Summary: These practice guidelines for the biological, mainly pharmacological treatment of bipolar depression were developed by an international task force of the World Federation of Societies of B...

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World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Bipolar Disorders, Part I: Treatment of Bipolar Depression

Practitioner’s Guide to Psychoactive Drugs for Children and Adolescents

As with the two preceding guidelines of this series, these practice guidelines for the pharmacological maintenance treatment of bipolar disorder were developed by an international task force of the World Federation of Societies of Biological Psychiatry (WFSBP). Their purpose is to supply a systematic overview of all scientific evidence relating to maintenance treatment. The data used for these guidelines were extracted from a MEDLINE and EMBASE search, from recent proceedings from key conferences and various national and international treatment guidelines. The scientific justification of support for particular treatments was categorised into four levels of evidence (A-D). As these guidelines are intended for clinical use, the scientific evidence was not only graded, but also reviewed by the experts of the task force to ensure practicality.

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The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders, Part III: Maintenance Treatment

Head injury, bipolar disorder, and response to valproate.

Epilepsy affects individuals of all ages. Regimens of antiepileptic drugs (AEDs) and side-effect profiles differ for infants, children, adults, and the elderly. Thus, the epileptologist must be familiar with the specific changes of AED metabolism with age. In general, metabolic rates are fastest in children; therefore, AED half-lives are shortest in this group. Rates of AED elimination are slowest in neonates, infants, and children. Thus, children need larger dosages, on a mg/kg basis, than adults. The usual phenytoin (PHT) dosage in adults is 4-6 mg/kg per day, but children may need a dosage three to five times higher. On the other hand, the PHT dosages in the elderly may need to be 3-4 mg/kg per day to achieve therapeutic levels. Likewise, the half-life of carbamazepine (CBZ) is shortest in children and the elderly. Profiles of metabolites may also be age-specific, a difference of particular importance for valproate (VPA). The relative amount of VPA metabolized to 4-ene is more than twofold less in adults than in children, which may explain the different profile of hepatotoxicity seen by age. The elderly may be more vulnerable to adverse effects of AEDs. Many elderly have neurologic deficits that may render them more vulnerable to neurotoxic effects such as ataxia and cognitive disturbances. Also, low serum albumin concentrations, which result in decreased binding, may mask high serum AED concentrations. The hyponatremia associated with CBZ may be a particular concern in the elderly. Gingival hyperplasia, a concern in children, may not be a problem in the elderly.

Metabolism of antiepileptic medication: newborn to elderly.

The review presents 23 studies on the action of carbamazepine (CZP) in manic-depressive disorder, some of these studies being double-blind investigations, others open investigations and some anecdotal reports. Surveys of therapeutic as well as prophylactic effects in manias and depressions are presented. There seems to be a definite antimanic and a less expressed but indubitable antidepressant therapeutic effect of CZP, and a considerable prophylactic effect in mania as well as depression, an effect which is possibly a little less than that of lithium. It must, however, be stressed that this conclusion is based on a number of different and heterogeneous studies which have been combined. In addition 5 cases are presented concerning rapid cycling cases with early onset of the disorder and without response to or bad compliance with lithium. In spite of the clinical similarity of these cases the effect of CZP was good in 3 and poor in 2 of the 5 cases presented.

Carbamazepine in treatment and prophylaxis of manic-depressive disorder.

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Carbamazepine in treatment and prophylaxis of manic-depressive disorder.