Martin Plöderl, Mark A Horowitz, Michael P Hengartner
{"title":"Re: \"A Multicenter Double-Blind, Placebo-Controlled Trial of Escitalopram in Children and Adolescents with Generalized Anxiety Disorder\" by Strawn et al.-Concerning Harm-Benefit Ratio in a Recent Trial About Escitalopram for Generalized Anxiety Disorder.","authors":"Martin Plöderl, Mark A Horowitz, Michael P Hengartner","doi":"10.1089/cap.2023.0029","DOIUrl":"https://doi.org/10.1089/cap.2023.0029","url":null,"abstract":"","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41162658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1089/cap.2023.29243.editorial
Harold S Koplewicz
{"title":"From the Editor-in-Chief's Desk.","authors":"Harold S Koplewicz","doi":"10.1089/cap.2023.29243.editorial","DOIUrl":"10.1089/cap.2023.29243.editorial","url":null,"abstract":"","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10018160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paul P Yeung, Kimball A Johnson, Robert Riesenberg, Amelia Orejudos, Todd Riccobene, Hari V Kalluri, Paul R Malik, Shane Varughese, Robert L Findling
Objective: Cariprazine is a dopamine D3-preferring D3/D2 and serotonin 5-HT1A receptor partial agonist approved to treat adults with schizophrenia and manic/mixed or depressive episodes associated with bipolar I disorder. This study, which is the first to evaluate cariprazine in pediatric patients with autism spectrum disorder (ASD) (including children 5-9 years of age) using an oral solution formulation, evaluated the safety, tolerability, pharmacokinetics (PK), and exploratory efficacy of cariprazine and its two major active metabolites, desmethyl cariprazine (DCAR) and didesmethyl cariprazine (DDCAR). Methods: This clinical pharmacology, open-label, multiple-dose study enrolled 25 pediatric patients from 5 to 17 years of age, who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for ASD. All patients began treatment with cariprazine 0.5 mg once daily (QD) and underwent a titration over 7 days to maintenance doses of 1.5 or 3 mg QD for patients 13-17 years of age at Screening, 0.75 or 1.5 mg QD for patients 10-12 years of age at Screening, and 0.5 or 1.5 mg QD for patients 5-9 years of age at Screening. After 6 weeks total of dosing, there was a 6-week follow-up period. Study assessments included adverse events (AEs), safety parameters, noncompartmental PK parameters, and exploratory efficacy assessments, including the Aberrant Behavior Checklist-Irritability Subscale (ABC-I), Clinical Global Impressions (CGI-S), Caregiver Global Impressions (CgGI-S), Children's Yale-Brown Obsessive Compulsiveness Scale Modified for ASD (CYBOCS-ASD), Social Responsiveness Scale (SRS), and Vineland Adaptive Behavior Scale (VABS-III). Results: All AEs were mild or moderate in severity. Most frequent treatment-emergent adverse events (TEAEs) were increased weight, increased alanine aminotransferase, increased appetite, dizziness, agitation, and nasal congestion. Increases in weight were not considered clinically meaningful. Two subjects reported extrapyramidal symptom-related TEAEs that resolved without leading to discontinuation. Dose-normalized exposures of all analytes were modestly higher in pediatric patients from 5 to 9 years of age when compared to older patients. Consistent with previous studies, at steady state, the rank of exposure in plasma was DDCAR > cariprazine > DCAR. There was numerical improvement on all exploratory endpoints (ABC-I, CGI-S, CgGI-S, CYBOCS-ASD, SRS, and VABS-III). Conclusions: PK of cariprazine and its metabolites were characterized in pediatric patients with ASD at doses up to 3 mg QD (13-17 years) and 1.5 mg QD (5-12 years). Caripazine treatment was generally well tolerated and results from this study will inform the selection of appropriate pediatric doses for subsequent studies.
