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Child & Adolescent Bipolar Foundation

Child & Adolescent Bipolar Foundation. Lithium testing in children: a Public Health Necessity June 11, 2002 Martha Hellander, J.D., Executive Director. CABF Parents. Age 30s-50s 98% female 71% married 26% hold graduate degrees 42% employed full-time. CABF Children. Age 1-8 24%

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Child & Adolescent Bipolar Foundation

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  1. Child & Adolescent Bipolar Foundation Lithium testing in children: a Public Health Necessity June 11, 2002 Martha Hellander, J.D., Executive Director

  2. CABF Parents • Age 30s-50s • 98% female • 71% married • 26% hold graduate degrees • 42% employed full-time

  3. CABF Children • Age 1-8 24% • Age 9-12 36% • Age 12-l8 37% • Age 19+ 4% • Hospitalized 1-9+ times 54% • Never hospitalized 46%

  4. Addiction • 39-60% risk of developing Substance Use Disorder Wilens, et al. “Risk for Substance Use Disorders in Youths With Child and Adolescent-Onset Bipolar Disorder.” JAACAP38(6):680-685, 1999

  5. Addiction (cont’d) • Lithium reduces adolescent substance use and stabilizes mood in RCT Geller B et al (1998). Double-blind and placebo controlled study of lithium for adolescent bipolar disorders with secondary substance dependency. JAACAP 37:171-178.

  6. Incarceration • In 50 kids consecutively screened on intake in Texas detention center, 20% had acute mania (another 20% depression) Pliszka, et al, “Affective Disorder in Juvenile Offenders: A Preliminary Study,” Am J Psychiatry 157:1, Jan. 2000

  7. Suicidality in BP Children • 25% serious thoughts, plan or intent in prepubertal kids with mania Geller et al: Two-year prospective follow-up of children with a prepubertal and early adolescent bipolar disorder phenotype. Am J Psychiatry 159:927-933, 2002

  8. Suicidality and Death In BP Adults • 18 % mortality • Lithium reduces suicide regardless of whether it stabilizes mood Tondo and Baldessarini, “Reduced Suicide Risk During Lithium Maintenance Treatment,” J Clin Psychiatry 2000:61 (suppl)

  9. Timeline • 1949 John Cade treats mania w/lithium • 1952 18 cases of pediatric mania reported • 1970 Lithium approved by FDA for mania • 1975 NIMH recognizes pediatric depression • 1995 NIMH recognizes pediatric mania • 2002 No standard treatment for pediatric mania

  10. Medications used to treat pediatric bipolar disorder symptoms • ~ 40+ medications used clinically • Indicated for mania >12 = 1 (Lithium) • Indicated for mania <12 = 0 • Indicated for BP depression = 0

  11. CABF Survey 2002 n=854Medication Use: Lifetime No. of Meds • 1-3 15% • 4-5 20% • 6-10 34% • 11-15 19% • 16-20 5% • > 20 6%

  12. Medication Use: Current No. of Meds • 1 13% • 2 30% • 3 28% • 4 15% • 5 7% • 6-10 7%

  13. Medication Use: Class • Anticonvulsants 79% • Atypical anti-psychotics 68% • AD/SSRIs 33% • Lithium 30% • Stimulants 26% • Typical antipsychotics 11% • Anxiety/Sleep 9%

  14. Summary • Lithium is widely used in children and adolescents with bipolar disorder • Lithium is off patent and unlikely to be tested by pharmaceutical industry • Lithium lacks data for pediatric use • New studies would produce benefits for children with pediatric bipolar disorder

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