Journal of child and adolescent psychopharmacology最新文献

Objectives: Individuals with both avoidant/restrictive food intake disorder (ARFID) and pediatric acute-onset neuropsychiatric syndrome (PANS) report restrictive eating. Inflammatory and immunological alterations may drive the onset of restrictive eating and comorbid obsessive-compulsive (OC) symptoms in PANS, while the etiology of restrictive eating in ARFID is unknown. Nevertheless, few studies have explored PANS and related OC symptoms among individuals with ARFID. We aimed to identify the frequency and nature of PANS and OC symptoms among those with full or subthreshold ARFID. We also explored associations between OC severity, ARFID profiles, and infection history.

Methods: The study included 37 adolescents and young adults with subthreshold or full ARFID. We quantified the frequency of PANS/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection symptoms and diagnoses, as well as OC symptoms and severity, in our ARFID sample. We analyzed associations between ARFID profiles and OC severity, along with the relationship between infection history and OC severity.

Results: Two individuals (5%) met PANS criteria, and 17 (46%) reported lifetime mild-severe OC severity. The fear of aversive consequences profile was associated with a significant increase in log-transformed OC severity (β = 1.2, p = 0.04, adjusted R² = 0.10) after adjusting for sensory sensitivity, lack of interest, and body mass index z-score. We did not find any associations between OC severity and infection history.

Discussion: In the first study to examine PANS and related symptoms among individuals with ARFID, we demonstrated salient overlap between PANS, OC symptoms, and ARFID. Further research is needed to examine the relationship between ARFID and PANS.

Objective: Cognitive disengagement syndrome (CDS) is associated with internalizing symptoms, emotion regulation (ER) difficulties, daytime sleepiness, and impulsivity; however, their interrelations in adolescents with subthreshold attention-deficit/hyperactivity disorder (ADHD) remain underexamined. This study aimed to evaluate the relationships between CDS, ADHD symptoms, ER problems, daytime sleepiness, trait impulsivity, and internalizing symptoms and to determine the mediating roles of ER problems and daytime sleepiness.

Methods: This cross-sectional, clinic-based study included 144 treatment-naïve adolescents (12-18 years) referred for inattention and/or hyperactivity/impulsivity complaints. Parent-reported measures (Conners Parent Rating Scale-Revised-Short Form (CPRS-R-SF); Child and Adolescent Behavior Inventory-Sluggish Cognitive Tempo Scale [(CABI-SCT]) and adolescent self-reports (Pediatric Daytime Sleepiness Scale [PDSS], Revised Child Anxiety and Depression Scale-Child Version [RCADS-CV], Difficulties in Emotion Regulation Scale-Short Form [DERS-16], Barratt Impulsiveness Scale-Brief) were administered. Pearson correlations with Bonferroni-Holm correction and structural equation modeling were performed. The CPRS ADHD index and CABI-SCT served as predictors, DERS-16 and PDSS as mediators, RCADS-CV-Total as the outcome, and trait impulsivity, sex, and socioeconomic status were included as confounders.

Results: CDS showed moderate-to-high correlations with ADHD indices and significant associations with all internalizing domains except separation anxiety. CDS and daytime sleepiness were moderately correlated, and both were significantly associated with ER difficulties. Trait impulsivity correlated with CDS, ER problems, and internalizing symptoms. CDS was associated with internalizing symptoms through an indirect pathway involving ER difficulties, whereas daytime sleepiness did not a significant mediating effect. Trait impulsivity significantly predicted CDS, ADHD symptoms, ER difficulties, and daytime sleepiness, supporting its role as a shared vulnerability factor.

Conclusion: CDS symptoms appear more closely related to ER difficulties and internalizing symptoms than subthreshold ADHD symptoms in clinically referred adolescents. ER problems may represent a key mechanism linking CDS to internalizing psychopathology. Routine assessment of CDS symptoms, ER skills, and sleep-related problems may facilitate early identification of at-risk youth. Interventions targeting ER skills and sleep-related processes may represent potential targets for future interventional research, and that longitudinal studies using multimethod assessments are needed to clarify causal pathways.

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood. Conventional adiposity indicators have been linked to ADHD. Relative fat mass (RFM), a novel adiposity measure, has demonstrated advantages in predicting metabolic and cardiovascular disease risk, conditions that share overlapping pathophysiological mechanisms with ADHD. This study aimed to investigate the association between RFM and ADHD, with a particular focus on sex-specific differences.

Methods: Data were obtained from the 1999-2004 National Health and Nutrition Examination Survey, including 5089 children aged 6-14 years. RFM was calculated using height and waist circumference, and ADHD was defined based on physician diagnosis reported in the questionnaire. Multivariable logistic regression models were applied to assess the association between RFM and ADHD. Smooth curve fitting was conducted to validate the results, and subgroup analyses were performed separately for boys and girls.

Results: A significant sex-specific association between RFM and ADHD was observed. Among boys, higher RFM levels were inversely associated with ADHD (Model 3: odds ratio [OR] = 0.967, 95% confidence interval [CI]: 0.946-0.989), whereas among girls, higher RFM levels were positively associated with ADHD (Model 3: OR = 1.043, 95% CI: 1.007-1.081). Smooth curve fitting confirmed these opposite linear trends in both sexes. Subgroup analyses further demonstrated that this sex-specific pattern was consistent across strata defined by age, health insurance status, maternal smoking during pregnancy, and birth weight.

