection of the bipolar phenotype. British J of Psychiatry. 2011/04. 198(4):284-288. [Full Text].

  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th. Arlington, VA: American Psychiatric Publishing.; 2013.

  3. Goldberg JF, Harrow M. A 15-year prospective follow-up of bipolar affective disorders: comparisons with unipolar nonpsychotic depression. Bipolar Disord. 2011 Mar. 13(2):155-63. [Medline].

  4. Marcus R, Khan A, Rollin L, et al. Efficacy of aripiprazole adjunctive to lithium or valproate in the long-term treatment of patients with bipolar I disorder with an inadequate response to lithium or valproate monotherapy: a multicenter, double-blind, randomized study. Bipolar Disord. 2011 Mar. 13(2):133-44. [Medline].

  5. Chen CH, Lee CS, Lee MT, Ouyang WC, Chen CC, Chong MY, et al. Variant GADL1 and response to lithium therapy in bipolar I disorder. N Engl J Med. 2014 Jan 9. 370(2):119-28. [Medline].

  6. Singh MK, Ketter TA, Chang KD. Atypical antipsychotics for acute manic and mixed episodes in children and adolescents with bipolar disorder: efficacy and tolerability. Drugs. 2010 Mar 5. 70(4):433-42. [Medline]. [Full Text].

  7. Correll CU, Olvet DM, Auther AM, et al. The Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P): description and validation in a psychiatric sample and healthy controls. Bipolar Disord. 2014 May 8. [Medline].

  8. Duffy A, Horrocks J, Doucette S, Keown-Stoneman C, McCloskey S, Grof P. The developmental trajectory of bipolar disorder. Br J Psychiatry. 2014 Feb. 204(2):122-8. [Medline].

  9. Adleman NE, Kayser R, Dickstein D, Blair RJ, Pine D, Leibenluft E. Neural correlates of reversal learning in severe mood dysregulation and pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2011 Nov. 50(11):1173-1185.e2. [Medline].

  10. Garrett A, Chang K. The role of the amygdala in bipolar disorder development. Dev Psychopathol. 2008 Fall. 20(4):1285-96. [Medline].

  11. Grosso G, Pajak A, Marventano S, Castellano S, Galvano F, Bucolo C, et al. Role of omega-3 Fatty acids in the treatment of depressive disorders: a comprehensive meta-analysis of randomized clinical trials. PLoS One. 2014. 9(5):e96905. [Medline]. [Full Text].

  12. Caetano SC, Silveira CM, Kaur S, Nicoletti M, Hatch JP, Brambilla P, et al. Abnormal corpus callosum myelination in pediatric bipolar patients. J Affect Disord. 2008 Jun. 108(3):297-301. [Medline]. [Full Text].

  13. Pandey GN, Ren X, Dwivedi Y, Pavuluri MN. Decreased protein kinase C (PKC) in platelets of pediatric bipolar patients: effect of treatment with mood stabilizing drugs. J Psychiatr Res. 2008 Jan. 42(2):106-16. [Medline]. [Full Text].

  14. Mick E, Kim JW, Biederman J, Wozniak J, Wilens T, Spencer T, et al. Family based association study of pediatric bipolar disorder and the dopamine transporter gene (SLC6A3). Am J Med Genet B Neuropsychiatr Genet. 2008 Oct 5. 147B(7):1182-5. [Medline].

  15. Pavuluri MN, Passarotti AM, Fitzgerald JM, Wegbreit E, Sweeney JA. Risperidone and divalproex differentially engage the fronto-striato-temporal circuitry in pediatric mania: a pharmacological functional magnetic resonance imaging study. J Am Acad Child Adolesc Psychiatry. 2012 Feb. 51(2):157-170.e5. [Medline].

  16. Chang KD, Steiner H, Ketter TA. Psychiatric phenomenology of child and adolescent bipolar offspring. J Am Acad Child Adolesc Psychiatry. 2000 Apr. 39(4):453-60. [Medline].

  17. Danielyan A, Pathak S, Kowatch RA, Arszman SP, Johns ES. Clinical characteristics of bipolar disorder in very young children. J Affect Disord. 2007 Jan. 97(1-3):51-9. [Medline].

  18. Chang K, Howe M, Gallelli K, Miklowitz D. Prevention of pediatric bipolar disorder: integration of neurobiological and psychosocial processes. Ann N Y Acad Sci. 2006 Dec. 1094:235-47. [Medline].