{"title":"Cariprazine in Pediatric Patients with Autism Spectrum Disorder: Results of a Pharmacokinetic, Safety and Tolerability Study.","authors":"Paul P Yeung, Kimball A Johnson, Robert Riesenberg, Amelia Orejudos, Todd Riccobene, Hari V Kalluri, Paul R Malik, Shane Varughese, Robert L Findling","doi":"10.1089/cap.2022.0097","DOIUrl":"https://doi.org/10.1089/cap.2022.0097","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Cariprazine is a dopamine D<sub>3</sub>-preferring D<sub>3</sub>/D<sub>2</sub> and serotonin 5-HT<sub>1A</sub> receptor partial agonist approved to treat adults with schizophrenia and manic/mixed or depressive episodes associated with bipolar I disorder. This study, which is the first to evaluate cariprazine in pediatric patients with autism spectrum disorder (ASD) (including children 5-9 years of age) using an oral solution formulation, evaluated the safety, tolerability, pharmacokinetics (PK), and exploratory efficacy of cariprazine and its two major active metabolites, desmethyl cariprazine (DCAR) and didesmethyl cariprazine (DDCAR). <b><i>Methods:</i></b> This clinical pharmacology, open-label, multiple-dose study enrolled 25 pediatric patients from 5 to 17 years of age, who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for ASD. All patients began treatment with cariprazine 0.5 mg once daily (QD) and underwent a titration over 7 days to maintenance doses of 1.5 or 3 mg QD for patients 13-17 years of age at Screening, 0.75 or 1.5 mg QD for patients 10-12 years of age at Screening, and 0.5 or 1.5 mg QD for patients 5-9 years of age at Screening. After 6 weeks total of dosing, there was a 6-week follow-up period. Study assessments included adverse events (AEs), safety parameters, noncompartmental PK parameters, and exploratory efficacy assessments, including the Aberrant Behavior Checklist-Irritability Subscale (ABC-I), Clinical Global Impressions (CGI-S), Caregiver Global Impressions (CgGI-S), Children's Yale-Brown Obsessive Compulsiveness Scale Modified for ASD (CYBOCS-ASD), Social Responsiveness Scale (SRS), and Vineland Adaptive Behavior Scale (VABS-III). <b><i>Results:</i></b> All AEs were mild or moderate in severity. Most frequent treatment-emergent adverse events (TEAEs) were increased weight, increased alanine aminotransferase, increased appetite, dizziness, agitation, and nasal congestion. Increases in weight were not considered clinically meaningful. Two subjects reported extrapyramidal symptom-related TEAEs that resolved without leading to discontinuation. Dose-normalized exposures of all analytes were modestly higher in pediatric patients from 5 to 9 years of age when compared to older patients. Consistent with previous studies, at steady state, the rank of exposure in plasma was DDCAR > cariprazine > DCAR. There was numerical improvement on all exploratory endpoints (ABC-I, CGI-S, CgGI-S, CYBOCS-ASD, SRS, and VABS-III). <b><i>Conclusions:</i></b> PK of cariprazine and its metabolites were characterized in pediatric patients with ASD at doses up to 3 mg QD (13-17 years) and 1.5 mg QD (5-12 years). Caripazine treatment was generally well tolerated and results from this study will inform the selection of appropriate pediatric doses for subsequent studies.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10458368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10456069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01Epub Date: 2023-07-20DOI: 10.1089/cap.2023.0001
Bruno Biagianti, Christine Conelea, Sawsan Dabit, Daniel Ross, Katie L Beard, Elizabeth Harris, Erin Shen, Josh Jordan, Gail A Bernstein
Objective: Cognitive-Behavioral Group Therapy (CBGT) is an established treatment for Social Anxiety (SA). However, diagnostic recovery rate is only 20.5% in CBGT, and up to 50% of patients remain symptomatic posttreatment. Using videocalls to deliver digital CBGT (dCBGT) is feasible, cost-effective, and efficacious. Yet, the impact of dCBGT on social functioning remains limited, as dCBGT does not offer opportunities for monitoring cognition and behavior in social situations. Wiring Adolescents with Social Anxiety via Behavioral Interventions (WASABI), a clinician-assisted application that uses ecological momentary assessments (EMAs), cognitive bias tests, and clinical self-reports, was investigated as an adjunct to dCBGT. Methods: A prospective, parallel arm, double-blind randomized controlled trial was employed in 24 SA adolescents randomly assigned to dCBGT versus dCBGT plus WASABI. Results: Study completion rates (83%) and exit survey data indicated that WASABI is feasible and acceptable. Engagement with EMAs varied from four to 244 EMAs completed per person. Cognitive bias tests and clinical self-reports were completed at least weekly by 53% and 69% of participants, respectively. While standard tests did not reveal statistically significant differences between dCBGT plus WASABI and dCBGT alone, effect sizes were greater for dCBGT plus WASABI on symptom severity, social skills, and functioning. Conclusions: Despite the small sample, preliminary results suggest that WASABI is feasible, acceptable, and may be an effective augmentation tool for treating SA in teenagers.
