Pub Date : 2011-10-01DOI: 10.1521/capn.2011.16.5.3
Michael S Gaffrey, Rivfka Shenoy, Joan L Luby
{"title":"Effects of Stimulants and SSRIs on Brain Function in Children: Emerging Clues from fMRI Studies.","authors":"Michael S Gaffrey, Rivfka Shenoy, Joan L Luby","doi":"10.1521/capn.2011.16.5.3","DOIUrl":"https://doi.org/10.1521/capn.2011.16.5.3","url":null,"abstract":"","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"16 5","pages":"3-10"},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1521/capn.2011.16.5.3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31410649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-08-17DOI: 10.1521/CAPN.2011.16.3.1
L. Propper, H. Orlik
{"title":"Focus: Pharmacotherapy of Severe Disruptive Behavioral Symptoms Associated with Autism","authors":"L. Propper, H. Orlik","doi":"10.1521/CAPN.2011.16.3.1","DOIUrl":"https://doi.org/10.1521/CAPN.2011.16.3.1","url":null,"abstract":"","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"16 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2011-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1521/CAPN.2011.16.3.1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67089656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-08-17DOI: 10.1521/CAPN.2011.16.3.9
Tricia L. Beattie
Description and Impact of Behavior Problems Behavior problems are common in children with autism spectrum disorder (ASD) and range from relatively mild difficulties (e.g., tantrums, stereotypies, and noncompliance) to more severe behaviors, including selfinjury and aggression toward others. Problem behaviors are considered to be part of the clinical presentation of autism and have been linked to a range of difficulties including language and communication challenges, as well as sensory-based problems, and emotion dysregulation (APA, 2000; Gadow, DeVincent, Pomeroy, & Azizian, 2004; Koegel, Koegel, & Surratt, 1992; Lecavalier, 2006). More serious behaviors such as aggression and selfinjury not only pose immediate safety risks for the individual child and his or her caregivers but are also associated with broader functional impairments (RUPP Autism Network, 2007). They can interfere with learning opportunities, limit positive social interactions, and are associated with overall reduced independence (Horner, Carr, Strain, Todd, & Reed, 2002). Research suggests that behavioral difficulties often persist and worsen without appropriate treatment (Horner, et al., 2002; Tonge & Einfeld, 2003) and disruptive behavior in children with autism have been associated with high levels of parental stress, family isolation and decreased family cohesion (Lecavalier, Leone, & Wiltz, 2006; Schieve, Blumberg, Rice, Visser & Boyle, 2007). Given the prevalence, chronicity, and impact of behavior problems in children with ASD, the development of effective and feasible treatment options is critical for this population. Medication has been shown to be helpful in managing severe, disruptive behaviors in ASD; however, the effects of medication do not target core symptoms of the disorder, are often associated with adverse events, and challenging behaviors tend to re-emerge if the medication is discontinued (Aman, McDougle, Scahill, Handen, Arnold, Johnson, et al., 2009). There is a vast amount of research demonstrating the effectiveness of behavioral interventions in treating disruptive behavior in autism as well as targeting core social and communication deficits. Thus, intensive behavioral interventions have become a predominant treatment approach for autism and are the focus of this article (Bregman, Zager, & Gerdtz, 2005).
