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Effective therapies for bipolar children sought through TEAM study

Washington University In St Louis : 11 August, 2006  (Technical Article)
Child psychiatry researchers at Washington University School of Medicine in St. Louis are investigating the effectiveness of several therapies for children with bipolar disorder, also known as manic depressive illness.
The study, called Treatment of Early Age Mania, builds on previous research that showed bipolar disorder can occur in children as young as 7. During the manic phase of the illness, children may experience an inflated sense of power and self esteem and inappropriately behave as if they are in charge at home or school. They may seem extremely happy, silly and giddy, but their moods can change rapidly. A decreased need for sleep and excessive chatter also are common. Some bipolar children experience depression at the same time.

Diagnosis is difficult because the manic phase can be confused with the more common attention deficit hyperactivity disorder. The confusion arises because mania and ADHD both involve hyperactivity, irritability and distractibility. However, researchers have developed a diagnostic interview that differentiates bipolar disorder from ADHD and other psychiatric illnesses. All children eligible for the TEAM study will be evaluated using that interview.

Although characteristics of the disorder in children are now clear, there is little available data about appropriate treatment. Despite several effective medications for adults, specific testing in children is needed because they often respond to medications differently.

To investigate the effectiveness of medications for the treatment of childhood bipolar disorder, the National Institute of Mental Health funded the TEAM treatment study, the first and largest federally funded study of it's kind. Barbara Geller, M.D., professor of child psychiatry at Washington University School of Medicine and a pioneer in the recognition of bipolar disorder in children, leads the national study.

In St. Louis, Washington University School of Medicine's Early Emotional Development Program is one of five national sites participating in the TEAM study. Joan L. Luby, M.D., associate professor of child psychiatry is principal investigator for the St. Louis site.

In this study, researchers are investigating how well different medications and medication combinations work in making bipolar children between the ages of 6 and 15 feel better. The TEAM study is unique because there are no inactive placebos given; all children will receive active treatment.

Qualified participants are randomly selected to receive either lithium, a drug commonly prescribed for adults with bipolar disorder; valproate, an anticonvulsant drug that has been related to improvement of manic symptoms in a few smaller studies; or risperidone, an antipsychotic medication used in adults with schizophrenia that also is being tested in children with autism.

'There is no proven, effective treatment for children with bipolar disorder,' Luby says. 'But we hope that by comparing these drugs and drug combinations we might be able to find ways to better control this severe illness in affected children.'

In addition to diagnostic evaluations and free study medications, volunteers receive laboratory tests at several intervals during the study. When the eight- or 16-week study period has been completed, volunteers who have had good responses from investigational medications may continue taking those drugs. Subjects will be compensated for participating in a follow-up examination six months after completion of the initial study period.
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