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Cited by 389Bipolar Disorder and TreatmentSchizophrenia research and treatmentPersonality Disorders and Psychopathology

The DOI matches its Crossref record; 50 of the 50 references it cites were found in a registry or an index.

Effect Size of Lithium, Divalproex Sodium, and Carbamazepine in Children and Adolescents With Bipolar Disorder

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KOWATCH, ROBERT A., SUPPES, TRISHA, CARMODY, THOMAS J., BUCCI, JOHN P., HUME, JUDITH H., KROMELIS, MICHELLE, EMSLIE, GRAHAM J., WEINBERG, WARREN A., RUSH, A. JOHN·2000·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1097/00004583-200006000-00009
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Abstract

Objective To develop effect sizes for 3 mood stabilizers--lithium, divalproex sodium, and carbamazepine--for the acute-phase treatment of bipolar I or II disorder, mixed or manic episode, in children and adolescents aged 8 to 18 years.Method Forty-two outpatients with a mean age of 11.4 years (20 with bipolar I disorder and 22 with bipolar II disorder) were randomly assigned to 6 weeks of open treatment with either lithium, divalproex sodium, or carbamazepine. The primary efficacy measures were the weekly Clinical Global Impression Improvement scores and the Young Mania Rating Scale (Y-MRS).Results Using a > or = 50% change from baseline to exit in the Y-MRS scores to define response, the effect size was 1.63 for divalproex sodium, 1.06 for lithium, and 1.00 for carbamazepine. Using this same response measure with the intent-to-treat sample, the response rates were as follows: sodium divalproex, 53%; lithium, 38%; and carbamazepine, 38% (chi 2(2) = 0.85, p = .60). All 3 mood stabilizers were well tolerated, and no serious adverse effects were seen.Conclusions Divalproex sodium, lithium, and carbamazepine all showed a large effect size in the open treatment of children and adolescents with bipolar I or II disorder in a mixed or manic episode.

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  • Other studies have suggested the efficacy of combination therapy (risperidone plus lithium or divalproex and lithium plus divalproex or carbamazepine) to achieve and maintain remission.

    “Further, other studies have also suggested the efficacy of combination therapy (eg, risperidone plus lithium or divalproex584 and lithium plus divalproex or carbamazepine606) to achieve and maintain remission.”

    From Canadian Network for Mood and Anxiety Treatments ( CANMAT ) and International Society for Bipolar Disorders ( ISBD ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [606]

    The Discussion (page not available) says patients who did not respond to monotherapy frequently responded, in the authors’ clinical experience, to combinations of mood stabilizers and other agents. It does not identify lithium plus divalproex or carbamazepine as effective pairings, or report that combination therapy achieved and maintained remission; a six-month continuation protocol was still being explored. (LLM, conf=0.84)

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Research works printed but not linked: 1

  1. Kashani, 1987, Psychiatric disorders in a community sample of adolescents, Am J Psychiatry, 144, 584

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Metadata

Authors
KOWATCH, R. A., SUPPES, T., CARMODY, T. J., BUCCI, J. P., HUME, J. H., KROMELIS, M., EMSLIE, G. J., WEINBERG, W. A., & RUSH, A. J.
Affiliations
  • Cardinal Glennon Children’s Medical Center (US)
  • Children's Medical Center (US)
Corresponding author
KOWATCH, ROBERT A.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2000-06
Volume
39
Issue
6
Pages
713-720
ISSN
0890-8567 (ISSN-L)
DOI
10.1097/00004583-200006000-00009
OpenAlex
W2022501784
Cited by
389
References
50
Citations by year
2026: 3 · 2025: 2 · 2024: 7 · 2023: 5 · 2022: 5 · 2021: 4 · 2020: 2 · 2019: 30 · 2018: 9 · 2017: 21 · 2016: 11 · 2015: 6 · 2014: 11 · 2013: 7 · 2012: 15
FWCI
15.92
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
NIMH (K07-MH01057, MH53799)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
bipolar disorder, mood stabilizers, lithium, divalproex sodium, carbamazepine, children and adolescents, manic episodes, mixed states, acute phase treatment, effect size, Young Mania Rating Scale, Clinical Global Impression Scale, treatment response
MeSH terms
Acute Disease, Adolescent, Age Factors, Bipolar Disorder, Carbamazepine, Child, Dose-Response Relationship, Drug, Female, Humans, Lithium, Male, Outpatients, Pilot Projects, Psychiatric Status Rating Scales, Valproic Acid, Antimanic Agents

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