Journal of child and adolescent psychopharmacology最新文献

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.

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.

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.