Showing papers in "Journal of Child and Adolescent Psychopharmacology in 2010"
TL;DR: Good reliability and validity of the Children's Depression Rating Scale-Revised is presented in adolescents with depression and correlations between the CDRS-R and other outcomes are demonstrated.
Abstract: Objective: The aim of this study was to present the reliability and validity of the Children's Depression Rating Scale–Revised (CDRS-R) in the adolescent age group. Method: Adolescents with symptoms of depression were assessed using the CDRS-R and global severity and functioning scales at screening, baseline, and after 12 weeks of fluoxetine treatment. Global improvement was also assessed at week 12 (or exit). Reliability and validity were analyzed using Classical Test Theory (item-total correlations and internal consistency) and correlations between the CDRS-R and other outcomes. Results: Adolescents (n = 145) were evaluated at screening; 113 (77.9%) met criteria for major depressive disorder, 8 (5.5%) had subthreshold depressive symptoms, and 24 (16.6%) had minimal depressive symptoms. Ninety-four adolescents had a baseline visit after 1 week, and 88 were treated with fluoxetine. Internal consistency for the CDRS-R was good at all three visits (screening: 0.79; baseline: 0.74; exit: 0.92), and ...
162 citations
TL;DR: Structural and functional abnormalities in multiple parallel corticostriatal circuits may underlie the behavioral manifestations of Tourette's disorder and related neuropsychiatric disorders over the course of development.
Abstract: Objective: This article reviews the available scientific literature concerning the neurobiological substrates of Tourette's disorder (TD). Methods: The electronic databases of PubMed, ScienceDirect, and PsycINFO were searched for relevant studies using relevant search terms. Results: Neuropathological as well as structural and functional neuroimaging studies of TD implicate not only the sensorimotor corticostriatal circuit, but also the limbic and associative circuits as well. Preliminary evidence also points to abnormalities in the frontoparietal network that is thought to maintain adaptive online control. Evidence supporting abnormalities in dopaminergic and noradrenergic neurotransmission remains strong, although the precise mechanisms remain the subject of speculation. Conclusion: Structural and functional abnormalities in multiple parallel corticostriatal circuits may underlie the behavioral manifestations of TD and related neuropsychiatric disorders over the course of development. Further l...
162 citations
TL;DR: Evidence regarding the immunobiology as well as the relevant clinical and therapeutic aspects of TD, OCD, and PANDAS are explored, considering the overlap of clinical and neuroanatomic findings among these disorders.
Abstract: Obsessive-compulsive disorder (OCD) and related conditions including Tourette's disorder (TD) are chronic, relapsing disorders of unknown etiology associated with marked impairment and disability. Associated immune dysfunction has been reported and debated in the literature since the late 80s. The immunologic culprit receiving the most interest has been Group A Streptococcus (GAS), which began to receive attention as a potential cause of neuropsychiatric symptoms, following the investigation of the symptoms reported in Sydenham's chorea (SC) and rheumatic fever, such as motor tics, vocal tics, and both obsessive-compulsive and attention deficit/hyperactivity symptoms. Young children have been described as having a sudden onset of these neuropsychiatric symptoms temporally associated with GAS, but without supporting evidence of rheumatic fever. This presentation of OCD and tics has been termed pediatric autoimmune neuropsychiatric disorders associated with Streptococcus (PANDAS). Of note, SC, OCD,...
136 citations
TL;DR: In this article, a pilot study examined changes in brain function following each type of treatment in generalized anxiety disorder (GAD) using functional magnetic resonance imaging (fMRI) scans acquired before and after treatment for patients and over two comparable time points for controls.
