Journal of child and adolescent psychopharmacology最新文献

Introduction: Neuroleptic malignant syndrome (NMS), catatonia, and serotonin syndrome (SS) are unique neuropsychiatric conditions that share overlapping clinical features. Case Report: A 14-year-old boy presented to the hospital for surgical resection of a pineal gland teratoma. Following surgery, he developed cerebellar cognitive and affective syndrome, which led to dramatic behavioral changes, including suicidal behavior and agitation. Throughout his postsurgical course, he exhibited signs and symptoms concerning for overlapping NMS, catatonia, and SS. Discussion: Through this case we highlight the complex neurophysiology of three neuropsychiatric syndromes, review the treatment course for this patient, and raise awareness that these neuropsychiatric syndromes can occur concurrently.

Objective: To describe the rates and predictors of youth and parent satisfaction following engagement in one of three evidence-based treatments or a placebo control for youth anxiety. Method: In a multisite randomized controlled trial (RCT) of youth ages 7-17 (n = 426) and parents (n = 429) comparing cognitive behavioral therapy (CBT), sertraline (SRT), the combination of the two (COMB), and placebo (PBO), we examined satisfaction at the end of acute treatment and assessed predictors including clinical change, pretreatment expectations, reactions to treatment assignment, and therapeutic relationship using multiple hierarchical linear regressions. Results: Satisfaction was high across all treatments. Both parents and youth reported the highest satisfaction with COMB, followed by CBT and SRT, and the least satisfaction with PBO. Parents were more satisfied than youth, and remitters were more satisfied than nonremitters. In CBT-containing arms, a stronger child-therapist relationship at week 6 predicted greater parent and youth satisfaction. Higher expectations of improvement at pretreatment predicted greater youth, but not parent, satisfaction in CBT and SRT. Discussion: Posttreatment, youth and parents report greater satisfaction with combination therapy over the monotherapies and PBO. Satisfaction patterns largely mirror clinical outcomes. An early strong youth-reported therapeutic alliance is key to satisfaction in CBT, highlighting the importance of child-therapist alignment when selecting anxiety treatments.

Background: Improving early recognition and accurate diagnosis of major depressive disorder (MDD) in childhood is a pressing concern. Quantitative electroencephalogram (qEEG) may be an effective, noninvasive diagnostic biomarker for MDD. Prior work by our team demonstrated decreased resting connectivity, as measured by qEEG coherence, in a heterogeneous group of adolescents with MDD compared with age and gender-matched healthy controls (HCs). This study explored qEEG coherence as a predictor of MDD diagnosis in a prospective, longitudinal sample of medication-free, adolescents with MDD versus HCs. Methods: Twenty-eight adolescents with MDD (Children's Depression Rating Scale score ≥40) and 27 age and gender-matched HCs (age 14-17, 78% female) received a baseline resting 32-channel EEG. Brain-wide coherence between channel pairs was calculated for the frequency bands (alpha, beta, theta, and delta) and compared between MDD youth and HC. Random forest classifiers were used to predict individual MDD status using baseline qEEG coherence. Models were trained and tested using 10-repeated, 10-fold cross-validation, and performance was evaluated with the area under the receiver operating characteristic curve (AUC-ROC). The contribution of individual predictors was assessed using permutation importance. Model significance was assessed using permutation testing (B = 1000 resamples). Results: Random forest models predicted depression status with a trend-level of significance (mean AUC-ROC = 0.65, p = 0.08). Among the most predictive channel pairs, adolescent MDD was characterized by lower coherence in T7-P7 (p < 0.05), Fz-Cz, and Fp2-F8 as well as higher coherence in P4-O2 and Cz-Pz. Conclusions: This study provides preliminary evidence that multivariate patterns of qEEG may inform the diagnosis of adolescent MDD. Specific aberrant patterns of coherence within the default mode network and cognitive control network were characteristic of adolescent MDD. Ongoing work will seek to replicate these findings in a larger cohort.

Background: Despite the increased risk for psychopathology in individuals with neurogenetic syndromes, very few psychopharmacology trials have been conducted in these populations. Objectives: The objective of this perspectives article is to describe recruitment challenges and potential solutions for psychopharmacology trials in neurogenetic syndromes. Methods: We describe recruitment challenges and lessons learned from an open-label trial of fluoxetine for the treatment of depression in adults with Down syndrome (DS). These challenges are contrasted with a successful open-label trial of buspirone for the treatment of anxiety in Williams syndrome. Results: Factors that contributed to recruitment challenges include limited research on the clinical presentation of depression in DS and the relatively small target population. This experience highlights the importance of foundational research studies on the phenomenology of target symptoms and burden of disease, as well as disseminating that information to the patient/family community. Partnership with a local family organization with close ties to the patient population can assist in overcoming recruitment barriers. Conclusion: The successes and challenges of early psychopharmacology clinical trials in neurogenetic syndromes should be considered for future trials.