  19. Chang KD. The bipolar spectrum in children and adolescents: developmental issues. J Clin Psychiatry. 2008 Mar. 69(3):e9. [Medline].

  20. Faraone SV, Biederman J, Wozniak J, Mundy E, Mennin D, O'Donnell D. Is comorbidity with ADHD a marker for juvenile-onset mania?. J Am Acad Child Adolesc Psychiatry. 1997 Aug. 36(8):1046-55. [Medline].

  21. Strober M, DeAntonio M, Schmidt-Lackner S, Freeman R, Lampert C, Diamond J. Early childhood attention deficit hyperactivity disorder predicts poorer response to acute lithium therapy in adolescent mania. J Affect Disord. 1998 Nov. 51(2):145-51. [Medline].

  22. Birmaher B, Axelson D, Monk K, Kalas C, Goldstein B, Hickey MB, et al. Lifetime psychiatric disorders in school-aged offspring of parents with bipolar disorder: the Pittsburgh Bipolar Offspring study. Arch Gen Psychiatry. 2009 Mar. 66(3):287-96. [Medline]. [Full Text].

  23. Birmaher B. Longitudinal course of pediatric bipolar disorder. Am J Psychiatry. 2007 Apr. 164(4):537-9. [Medline].

  24. Demeter CA, Townsend LD, Wilson M, Findling RL. Current research in child and adolescent bipolar disorder. Dialogues Clin Neurosci. 2008. 10(2):215-28. [Medline].

  25. Chang KD. The use of atypical antipsychotics in pediatric bipolar disorder. J Clin Psychiatry. 2008. 69 Suppl 4:4-8. [Medline].

  26. [Guideline] Gleason MM, Egger HL, Emslie GJ, Greenhill LL, Kowatch RA, Lieberman AF, et al. Psychopharmacological treatment for very young children: contexts and guidelines. J Am Acad Child Adolesc Psychiatry. 2007 Dec. 46(12):1532-72. [Medline].

  27. Pavuluri MN, Passarotti A. Neural bases of emotional processing in pediatric bipolar disorder. Expert Rev Neurother. 2008 Sep. 8(9):1381-7. [Medline].

  28. Dickstein DP, Nelson EE, McClure EB, Grimley ME, Knopf L, Brotman MA, et al. Cognitive flexibility in phenotypes of pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2007 Mar. 46(3):341-55. [Medline].

  29. Brotman MA, Skup M, Rich BA, Blair KS, Pine DS, Blair JR, et al. Risk for bipolar disorder is associated with face-processing deficits across emotions. J Am Acad Child Adolesc Psychiatry. 2008 Dec. 47(12):1455-61. [Medline]. [Full Text].

  30. Doyle AE, Wozniak J, Wilens TE, Henin A, Seidman LJ, Petty C, et al. Neurocognitive impairment in unaffected siblings of youth with bipolar disorder. Psychol Med. 2009 Aug. 39(8):1253-63. [Medline]. [Full Text].

  31. Joseph MF, Frazier TW, Youngstrom EA, Soares JC. A quantitative and qualitative review of neurocognitive performance in pediatric bipolar disorder. J Child Adolesc Psychopharmacol. 2008 Dec. 18(6):595-605. [Medline]. [Full Text].

  32. Wilens TE, Biederman J, Adamson JJ, Henin A, Sgambati S, Gignac M, et al. Further evidence of an association between adolescent bipolar disorder with smoking and substance use disorders: a controlled study. Drug Alcohol Depend. 2008 Jun 1. 95(3):188-98. [Medline]. [Full Text].

  33. Miklowitz DJ, Axelson DA, Birmaher B, George EL, Taylor DO, Schneck CD, et al. Family-focused treatment for adolescents with bipolar disorder: results of a 2-year randomized trial. Arch Gen Psychiatry. 2008 Sep. 65(9):1053-61. [Medline]. [Full Text].

  34. Duax JM, Youngstrom EA, Calabrese JR, Findling RL. Sex differences in pediatric bipolar disorder. J Clin Psychiatry. 2007 Oct. 68(10):1565-73. [Medline].

  35. Duffy A. The early course of bipolar disorder in youth at familial risk. J Can Acad Child Adolesc Psychiatry. 2009 Aug. 18(3):200-5. [Medline]. [Full Text].