Abstract: Objective: Generalized anxiety disorder (GAD) is a prevalent and debilitating psychiatric condition of adolescence. Two effective forms of treatment are cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs). This pilot study examined changes in brain function following each type of treatment in GAD. Method: Subjects were 14 youths with GAD (7 had CBT, 7 received fluoxetine) and 10 age- and gender-matched healthy peers. Functional magnetic resonance imaging (fMRI) scans were acquired before and after treatment for patients and over two comparable time points for controls. During fMRI acquisition, a probe detection task with emotional (angry, happy) and neutral faces allowed for assessment of neural response to threat. Following previous research, region of interest analyses were performed in the right ventrolateral prefrontal cortex (VLPFC). Results: fMRI results showed increased right VLPFC activation, relative to controls, in the medication (t(15) = 3.01, p < 0.0...
114 citations
TL;DR: Sertraline was a generally safe treatment in children and adolescents with PTSD, but did not demonstrate efficacy when compared to placebo during 10 weeks of treatment.
Abstract: Objective: The aim of this study was to evaluate the safety and efficacy of sertraline in children and adolescents who met Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for posttraumatic stress disorder (PTSD). Method: Children and adolescents (6–17 years old) meeting DSM-IV criteria for PTSD were randomized to 10 weeks of double-blind treatment with sertraline (50–200 mg/day) or placebo. The primary efficacy measure was the University of California, Los Angeles Post-Traumatic Stress Disorder Index for DSM-IV (UCLA PTSD-I). Results: A total of 131 patients met entry criteria and were randomized to sertraline (n = 67; female, 59.7%; mean age, 10.8; mean UCLA PTSD-I score, 43.8 ± 8.5) or placebo (n = 62; female, 61.3%; mean age, 11.2; mean UCLA PTSD-I score, 42.1 ± 8.8). There was no difference between sertraline and placebo in least squares (LS) mean change in the UCLA PTSD-I score, either on a completer analysis (−20.4 ± 2.1 vs. −22.8 ± 2.1; p = 0.373) or on...
92 citations
TL;DR: Aggression is common in clinically referred ADHD youngsters and should be identified as a legitimate target for psychopharmacological treatment in children and adolescents with moderate to severe ADHD and nonanxiety co-morbid diagnostic disorders.
Abstract: OBJECTIVE: The aim of this study was to characterize aggression and its relationship to psychiatric co-morbidity, attention-deficit/hyperactivity disorder (ADHD) subtype, and ADHD symptom severity in clinically referred ADHD youngsters. We also wanted to ascertain whether reactive and impulsive aggression is more prevalent than proactive aggression in an ADHD sample. METHOD: Consecutively referred ADHD children and adolescents (n = 268) and community controls (n = 100) were assessed systematically regarding demographics, psychiatric diagnosis, overt aggression severity, proactive and reactive aggression severity, and ADHD symptom severity using correlational analysis and analysis of covariance (ANCOVA). RESULTS: Across all aggression measures, ADHD children were more aggressive than community controls. ADHD children with nonanxiety co-morbid disorders were more aggressive than ADHD children without such co-morbidity. The number of co-morbid psychiatric diagnoses and ADHD symptom severity were significantly associated with aggression. ADHD youngsters demonstrated significantly more reactive than proactive forms of aggression across all co-morbid diagnoses. CONCLUSIONS: Aggression is common in clinically referred ADHD youngsters and should be identified as a legitimate target for psychopharmacological treatment in children and adolescents with moderate to severe ADHD and nonanxiety co-morbid diagnostic disorders. Language: en
72 citations
TL;DR: The pharmacology of the antiglutamatergic drug riluzole (Rilutek) is reviewed and the experience in the study of the drug in children, with emphasis on adverse effects noted so far in these younger patients.
Abstract: The antiglutamatergic drug riluzole (Rilutek®) is presently being used off label in the treatment of psychiatric conditions in adult patients and, increasingly, in children. This article briefly reviews the pharmacology of this drug and its current investigative and clinical uses and adverse effects. It also reports on our experience to date in the study of the drug in children, with emphasis on adverse effects noted so far in these younger patients.
67 citations
TL;DR: Distinguishing clinical characteristics in PANDAS, which included urinary urgency, hyperactivity, impulsivity, and deterioration in handwriting, are linked to basal ganglia functions.
