TREATMENT OF BIPOLAR DISORDER IN CHILDREN AND ADOLESCENTS Treatment of Bipolar Disorder in Children and Adolescents Edited by BARBARA GELLER MELISSA P. DELBELLO THE GUILFORD PRESS New York London ©2008TheGuilfordPress ADivisionofGuilfordPublications,Inc. 72SpringStreet,NewYork,NY10012 www.guilford.com Allrightsreserved Nopartofthisbookmaybereproduced,translated,storedin aretrievalsystem,ortransmitted,inanyformorbyanymeans, electronic,mechanical,photocopying,microfilming,recording, orotherwise,withoutwrittenpermissionfromthePublisher. PrintedintheUnitedStatesofAmerica Thisbookisprintedonacid-freepaper. Lastdigitisprintnumber: 9 8 7 6 5 4 3 2 1 Theauthorshavecheckedwithsourcesbelievedtobereliableintheireffortstoprovideinformation thatiscompleteandgenerallyinaccordwiththestandardsofpracticethatareacceptedatthetime ofpublication.However,inviewofthepossibilityofhumanerrororchangesinmedicalsciences, neithertheauthors,northeeditorsandpublisher,noranyotherpartywhohasbeeninvolvedinthe preparationorpublicationofthisworkwarrantsthattheinformationcontainedhereinisinevery respectaccurateorcomplete,andtheyarenotresponsibleforanyerrorsoromissionsortheresults obtainedfromtheuseofsuchinformation.Readersareencouragedtoconfirmtheinformationcon- tainedinthisbookwithothersources. LibraryofCongressCataloging-in-PublicationData Treatmentofbipolardisorderinchildrenandadolescents/editedbyBarbaraGeller, MelissaP.DelBello. p.;cm. Includesbibliographicalreferencesandindex. ISBN:978-1-59385-678-6(hardcover:alk.paper) 1. Manicdepressiveillnessinchildren—Treatment.2. Manicdepressiveillnessin adolescence—Treatment. I.Geller,Barbara.II.DelBello,MelissaP. [DNLM:1. BipolarDisorder—drugtherapy. 2. Adolescent. 3. BipolarDisorder— complications. 4. BipolarDisorder—psychology. 5. Child. WM207T7842008] RJ506.D4T772008 618.92′895—dc22 2008004582 AAbboouutt tthhee EEddiittoorrss About the Editors BarbaraGeller,MD,isProfessorofPsychiatryatWashingtonUniversityin St. Louis. An internationally recognized researcher for studies of child and adolescentbipolardisorders,Dr.Gellerisprincipalinvestigatoronmultiple National Institute of Mental Health-funded projects. Dr. Geller earned her medicaldegreefromAlbertEinsteinCollegeofMedicineinNewYork,and completed her residency and fellowship at New York University–Bellevue Medical Center. She has served on numerous federal advisory committees, editorialboards,andadvocacygroupscientificadvisoryboards.Among her awardsaretheAmericanAcademyofChildandAdolescentPsychiatryNa- than Cummings Special Research Award and the National Alliance on Mental Illness Exemplary Psychiatrist Award. Widely published, Dr. Geller has written more than 125 articles on diagnosticcharacteristics,phenomen- ology,longitudinalcourse,familypsychopathology,molecular genetics, and pharmacological treatment of pediatric manic–depressive disorders. Melissa P. DelBello, MD, MS, is Associate Professor of Psychiatry and Pe- diatrics,Vice-ChairforClinicalResearch,andCodirectoroftheDivisionof BipolarDisordersResearchattheUniversityofCincinnatiCollegeofMedi- cine.SheisalsoDirector,ResearchEducationandTraining,ChildandAdoles- centPsychiatryDivision,atCincinnatiChildren’sHospitalMedicalCenter. Dr. DelBello earned her medical degree with honors from the University of Rochester School of Medicine in Rochester, New York. She completed her residency in psychiatry at the Payne Whitney Clinic, New York Hospital– Cornell Medical Center, and at the University of Cincinnati College of Medicine,andafellowshipinChildandAdolescentPsychiatryatCincinnati Children’s Hospital Medical Center. Dr. DelBello is the author or coauthor of over 100 journal articles or chapters, and her primary research interests include neuropharmacology and neurodevelopment of pediatric bipolar disorder. v CCoonnttrriibbuuttoorrss Contributors Shannon Rae Barnett, MD, is Assistant Professor of Psychiatry in the Division of Child and Adolescent Psychiatry at the Johns Hopkins University School of Medicine in Baltimore, Maryland. Dr. Barnett has worked on several multisite studies focusing on mood disorders in children and adolescents, including the Treatment of Early Age Mania, the Treatment for Adolescents with Depression Study, and the Treatment of Adolescent Suicide Attempters. In addition, Dr. Barnett is the Director of Adolescent Psychiatry Services at Johns Hopkins Bayview Medical Center, where she leads a treatment team with an emphasis on treating adolescents with mood disorders. Samantha Blankenship, MSW, is the study monitor for the Treatment of Early Age Mania study at Washington University and has contributed to the work on the Pediatric Depression Study. She specializes in education and clinical research with young children and families, including intensive training in therapeutic interventions with preschool- and school-age children. Through her work at the Early Emotional Development Program at Washington University, Ms. Blankenship has coauthored multiple articles on preschool mood disorders. Hallie R. Bregman, BA, is a research coordinator at the Child and Adolescent Neuropsychiatric Research Program at Cambridge Health Alliance, Cambridge, Massachusetts. She earned her bachelor’s degree with honors in psychology from the University of Delaware, where she was awarded the Psychology Research Award in 2006. Kiki D. Chang, MD, is Associate Professor of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine, Division of Child Psychiatry. He is Director of the Pediatric Bipolar Disorders Clinic and Research Program, where he specializes in pediatric psychopharmacology and treatment of