  36. Kendall T, Tyrer P, Whittington C, Taylor C. Assessment and management of psychosis with coexisting substance misuse: summary of NICE guidance. BMJ. 2011 Mar 23. 342:d1351. [Medline].

  37. Pavuluri MN, O'Connor MM, Harral EM, Sweeney JA. An fMRI study of the interface between affective and cognitive neural circuitry in pediatric bipolar disorder. Psychiatry Res. 2008 Apr 15. 162(3):244-55. [Medline]. [Full Text].

  38. Brodsky BS, Mann JJ, Stanley B, Tin A, Oquendo M, Birmaher B, et al. Familial transmission of suicidal behavior: factors mediating the relationship between childhood abuse and offspring suicide attempts. J Clin Psychiatry. 2008 Apr. 69(4):584-96. [Medline]. [Full Text].

  39. Romero S, Birmaher B, Axelson D, Goldstein T, Goldstein BI, Gill MK, et al. Prevalence and correlates of physical and sexual abuse in children and adolescents with bipolar disorder. J Affect Disord. 2009 Jan. 112(1-3):144-50. [Medline]. [Full Text].

  40. Frazier TW, Demeter CA, Youngstrom EA, Calabrese JR, Stansbrey RJ, McNamara NK, et al. Evaluation and comparison of psychometric instruments for pediatric bipolar spectrum disorders in four age groups. J Child Adolesc Psychopharmacol. 2007 Dec. 17(6):853-66. [Medline].

  41. Biederman J, Faraone S, Milberger S, Guite J, Mick E, Chen L, et al. A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Arch Gen Psychiatry. 1996 May. 53(5):437-46. [Medline].

  42. Pine DS, Guyer AE, Goldwin M, Towbin KA, Leibenluft E. Autism spectrum disorder scale scores in pediatric mood and anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2008 Jun. 47(6):652-61. [Medline]. [Full Text].

  43. Copeland WE, Shanahan L, Costello EJ, Angold A. Childhood and adolescent psychiatric disorders as predictors of young adult disorders. Arch Gen Psychiatry. 2009 Jul. 66(7):764-72. [Medline]. [Full Text].

  44. Kovacs M, Pollock M. Bipolar disorder and comorbid conduct disorder in childhood and adolescence. J Am Acad Child Adolesc Psychiatry. 1995 Jun. 34(6):715-23. [Medline].

  45. Steiner H. Evaluation and management of violent behavior in bipolar adolescents. Symposium 19D. Chicago, IL: The 153rd Annual Meeting of the American Psychiatric Association; May 14, 2000.

  46. Stanley B, Brown G, Brent DA, Wells K, Poling K, Curry J, et al. Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability. J Am Acad Child Adolesc Psychiatry. 2009 Oct. 48(10):1005-13. [Medline]. [Full Text].

  47. de Leon J, Armstrong SC, Cozza KL. Clinical guidelines for psychiatrists for the use of pharmacogenetic testing for CYP450 2D6 and CYP450 2C19. Psychosomatics. 2006 Jan-Feb. 47(1):75-85. [Medline].

  48. Thomas T, Stansifer L, Findling RL. Psychopharmacology of pediatric bipolar disorders in children and adolescents. Pediatr Clin North Am. 2011 Feb. 58(1):173-87, xii. [Medline].

  49. Bearden CE, Soares JC, Klunder AD, Nicoletti M, Dierschke N, Hayashi KM, et al. Three-dimensional mapping of hippocampal anatomy in adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2008 May. 47(5):515-25. [Medline]. [Full Text].

  50. Chang K. Adult bipolar disorder is continuous with pediatric bipolar disorder. Can J Psychiatry. 2007 Jul. 52(7):418-25. [Medline].

  51. Baumer FM, Howe M, Gallelli K, Simeonova DI, Hallmayer J, Chang KD. A pilot study of antidepressant-induced mania in pediatric bipolar disorder: Characteristics, risk factors, and the serotonin transporter gene. Biol Psychiatry. 2006 Nov 1. 60(9):1005-12. [Medline].

  52. [Guideline] Kowatch RA, Fristad M, Birmaher B, Wagner KD, Findling RL, Hellander M. Treatment guidelines for children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2005 Mar. 44(3):213-35. [Medline].

  53. Geller B, Luby JL, Joshi P, Wagner KD, Emslie G, Walkup JT, et al. A randomized controlled trial of risperidone, lithium, or divalproex sodium for initial treatment of bipolar I disorder, manic or mixed phase, in children and adolescents. Arch Gen Psychiatry. 2012 May. 69(5):515-28. [Medline].

