Study of the Efficacy of Adjunctive Lithium Treatment for the Treatment of Psychotic Mania

Northwell Health

Overview

The proposed pilot study is a placebo-controlled, parallel group, randomized clinical trial comparing two treatment strategies in adolescents with mania and prominent psychotic features. One group will receive a second generation antipsychotic (SGA) and placebo and the other will receive a SGA and lithium. The primary double-blind phase of the study will last 8 weeks, followed by a 24-week extension-phase.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Conditions

Bipolar I Disorder

Interventions

Lithium treatment in combination with a SGA (Second Generation Antipsychotic)DRUG

All patients will be treated with aripiprazole with a target dose of 10 mg/day and a max daily dose of 30 mg. If aripiprazole is ineffective or not tolerated, it will be tapered and risperidone treatment will be started. If patient had an adequate aripiprazole trial in the past as described above, risperidone will be the initial treatment. Risperidone dosing will begin with 0.5 mg/day on day 1 with a target dose of 2.5 mg/day and a max daily dose of 6mg. Subjects in the lithium /adjunctive SGA group will be started at 900 mg/day lithium in thrice daily dosing. The lithium dose will be increased to 1200mg/day on day 4 if lithium has been well-tolerated and symptoms of mania remain, as determined by a phone assessment done by a blinded study physician. The target serum level of lithium will be 1.2 mEq/L (range 0.8 to 1.4 mEq/L).

Placebo/Adjunctive SGA treatmentDRUG

Eligibility

Sex: ALLMin age: 12 YearsMax age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Males and females, 12-18 years old, inpatients or outpatients * meet DSM-IV criteria for Bipolar I disorder - manic or mixed episode * psychotic symptoms present Exclusion criteria: * current serious homicidal/suicidal ideation * prior non-response or intolerance to an adequate trial of lithium * prior non-response or intolerance to adequate trials of both aripiprazole and risperidone * any unstable medical condition or medical contraindication to treatment with lithium, aripiprazole or risperidone * inability or unwillingness to discontinue concomitant medication that interferes with the pharmacokinetics of either lithium, aripiprazole, or risperidone * seizure disorder * pregnant or, if sexually active, not using birth control, such as oral contraceptives, two barrier methods, long-acting depot preparations or an intra-uterine device * Full Scale IQ less than 70 * meets criteria for a DSM-IV diagnosis of substance-induced mood disorder or mood disorder due to a general medical condition.

Locations (1)

The Zucker Hillside Hospital, North Shore-LIJ Health System

Glen Oaks, New York, United States

Outcomes

Primary Outcomes

Acute phase :Time to partial or full response

Acute phase: Partial response is defined as at least a 25% -49% reduction in YMRS score and a CGI improvement item score of 2. Full response is defined as a reduction in YMRS score of 50% or more and a CGI improvement item score of 1 "very much improved."

Time frame: 8 weeks

Continuation Phase: time to recurrence of a subsyndromal mood episode

We will measure the amount of time for patients to have a recurrance of a subsyndomal mood episode during the Continuation Phase

Time frame: 24 weeks

Secondary Outcomes

Acute phase: number of suicidal events

Time frame: 8 weeks

Acute phase: positive urine toxicology screens (yes/no variable)

Time frame: 8 weeks

Acute phase: adherence to medication regimen.

Time frame: 8 weeks

Data from ClinicalTrials.gov

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