目的:认知行为团体疗法(CBGT认知行为团体疗法(CBGT)是一种治疗社交焦虑(SA)的成熟疗法。然而,CBGT 的诊断康复率仅为 20.5%,多达 50% 的患者在治疗后仍有症状。使用视频电话进行数字化社交焦虑治疗(dCBGT)是可行的,既经济又有效。然而,dCBGT 对社交功能的影响仍然有限,因为 dCBGT 无法监测社交场合中的认知和行为。通过行为干预治疗青少年社交焦虑(Wiring Adolescents with Social Anxiety via Behavioral Interventions,WASABI)是一种由临床医生辅助的应用程序,它使用了生态瞬间评估(EMA)、认知偏差测试和临床自我报告,作为 dCBGT 的辅助治疗方法进行了研究。研究方法采用前瞻性、平行臂、双盲随机对照试验,在 24 名 SA 青少年中随机分配 dCBGT 与 dCBGT 加 WASABI。试验结果研究完成率(83%)和退出调查数据表明,WASABI 是可行且可接受的。每人完成的 EMA 从 4 次到 244 次不等。分别有 53% 和 69% 的参与者至少每周完成一次认知偏差测试和临床自我报告。虽然标准测试并未显示出 dCBGT 加 WASABI 与单独使用 dCBGT 之间存在统计学意义上的显著差异,但 dCBGT 加 WASABI 在症状严重程度、社交技能和功能方面的效应大小更大。结论:尽管样本较少,但初步结果表明,WASABI 是可行的、可接受的,而且可能是治疗青少年自闭症的有效辅助工具。
{"title":"A Mobile Application Adjunct to Augment Cognitive-Behavioral Group Therapy for Adolescents with Social Anxiety: Feasibility and Acceptability Results from the Wiring Adolescents with Social Anxiety via Behavioral Interventions Pilot Trial.","authors":"Bruno Biagianti, Christine Conelea, Sawsan Dabit, Daniel Ross, Katie L Beard, Elizabeth Harris, Erin Shen, Josh Jordan, Gail A Bernstein","doi":"10.1089/cap.2023.0001","DOIUrl":"10.1089/cap.2023.0001","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Cognitive-Behavioral Group Therapy (CBGT) is an established treatment for Social Anxiety (SA). However, diagnostic recovery rate is only 20.5% in CBGT, and up to 50% of patients remain symptomatic posttreatment. Using videocalls to deliver digital CBGT (<i>d</i>CBGT) is feasible, cost-effective, and efficacious. Yet, the impact of <i>d</i>CBGT on social functioning remains limited, as <i>d</i>CBGT does not offer opportunities for monitoring cognition and behavior in social situations. Wiring Adolescents with Social Anxiety via Behavioral Interventions (WASABI), a clinician-assisted application that uses ecological momentary assessments (EMAs), cognitive bias tests, and clinical self-reports, was investigated as an adjunct to <i>d</i>CBGT. <b><i>Methods:</i></b> A prospective, parallel arm, double-blind randomized controlled trial was employed in 24 SA adolescents randomly assigned to <i>d</i>CBGT versus <i>d</i>CBGT plus WASABI. <b><i>Results:</i></b> Study completion rates (83%) and exit survey data indicated that WASABI is feasible and acceptable. Engagement with EMAs varied from four to 244 EMAs completed per person. Cognitive bias tests and clinical self-reports were completed at least weekly by 53% and 69% of participants, respectively. While standard tests did not reveal statistically significant differences between <i>d</i>CBGT plus WASABI and <i>d</i>CBGT alone, effect sizes were greater for <i>d</i>CBGT plus WASABI on symptom severity, social skills, and functioning. <b><i>Conclusions:</i></b> Despite the small sample, preliminary results suggest that WASABI is feasible, acceptable, and may be an effective augmentation tool for treating SA in teenagers.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10458379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1089/cap.2023.29242.rfs2022
Melissa DelBello
{"title":"Rosalind Franklin Society Proudly Announces the 2022 Award Recipient for <i>Journal of Child and Adolescent Psychopharmacology</i>.","authors":"Melissa DelBello","doi":"10.1089/cap.2023.29242.rfs2022","DOIUrl":"https://doi.org/10.1089/cap.2023.29242.rfs2022","url":null,"abstract":"","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10016546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicole E Yan, Mikaela K Dimick, Kody G Kennedy, Clement C Zai, James L Kennedy, Bradley J MacIntosh, Benjamin I Goldstein