Objective: This article presents the protocol for an open-label clinical trial examining the effectiveness of atomoxetine augmentation in adolescents with nonsuicidal self-injury (NSSI) and attention problems and reports preliminary findings from the initial group of participants. Methods: Adolescents (n = 27) aged 13-18 years who met the criteria for NSSI according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and had either full or subclinical attention-deficit/hyperactivity disorder (ADHD) were recruited. All participants had not received ADHD medication for at least 4 weeks prior to enrollment. Psychiatric diagnoses were confirmed using the Kiddie Schedule for Affective Disorders and Schizophrenia. After 12 weeks of adjunctive atomoxetine treatment, NSSI severity (primary outcome) was measured using the Inventory of Statements About Self-Injury. Secondary outcomes included the Children's Depression Rating Scale (CDRS), the Children's Depression Inventory (CDI), the Screen for Child Anxiety Related Emotional Disorders (SCARED), and DuPaul's ADHD Rating Scale (ARS). Additional assessments targeting factors related to NSSI included demographic characteristics, childhood adversity, personality functioning, continuous performance task, and functional near-infrared spectroscopy. Results: Twenty-three participants (22 female, 1 male) completed the trial (mean final dose: 58.3 ± 13.7 mg), while four discontinued (two voluntarily, two due to adverse events). Significant improvements were observed in CDRS (p < 0.001), CDI (p = 0.031), and NSSI severity (p = 0.007). In the ADHD group, significant improvements were observed in CDRS (p = 0.017) and NSSI severity (p = 0.034), with a trend toward improvement in CDI (p = 0.058). The subclinical ADHD group showed significant improvement in CDRS (p = 0.006), with a trend toward improvement in NSSI severity (p = 0.083). Conclusion: Atomoxetine augmentation may reduce NSSI severity in adolescents with attention problems, particularly in those with comorbid ADHD, warranting further investigation in larger controlled trials.

Purpose: There has been recent concern for the rising rates of catatonia diagnosis in pediatric populations. We set out to determine if the rates of catatonia diagnosis have risen at an academic pediatric medical center. Methods: The clinical records of 131 patients were obtained from encounters during 2018-2023 in which a diagnosis of catatonia was made in the pediatric emergency department or inpatient medical hospital. Ordinary least squares regression and linear regression analyses were used to determine if the prevalence of catatonia diagnoses, underlying diagnostic category, and Bush-Francis Catatonia Rating Scale scores changed over time. Results: A 10-fold increase was observed in catatonia diagnoses between 2018 and 2023. A statistically significant relationship between the year of pediatric catatonia diagnoses was discovered (p = 0.01), with an R² value of 0.83 suggesting that approximately 83% of the variance can be attributed to the passage of time. Both medical and psychiatric causes of catatonia showed an upward trend over the course of the study period. The average Bush-Francis Catatonia Rating Scale scores showed a slight upward trend but were not statistically significant. Conclusion: In this sample of pediatric patients hospitalized at a large academic medical center, the rate of catatonia diagnoses related to both medical and psychiatric causes rose between 2018 and 2023. These data are consistent with previous evidence highlighting an increase in catatonia diagnoses during this period. The COVID-19 pandemic and increasing awareness of catatonia in children may have contributed to this trend. These data support the importance of investigation into this trend and improving education on catatonia for clinicians and the public.

Objective: Evidence for medical cannabis use and effectiveness in autism has begun to accumulate but remains limited, even as clinical interest has rapidly increased. In Israel, medical cannabis may be prescribed for autism with severe behavioral disturbances under strict Ministry of Health criteria requiring prior trials of two Food and Drug Administration (FDA)-approved antipsychotics. Using a large real-world dataset, this study aimed to characterize autistic individuals prescribed medical cannabis and evaluate adherence to national guidelines. Methods: A retrospective cohort study was conducted using electronic medical records from Clalit Health Services, Israel's largest Health Maintenance Organization. All individuals with a documented autism diagnosis between 1990 and 2025 were identified (N = 36,610) and classified as cannabis-prescribed (N = 462) or not-prescribed (N = 36,148). Demographic and clinical characteristics were compared, including prior use of FDA-approved antipsychotics. Results: Only 1.2% of individuals with autism were prescribed medical cannabis. Of these, 4.3% of prescriptions were issued for children under 5 years of age. The cannabis-prescribed group was diagnosed earlier (median 3 vs. 5 years, p < 0.001) and had higher rates of ADHD (42% vs. 30%), intellectual disability (12% vs. 5%), and epilepsy (14% vs. 6%) (all p < 0.001). While 69% had used at least one FDA-approved antipsychotic medication prior to cannabis initiation, only 28% had documented trials of both, as required by national guidelines. Marked sociodemographic disparities were also observed: the cannabis-prescribed group had a higher socioeconomic status (median SES 7 vs. 6, p < 0.001) and lower representation of Arab individuals (2.7% vs. 11%, p < 0.001). Conclusions: Medical cannabis use among autistic individuals was rare and mainly observed among those with more complex clinical profiles and higher socioeconomic backgrounds. Most prescriptions did not fully comply with guidelines requiring prior antipsychotic trials. These findings underscore the need for enhanced regulatory oversight, equitable access, and longitudinal research to evaluate real-world outcomes and guide evidence-based clinical practice.