Abstract: Objective: The objectives of this study were to identify unique clinical characteristics of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) compared with a control group of children with non-PANDAS obsessive-compulsive disorder (OCD) with respect to ancillary symptoms, types of obsessions and compulsions, symptom severity, and co-morbid DSM-IV diagnoses. Method: Classification of PANDAS was based on review of pediatric and psychiatric records using the criteria developed by Swedo and colleagues. Children aged 6–14 with PANDAS (n = 21) and non-PANDAS OCD (n = 18) were assessed by blind independent evaluators using the PANDAS Questionnaire, Children's Yale-Brown Obsessive Compulsive Scale, Yale Global Tic Severity Scale, and Anxiety Disorders Interview Schedule for DSM-IV. Results: PANDAS children were significantly more likely to present with separation anxiety, urinary urgency, hyperactivity, impulsivity, deterioration in handwriting...
65 citations
TL;DR: There were some advantages to treatment with micronutrients-lower activity level, less social withdrawal, less anger, better spontaneity with the examiner, less irritability, lower intensity SIB, markedly fewer adverse events, and less weight gain.
Abstract: Autism spectrum disorder (ASD) is often accompanied by self-injurious behavior (SIB), aggression, and tantrums, symptoms that have reportedly improved with micronutrient (vitamins and minerals) treatment. The current study took advantage of naturally occurring differences in parental preferences for treatment approaches. The micronutrient group asked for treatment without pharmaceuticals (n = 44, aged 2–28 years at entry [M = 8.39 ± 5.58]). Their records were matched with those of 44 similar children whose families requested conventional treatment (medication group). Both groups improved on both the Childhood Autism Rating Scale and the Childhood Psychiatric Rating Scale (all p values <0.0001). Both groups also exhibited significant decreases in total Aberrant Behavior Checklist scores, but the micronutrient group's improvement was significantly greater (p < 0.0001). SIB Intensity was lower in the micronutrient group at the end of the study (p = 0.005), and improvement on the Clinical Global Impr...
65 citations
TL;DR: During accurate NoGo but impaired Go trial performance, children with bipolar I or II disorder showed increased right DLPFC activation versus controls, suggesting increased recruitment of executive control regions for accurate response inhibition.
Abstract: Objectives
Pediatric bipolar disorder is characterized by core deficits in mood and executive function and commonly co-occurs with attention-deficit/hyperactivity disorder (ADHD). We aimed to examine response inhibition in this population, as an element of executive function, which, if aberrant, may interfere with learning and information processing.
64 citations
TL;DR: Assessment and treatment strategies are reviewed to include current advances in research in pediatric obsessive-compulsive disorder.
Abstract: Recently, research in pediatric obsessive-compulsive disorder (OCD) has expanded to include large family genetic studies, elaboration of phenotypic dimensions, description of co-morbid disorders and their moderating effects on treatment response and outcome, research on immune-based neuropsychiatric causes, randomized controlled trials of selective serotonin reuptake inhibitors (SSRIs), randomized controlled trials of cognitive behavioral therapy (CBT), comparative treatment trials; new approaches in behavior therapy, and increased awareness of newer approaches to treatment. The purpose of this article is to review assessment and treatment strategies to include current advances in research.
TL;DR: Behavioral treatment combined with antipsychotic medication was the most effective approach to reducing aggressive behaviors in youths with ASD.
Abstract: Background: The use of antipsychotic medications to treat aggression in youths with autism spectrum disorders (ASD) is based on open-label trials and efficacy studies. There are no studies examining the combined effectiveness of antipsychotic medications and intensive behavioral intervention (IBI) to treat aggression in ASD. Methods: Youths with ASD and aggressive behavior received IBI. Medication use remained stable during the study period and was coded into antipsychotic, mood-stabilizing, and nonstimulant attention-deficit/hyperactivity disorder (ADHD)/sleep medication classes. Analysis of covariance (ANCOVA) and survival analyses examined the effects of medication classes on the average number of aggressive behaviors and time to behavior plan success. Results: Thirty-two youths (mean age = 11.16, standard deviation [SD] = 3.31, range = 4–16 years, 75% male) with ASD received aggression reduction plans. Of these, 25 youths were taking at least one psychiatric medication (antipsychotic n = 18, ...