Background: Vascular endothelial growth factor (VEGF) may be relevant to bipolar disorder (BD) and brain structure. We evaluated VEGF rs699947 single-nucleotide polymorphism in relation to structural neuroimaging phenotypes in youth BD. Methods: We collected 3 T anatomical magnetic resonance images from 154 youth (79 BD and 75 healthy control [HC]) genotyped for VEGF rs699947. The participants were age (BD = 17.28 ± 1.40 and HC = 17.01 ± 1.83, t = -1.02, p = 0.31) and sex (BD = 63.3% females and HC = 52.0% females, χ2 = 2.01, p = 0.16) matched. Cortical thickness, surface area (SA), and volume were examined by region-of-interest (ROI) and vertex-wise analyses using general linear models (GLMs). ROI investigations selected for the prefrontal cortex (PFC), amygdala, and hippocampus. Vertex-wise analyses controlled for age, sex, and intracranial volume. Results: ROI results found lower PFC SA (p = 0.003, ηp2 = 0.06) and volume (p = 0.04, ηp2 = 0.03) in BD and a main effect of rs699947 on hippocampal volume (p = 0.03, ηp2 = 0.05). The latter two findings did not survive multiple comparisons. Vertex-wise analyses found rs699947 main effects on left postcentral gyrus volume (p < 0.001), right rostral anterior cingulate SA (p = 0.004), and right superior temporal gyrus thickness (p = 0.004). There were significant diagnosis-by-genotype interactions in the left superior temporal, left caudal middle frontal, left superior frontal, right fusiform, and right lingual gyri, and the left insular cortex. Posthoc analyses revealed the AA allele was associated with larger brain structures among HC, but smaller brain structures in BD for most clusters. Conclusions: Overall, we found preliminary evidence of divergent associations between BD and HC youth in terms of neurostructural correlates of VEGF rs699947 encompassing highly relevant frontotemporal regions.
{"title":"Vascular Endothelial Growth Factor Polymorphism rs699947 Is Associated with Neurostructural Phenotypes in Youth with Bipolar Disorder.","authors":"Nicole E Yan, Mikaela K Dimick, Kody G Kennedy, Clement C Zai, James L Kennedy, Bradley J MacIntosh, Benjamin I Goldstein","doi":"10.1089/cap.2022.0083","DOIUrl":"https://doi.org/10.1089/cap.2022.0083","url":null,"abstract":"<p><p><b><i>Background:</i></b> Vascular endothelial growth factor (VEGF) may be relevant to bipolar disorder (BD) and brain structure. We evaluated <i>VEGF</i> rs699947 single-nucleotide polymorphism in relation to structural neuroimaging phenotypes in youth BD. <b><i>Methods:</i></b> We collected 3 T anatomical magnetic resonance images from 154 youth (79 BD and 75 healthy control [HC]) genotyped for <i>VEGF</i> rs699947. The participants were age (BD = 17.28 ± 1.40 and HC = 17.01 ± 1.83, <i>t</i> = -1.02, <i>p</i> = 0.31) and sex (BD = 63.3% females and HC = 52.0% females, <i>χ</i><sup>2</sup> = 2.01, <i>p</i> = 0.16) matched. Cortical thickness, surface area (SA), and volume were examined by region-of-interest (ROI) and vertex-wise analyses using general linear models (GLMs). ROI investigations selected for the prefrontal cortex (PFC), amygdala, and hippocampus. Vertex-wise analyses controlled for age, sex, and intracranial volume. <b><i>Results:</i></b> ROI results found lower PFC SA (<i>p</i> = 0.003, <i>η<sub>p</sub></i><sup>2</sup> = 0.06) and volume (<i>p</i> = 0.04, <i>η<sub>p</sub></i><sup>2</sup> = 0.03) in BD and a main effect of rs699947 on hippocampal volume (<i>p</i> = 