The use of antimanic medications by community practitioners for children with bipolar I disorder is relatively low, study findings suggest.

Researchers, led by Barbara Geller, from Washington University in St Louis, Missouri, USA, say the findings were unexpected, “based on epidemiologic findings of markedly increased prescriptions of antipsychotic medications during the same time frame as this study.”

They suggest that bipolar I disorder in children is going unrecognized by general and pediatric physicians who are responsible for treatment but are less informed about the condition.

“If these factors related to primary caregivers are operative, education programs to teach primary physicians about when to refer for psychiatric consultation would be in order,” the team says.

Geller et al reviewed the treatment given to 115 children with a first-episode of bipolar I disorder and severity scores in the clinically impaired range. The children were aged 7??”16 years and were participating in the ongoing Phenomenology and Course of Pediatric Bipolar Disorders study, which was begun in 1995.

All treatment was provided by the patients’ own community practitioners, exactly as they would under non-research situations.

During 8 years of study, only 62.6% of the children were given any antimanic medication, such as an antipsychotic, anticonvulsant, or lithium, at any time. Seven (6.1%) did not receive any psychotropic medications and 10 (8.7%) did not receive any nonpharmacologic treatment.

Non-antimanic medication was prescribed more frequently than antimanic medication, with 77.4% of children given medication for attention-deficit hyperactivity disorder and 64.3% antidepressants.

Of the patients, 72 were identified at psychiatric sites and these children were more likely to receive antimanic medications than the remaining children ascertained at pediatric sites.

Outcomes for the children have previously been reported by MedWire News, and showed that 87.8% of the children recovered from mania during the 8 years of follow-up, and earlier recovery was associated with a greater percentage of weeks taking lithium.

Nevertheless, 73.3% of children who recovered from mania had a relapse during the 8-year study, and the lifetime estimate of relapse after recovery was high, at 77.8%.

“Given these findings, and the poor prognosis from prospective follow-up studies of child bipolar I disorder, there is a need for further research that informs the development of treatment strategies,” the researchers conclude in the journal Bipolar Disorders.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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