Journal of child and adolescent psychopharmacology最新文献

Background: Children with intellectual disability (ID) are more susceptible to adverse effects from standard psychiatric medications, often necessitating the use of off-label treatments. In the limited studies to date, Clonidine has displayed evidence of benefit in treating attention-deficit/hyperactivity disorder (ADHD), sleep onset difficulties, behaviors that challenge, and tics. Methods: This naturalistic study involved a cross-sectional survey completed by 4 consultant psychiatrists, detailing 50 children with ID treated with Clonidine over a 3-year period. Data collected included treatment indications, dosage, and retrospective Developmental Disabilities Modification of Children's Global Assessment Scalescores to evaluate functioning before treatment and again 6-12 months later. Results: Among children who remained stable on Clonidine, ordinal regression analyses revealed that total Clonidine dose, level of ID, concomitant medications, and comorbid diagnoses significantly predicted improved functioning at 2 months, which was sustained after 1 year of treatment with Clonidine. Conclusions: Clonidine is useful to treat ADHD, sleep difficulties, tics, and behaviors that challenge. Clonidine was generally well tolerated and appears to be an effective treatment option for children with ID. This will inform the clinical practice of both pediatricians and psychiatrists who support and treat children with ID.

Objective: Current standards for treatment of anorexia nervosa (AN) in children and adolescents include Family-Based Treatment and nutrition restoration. The use of aripiprazole for AN has been detailed through case series and one retrospective review analyzing the change in outcomes on body mass index and weight restoration. The goal of this descriptive study was to evaluate the impact of aripiprazole on food avoidant behaviors (FABs) and to describe prescribing patterns, including dosing and tolerability. Methods: This was a retrospective, descriptive, matched, cohort study of pediatric patients with AN admitted to an eating disorders program (EDP) between January 1, 2018, and December 31, 2023. Patients were included in this study if they had a diagnosis of AN and were started on aripiprazole for eating disorder cognitions. Patients were matched 1:2 to a control group based on age, sex, and length of stay. Results: A total of 42 patients on aripiprazole were analyzed and matched to 84 controls. Aripiprazole was associated with a reduction in FABs with a mean change over the evaluated time period of 3.5 versus 0.9 (p = 0.026). The mean starting dose of aripiprazole was 1.9 mg/day, with a mean discharge dose of 2.8 mg/day. Aripiprazole was overall well-tolerated. Conclusion: Aripiprazole was associated with an improvement in FABs among children and adolescents admitted to an EDP. Additionally, low-dose aripiprazole improved weight, likelihood of achieving target weight, and was well-tolerated.

Objectives: Obsessive compulsive disorder (OCD) is a chronic psychiatric condition that significantly impairs various domains, including social, academic, and overall functioning. While antidepressants and psychotherapy-specifically cognitive behavioral therapy-are the standard first-line treatments, there is considerable variability in the use of augmenting agents, particularly antipsychotics. This study examines treatment patterns in children and adolescents with OCD. Methods: This population-based retrospective cohort study utilized the TriNetX research network to identify patients aged 6-18 with an OCD diagnosis (F42, N = 37,355). Treatment patterns were analyzed based on sociodemographic factors (age, gender, and race/ethnicity) and clinical settings (inpatient vs. outpatient). Odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated, with Cox proportional hazards models used to adjust for potential confounders. Results: The average age of OCD diagnosis in youth was 10.9 years, with a balanced gender distribution. Psychiatric comorbidities were common, particularly anxiety disorders (53%), attention-deficit hyperactivity disorder (47%), and mood disorders (37%). Antidepressants were prescribed to 55% of patients, with sertraline and fluoxetine being the most common, while 22% were prescribed antipsychotics, primarily aripiprazole and risperidone. In addition, 31% had billable therapy codes. Racial and ethnic minority groups received less treatment overall, with lower odds of receiving antidepressants (OR 0.51-0.74) and therapy (OR 0.75) among Black youth. In contrast, Black youth were more likely to be prescribed antipsychotics (OR 1.18). Among those prescribed antipsychotics, 47% had prior antidepressant use, 22% had billed psychotherapy, and only one-sixth had both before starting antipsychotics. Inpatient hospitalization, as an indicator of symptom severity, was strongly associated with antipsychotic prescriptions (adjusted HR: 3.03, 95% CI: 2.85, 3.21). Conclusions: There is considerable variability in the pharmacological management of pediatric OCD, with frequent use of antipsychotics even before first-line treatments. The low utilization of psychotherapy suggests gaps in adherence to evidence-based care. These findings highlight the need for improved adherence to OCD treatment guidelines, with a focus on increasing access to psychotherapy.