0.03, <i>η<sub>p</sub></i><sup>2</sup> = 0.05). The latter two findings did not survive multiple comparisons. Vertex-wise analyses found rs699947 main effects on left postcentral gyrus volume (<i>p</i> < 0.001), right rostral anterior cingulate SA (<i>p</i> = 0.004), and right superior temporal gyrus thickness (<i>p</i> = 0.004). There were significant diagnosis-by-genotype interactions in the left superior temporal, left caudal middle frontal, left superior frontal, right fusiform, and right lingual gyri, and the left insular cortex. <i>Posthoc</i> analyses revealed the AA allele was associated with larger brain structures among HC, but smaller brain structures in BD for most clusters. <b><i>Conclusions:</i></b> Overall, we found preliminary evidence of divergent associations between BD and HC youth in terms of neurostructural correlates of <i>VEGF</i> rs699947 encompassing highly relevant frontotemporal regions.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10024452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1089/cap.2023.29244.bjc
Sean E Oldak, Manasi S Parrish, Alyssa Cruz, Yasin Bez, Aarti Jerath, Barbara J Coffey
{"title":"Cannibalistic Ideation in a 14-Year-Old Girl: Psychosis or Trauma?","authors":"Sean E Oldak, Manasi S Parrish, Alyssa Cruz, Yasin Bez, Aarti Jerath, Barbara J Coffey","doi":"10.1089/cap.2023.29244.bjc","DOIUrl":"https://doi.org/10.1089/cap.2023.29244.bjc","url":null,"abstract":"","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10016547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01Epub Date: 2023-06-22DOI: 10.1089/cap.2023.0018
Eric M Mendez, Katherine K Dahlsgaard, John M Hjelmgren, Jeffrey A Mills, Vikram Suresh, Jeffrey R Strawn
Background: Treatment of obsessive-compulsive disorder (OCD) in children and adolescents frequently involves cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), or their combination. However, how adding CBT to SSRIs affects the trajectory and magnitude of improvement has not been evaluated meta-analytically. Methods: We performed a meta-analysis using weekly data from prospective randomized parallel group trials of CBT and SSRIs in pediatric patients with OCD. Response was modeled for the change in the Child Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) using a Bayesian hierarchical model over 12 weeks. Results: Fourteen studies included pharmacotherapy arms, 4 studies included combined pharmacotherapy and psychotherapy, and 10 studies included a placebo or control arm. The studies included 1146 patients (mean age 12.7 ± 1.3 years, mean 42.1% female). In the logarithmic model of response, statistically significant differences in treatment effects for CBT+SSRI and SSRI monotherapy were observed compared with placebo (SSRI β = -3.59, credible interval [95% CrI]: -4.13 to -3.02, p < 0.001; SSRI+CBT β = -4.07, 95% CrI: -5.05 to -3.04, p < 0.001). Adding CBT to an SSRI produced numerically (but not statistically significantly) greater improvement over 12 weeks. Greater improvement was observed in studies with more boys (p < 0.001), younger patients (p < 0.001), and in studies with greater baseline symptom severity (p < 0.001). Conclusions: In children and adolescents with OCD, compared with placebo, both SSRIs and SSRI+CBT produced early and sustained improvement over 12 weeks, although the improvement was also related to sample characteristics. Longer term studies are needed to determine when the additive benefit of CBT emerges relative to SSRI monotherapy.