depression and bipolar disorder in children and adolescents. His research includes brain imaging, genetics, and medication and psychotherapy trials, with a special focus on early identification and prevention of bipolar disorder. Dr. Chang is the author of over 50 papers and book chapters regarding bipolar disorder. vi Contributors vii Christoph U. Correll, MD, is Assistant Professor of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York. He has been working as a research psychiatrist at the Zucker Hillside Hospital, where he is the Medical Director of the Recognition and Prevention Program, a National Institute of Mental Health-funded research program for the early identification and treatment of youth at risk for psychosis. His research focuses on early-phase psychotic and bipolar disorders and the risk–benefit evaluation of psychotropic medications, particularly antipsychotics and mood stabilizers. He has received more than 20 research awards and has authored numerous articles in the area of the psychotic and bipolar prodrome, as well as adverse effects of antipsychotics in youth and adults. Kristen H. Davidson, PhD, is in private practice in Rochester, New York, and is a clinical senior instructor in the Departments of Psychiatry and Pediatrics at the University of Rochester Medical Center. She has authored several articles and book chapters on the assessment and treatment of childhood mood disorders. Melissa P. DelBello, MD, MS (see “About the Editors”). Robert L. Findling, MD, is the Director of the Division of Child and Adolescent Psychiatry at University Hospitals Case Medical Center and Professor of Psychiatry and Pediatrics at Case Western Reserve University. He is both a child and adolescent psychiatrist as well as a pediatrician. Dr Findling’s research endeavors have focused on pediatric psychopharmacology and psychotic disorders in children. He has been honored with numerous awards and has received international recognition as a clinical investigator. Dr. Findling is the principal investigator of a National Institute of Child Health and Human Development contract examining lithium in the treatment of pediatric mania and also the principal investigator of a National Institue of Mental Health study assessing the longitudinal course of children with symptoms of mania. Jean A. Frazier, MD, is the Director of Child Psychopharmacology and the Child and Adolescent Neuropsychiatric Research Program at Cambridge Health Alliance, where she is also Codirector of the Center for Child and Adolescent Development. Dr. Frazier is Associate Professor of Psychiatry at Harvard Medical School and is internationally known for her work with children with serious mental illness and those with developmental disabilities. She has published over 70 articles and book chapters and has won numerous awards, including the Annual Exemplary Psychiatrist Award from the National Alliance on Mental Illness and the Outstanding Psychiatrist Award for Research from the Massachusetts Psychiatric Society. Mary A. Fristad, PhD, is Professor of Psychiatry and Psychology at The Ohio State University (OSU) and the Director of Research and Psychological Services in the OSU Division of Child and Adolescent Psychiatry. Dr. Fristad has published over 125 articles and book chapters addressing the assessment and treatment of childhood- onset depression, suicidality, and bipolar disorder. She edited the Handbook of Serious Emotional Disturbance in Children and Adolescents and has written a book for families entitled Raising a Moody Child: How to Cope with Depression and Bipolar Disorder. Dr. Fristad serves on the board of directors for five web-based education and support groups for children and families with mood disorders. She has been the principal or co-principal investigator on over two dozen federal, state, and local grants, all focusing on the assessment and/or treatment of childhood-onset mood disorders. viii Contributors Barbara Geller, MD (see “About the Editors”). Martin Gignac, MD, FRCP, has been working as a psychiatrist and clinical research coordinator at the adolescents’ unit of the Institut Philippe-Pinel de Montréal, where he is also head of the outpatient clinic for severe disruptive disorders in adolescence. In addition, he has been involved in several studies and published articles and book chapters in the field of pediatric psychopharmacology. Joseph A. Jackson, DO, is Instructor in Psychiatry at Harvard Medical School and the Medical Director of the Developmental Disabilities Program at the Center for Child and Adolescent Development, Cambridge Health Alliance. His expertise is in working with children with multicomplex disorders, particularly those with comorbid pervasive developmental disorders and bipolar disorder. Gagan Joshi, MD, is a clinical and research psychiatrist and the Scientific Director of the Pervasive Developmental Disorders Research Program in the Pediatric Psychopharmacology Unit at Massachusetts General Hospital and Instructor in Psychiatry at Harvard Medical School. Dr. Joshi’s clinical and research interest is in pediatric bipolar disorder and pervasive developmental disorders, with particular focus on the comorbid conditions associated with these disorders. Besides conducting research, he also takes care of youth with these conditions in his clinical practice at Massachusetts General Hospital. He received the prestigious Ethel Dupont Warren Fellowship Award through the Department of Psychiatry at Harvard Medical School, the Norma Fine Fellowship, the 25th Collegium Internationale Neuro- Psychopharmalogicum