TL;DR: Interestingly, children with ADHD receiving concurrent MPH showed no difference in Mn serum levels versus controls, and the impact of naturalistic treatment with MPH determined that Mn concentrations were significantly reduced from baseline values following MPH exposure.
Abstract: Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder that affects children worldwide. The etiology of ADHD is complex and not fully understood. Earlier studies associated elevated levels of manganese (Mn) with learning problems, attention deficits, and ADHD. Furthermore, it has also been shown that the dopamine (DA) system, the primary site of action of pharmacological ADHD treatments, is influenced by high levels of Mn. Recent studies have suggested that Mn accumulates in dopaminergic neurons via the presynaptic dopamine transporter (DAT). A role for altered functioning of the dopaminergic system in the etiology of ADHD has been well established through neurochemical, neurophysiological, imaging, and genetics studies. Methylphenidate (MPH) is a psychostimulant commonly used to manage ADHD symptoms. The pharmacotherapeutic effect of MPH occurs primarily through its action of inhibiting DAT, and thus increasing dopamine, as well as other catecholamines, at the synap...
TL;DR: Psychopharmacotherapy in PBD patients led to differential effort with persistently increased activity in the affective regions and decreasedActivity in the cognitive regions relative to HC, demonstrating altered mechanisms of affective and cognitive systems of brain function, regardless of symptom response.
Abstract: Objective: This functional magnetic resonance imaging (fMRI) study investigated the effects of pharmacotherapy on brain function underlying affect dysregulation and cognitive function in pediatric bipolar disorder (PBD). Method: Healthy controls (HC) (n = 14; mean age = 14.1 ± 2.4 years) and unmedicated PBD patients with manic or hypomanic episodes (n = 17; mean age = 14.3 ± 1.1 years) were matched on intelligence quotient (IQ) and demographic factors. The fMRI studies were performed at baseline and after 14 weeks, during which PBD patients were treated initially with second-generation antipsychotics (SGAs) followed by lamotrigine monotherapy. The pediatric affective color-matching task was used where subjects matched the color of a positive, negative, or neutral word with one of the two colored circles below in each of the trials. There were five blocks of each emotional word type, with 10 trials per block. Results: Behavioral data showed that the PBD group was modestly slower and less accurate ...
TL;DR: The prediction of amphetamine optimal dose by ferritin concentration suggests that iron supplementation should be investigated as a potential intervention to optimize response to psychostimulants at a lower dose in individuals with low iron stores and ADHD.
Abstract: Introduction: Iron deficiency (ID) has been associated with attention and behavioral problems, in general, and with attention-deficit/hyperactivity disorder (ADHD), in particular. The study aim was to explore whether iron stores, as reflected by serum ferritin concentration, predicted response to psychostimulants. Methods: Six- to 14-year-old children with ADHD enrolled in a multiphase, double-blind, randomized, placebo-controlled trial investigating zinc supplementation in treating ADHD and optimizing response to psychostimulants. The Swanson, Nolan, and Pelham (SNAP) ADHD rating scale was the primary clinical instrument. Serum ferritin concentration was obtained at baseline and 8 weeks later. Partial correlations, adjusting for age and sex, were computed. Results: Fifty-two participants (83% males) had a mean age of 10 years. Their ADHD symptoms were moderately severe at baseline (SNAP item mean = 2.1). Their mean ferritin concentration was 18.4 ng/mL, with 23% of the participants having a leve...
TL;DR: Risperidone can be individually titrated to optimal dosage for excellent response in the majority of children and is better with greater symptom severity, while weight gain is not necessary for ris peridone benefit and may even detract from it.