{"title":"Non-Pharmacological Treatment of Problem Behaviors in Children with Autism Spectrum Disorder","authors":"Tricia L. Beattie","doi":"10.1521/CAPN.2011.16.3.9","DOIUrl":"https://doi.org/10.1521/CAPN.2011.16.3.9","url":null,"abstract":"Description and Impact of Behavior Problems Behavior problems are common in children with autism spectrum disorder (ASD) and range from relatively mild difficulties (e.g., tantrums, stereotypies, and noncompliance) to more severe behaviors, including selfinjury and aggression toward others. Problem behaviors are considered to be part of the clinical presentation of autism and have been linked to a range of difficulties including language and communication challenges, as well as sensory-based problems, and emotion dysregulation (APA, 2000; Gadow, DeVincent, Pomeroy, & Azizian, 2004; Koegel, Koegel, & Surratt, 1992; Lecavalier, 2006). More serious behaviors such as aggression and selfinjury not only pose immediate safety risks for the individual child and his or her caregivers but are also associated with broader functional impairments (RUPP Autism Network, 2007). They can interfere with learning opportunities, limit positive social interactions, and are associated with overall reduced independence (Horner, Carr, Strain, Todd, & Reed, 2002). Research suggests that behavioral difficulties often persist and worsen without appropriate treatment (Horner, et al., 2002; Tonge & Einfeld, 2003) and disruptive behavior in children with autism have been associated with high levels of parental stress, family isolation and decreased family cohesion (Lecavalier, Leone, & Wiltz, 2006; Schieve, Blumberg, Rice, Visser & Boyle, 2007). Given the prevalence, chronicity, and impact of behavior problems in children with ASD, the development of effective and feasible treatment options is critical for this population. Medication has been shown to be helpful in managing severe, disruptive behaviors in ASD; however, the effects of medication do not target core symptoms of the disorder, are often associated with adverse events, and challenging behaviors tend to re-emerge if the medication is discontinued (Aman, McDougle, Scahill, Handen, Arnold, Johnson, et al., 2009). There is a vast amount of research demonstrating the effectiveness of behavioral interventions in treating disruptive behavior in autism as well as targeting core social and communication deficits. Thus, intensive behavioral interventions have become a predominant treatment approach for autism and are the focus of this article (Bregman, Zager, & Gerdtz, 2005).","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1521/CAPN.2011.16.3.9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67089714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-07-13DOI: 10.1521/CAPN.2011.16.2.1
Holly E. Semble, Michele J. Dadson
Adherence can be defi ned as the extent to which a patient’s behavior coincides with prescribed health advice. Non-adherence is multifactorial and can include failure to take any medication, taking erroneous doses, failure to fi ll prescriptions, taking medication at the incorrect times, adhering partially to the prescribed medication regimen, and/or consuming incorrect combinations of medication (Pogge, Singer, & Harvey, 2005). Research has shown that medication adherence is one of the single most important factors in delaying or preventing relapse among adults with psychosis. For example, in one study the authors noted that within one year, patients who had medication gaps of 30 days or longer were four times more likely to be hospitalized (Weiden, Kozma, Grogg, & Locklear, 2004). While there is ample research on the rates and the importance of adherence to antipsychotics in adults, there is little information about medication use and treatment adherence among children and adolescents with psychosis.
