work rapidly and prevent hospitalization (Keck PE Jr., Hirschfeld RMA, Allen MH et al., Safety and efficacy of rapid-loading divalproex sodium in acutely manic patients). For comparison, patients were assigned randomly to a ten day treatment schedule of loading doses of Depakote (a mood stabilizer), or non-loading doses of Depakote or Lithium. In the loading strategy, 20 patients received 30 mg per day of Depakote for days 1 and 2, and then dropped back to 20 mg per day in divided doses. In the non-loading strategy, 20 patients received 750 mg of Depakote daily in divided doses. In the Lithium strategy, 19 patients received 300 mg of the drug 3 times a day. The researchers found that all of the patients showed decreased signs of manic symptoms by day 3 of the study, but the patients assigned to the loading doses of Depakote showed improvement by day 2. In addition, the difference between treatment groups was accentuated in patients with more severe manic symptoms (Keck et al., 1999). Of course, no one medication works for all children with COBPD. Sometimes 2 or more are needed collectively to reach and maintain mood stability. Parents should expect a trial and error period in which their childs doctor may have to try many different medications in different combinations before the best treatment is found. One way to speed up the trial and error process toward an effective medication is through the use of cycle charts. Cycle charts are a way of keeping track of your childs mood throughout the day, along with what medication is given and how often. These charts can be extremely important to the doctor when prescribing the medications as well as to the therapist conducting the psychotherapy. Recording a childs moods in the form of a simple graph, these cycle charts provide a visual display of the course of the illness and brings into focus the symptoms and behaviors that define the condition (Papolos and Papolos, 1999). The second phase of ...
