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Prescribing for Children and Adolescents
To Prepare.
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Use the Walden library to research evidence-based treatments for Bipolar I disorder in children and adolescents.
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You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating Bipolar I disorder in children and adolescents.
The Assignment (1–2 pages)
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Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating Bipolar I disorder in children and adolescents.
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Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
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Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
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Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.
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Prescribing for Children and Adolescents
Most children and adolescents experience mood changes as part of their growth and development. However, when the moods persist and interfere with normal functioning, then it is highly suspicious of a psychiatric manifestation like bipolar I- a condition characterized by extreme shifts in behavior, mood, and energy. Symptoms often appear in adolescence or adulthood but the condition is now common among children and teenagers. Diagnosis and management at a young age are difficult due to conditions with similar presentations in childhood and the numerous side-effects of psychotropics. Moreover, Bipolar I presents a unique challenge due to mixed features that associate it with suicidality and difficulties in effective treatments. Therefore, health professionals must conduct a thorough risk assessment, utilize available clinical practice guidelines to make a diagnosis, and carefully analyze the intended plan of care for better outcomes.
Clinical Guidelines
Treatment for children/adolescents with BD has had significant improvements over the years. However, the earliest guideline from the American Academy of Child and Adolescent Psychiatry (2007) does not incorporate the latest evidence (Kearns & Hawley, 2014). Therefore, for my study, I will consider the latest guidelines from the Canadian Network for Mood and Anxiety (2018) to inform treatment and care approaches (Murray, 2018). It incorporates recent evidence and provides new knowledge into BD-I care for minors.
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Medications
Bipolar children and adolescents work with the health provider and the parent/caregiver to develop a plan of care aimed at symptom remission and improved quality of life. Choices can be pharmacological, non-pharmacological, or both. An example of a pharmacological agent is Aripiprazole, an FDA-approved drug for bipolar I (mania and mixed episodes) for children/adolescents (Murray, 2018). It is a first-line option, a second-generation antipsychotic. It is highly tolerable and has minimal side-effects compared to other antipsychotics (Kirino, 2014). Health providers also use off-label drugs in bipolar-I treatment (Kearns & Hawley, 2014). An example is Lamotrigine.
Cognitive behavior therapy is an effective approach for child/adolescent bipolar-I. In a problem-focused approach, the therapist works with the minor to develop effective coping mechanisms that help handle complex situations more effectively (Hommerding, 2016). It also helps identify any triggers to bipolar symptoms like inadequate sleep and utilizes specific behavior and thinking measures to enhance better coping. Therapists may also involve parents/caregivers in sessions to equip them with new strategies to guide the minors in their new coping skills (Hommerding, 2016). Such directed focus makes CBT an effective approach for BD.
Risk Assessment
Risk assessment is a unique approach to patient management to prevent or minimize a patient’s medication harm. Health professionals have to conduct a risk assessment before prescribing antipsychotics for BD. Guidelines suggest checking the family/patient history for treatment response, evidence of efficacy, patients/family preferences, side effects, adverse reactions, and the phase of illness (Murray, 2018). Considering these factors is part of a comprehensive care approach to the patient’s management.
The FDA also works to promote medication safety and efficacy through risk assessment. The organization approves drugs after satisfying that they have a higher benefit margin than risks. It means that an FDA-approved medication has a high likelihood that a patient is going to benefit from the intended purpose of the drug. However, these medications are not without risks. They can still lead to harmful interactions, may not work for certain individuals, and there is a possibility that they may cause additional harm.
Off-label options are those medications whose risk is higher compared to the intended benefits. It is using medication that is not approved for one’s condition/disease. Taking the drug increases the possibility of harm. However, they are not entirely unnecessary in patient care. They become options when a patient exhausts all other approved medications for their disease.
Conclusion
Bipolar disorder in children and adolescents remains to be a challenge for health care professionals. However, continued research and developments continuously update health professionals about recent developments. Part of this effort is the FDA’s role in drug approval to facilitate better patient outcomes. However, more research is necessary to achieve better treatment approaches for BD in children/adolescents.
References
Hommerding, B. A. (2016). Family-Focused Interventions for Children and Adolescents with Bipolar Disorder.
Kearns, M. A., & Hawley, K. M. (2014). Predictors of polypharmacy and off-label prescribing of psychotropic medications: a national survey of child and adolescent psychiatrists. Journal of psychiatric practice, 20(6), 438.
Kirino, E. (2014). Profile of aripiprazole in the treatment of bipolar disorder in children and adolescents. Adolescent health, medicine, and therapeutics, 5, 211.
Murray, G. (2018). Adjunctive psychosocial interventions for bipolar disorder: some psychotherapeutic context for the Canadian Network for Mood and Anxiety Treatments (CANMAT) & International Society for Bipolar Disorders (ISBD) guidelines. Bipolar Disorder, 10.
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