Case Study: Antimanic Effectiveness of Dextroamphetamine in a Brain-Injured Adolescent

doi:10.1097/00004583-199504000-00014

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 34, Issue 4, April 1995, Pages 472-476

https://doi.org/10.1097/00004583-199504000-00014 Get rights and content

ABSTRACT

A relatively enduring and counterintuitive antimanic response to dextroamphetamine in a brain-injured adolescent who had failed trials involving divalproex, lithium, haloperidol, and carbamazepine is described. This finding combined with data from previous reports of antimanic effects of test doses of stimulants imply that such a pharmacological probe may prove relevant for the prediction of treatment response of mania to dextroamphetamine and perhaps for subclassification of bipolar disorder.

REFERENCES (20)

GA Carlson et al.
The effects of methylphenidate and lithium on attention and activity level
J Am Acad Child Adolesc Psychiatry
(1992)
C Ounsted
The hyperkinetic syndrome in epileptic children
Lancet
(1955)
M Strober et al.
Family study of bipolar I disorder in adolescence
J Affect Disord
(1988)
VA Beckman et al.
d-Amphecamin beim manischen Syndrom
Arzneimittelforschung
(1976)
J Biederman
Recent developments in child and adolescent psychiatry and psychopharmacology
Currents
(1994)
WA Brown et al.
Alleviation of manic symptoms with catecholamine agonists
Am J Psychiatry
(1979)
Drugdex (1994), Denver: Micromedex, Vol...
MJ Garvey et al.
Dextroamphetamine treatment of mania
J. Clin Psychiatry
(1987)
FK Goodwin et al.
JM Himmelhoch et al.
Mixed mania: diagnosis and treatment
Psychopharmacol Bull
(1986)

There are more references available in the full text version of this article.

Cited by (25)