{"title":"Adherence to Antipsychotic Therapy: Risk and Protective Factors","authors":"Holly E. Semble, Michele J. Dadson","doi":"10.1521/CAPN.2011.16.2.1","DOIUrl":"https://doi.org/10.1521/CAPN.2011.16.2.1","url":null,"abstract":"Adherence can be defi ned as the extent to which a patient’s behavior coincides with prescribed health advice. Non-adherence is multifactorial and can include failure to take any medication, taking erroneous doses, failure to fi ll prescriptions, taking medication at the incorrect times, adhering partially to the prescribed medication regimen, and/or consuming incorrect combinations of medication (Pogge, Singer, & Harvey, 2005). Research has shown that medication adherence is one of the single most important factors in delaying or preventing relapse among adults with psychosis. For example, in one study the authors noted that within one year, patients who had medication gaps of 30 days or longer were four times more likely to be hospitalized (Weiden, Kozma, Grogg, & Locklear, 2004). While there is ample research on the rates and the importance of adherence to antipsychotics in adults, there is little information about medication use and treatment adherence among children and adolescents with psychosis.","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"16 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2011-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1521/CAPN.2011.16.2.1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67089860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-07-13DOI: 10.1521/CAPN.2011.16.2.5
Jay A. Salpekar, A. Zeitchick
Pharmacologic treatment approaches for either ADHD (attention deficit hyperactivity disorder) or epilepsy, individually, are well studied. However, very few studies have addressed treatment strategies for children with both conditions. This is unfortunate, as ADHD is the most common psychiatric comorbidity occurring in children with epilepsy (Salpekar & Dunn, 2007). Although the prevalence of ADHD in the general pediatric population ranges from 5–10%, the prevalence of ADHD in children with pediatric epilepsy ranges from 20–38%. The predominantly inattentive subtype is more common (24%) than the combined type (11%) or predominantly hyperactive-impulsive subtype (2%) (Dunn et al., 2003). In some cases, significant distractibility may be identified even before the diagnosis of epilepsy is made (Hesdorffer et al., 2004). Epilepsy is a common illness, affecting nearly 1% of the general pediatric population, and is defined by having two or more unprovoked, afebrile seizures (Davis et al., 2010). The most widely used classification system, developed by the International League Against Epilepsy (ILAE), differentiates epilepsy by etiology and seizure type (Engel, 2006). Specific seizure types are distinguished as either partial or generalized. Partial seizures are identified when the initial clinical or electroencephalographic (EEG) change reflects a focal area of the brain, while generalized seizures are identified where the initial EEG change is widespread throughout the brain. Partial seizures are further classified as simple, if there is no change in consciousness, or complex, if consciousness is altered. Complex partial seizures are frequently associated with auras, five to ten second periods prior to a seizure event, during which an individual may experience physical sensations such as epigastric discomfort, or emotional symptoms such as fear or panic. Seizure episodes or auras may interrupt consciousness, and the result may be apparent distractibility or altered attention. Absence seizures, typically characterized by episodes of 10 seconds or more of staring and altered consciousness, are commonly misdiagnosed as inattention and represent an important differential diagnosis for ADHD (Williams et al., 2002).
