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Objective: To examine initial response to treatment in a large sample of acutely manic bipolar I adolescents and to examine potential predictors of nonresponse, such as the presence of prominent depressive features, psychosis, or psychiatric comorbidity.

Method: Adolescents, 12 to 18 years of age, with an acute manic episode were treated with open lithium. Response was defined as a decline in Young Mania Rating Scale total score of >=33% and a rating of "much improved" or "very much improved" on the Clinical Global Impressions Improvement item at week 4. Remission of mania was defined as a Young Mania Rating Scale score of <=6. Axis I diagnoses were assessed using the Lifetime Schedule for Affective Disorders and Schizophrenia for Adolescents.

Results: Of 100 subjects, 63 met response criteria and 26 achieved remission of manic symptoms at the week 4 assessment. Prominent depressive features, age at first mood episode, severity of mania, and comorbidity with attention-deficit/hyperactivity disorder did not distinguish responders from nonresponders. When treated with adjunctive antipsychotic medication, subjects with psychotic features at baseline responded as well as subjects without psychosis.

Conclusions: In this largest systematic treatment trial of acutely manic adolescents to date, lithium appears effective for acute stabilization of symptoms. Controlled treatment studies in adolescents with acute mania are needed.

Copyright 2003 (C) American Academy of Child and Adolescent Psychiatry