Abstract: Objective/Background: The National Institute of Mental Health (NIMH) Research Units on Pediatric Psychopharmacology (RUPP) Autism Network found an effect size of d = 1.2 in favor of risperidone on the main outcome measure in an 8-week double-blind, placebo-controlled trial for irritability in autistic disorder. This paper explores moderators and mediators of this effect. Method: Intention-to-treat (ITT) analyses were conducted with suspected moderators and mediators entered into the regression equations. MacArthur Foundation Network subgroup guidelines were followed in the evaluation of the results. Results: Only baseline severity moderated treatment response: Higher severity showed greater improvement for risperidone but not for placebo. Weight gain mediated treatment response negatively: Those who gained more weight improved less with risperidone and more with placebo. Compliance correlated with outcome for risperidone but not placebo. Higher dose correlated with worse outcome for placebo, but ...
TL;DR: Predictors of placebo response in internalizing disorders of youths parallel those in adult studies, with the exception of race, and should be considered when designing placebo-controlled trials in youths to enhance findings of true drug-placebo differences.
Abstract: Objective: The aim of this study was to assess predictors of placebo response in all available short-term, placebo-controlled trials of psychotropic drugs for children and adolescents with internalizing disorders, major depressive disorder (MDD), obsessive compulsive disorder (OCD,) and anxiety disorders (ANX) exclusive of OCD and posttraumatic stress disorder (PTSD). Method: We reviewed the literature relevant to the use of psychotropic medication in children and adolescents with internalizing disorders, restricting our review to double-blind studies including a placebo arm. Placebo response, defined according to each trial's primary response outcome variable and Clinical Global Impressions–Improvement, when available, and potential predictive variables were extracted from 40 studies. Results: From 1972 to 2007, we found 23 trials that evaluated the efficacy of psychotropic medication involving youth with MDD, 7 pertaining to youths with OCD, and 10 pertaining to youths with ANX (N = 2,533 patie...
TL;DR: Aripiprazole is efficacious in the treatment of irritability in children and adolescents with autistic disorder, particularly with respect to symptoms associated with tantrum behavior.
Abstract: Objectives: The aim of this study was to evaluate the efficacy of aripiprazole in the treatment of discrete symptoms of irritability associated with autistic disorder, as well as other symptoms captured on the Aberrant Behavior Checklist (ABC). Methods: This was a post hoc analysis of data from two 8-week, randomized, double-blind, multicenter trials to evaluate the efficacy of aripiprazole dosed flexibly (2–15 mg/day, n = 47) or fixed (5, 10,or 15 mg/day, n = 166) versus placebo (flexibly dosed, n = 51; fixed dose, n = 52). The effects of treatment on the 58 ABC items were evaluated. Results: Statistically significantly greater improvement was seen with aripiprazole versus placebo (p < 0.05) for all arms in both trials on the ABC–Irritability total subscale score and on the following individual ABC–Irritability items: Mood changes quickly, cries/screams inappropriately, and stamps feet/bangs objects. Several additional items measuring tantrum-like behaviors improved in the flexibly dosed trial a...
TL;DR: Differences between age- and gender-normed body mass index-standardized z scores at baseline and after 8 weeks of open-label, flexible-dose risperidone treatment are investigated, and the current preliminary findings suggest that the variant T allele of the -759C/T HTR2C promoter polymorphism is protective against ris peridone-induced weight gain.
Abstract: Weight gain is an important adverse effect of risperidone, but predictors of significant weight gain have yet to be identified in pediatric patients. Here, we investigated differences between age- and gender-normed body mass index–standardized z scores at baseline and after 8 weeks of open-label, flexible-dose risperidone treatment (mean dose: 1.70 mg/day) in 32 youths with pervasive developmental disorder (mean age = 8.74, range = 5–16 years) in relation to −759C/T 5-hydroxytryptamine 2C receptor (HTR2C) promoter and rs1414334 HTR2C intragenic C/G alleles, along with gender, age, and risperidone dose, using repeated measures analyses of variance. Carriers of the HTR2C promoter T allele gained an average of 0.043 ± 0.017 body mass index–standardized z scores (1.84 ± 1.51 kg) versus 0.64 ± 0.35 z (3.23 ± 1.47 kg) for non–T-allele carriers (p < 0.001). Presence of the rs1414334 C allele played no significant role. Further, weight gain appeared to be associated with younger age and higher doses of r...