Introduction: Evaluating antidepressant side effects in children and adolescents is important, as side effects can significantly impact treatment adherence and outcomes. While there are tools to assess side effects globally encompassing various body systems, their administration time can be substantial, limiting their practical use in clinical settings. This is especially challenging in pediatric practice, where providers need to collect information from both patients and guardians. The Frequency, Intensity, Burden of Side Effects Rating-Child (FIBSER-C) was developed to address this need and assesses side effect frequency, intensity, and burden; however, its psychometric properties have not been examined in pediatric samples. Methods: The analytic sample included n = 746 youth among the first 1000 participants who completed FIBSER-C and were taking antidepressant medication(s). The construct validity of FIBSER-C was examined by confirmatory factor analysis; internal consistency was evaluated using Cronbach's alpha (α); convergent and divergent validity were assessed by examining its association with depression severity and functioning measures. Results: FIBSER-C showed a single-factor structure, with standardized item loadings of 0.73, 0.83, and 0.89. The scale showed good internal consistency (Cronbach's α = 0.85). The FIBSER-C total score was weakly and positively associated with total PHQ-A, Patient-Reported Outcomes Measurement Information System (PROMIS)-Pain, PROMIS-Pain Severity, and PROMIS-Fatigue and was weakly and inversely associated with PROMIS-Physical Function. Conclusions: The FIBSER-C had has good internal consistency and a single-factor solution. The associations between side effect burden and depression severity, as well as functioning domains, were weak. Further research should explore the consistency and stability of the scale over time.

Introduction: Accurate assessment of treatment outcomes in patients with Tourette syndrome (TS) is essential for evidence-based clinical care. This report determined the minimal clinically important difference (MCID) on the Yale Global Tic Severity Scale (YGTSS) Total Tic Score (YGTSS-TTS) and YGTSS Impairment Scale (YGTSS-I), using the Clinical Global Impression of TS Severity (CGI-TS-S) and Improvement (CGI-TS-I) as anchors, in pediatric patients with TS receiving pharmacotherapy. Materials and Methods: Analyses used data from two clinical trials of ecopipam (a randomized controlled trial and its open-label extension). Receiver operating characteristic (ROC) analysis determined the percentage reduction in YGTSS scores that distinguished patients with improvement from those with no change or worsening on the CGI-TS-S and CGI-TS-I. Spearman's correlation, empirical cumulative distribution function, and probability distribution function analyses examined relationships between YGTSS-TTS and CGI-TS-S or CGI-TS-I. Results: Overall, 133 patients (75.2% male; mean [SD] age, 12.7 [2.8]) were included; 63.2% had improvement on the CGI-TS-S, and 78.2% showed improvement on the CGI-TS-I. Percentage reduction in YGTSS scores that distinguished improvement from no change or worsening on the CGI-TS-S and CGI-TS-I ranged from 18.6%-33.3% (area under the ROC curve range, 0.71-0.81). Improvement on the YGTSS-TTS was correlated with posttreatment CGI-TS-S (r = -0.65; p < 0.001) and CGI-TS-I (r = -0.61; p < 0.001) scores. The MCID for YGTSS-TTS was achieved by 67% and 62% of patients with improvement on the CGI-TS-S and CGI-TS-I, respectively. Conclusions: This analysis is the first to determine the MCID for YGTSS in a pediatric population with TS receiving pharmacotherapy. Whether using CGI-TS-S or CGI-TS-I as the anchor, a 25% reduction in YGTSS scores was a generally appropriate minimum threshold to define clinically meaningful improvement in this population. Findings offer an objective threshold for classifying clinically meaningful improvement in children and adolescents receiving pharmacotherapy for TS in clinical practice.

Background: Aggression and irritability are common challenges in children with autism spectrum disorder (ASD), often requiring pharmacological management. Divalproex, an anticonvulsant and mood stabilizer, is used off-label for these symptoms, but its effectiveness remains unclear. This systematic review evaluates the efficacy and safety of divalproex in managing aggression and irritability in children with ASD. Methods: A systematic review was conducted following PRISMA guidelines, registered with PROSPERO (CRD420251029754). Searches were performed in PubMed, Embase, PsycINFO, and Web of Science, identifying studies involving children with ASD treated with divalproex, valproic acid, or valproate sodium. Data were extracted on study design, sample size, intervention details, outcomes, and adverse effects. Results: Ten studies met inclusion criteria, comprising three randomized controlled trials, one open-label trial, and six case reports. Intravenous (IV) divalproex demonstrated rapid reductions in aggression, suggesting potential for acute stabilization. However, oral divalproex produced inconsistent results for chronic aggression and irritability. Adverse effects included weight gain, sedation, and behavioral activation, with toxicity risks in polypharmacy settings. Discussion/Conclusion: Divalproex may offer value for acute management of aggression in children with ASD when administered intravenously. Its role in chronic management is less clear, with inconsistent outcomes and notable side effects. Clinicians should prioritize regular serum monitoring and consider alternative options for chronic use. Further research is needed to clarify its clinical role, particularly in diverse patient populations.