Journal of child and adolescent psychopharmacology最新文献

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.

Introduction: This randomized controlled pilot trial examined whether adjunctive triple chronotherapy (TCT) in adolescents hospitalized with major depressive disorder (MDD) was (1) feasible, and (2) suggested to be more effective in managing depression and accompanying symptoms at 60 days postdischarge, compared to adolescents with depression who received treatment-as-usual (TAU).

Methods: TCT participants underwent sleep deprivation for up to 36 hours, sleep phase advancement for four days, and daily exposure to light therapy. Both arms received medication management and group therapy during the inpatient stay. Outpatient visits occurred on Days 7/10, 30, and 60. Outcomes included depression, anxiety, insomnia, self-harm, suicidality, and quality of life.

Results: Sixty-four adolescents were enrolled, 32 into TCT, 32 into TAU. The mean age was 15 years, the majority were female, Caucasian, and non-Hispanic/non-Latino. Compared to baseline, both TCT and TAU participants showed a significantly lower Patient Health Questionnaire-Adolescent (PHQ-A) score by Day 4 (TCT: N = 31, $\overline{X}$=20.4 ± 3.54 vs. N = 17, $\overline{X}$=9.12 ± 6.98, p < 0.001; TAU: N = 32; $\overline{X}$=20.1 ± 3.99 vs. N = 10; $\overline{X}$=8.6 ± 5.93, p < 0.001) and by Day 60 (TCT: N = 11, $\overline{X}$=7.45 ± 5.22, p < 0.001; TAU: N = 14, $\overline{X}$=13.36 ± 7.25, p < 0.001). For between-group differences, TCT participants reported significantly lower PHQ-A scores at Day 60 compared to TAU participants (N = 11, $\overline{X}$=7.45 ± 5.22 vs. N = 14, $\overline{X}$=13.36 ± 7.25, p = 0.03). Anxiety and insomnia were significantly lower at treatment end in the TCT arm (N = 11, $\overline{X}$=1.91 ± 1.97 vs. N = 14; $\overline{X}$=4.64 ± 2.79, p = 0.009) and (N = 11, $\overline{X}$=6.55 ± 6.64 vs. N = 14; $\overline{X}$=12.21 ± 6.76, p = 0.05), respectively. Retention was a challenge; approximately 2/3 of the sample dropped out by study end.

Conclusions: TCT is a potentially effective adjunctive treatment for MDD in adolescents.

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.

Background: The use of psychotropic medication among children and adolescents has increased, but long-term studies on inpatients are scarce.

Methods: In Finland, nationwide inpatient data among children and adolescents (<18 years) were collected on one day from three different years, 2000, 2011, and 2018. Medication use was analyzed according to medication groups, individual medications, and the number of medications. Additional information included diagnoses and severity measures of suicidality, violence, and functional impairment. Logistic regression was used to analyze the changes between 2000 and 2018 and between 2011 and 2018.

Results: The most robust increase was observed in attention-deficit/hyperactivity disorder medications (between 2000 and 2018 odds ratio [OR]: 21.74, 95% confidence interval [CI]: 7.75-58.82 and between 2011 and 2018 OR: 2.20, 95% CI: 1.37-3.52), followed by antipsychotics (OR: 3.15, 95% CI: 2.34-4.24 and OR: 1.35, 95% CI: 1.02-1.81, respectively), and antidepressants (between 2000 and 2018 OR: 1.87, 95% CI: 1.36- 2.57). The use of benzodiazepines decreased notably between 2011 and 2018 (OR: 0.09, 95% CI: 0.03-0.22). When diagnoses and severity measures were included in the multivariate analysis, the increases were associated with respective diagnoses, being adolescent, and the severity of the condition.

Conclusions: Medication use increased vastly between 2000 and 2018, but levelled off between 2011 and 2018. Explanations include changes in clinical practices, the surface of new medications, increased awareness of neuropsychiatric disorders, and the replacement of benzodiazepines. More information on the long-term effects of increased use of antipsychotics and multi-medication is warranted.

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.

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.