TL;DR: An increase in incidence in use of ADHD drugs between 2001 and 2006 in The Netherlands is demonstrated, despite the lack of full reimbursement of these extended-release drugs.
Abstract: Background: Previous Dutch studies showed increasing psychostimulant use, especially methylphenidate immediate-release (MPH-IR), between 1995 and 2003. In 2003 the extended-release (ER) formulation of MPH and in 2005 atomoxetine (ATX) were introduced in The Netherlands, which increased treatment options. Objective: The aim of this study was to describe the change in incidence of attention-deficit/hyperactivity disorder (ADHD) drugs and the prescription profiles of patients younger than 45 years starting treatment with these medicines between 2001 and 2006. Methods: Data were obtained from Dutch community pharmacies as collected by the Foundation for Pharmaceutical Statistics, covering 97% of all dispenses for prescription medicines to outpatients in The Netherlands. Results: The overall incidence of ADHD drugs use increased 6.5-fold from 2001 to 2006 in men as well as in women. The absolute incidence was highest among 6- to 11-year-old boys. The percentage of first-time MPH-IR users decreased fro...
TL;DR: In this preliminary open-label trial, aripiprazole showed effectiveness in treating tic symptoms without causing significant weight gain or other serious side effects and could be an option for TD cases that do not respond to conventional therapies.
Abstract: Objective: The primary aim of the study was to evaluate the effectiveness and tolerability of aripiprazole on motor and vocal tics in children and adolescents with Tourette's disorder (TD). The secondary aim was to assess the response of TD-associated behaviors to aripiprazole exposure. Methods: This was an 8-week, open-label trial with flexible dosing strategy of aripiprazole in children and adolescaents with TD. A total of 72 patients, aged 6–18 years, participated in the 8-week trial. The Yale Global Tic Severity Scale (YGTSS), the Clinical Global Impressions–Tics (CGI–Tics), and the Child Behavior Checklist (CBCL) were compared at the baseline, weeks 2 and 4, and end point. The side effects of aripiprazole, electrocardiogram (ECG), and body mass index (BMI) were evaluated. Results: Over the 8-week trial, aripiprazole administration was associated with a significant decrease in total tic severity as measured by the YGTSS (50.3% reduction by week 8). The mean scores of motor tic in the YGTSS we...
TL;DR: Examination of rates of psychotropic medication use over time among a national probability sample of youths involved with child welfare/child protective services (CW/CPS) in the National Survey of Child and Adolescent Well-Being (NSCAW) demonstrated complex relationships with group membership.
Abstract: Objective: The aim of this study was to examine rates of psychotropic medication use over time among a national probability sample of youths involved with child welfare/child protective services (CW/CPS) in the National Survey of Child and Adolescent Well-Being (NSCAW). Methods: Growth mixture modeling was used to classify 2,521 youths into groups based on individual medication use trajectories. Determinants associated with groupings were examined using logistic regression. Results: Overall, 22% of youths used medications over 3 years. Three groups were identified: (1) Low medication use (85%, n = 2,057), where medication was used rarely or never; (2) increasing medication use, where medication was commonly started after investigation (4%, n = 148); and (3) high medication use, where medication use was endorsed over multiple study waves (12%, n = 316). On multivariate modeling, physical abuse predicted membership in the increasing-use group (reference group, low use); Caucasian (versus African Am...
TL;DR: Clinical improvement, in terms of both body mass index (BMI) recovery and global functioning, paralleled the improvement of hyperactivity, and was evident at the end of the first month of treatment, and further increased in the following 5 months, with minimal side effects.