{"title":"What Is the Added Benefit of Combining Cognitive Behavioral Therapy and Selective Serotonin Reuptake Inhibitors in Youth with Obsessive Compulsive Disorder? A Bayesian Hierarchical Modeling Meta-Analysis.","authors":"Eric M Mendez, Katherine K Dahlsgaard, John M Hjelmgren, Jeffrey A Mills, Vikram Suresh, Jeffrey R Strawn","doi":"10.1089/cap.2023.0018","DOIUrl":"10.1089/cap.2023.0018","url":null,"abstract":"<p><p><b><i>Background:</i></b> Treatment of obsessive-compulsive disorder (OCD) in children and adolescents frequently involves cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), or their combination. However, how adding CBT to SSRIs affects the trajectory and magnitude of improvement has not been evaluated meta-analytically. <b><i>Methods:</i></b> We performed a meta-analysis using weekly data from prospective randomized parallel group trials of CBT and SSRIs in pediatric patients with OCD. Response was modeled for the change in the Child Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) using a Bayesian hierarchical model over 12 weeks. <b><i>Results:</i></b> Fourteen studies included pharmacotherapy arms, 4 studies included combined pharmacotherapy and psychotherapy, and 10 studies included a placebo or control arm. The studies included 1146 patients (mean age 12.7 ± 1.3 years, mean 42.1% female). In the logarithmic model of response, statistically significant differences in treatment effects for CBT+SSRI and SSRI monotherapy were observed compared with placebo (SSRI <i>β</i> = -3.59, credible interval [95% CrI]: -4.13 to -3.02, <i>p</i> < 0.001; SSRI+CBT <i>β</i> = -4.07, 95% CrI: -5.05 to -3.04, <i>p</i> < 0.001). Adding CBT to an SSRI produced numerically (but not statistically significantly) greater improvement over 12 weeks. Greater improvement was observed in studies with more boys (<i>p</i> < 0.001), younger patients (<i>p</i> < 0.001), and in studies with greater baseline symptom severity (<i>p</i> < 0.001). <b><i>Conclusions:</i></b> In children and adolescents with OCD, compared with placebo, both SSRIs and SSRI+CBT produced early and sustained improvement over 12 weeks, although the improvement was also related to sample characteristics. Longer term studies are needed to determine when the additive benefit of CBT emerges relative to SSRI monotherapy.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10458367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10102870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arman Danielyan, Luis R Patino, Tessa Benanzer, Thomas J Blom, Jeffrey A Welge, Kiki D Chang, Caleb M Adler, Melissa P DelBello
Background: Depression associated with bipolar disorder (BD) is more common compared to mania. Cognitive, family, and quality-of-life (QOL) factors associated with pediatric bipolar depression are understudied. The goal of this study was to evaluate cognitive, family environmental, and QOL characteristics of youth with bipolar depression. Methods: Thirty-two youth (12-18 years of age) with BD type I currently depressed were recruited from inpatient and outpatient setting. Subjects were assessed using the Behavior Rating Inventory of Executive Function (BRIEF), the Family Environment Scale (FES), and the Child Health Questionnaire-Parental-Form 50 (CHQ-PF50). Results were compared with population norms and the relationship between these domains was calculated. Results: Youth with depression associated with BD did not show significant impairment in executive functions. They displayed impaired family environment in the domains of cohesion, independence, achievement orientation, and organization. Youth also displayed impairments in the psychosocial health domains compared with the population normative data. The CHQ-Psychosocial health significantly negatively correlated with the BRIEF-Global Executive Control score (r = -0.76, p < 0.0001). Conclusion: Depression in youth with BD is associated with impairments in family functioning and QOL. Impairments in psychosocial QOL are associated with cognitive functioning. Further intervention studies examining executive functioning and family environment as treatment targets are needed. ClinicalTrials.gov identifier:NCT00232414.
背景:与躁狂症相比,与双相情感障碍(BD)相关的抑郁症更为常见。与小儿双相抑郁症相关的认知、家庭和生活质量(QOL)因素尚未得到充分研究。本研究旨在评估双相抑郁症青少年的认知、家庭环境和 QOL 特征。研究方法从住院病人和门诊病人中招募了 32 名患有躁郁症 I 型的青少年(12-18 岁)。受试者使用执行功能行为评定量表(BRIEF)、家庭环境量表(FES)和儿童健康问卷--家长问卷 50(CHQ-PF50)进行评估。将结果与人群标准进行比较,并计算这些领域之间的关系。结果显示患有抑郁症并伴有BD的青少年在执行功能方面没有表现出明显的障碍。他们在凝聚力、独立性、成就取向和组织性等领域的家庭环境表现受损。与人群常模数据相比,青少年在社会心理健康领域也表现出了障碍。CHQ-心理社会健康与BRIEF-全局执行控制得分呈显著负相关(r = -0.76,p 结论:BD青少年的抑郁与BRIEF-全局执行控制得分呈显著负相关:患有 BD 的青少年抑郁症与家庭功能和 QOL 的损害有关。心理社会QOL的损害与认知功能有关。需要进一步开展干预研究,将执行功能和家庭环境作为治疗目标。ClinicalTrials.gov 标识符:NCT00232414。
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Pub Date : 2023-06-01DOI: 10.1089/cap.2023.29240.editorial
Harold S Koplewicz
{"title":"From the Editor-in-Chief's Desk.","authors":"Harold S Koplewicz","doi":"10.1089/cap.2023.29240.editorial","DOIUrl":"https://doi.org/10.1089/cap.2023.29240.editorial","url":null,"abstract":"","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9688247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}