  54. Correll CU. Clinical psychopharmacology of pediatric mood stabilizer and antipsychotic treatment, part 1: challenges and developments. J Clin Psychiatry. 2007 Aug. 68(8):1301-2. [Medline].

  55. Findling RL, Frazier JA, Kafantaris V, Kowatch R, McClellan J, Pavuluri M, et al. The Collaborative Lithium Trials (CoLT): specific aims, methods, and implementation. Child Adolesc Psychiatry Ment Health. 2008 Aug 12. 2(1):21. [Medline]. [Full Text].

  56. Croarkin PE, Emslie GJ, Mayes TL. Neuroleptic malignant syndrome associated with atypical antipsychotics in pediatric patients: a review of published cases. J Clin Psychiatry. 2008 Jul. 69(7):1157-65. [Medline].

  57. Bogarapu S, Bishop JR, Krueger CD, Pavuluri MN. Complementary medicines in pediatric bipolar disorder. Minerva Pediatr. 2008 Feb. 60(1):103-14. [Medline].

  58. Wozniak J, Biederman J, Mick E, Waxmonsky J, Hantsoo L, Best C, et al. Omega-3 fatty acid monotherapy for pediatric bipolar disorder: a prospective open-label trial. Eur Neuropsychopharmacol. 2007 May-Jun. 17(6-7):440-7. [Medline].

  59. DelBello MP, Kowatch RA, Adler CM, Stanford KE, Welge JA, Barzman DH, et al. A double-blind randomized pilot study comparing quetiapine and divalproex for adolescent mania. J Am Acad Child Adolesc Psychiatry. 2006 Mar. 45(3):305-13. [Medline].

  60. McClellan JM. Olanzapine and pediatric bipolar disorder: evidence for efficacy and safety concerns. Am J Psychiatry. 2007 Oct. 164(10):1462-4. [Medline].

  61. Wagner KD, Kowatch RA, Emslie GJ, Findling RL, Wilens TE, McCague K, et al. A double-blind, randomized, placebo-controlled trial of oxcarbazepine in the treatment of bipolar disorder in children and adolescents. Am J Psychiatry. 2006 Jul. 163(7):1179-86. [Medline].

  62. Goldstein TR, Birmaher B, Axelson D, Goldstein BI, Gill MK, Esposito-Smythers C, et al. Psychosocial functioning among bipolar youth. J Affect Disord. 2009 Apr. 114(1-3):174-83. [Medline]. [Full Text].

  63. Kemper KJ, Shannon S. Complementary and alternative medicine therapies to promote healthy moods. Pediatr Clin North Am. 2007 Dec. 54(6):901-26; x. [Medline]. [Full Text].

  64. Goldstein TR, Axelson DA, Birmaher B, Brent DA. Dialectical behavior therapy for adolescents with bipolar disorder: a 1-year open trial. J Am Acad Child Adolesc Psychiatry. 2007 Jul. 46(7):820-30. [Medline]. [Full Text].

  65. Swartz HA, Frank E, Zuckoff A, Cyranowski JM, Houck PR, Cheng Y, et al. Brief interpersonal psychotherapy for depressed mothers whose children are receiving psychiatric treatment. Am J Psychiatry. 2008 Sep. 165(9):1155-62. [Medline]. [Full Text].

 
Previous
Next
 
Table 1. Characteristic Behaviors Associated With Bipolar Disorder, ADHD, and Conduct Disorder
Behavior Bipolar Disorder ADHD Conduct Disorder
Self-esteem Inflated Inflated and/or deflated Inflated and/or deflated
Pleasure Euphoric in mania



Dysphoric in mixed or depressed state



Often dysphoric or euthymic Pleasure in violating societal norms, especially if not caught
Attention Distractible Distractible Normal to vigilant
Hyperactivity Goal directed Unproductive Goal directed
Sleep Episodic disturbances such as decreased need in mania Chronic poor sleep; often late bedtimes Not known to be disrupted except with substance abuse
Speech Pressured or rapid in mania; slow in depression Often rapid; may be pressured May be normal rate
Impulsivity Externally driven; reactionary Internally driven May have predatory or reactionary acts
Social Often good Often poor Often poor
Academic Often good Often poor Often poor
Psychomotor activity Agitated in mania or mixed states; retarded in depressed states Chronically agitated Easily agitated
ADHD—attention deficit/hyperactivity disorder.
Table 2. Medications for Pediatric Bipolar Disorder: Common Adverse Effects and Special Concerns
Medication Common Adverse Effects Pediatric Doses Special Concerns
Lithium carbonate (Lithobid) GI distress, lethargy or sedation, tremor, enuresis, weight gain, alopecia, cognitive blunting 10-30 mg/kg/d; dose must be adjusted by monitoring serum level and patient response; up-titrate on twice-daily schedule Hypothyroidism, diabetes insipidus, toxic in dehydration, polyuria, polydipsia, renal disease; drug-drug interactions and sodium intake may alter therapeutic serum levels