Abstract: Objective: The aim of this study was to evaluate the efficacy of olanzapine in girls with anorexia nervosa, restricting subtype (ANr). Methods: Thirteen patients (mean age 13.7 ± 2.3 years, age range 9.6–16.3 years) enrolled in a multimodal treatment for ANr were evaluated with standardized measures at baseline and after 1 and 6 months after starting low-dose olanzapine monotherapy (mean dose 4.13 mg/day). Results: A significant improvement was evident on weight (body mass index, BMI), global functioning (Children's Global Assessment Scale, CGAS), eating attitudes (Eating Attitudes Test-26, EAT-26), anxious-depressive symptoms (Child Behavior Checklist, CBCL) and hyperactivity (Structured Inventory for Anorexic and Bulimic Syndromes, SIAB). At the end of the 6-month follow up, 7 patients were responders according to an improvement of at least 50% in the EAT-26 results. The only measure that improved significantly in responders, but not in nonresponders, was hyperactivity (SIAB). Clinical improvem...
TL;DR: Preliminary results indicate replication of prior studies of behavioral tic suppression in youths with TD and without ADHD, and findings indicate tic reduction with acute dMPH challenge in children and adolescents with ADHD and TD.
Abstract: The aim of this study was to conduct a pilot study testing whether single-dose, immediate-release dexmethylphenidate (dMPH) can facilitate tic suppression in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and Tourette's disorder (TD) or chronic tic disorders. The primary hypothesis is that dMPH will improve behaviorally reinforced tic suppression in a standard tic suppression paradigm (TSP).Ten children with ADHD and TD were given dMPH on one visit and no medication on another, using a random crossover design. On both days, following a baseline period, subjects were reinforced for suppressing tics using a standard TSP.Thirteen subjects were enrolled; 10 subjects (mean age 12.7 +/- 2.6; 90% male) completed all study procedures. Relative to the no-medication condition, tics were reduced when children were given a single dose of dMPH. Behavioral reinforcement of tic suppression resulted in lower rates of tics compared to baseline, but dMPH did not enhance this suppression.Preliminary results indicate replication of prior studies of behavioral tic suppression in youths with TD and without ADHD. In addition, our findings indicate tic reduction (and not tic exacerbation) with acute dMPH challenge in children and adolescents with ADHD and TD.
TL;DR: Open-label CBZ-ER treatment was beneficial for the treatment of BD in children and future controlled trials are warranted.
Abstract: Objective: The aim of this study was to evaluate the safety and efficacy of extended release carbamazepine (CBZ-ER) monotherapy in the treatment of pediatric bipolar disorder (BD). Method: This was an 8-week, open-label, prospective trial of CBZ-ER monotherapy (788 ± 252 mg/day) to assess the effectiveness and tolerability of this compound in treating pediatric bipolar spectrum disorders. Assessments included the Young Mania Rating Scale (YMRS), Clinical Global Impressions–Improvement scale, Children's Depression Rating Scale, and Brief Psychiatric Rating Scale. Adverse events were assessed through spontaneous self-reports, vital signs weight monitoring, and laboratory analysis. Results: Of the 27 participating children with BD, 16 (59.%) completed the study. CBZ-ER treatment was associated with statistically significant, but modest, levels of improvement in mean YMRS scores (−10.1 ± 10.2, p < 0.001) with end-point mean YMRS score (21.8 ± 12.2) suggesting a lack of complete resolution of mania. C...
TL;DR: The clinical experience supports the assertion that ECT is a safe and effective treatment for SSD in adolescent patients.