无论是ADHD(注意缺陷多动障碍)还是癫痫的药物治疗方法，都得到了很好的研究。然而，很少有研究针对患有这两种疾病的儿童的治疗策略。这是不幸的，因为多动症是癫痫患儿中最常见的精神共病(Salpekar & Dunn, 2007)。虽然ADHD在普通儿科人群中的患病率在5-10%之间，但ADHD在小儿癫痫患儿中的患病率在20-38%之间。以注意力不集中为主的亚型(24%)比混合型(11%)或以多动冲动为主的亚型(2%)更为常见(Dunn等，2003)。在某些情况下，严重的注意力不集中甚至可以在癫痫诊断之前就被识别出来(Hesdorffer et al.， 2004)。癫痫是一种常见病，影响了近1%的普通儿科人群，其定义为两次或两次以上无因无热发作(Davis et al.， 2010)。由国际抗癫痫联盟(ILAE)制定的最广泛使用的分类系统根据病因和发作类型区分癫痫(Engel, 2006年)。具体的发作类型可分为局部发作或全身性发作。当最初的临床或脑电图(EEG)变化反映大脑的病灶区域时，可以确定部分性癫痫发作，而当最初的脑电图变化广泛分布于整个大脑时，可以确定全面性癫痫发作。部分性癫痫进一步分为简单型(如果意识没有改变)和复杂型(如果意识改变)。复杂的部分性癫痫发作通常与先兆有关，发作前5 - 10秒，在此期间，患者可能会经历身体感觉，如上腹部不适，或情绪症状，如恐惧或恐慌。癫痫发作或先兆可能中断意识，结果可能是明显的注意力分散或注意力改变。失神发作的典型特征是连续10秒或更长时间的凝视和意识改变，通常被误诊为注意力不集中，是ADHD的重要鉴别诊断(Williams et al, 2002)。
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Pub Date : 2011-06-17DOI: 10.1521/CAPN.2011.16.1.1
Jennifer Yen, M. Grover, A. Mao
{"title":"Antipsychotics and Autism: Weight, Metabolism, and Safety","authors":"Jennifer Yen, M. Grover, A. Mao","doi":"10.1521/CAPN.2011.16.1.1","DOIUrl":"https://doi.org/10.1521/CAPN.2011.16.1.1","url":null,"abstract":"","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"16 1","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2011-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1521/CAPN.2011.16.1.1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67089362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-12-01DOI: 10.1521/CAPN.2010.15.6.1
F. Macmaster, D. Rosenberg
Obsessive-compulsive disorder (OCD) is a chronic, severe and debilitating disorder, affecting over 3 million people in the United States. People afflicted with OCD have obsessions and compulsions that impair their functioning in life. According to the World Health Organization, OCD is among the ten most disabling medical conditions worldwide. The National Comorbidity Survey Replication, when examining anxiety disorders, found that OCD had the highest percentage of serious cases (50.6%) (Kessler et al., 2005). Lifetime prevalence estimates of OCD in pediatric and adult populations range from 1% to 3% (Kessler et al., 2005). The clinical presentation of OCD in childhood and adulthood is similar, making findings applicable across the age span. The mean age of onset for OCD in children is between 9 to 11 years in males and 11 to 13 years in females (Hanna, 1995). A more negative outcome is associated with an early age of onset. Furthermore, pediatric OCD was found to be chronic and unremitting in up to 87% of cases that failed to receive effective treatment (Stewart et al., 2004). Finally, an early diagnosis of OCD is associated with a higher risk for developing other psychiatric disorders into adulthood. THE CASE FOR NOVEL TREATMENTS OF OCD Serotonin reuptake inhibitors (SRI) are the only FDA approved medications for OCD. While considered effective in the clinical trial literature, treatment of OCD with SRI’s has proven limited in clinical practice. SRIs are only effective in 40 to 60% of patients (Jenike, 2004). Obviously, this leaves a considerable number still ill. Additionally, studies often define treatment response as a 20 to 40% reduction in symptoms. Hence, many subjects who are classed as “responders” still have marked symptoms after treatment (Jenike, 2004). OCD symptom severity scores, as calculated by the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), normally range from 15 to 20 post-treatment. A score in this range is still indicative of significant impairment. In addition to SRIs, cognitive behavioral therapy (CBT), alone or in combination with SRI, is also considered effective for treating OCD (POTS, 2004). Nonetheless, one-third of pediatric patients remain markedly ill even after receiving the combination of CBT and medication (POTS, 2004). What is more, data indicates that an earlier onset of OCD may be associated with the illness