Approved for patients 12 y and older



Sodium divalproex/valproic acid (Depakote, Depakene) Sedation, platelet dysfunction, liver disease, alopecia, weight gain 15-30 mg/kg/d; dose must be adjusted by monitoring serum levels; up-titrate on twice- or thrice-daily schedule Elevated liver enzymes or liver disease, drug-drug interactions, bone marrow suppression



Approved for patients 12 y and older



Aripiprazole (Abilify, Abilify Discmelt) Less likely to cause prolactinemia than risperidone; may cause Stevens-Johnson syndrome; as with other atypical antipsychotics, may cause tardive dyskinesia, dystonia, parkinsonism, hyperglycemia; use with caution in seizure disorders and cardiac disorders, including problems with cardiac contractility and electrical activity 2 mg once daily can be increased to 5 mg, 10 mg, 15 mg, to a maximum of 30 mg to start



titrate upwards at weekly to bimonthly intervals



levels may need to be adjusted in patients who are concurrently receiving lamotrigine, topiramate, Depakote, lithium, or other serotonin-norepinephrine reuptake, selective serotonin reuptake, or cytochrome P450 inhibitors



Do not administer if there is an unstable seizure disorder



Approved for patients 12 y and older



Carbamazepine (Equetro) Suppressed WBCs, dizziness, drowsiness, rashes, liver toxicity (rare) 10-20 mg/kg/d; dose must be adjusted by monitoring serum blood levels; up-titrate on twice-daily schedule Drug-drug interactions, bone marrow suppression
Asenapine (Saphris) Somnolence, oral paraesthesia 2.5 mg SL q12h initially; may increase to 5 mg SL q12hr after 3 days and to 10 mg SL q12hr after 3 additional days Pediatric patients are more sensitive to dystonia with initial dosing when recommended escalation schedule not followed



Approved for patients 10 y and older



Risperidone (Risperdal, Risperdal Consta, Risperdal M-Tab) Weight gain, sedation, orthostasis 0.25 mg bid or 0.5 mg at bedtime initially; titrate as tolerated to target dosage of 2-4 mg/d; not to exceed 6 mg/d Galactorrhea, extrapyramidal symptoms



Approved for patients 10 y and older



Quetiapine (Seroquel, Seroquel XR) Sedation, orthostasis, weight gain 50 mg bid initially; titrate as tolerated to target dosage of 400-600 mg/d Decrease dosage with hepatic impairment, may cause neuroleptic malignant syndrome or hyperglycemia



Approved for patients 10 y and older



Olanzapine (Zyprexa, Zyprexa Zydis, Zyprexa Relprevv) Weight gain, dyslipidemia, sedation, or orthostasis 2.5-5 mg at bedtime initially; titrate as tolerated to target dosage of 10-20 mg/d Metabolic syndrome, extrapyramidal symptoms
Clonazepam (Klonopin) Sedation, abnormal coordination, ataxia 0.01-0.04 mg/kg/d PO at bedtime or divided bid Caution with renal/hepatic impairment and asthma
Fluoxetine (Prozac) Headache, nausea, insomnia, anorexia, anxiety, asthenia, diarrhea, somnolence 10 mg PO qd; may consider increasing to 20 mg/d after 1 wk Long half-life; potential to exacerbate manic symptoms when not coadministered with an antimanic or mood-stabilizing agent
Ziprasidone (Geodon) Akathisia, nausea Off-label: 20 mg PO at bedtime; can increase to 40 mg (not to exceed 60 mg), usually in 2 divided doses for children Risk of sudden cardiac death due to torsades des pointes due to prolonged QT prolongation, which makes this medication undesirable for individuals with a family history of cardiac sudden death related to cardiac conduction abnormalities
WBC—white blood cell.
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.