Abstract: Objectives: The aim of this study was to evaluate the effectiveness and safety of electroconvulsive therapy (ECT) in adolescent patients diagnosed with schizophrenia spectrum disorders (SSD). Methods: All patients diagnosed with SSD who received ECT in the Child and Adolescent Psychiatry and Psychology Department in a general hospital in Barcelona, Spain, from January, 2003, to December, 2007, were identified retrospectively. As part of the usual evaluation protocol, Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression (CGI) scales were administered before ECT, after the acute ECT phase (CGI), and at 6 months from baseline. Data related to characteristics of these patients such as demographics, pharmacological treatment, ECT parameters, and side effects were registered. Results: Thirteen cases, ages 13–17 (mean age, 16.6 ± 1.2years), were included. Compared to pre-ECT scores, mean PANSS decreased significantly at 6-month assessment (t = 3.58, p = 0.004). Clinical response (...
TL;DR: There were few predictors of optimal dose of OROS other than baseline symptom severity, and adolescents required, on average, a higher absolute dose but a lower weight-adjusted dose (mg/kg) than was previously reported in children.
Abstract: Objective: The aim of this study was to evaluate dose–response characteristics in adolescents with attention-deficit/hyperactivity disorder (ADHD) treated with once-daily OROS® methylphenidate (OROS® MPH) during the 4-week, open-label, escalating dose-titration phase of a larger multisite, placebo-controlled trial. Patient factors such as age, height, weight, and baseline symptom severity were evaluated as predictors of selected dose, as was the degree of incremental response with each successive dose escalation. Methods: Adolescents 13–18 years of age with ADHD underwent a 4-week, open-label, escalating dose-titration trial to determine the minimal effective dose (18, 36, 54, or 72 mg once daily) of OROS® to be used in a multiphase, placebo-controlled study (NCT00249353). Both final absolute dose and mean weight-adjusted dose were used to assess predictors of response, using a one-way analysis of variance and regression analyses. Results: The majority of subjects who did not respond at lower dos...
TL;DR: The literature review reveals that the treatment of Tourette's disorder and tics has evolved from an early history of marginally effective approaches to the advent of neuroleptics, which started a new era in TD and tic treatment, with a significantly broader range of effectiveness.
Abstract: Objective: The aim of this study was to review the efficacy of various treatments for Tourette's disorder (TD) and tics. Method: This study is a historical review of the treatment modalities prior to the advent of neuroleptics. A review of double-blind and placebo-controlled clinical trials and open studies on the use of neuroleptics and selected reports was also carried out. Results: The literature review reveals that the treatment of TD and tics has evolved from an early history of marginally effective approaches to the advent of neuroleptics, which started a new era in TD and tic treatment, with a significantly broader range of effectiveness. Conclusions: Although progress has been made, the literature review nevertheless reveals a great deal of confusion as related to the clinical heterogeneity of TD and tics, differences in populations, medication–dose combinations, and outcomes. However, a role for a limited number of pharmacologic agents, combined with psychosocial approaches, has been ide...
TL;DR: Gene variants in MDR1 may influence guanfacine response on hyperactive-impulsive behaviors via altered membrane transport and if replicated in larger samples, additional studies would be important to clarify the mechanisms underlying this effect and to determine its clinical significance.
Abstract: Objective: Guanfacine has been shown to reduce hyperactive behaviors in children with attention-deficit/hyperactivity disorder (ADHD) and possibly in children with pervasive developmental disorder (PDD) and hyperactivity. The aim of this exploratory study was to examine whether gene variants encoding the multidrug resistance protein (MDR1 or ABCB1) , a drug transporter at the blood–brain barrier, are associated with variability in the efficacy of guanfacine in children with PDD and hyperactivity. Methods: Children with PDD who participated in an 8-week open-label trial of guanfacine were genotyped for the C3435T single-nucleotide polymorphism (SNP) variant of the MDR1 gene, a variant reported to alter function of the transporter. The decrease from baseline to 8 weeks in parent-rated Aberrant Behavior Checklist (ABC) hyperactivity and Swanson, Nolan, and Pelham (SNAP) scores were analyzed by MDR1 genotype. Response was compared between subjects homozygous for the minor allele T of the C34535T MDR1...