being more treatment refractory (POTS, 2004). Indeed, OCD is one of the few remaining psychiatric disorders for which there is a neurosurgical treatment indication. The persistence of symptoms and the limited nature of treatment response indicates that the serotonin paradigm of understanding OCD cannot fully account for the underlying neurobiology of the illness. Therefore, novel, evidence based approaches are needed to advance treatment of OCD. The glutamate hypothesis of OCD, first developed over a decade ago (Rosenberg & Keshavan, 1998), and resulting biological evidence has recently
强迫症(OCD)是一种慢性的、严重的、使人衰弱的疾病，在美国影响着超过300万人。受强迫症折磨的人有影响他们生活功能的强迫和强迫。据世界卫生组织称，强迫症是世界上十大最致残的疾病之一。国家共病调查复制，当检查焦虑症时，发现强迫症的严重病例比例最高(50.6%)(Kessler et al.， 2005)。强迫症在儿童和成人人群中的终生患病率估计在1%到3%之间(Kessler et al, 2005)。强迫症在儿童期和成人期的临床表现是相似的，这使得研究结果适用于整个年龄段。儿童强迫症的平均发病年龄男性为9 - 11岁，女性为11 - 13岁(Hanna, 1995)。更消极的结果与发病年龄较早有关。此外，在未能得到有效治疗的病例中，高达87%的儿童强迫症被发现是慢性和持续的(Stewart et al.， 2004)。最后，强迫症的早期诊断与成年后发展为其他精神疾病的高风险相关。5 -羟色胺再摄取抑制剂(SRI)是FDA批准的唯一治疗强迫症的药物。虽然在临床试验文献中被认为是有效的，但在临床实践中，用SRI治疗强迫症被证明是有限的。SRIs仅对40% - 60%的患者有效(Jenike, 2004)。显然，这使得相当多的人仍然生病。此外，研究通常将治疗反应定义为症状减轻20%至40%。因此，许多被归类为“应答者”的受试者在治疗后仍有明显的症状(Jenike, 2004)。根据儿童耶鲁-布朗强迫症量表(CY-BOCS)计算的强迫症症状严重程度评分，治疗后通常在15到20之间。在这个范围内的分数仍然表明严重的损害。除了SRI，认知行为疗法(CBT)，单独或与SRI联合，也被认为对治疗强迫症有效(POTS, 2004)。尽管如此，三分之一的儿科患者即使在接受CBT和药物治疗相结合后仍然明显不适(POTS, 2004)。更重要的是，数据表明，强迫症的早期发病可能与该疾病更难治疗有关(POTS, 2004)。事实上，强迫症是为数不多的需要神经外科治疗的精神疾病之一。症状的持续和治疗反应的有限性表明，理解强迫症的血清素范式不能完全解释该疾病的潜在神经生物学。因此，需要新的、基于证据的方法来推进强迫症的治疗。强迫症的谷氨酸假说最早是在十多年前提出的(Rosenberg & Keshavan, 1998)，其产生的生物学证据最近被转化为谷氨酸调节剂在儿童强迫症治疗中的应用。
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Pub Date : 2010-12-01DOI: 10.1521/CAPN.2010.15.6.6
F. Macmaster, D. Rosenberg
Obsessive-compulsive disorder (OCD) is a major public health problem - among the ten most disabling medical conditions worldwide (Murray & Lopez, 1996). The two fundamental reasons to focus on pediatric OCD are first, that OCD typically has its onset during childhood and adolescence (Pauls, Alsobrook, Goodman, Rasmussen & Leckman, 1995) and second, that pediatric OCD is continuous with adult OCD. The age of onset for pediatric OCD ranges from 9 to11 years in boys to 11 to 13 years in girls (Hanna, 1995; Riddle et al., 1990), with an earlier age of onset associated with a more negative outcome (Skoog & Skoog, 1999; Stewart et al., 2004). There is a strong genetic component to OCD, with heritability estimates in children and adolescents ranging from 45% to 65% (van Grootheest, Cath, Beekman & Boomsma, 2005).
{"title":"NEUROBIOLOGICAL EVIDENCE SUPPORTING GLUTAMATE'S ROLE IN PEDIATRIC OBSESSIVE COMPULSIVE DISORDER.","authors":"F. Macmaster, D. Rosenberg","doi":"10.1521/CAPN.2010.15.6.6","DOIUrl":"https://doi.org/10.1521/CAPN.2010.15.6.6","url":null,"abstract":"Obsessive-compulsive disorder (OCD) is a major public health problem - among the ten most disabling medical conditions worldwide (Murray & Lopez, 1996). The two fundamental reasons to focus on pediatric OCD are first, that OCD typically has its onset during childhood and adolescence (Pauls, Alsobrook, Goodman, Rasmussen & Leckman, 1995) and second, that pediatric OCD is continuous with adult OCD. The age of onset for pediatric OCD ranges from 9 to11 years in boys to 11 to 13 years in girls (Hanna, 1995; Riddle et al., 1990), with an earlier age of onset associated with a more negative outcome (Skoog & Skoog, 1999; Stewart et al., 2004). There is a strong genetic component to OCD, with heritability estimates in children and adolescents ranging from 45% to 65% (van Grootheest, Cath, Beekman & Boomsma, 2005).","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"57 1","pages":"6-10"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89757131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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