ABSTRACT

Objective: We review the current limited research on pediatric bipolar spectrum disorder (BPSD) treatment moderators..

Method: Four pharmacotherapy and nine psychotherapy moderator studies in youth with pediatric BPSD is summarized.

Results: 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.

Conclusions: 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.

摘要

目的：我们回顾目前关于小儿双相障碍 (BPSD) 治疗调节剂的有限研究。

方法：总结了针对儿童 BPSD 青年的四项药物治疗和九项心理治疗调节研究。

结果：两项药物治疗研究表明，年幼的儿童和攻击性更强的儿童病情更糟。关于优先结果，一项研究发现，年龄较大的青年比年轻的青年对锂的反应更好；所有年轻人，无论年龄大小，对丙戊酸的反应都相似。一项研究发现，非肥胖青年和那些患有注意力缺陷多动障碍的人对利培酮的反应比对锂的反应更好。与双丙戊酸钠相比，利培酮治疗精神病和破坏性行为障碍的结果喜忧参半。暂时地，患有广泛性焦虑症的青少年更有可能对丙戊酸盐作出反应，而恐慌的青少年则更倾向于服用锂盐。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/非自杀性自伤不会减轻结果。虽然没有复制，较高的基线炎症标志物与抑郁症状的减少有关；基线较高的自尊和共存的注意力缺陷多动障碍与（轻）躁狂症状的急剧下降有关。

结论：关于基线情绪严重程度、其他共存疾病、父母抑郁症、家庭收入和表达情绪在调节治疗结果中的作用，研究结果喜忧参半。在确定结论性结果之前，药物治疗和心理治疗干预都需要复制这些可能的调节剂。需要检查更大的 BPSD 青年样本和更长的随访时间，以阐明有意义的治疗调节剂。