Journal of child and adolescent psychopharmacology最新文献

Objective: This article presents the protocol for an open-label clinical trial examining the effectiveness of atomoxetine augmentation in adolescents with nonsuicidal self-injury (NSSI) and attention problems and reports preliminary findings from the initial group of participants. Methods: Adolescents (n = 27) aged 13-18 years who met the criteria for NSSI according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and had either full or subclinical attention-deficit/hyperactivity disorder (ADHD) were recruited. All participants had not received ADHD medication for at least 4 weeks prior to enrollment. Psychiatric diagnoses were confirmed using the Kiddie Schedule for Affective Disorders and Schizophrenia. After 12 weeks of adjunctive atomoxetine treatment, NSSI severity (primary outcome) was measured using the Inventory of Statements About Self-Injury. Secondary outcomes included the Children's Depression Rating Scale (CDRS), the Children's Depression Inventory (CDI), the Screen for Child Anxiety Related Emotional Disorders (SCARED), and DuPaul's ADHD Rating Scale (ARS). Additional assessments targeting factors related to NSSI included demographic characteristics, childhood adversity, personality functioning, continuous performance task, and functional near-infrared spectroscopy. Results: Twenty-three participants (22 female, 1 male) completed the trial (mean final dose: 58.3 ± 13.7 mg), while four discontinued (two voluntarily, two due to adverse events). Significant improvements were observed in CDRS (p < 0.001), CDI (p = 0.031), and NSSI severity (p = 0.007). In the ADHD group, significant improvements were observed in CDRS (p = 0.017) and NSSI severity (p = 0.034), with a trend toward improvement in CDI (p = 0.058). The subclinical ADHD group showed significant improvement in CDRS (p = 0.006), with a trend toward improvement in NSSI severity (p = 0.083). Conclusion: Atomoxetine augmentation may reduce NSSI severity in adolescents with attention problems, particularly in those with comorbid ADHD, warranting further investigation in larger controlled trials.

Background: Despite the increased risk for psychopathology in individuals with neurogenetic syndromes, very few psychopharmacology trials have been conducted in these populations. Objectives: The objective of this perspectives article is to describe recruitment challenges and potential solutions for psychopharmacology trials in neurogenetic syndromes. Methods: We describe recruitment challenges and lessons learned from an open-label trial of fluoxetine for the treatment of depression in adults with Down syndrome (DS). These challenges are contrasted with a successful open-label trial of buspirone for the treatment of anxiety in Williams syndrome. Results: Factors that contributed to recruitment challenges include limited research on the clinical presentation of depression in DS and the relatively small target population. This experience highlights the importance of foundational research studies on the phenomenology of target symptoms and burden of disease, as well as disseminating that information to the patient/family community. Partnership with a local family organization with close ties to the patient population can assist in overcoming recruitment barriers. Conclusion: The successes and challenges of early psychopharmacology clinical trials in neurogenetic syndromes should be considered for future trials.

Purpose: There has been recent concern for the rising rates of catatonia diagnosis in pediatric populations. We set out to determine if the rates of catatonia diagnosis have risen at an academic pediatric medical center. Methods: The clinical records of 131 patients were obtained from encounters during 2018-2023 in which a diagnosis of catatonia was made in the pediatric emergency department or inpatient medical hospital. Ordinary least squares regression and linear regression analyses were used to determine if the prevalence of catatonia diagnoses, underlying diagnostic category, and Bush-Francis Catatonia Rating Scale scores changed over time. Results: A 10-fold increase was observed in catatonia diagnoses between 2018 and 2023. A statistically significant relationship between the year of pediatric catatonia diagnoses was discovered (p = 0.01), with an R² value of 0.83 suggesting that approximately 83% of the variance can be attributed to the passage of time. Both medical and psychiatric causes of catatonia showed an upward trend over the course of the study period. The average Bush-Francis Catatonia Rating Scale scores showed a slight upward trend but were not statistically significant. Conclusion: In this sample of pediatric patients hospitalized at a large academic medical center, the rate of catatonia diagnoses related to both medical and psychiatric causes rose between 2018 and 2023. These data are consistent with previous evidence highlighting an increase in catatonia diagnoses during this period. The COVID-19 pandemic and increasing awareness of catatonia in children may have contributed to this trend. These data support the importance of investigation into this trend and improving education on catatonia for clinicians and the public.

Objectives/Background: Multiple factors influence symptom severity in Attention Deficit/Hyperactivity Disorder (ADHD). We examined four of these: diet, sleep hygiene, exercise, and lighting, in the International Collaborative ADHD Neurofeedback (ICAN) randomized clinical trial, which found large significant improvement with both active neurofeedback and control condition without treatment difference. Methods: A total of 142 participants aged 7-10 had breakfast and lunch intake and exercise recorded at each neurofeedback session. Parents completed the Children's Sleep Habits Questionnaire (CSHQ). Parents and teachers rated inattention on Conners3. Lifestyle changes were correlated with inattention changes. Results: At baseline, CSHQ correlated with parent-rated inattention (r = 0.17, p = 0.04), and length of sleep correlated with teacher-rated inattention (r = 0.20, p = 0.03). From baseline to treatment end food group variety (p = 0.029, d = 0.22) and sleep problems (p < 0.0001, d = -0.49) improved significantly, exercise time and protein intake marginally (p = 0.06 - 0.08). Parent-rated inattention improvement correlated with CSHQ improvement (Rho = 0.26, p = 0.002) and marginally with protein intake increase (Rho = 0.18, p = 0.06). The three components of the light-emitting-diode (LED)-induced circadian pathway hypothesis were significant. Conclusions: Most measures improved, but few significantly. How much they impact classroom attention remains unclear. Although parent ratings of inattention improvement correlated with sleep problems improvement, composited parent/teacher ratings (primary outcome) did not. The circadian pathway hypothesis associated with LED lighting was supported. These findings warrant further studies examining the role sleep hygiene can play in improving ADHD symptoms. Meanwhile, attention to sleep hygiene seems appropriate in any treatment plan for ADHD.