Conclusions: There is a significant sex-specific association between RFM and ADHD, showing an inverse relationship in boys and a positive association in girls. These findings suggest that the influence of adiposity distribution on ADHD differs by sex, highlighting the importance of considering sex differences when evaluating risk factors for ADHD.

Importance: Psychotropic classes concomitant with stimulants (PCCWS) in children and adolescents have shown an inconsistent impact on the risk of diabetes mellitus. PCCWS with 2-5 classes is common but the risk of diabetes subsequent to stimulant initiation is unknown. Objective: To assess the risk of diabetes in youth with PCCWS regimens with 2-5 additional psychotropic classes. Design: A retrospective cohort study was conducted using Medicaid claims data from 2007-2014. Youth aged 2-17 years with 1-7.5 years of continuous enrollment who were new stimulant users with clinician-reported psychiatric diagnosis were followed. Setting: Outpatient clinic and inpatient records for statewide Medicaid-insured youth in a mid-Atlantic state. Participants: The study cohort comprised 30,112 youth with an average follow-up of 6.4 years. Exposures: Among stimulant users, five groups were defined according to concomitant use. Main Outcomes and Measures: The major outcome is diabetes risk and was assessed using discrete-time failure models, after adjustment for disease risk score which was categorized using more than 120 baseline and time-dependent covariates. Results: Among 30,112 new stimulant users, 43 were new diabetes patients and 30,069 were nondiabetes patients. The absolute risk of diabetes in youth had an eight-fold increase from 3 to 5 class PCCWS regimens that included antipsychotics, antidepressants, or anticonvulsant-mood stabilizers (0.5; 1.13; 4.20 per 10,000 person-months, respectively). Compared with stimulant monotherapy, PCCWS with any of these 3 classes were significantly more likely to develop diabetes (adjusted relative risk [ARR], 2.58, (95% CI 1.05-6.82); 5.81, (2.29-14.75); 18.91, (6.07-58.90) for 3, 4 and 5 class PCCWS, respectively). Similarly, there was a significantly greater risk of diabetes for those with 120-779 days of cumulative duration than for shorter exposures, and in 4 and 5 class combined PCCWS including antipsychotics, antidepressants, or anticonvulsant-mood stabilizers [ARR, 3.78, (1.16-12.40)]. Conclusions: In a large Medicaid-insured, long-enrolled youth cohort, the use of PCCWS, particularly concomitant use with antipsychotic, antidepressant, and/or antipsychotic-mood stabilizers, and with long duration of these combinations were associated with an increased risk of diabetes. Relevance: The findings support a call for corroboration in a large national cohort of continuously enrolled Medicaid-insured pediatric youth with long follow-up.

Objective: Children who experience prolonged separation anxiety may develop "avoidance" patterns of emotional regulation that manifest in stressful behavioral responses. This study tests whether maladaptive habits and adjustment disorders mediate the link between separation anxiety and depression in primary school students. Methods: In November 2022, we conducted a cross-sectional survey of 4474 students from elementary schools in Qionghai and Dongfang cities, Hainan Province, China, using stratified cluster sampling. Parents completed the Mental Health Rate Scale for Pupils. Data were analyzed with SPSS 22.0 (descriptive statistics, analysis of variance, correlations), AMOS 26.0 (structural equation modeling [SEM]), and Mplus 8.3 (latent class analysis). Results: SEM revealed that 12.2% of participants met criteria for depression. Students with separation anxiety had 4.5-5.0 times higher odds of depression compared to those without separation anxiety (95% confidence interval [CI]: 3.8-6.2). Mediation analysis indicated that maladaptive habits and adjustment difficulties partially mediated this association, with stronger indirect effects observed in older grades (Grades 5 and 6: β = 0.32, 95% CI: 0.24-0.41 vs. Grades 3 and 4: β = 0.21, 95% CI: 0.15-0.28). Conclusions: These findings suggest that early identification of maladaptive coping patterns in children with separation anxiety could improve mental health outcomes. We recommend integrating "secure separation" education strategies into teacher training programs and school counseling services, including structured transition activities and separation rituals, to support children's emotional adjustment during school transitions.

Objective: To construct a network model depicting non-suicidal self-injury (NSSI) and its influencing factors in adolescents diagnosed with depression, identify the core symptoms within this network, explore the potential causal pathways, and generate hypotheses for future research. Methods: A sample of 705 adolescent patients with depressive disorders was recruited and assessed using three standardized questionnaires, namely the Childhood Trauma Questionnaire, the Aggression Questionnaire, and the Adolescent Self-Injury Questionnaire. Undirected network analysis, coupled with directed Bayesian network analysis, was employed to elucidate the interrelationships among symptoms. Results: In the network of NSSI-related influencing factors in adolescents with depression, emotional abuse, hostility, sexual abuse, and emotional neglect are important influencing factors. Hostility and anger serve as bridges that connect NSSI to other influencing factors. In the Bayesian network, emotional abuse is shown to precede other symptoms, such as hostility and anger; conversely, NSSI and physical aggression were positioned at the periphery of the network, indicating a greater reliance on other symptoms for their occurrence. Emotional abuse demonstrated the strongest associations with the greatest number of other problems in the network, indicating that emotional abuse plays a crucial role. Conclusion: Emotional abuse plays an important role in the network model of NSSI of adolescent depression patients and its influencing factors.

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.