Congress Young Investigators Award, and the American Academy of Child and Adolescent Psychiatry Pilot Research Award. Paramjit T. Joshi, MD, is the Endowed Chair of the Department of Psychiatry and Behavioral Sciences at the Children’s National Medical Center and Professor of Psychiatry, Behavioral Sciences, and Pediatrics at the George Washington University School of Medicine in Washington, DC. She is a Distinguished Fellow of the American Psychiatric Association and a recipient of its Bruno Lima award for outstanding contributions in the care and understanding of disaster psychiatry, as well as of the Exemplary Psychiatrist Award from the National Alliance on Mental Illness. She has held several national offices with the American Academy of Child and Adolescent Psychiatry and the American Board of Psychiatry and Neurology and currently is the President of the Society of Professors of Academic Programs of Child and Adolescent Psychiatry (2006–2008). She has taught and published extensively on mood disorders, psychopharmacology, and childhood trauma. Robert A. Kowatch, MD, PhD, is Professor of Psychiatry and Pediatrics at Cincinnati Children’s Hospital Medical Center. Dr. Kowatch has authored or coauthored more than 50 articles, 14 book chapters, and one book. He has published in the areas of the diagnosis and treatment of children and adolescents with bipolar disorder, sleep disorders, and depression. His articles have been published in the Journal of the American Academy of Child and Adolescent Psychiatry, Neuropsychopharmacology, Archives of General Psychiatry, and the Journal of Child Neurology, among others. He is a member of the American Academy of Child and Adolescent Psychiatry, the Society for Biological Psychiatry, and the American College of Neuropharmacology, and his research interests are in the diagnosis, treatment, and neurobiology of child and adolescent mood disorders. Contributors ix Joan L. Luby, MD, is an infant preschool psychiatrist and Associate Professor of Child Psychiatry at the Washington University School of Medicine in St. Louis, where she is the founder and director of the Early Emotional Development Program. Dr. Luby has been awarded grants from the National Institute of Mental Health and the National Alliance for Schizophrenia and Depression, which have supported her program of research on the phenomenology of early-onset mood disorders. Findings from these studies have been widely published in both child and adult psychiatric journals, and she has been the recipient of several awards, including the Gerald Klerman award for outstanding research in depression. Dr. Luby has committed her career to the study and clinical assessment and treatment of preschool children. She currently chairs the Infancy Committee of the American Academy of Child and Adolescent Psychiatry. Molly McGrath, LCSW, is a research clinician with the Early Emotional Development Program at Washington University. She has contributed to the work on the Pediatric Depression Study and the Treatment of Early Age Mania study. As a teaching assistant at Washington University’s George Warren Brown School of Social Work, Ms. McGrath lectures and facilitates discussions in courses on the foundations of social work practice. She also serves as a mental health consultant providing resources, referrals, behavioral observations, and inservice training for staff at an Early Head Start facility in the St. Louis area. David J. Miklowitz, PhD, is Professor of Psychology and Psychiatry at the University of Colorado at Boulder and a Senior Clinical Research Fellow in the Department of Psychiatry at Oxford University. His research focuses on family environmental factors and family psychoeducational treatments for adult- and childhood-onset bipolar disorder. He developed the family psychoeducational intervention known as “family- focused treatment” for adults and youth with bipolar disorder. Dr. Miklowitz has received awards from the University of California, Los Angeles; the International Congress on Schizophrenia Research; the National Alliance for Research on Schizophrenia and Depression; the University of Colorado; the International Society for Bipolar Disorders. He has received funding for his research from the National Institute of Mental Health, the John D. and Catherine T. MacArthur Foundation, the Robert Sutherland Foundation, and the Danny Alberts Foundation. Dr. Miklowitz has published more than 170 research articles and book chapters on bipolar disorder and schizophrenia, and five books, including The Bipolar Disorder Survival Guide. Kimberley L. Mullen, MA, is a doctoral candidate in clinical psychology at the University of Colorado at Boulder and has contributed to the research on family- focused treatment (FFT) for adolescents diagnosed with bipolar disorder. She currently works at the Denver Veterans Affairs Medical Center, where she provides clinical services and conducts research on the application of FFT for families of returning Iraq or Afghanistan veterans with posttraumatic stress disorder. Nick C. Patel, PharmD, PhD, is Assistant Professor of Pharmacy at the University of Georgia, and of Psychiatry at the Medical College of Georgia. His research interests are the pharmacological treatment of child and adolescent mood disorders and neuropsychopharmacology using magnetic resonance spectroscopy. He has authored or coauthored numerous articles in these areas. Jennifer Pautsch, MA, is Study Coordinator for the Early Intervention in Depression Study, which is piloting PCIT-ED, the parent–child interaction therapy–emotional