Arousal Regulation in Affective Disorders
2016, Systems Neuroscience in Depression
Brain arousal fundamentally impacts human behavior, and arousal has been implemented as a basic dimension of mental diseases in the Research Domain Criteria project of the National Institute of Mental Health. The “arousal regulation model of affective disorders” has been introduced, which links affective disorders to a disturbed regulation of brain arousal. This chapter will provide an overview of brain arousal regulation in affective disorders. Initially, theoretical models and common means of assessments will be discussed and the Vigilance Algorithm Leipzig (VIGALL), an electroencephalography (EEG)-based assessment of brain arousal regulation, will be presented. Afterward, the arousal regulation model will be described in detail, which explains several clinical phenomena and predicts the response to treatment based on the respective brain arousal disturbance. Therefore, the model is suggested for delineating pathophysiologically more homogeneous subgroups and for personalized treatment approaches.
The vigilance regulation model of affective disorders and ADHD
2014, Neuroscience and Biobehavioral Reviews
Citation Excerpt :
However, according to the model presented here, vigilance stabilising drugs should be able to stop the manic vicious circle. Indeed, when reviewing the literature, there is a lack of empirical evidence for detrimental effects of psychostimulants in mania (Hensch et al., 2010) and even empirical data suggesting the opposite, namely rapid antimanic effects of psychostimulants (Beckmann and Heinemann, 1976; Bschor et al., 2001; Garvey et al., 1987; Max et al., 1995; Schoenknecht et al., 2010). If psychostimulants had a high risk to induce or worsen mania, then the broad use of stimulants in ADHD would be a considerable problem because of the high comorbidity between ADHD and BD: In pediatric samples, comorbidity of BD and ADHD is especially high; up to 85% of children with BD have also been found to have ADHD, and up to 22% of children with ADHD are also diagnosed BD (Singh et al., 2006).
According to the recently proposed vigilance model of affective disorders (vigilance in the sense of “brain arousal”), manic behaviour is partly interpreted as an autoregulatory attempt to stabilise vigilance by creating a stimulating environment, and the sensation avoidance and withdrawal in Major Depressive Disorder (MDD) is seen as an autoregulatory reaction to tonically increased vigilance. Indeed, using a newly developed EEG-based algorithm, hyperstable vigilance was found in MDD, and the contrary, with rapid drops to sleep stages, in mania. Furthermore, destabilising vigilance (e.g. by sleep deprivation) triggers (hypo)mania and improves depression, whereas stabilising vigilance, e.g. by prolonged sleep, improves mania. ADHD and mania have common symptoms, and the unstable vigilance might be a common pathophysiology. There is even evidence that psychostimulants might ameliorate both ADHD and mania. Hyperactivity of the noradrenergic system could explain both the high vigilance level in MDD and, as recently argued, anhedonia and behavioural inhibition. Interestingly, antidepressants and electroconvulsions decrease the firing rate of neurons in the noradrenergic locus coeruleus, whereas many antimanic drugs have opposite effects.
Neuropsychiatry of Pediatric Traumatic Brain Injury
2014, Psychiatric Clinics of North America
Citation Excerpt :
There may be episodes when the child has intense lability, aggression, hyperactivity, and inattention, and meets criteria for overlapping syndromes of PC, mania or hypomania, and ADHD.9 Mood stabilizers may help and stimulants are not necessarily contraindicated.91 Several reports of stimulants administered to children with TBI who have attention and concentration deficits show positive results, although the data are mixed.92
Bipolar disorder and hyperactivity in adults
2007, Encephale
New medication strategies for comorbid substance use and bipolar affective disorders
2004, Biological Psychiatry
Citation Excerpt :
Furthermore, adolescents with BPD might initially seem to have ADHD owing to overlapping symptoms and the more common occurrence of ADHD in this age group (Faraone et al 1997; Geller et al 2000). Psychostimulants are a common pharmacotherapy for ADHD but might be contraindicated in most patients with BPD (Dunn and Kronenberger 2003; Geller and Luby 1997; Max et al 1995). Thus, the implications of stimulant treatment in these patients need consideration.
Comorbidity of substance abuse disorders (SUD) with bipolar disorders (BPD) is a serious treatment problem. Childhood BPD can be further complicated by comorbidity with attention-deficit/hyperactivity disorder (ADHD) and later SUD during adolescence. The aim of this article is to review the literature on pharmacotherapies for these patients. Developing the ideal pharmacotherapy for BPD and SUD can be informed by the role of γ-aminobutyric acid (GABA) in the neurobiology of SUD. This ideal pharmacotherapy would have several key characteristics. These characteristics include treating the BPD, relieving withdrawal symptoms, and preventing relapse to SUD. The ideal medication should have low abuse liability, require infrequent dosing, be well tolerated, and have few side effects. A medication approaching this ideal is the GABA enhancer valproate. Adding atypical antipsychotic agents might not improve valproate’s efficacy, but combining GABA medications with selective serotonin reuptake inhibitors holds promise for SUD with depression. Pemoline might be the best option for minimizing the risk of SUD complicating comorbid ADHD with BPD.
Combination pharmacotherapy in children and adolescents with bipolar disorder
2003, Biological Psychiatry
Citation Excerpt :
Yet there are some reports that show this is not always the case in bipolar children and adolescents. Max et al (1995) reported an excellent response to dextroamphetamine in a 14-year-old male with an organic bipolar disorder. Our preliminary data, and those of others, indicate that children and adolescents with bipolar disorders frequently have comorbid ADHD that requires treatment in addition to their bipolar disorder.
The purpose of this study was to develop prospective data on the effectiveness of combination pharmacotherapy of children and adolescents with bipolar disorder during a 6-month period of prospective, semi-naturalistic treatment.
Thirty-five subjects, with a mean age of 11 years, were treated in the extension phase of this study after having received 6–8 weeks of acute treatment with a single mood stabilizer. The extension phase of this study lasted for another 16 weeks, for a total of 24 weeks of prospective treatment. During this study phase, subjects were openly treated, and they could have their acute-phase mood stabilizer switched or augmented with another mood stabilizer, a stimulant, an antidepressant agent, or antipsychotic agent, if they were assessed to be a nonresponder to monotherapy with their initial mood stabilizer.
During the extension phase of treatment, 20 of 35 subjects (58%) required treatment with one or two mood stabilizers and either a stimulant, an atypical antipsychotic agent, or an antidepressant agent. The response rate to combination therapy was very good, with 80% of subjects treated responding to combination therapy with two mood stabilizers after not responding to monotherapy with a mood stabilizer.
This study suggests that children and adolescents with bipolar disorder are similar to adults with bipolar disorder, who also frequently require combination therapy.

View all citing articles on Scopus

: The authors thank Robert G. Robinson, M.D., for his helpful comments during manuscript preparation; Yutaka Sato, M.D., and Wilbur Smith, M.D., for interpretation of the neuroimaging; and Samuel Kuperman, M.D., for the graphics.

View full text

SPECIAL ARTICLECase Study: Antimanic Effectiveness of Dextroamphetamine in a Brain-Injured Adolescent

ABSTRACT

J Am Acad Child Adolesc Psychiatry

Lancet

J Affect Disord

d-Amphecamin beim manischen Syndrom

Arzneimittelforschung

Recent developments in child and adolescent psychiatry and psychopharmacology

Currents

Alleviation of manic symptoms with catecholamine agonists

Am J Psychiatry

Dextroamphetamine treatment of mania

J. Clin Psychiatry

Mixed mania: diagnosis and treatment

Psychopharmacol Bull

SPECIAL ARTICLE
Case Study: Antimanic Effectiveness of Dextroamphetamine in a Brain-Injured Adolescent