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.

Objective: The current study aimed to investigate the efficacy of probiotics in alleviating anxiety in children and adolescents.

Methods: Randomized placebo-controlled trials (RCTs) recruiting children and adolescents were identified through searching major databases using the main keywords "Probiotics" and "Anxiety." Outcomes included improvement in anxiety and treatment acceptability. Continuous and categorical data were expressed as effect size based on standardized mean difference (SMD) and odds ratios (ORs), respectively, with 95% confidence intervals.

Results: Meta-analysis of seven RCTs involving 912 participants (mean age = 8.21) showed no significant improvement in anxiety (SMD = -0.09, p = 0.54) between the probiotics and placebo groups. However, subgroup analysis revealed probiotics-associated anxiety improvement (SMD = -0.55, p = 0.02) in studies enrolling individuals with neurodevelopmental disorders but not in those without (SMD = 0.12, p = 0.48). A significant difference was noted between studies recruiting participants with such diagnoses and those without (SMD = -0.55 vs. 0.12, p = 0.05). Moreover, probiotics-related improvement in anxiety was found in individuals diagnosed with autism spectrum disorder (ASD) (SMD = -0.35, p = 0.03) but not attention deficit hyperactivity disorder (ADHD) (SMD = -0.21, p = 0.38). Overall dropouts exhibited no difference between the probiotics and placebo groups (OR = 0.90, p = 0.36).

Conclusion: Our results showed efficacy of probiotics against anxiety compared with placebos only in participants diagnosed with neurodevelopmental disorders, especially ASD. Nevertheless, insufficient evidence derived from limited studies (i.e., three trials for ASD and two for ADHD) requires further investigations for verification.

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.

Objectives: Depression is a prevalent co-occurring condition in youth living with HIV. This report is a secondary analysis of a multisite cluster randomized trial evaluating the efficacy of a health and wellness cognitive behavioral therapy (CBT) combined with a medication management algorithm utilizing measure-based care (COMB-R) compared with enhanced standard of care (ESC). We describe and compare antidepressant prescribing strategies (i.e., antidepressant treatment, type of antidepressant) for youth living with HIV at COMB-R sites to those at ESC sites over the 24-week intervention. We also describe self-reported adherence to antidepressants.

Methods: Participants (12-24 years) were youth living with HIV diagnosed with moderate to severe depression (Quick Inventory of Depressive Symptomatology [QIDS], Clinician-Rated score ≥11). Thirteen sites were randomly assigned to either the COMB-R arm or the ESC arm. Site-level means were compared using t-tests.

Results: While there was no difference at baseline in prescribing antidepressants, there was a significantly higher mean percentage of SSRI use at the COMB-R sites at week 24, compared with ESC sites (49.1% vs. 24.2%, p = 0.009). Although the COMB-R group had better outcomes on response and remission by week 24, there were no consistent within-group patterns in depression outcomes by group based on antidepressant treatment. The two groups differed in adherence in the last 30 days, with the COMB-R group reporting more missed medication.

Conclusions: Our results support the use of the medication management algorithm and measure-based care for the treatment of depression in youth living with HIV. Although treating depression, particularly in youth living with HIV, remains very complex, these findings provide some potential factors to guide future research. Overall, this report supports the importance of medication management in the context of a collaborative treatment model with CBT in improving depression outcomes.