Pub Date : 2009-08-27DOI: 10.1521/CAPN.2009.14.1.1
A. Robb
{"title":"Antidepressant Update: New Findings from TORDIA, CAMS and the Adolescent Escitalopram (Lexapro) Trial","authors":"A. Robb","doi":"10.1521/CAPN.2009.14.1.1","DOIUrl":"https://doi.org/10.1521/CAPN.2009.14.1.1","url":null,"abstract":"","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"14 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2009-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1521/CAPN.2009.14.1.1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67088390","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 : 2009-08-01DOI: 10.1521/CAPN.2009.14.4.5
Mini Tandon, J. Luby
{"title":"Psychopharmacology in Preschoolers: A Brief Guide to Clinicians","authors":"Mini Tandon, J. Luby","doi":"10.1521/CAPN.2009.14.4.5","DOIUrl":"https://doi.org/10.1521/CAPN.2009.14.4.5","url":null,"abstract":"","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"14 1","pages":"5-7"},"PeriodicalIF":0.0,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1521/CAPN.2009.14.4.5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67088911","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 : 2009-08-01DOI: 10.1521/CAPN.2009.14.4.1
J. Luby
{"title":"The Use of Psychotropic Agents in Preschool Children: Issues in Practice, Research and Public Policy","authors":"J. Luby","doi":"10.1521/CAPN.2009.14.4.1","DOIUrl":"https://doi.org/10.1521/CAPN.2009.14.4.1","url":null,"abstract":"","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"23 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1521/CAPN.2009.14.4.1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67088809","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 : 2009-06-01DOI: 10.1521/CAPN.2009.14.3.1
N. Carrey
{"title":"Is There A Role For “Older” Agents in Child Psychopharmacology?","authors":"N. Carrey","doi":"10.1521/CAPN.2009.14.3.1","DOIUrl":"https://doi.org/10.1521/CAPN.2009.14.3.1","url":null,"abstract":"","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"14 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2009-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1521/CAPN.2009.14.3.1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67088604","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 : 2009-06-01DOI: 10.1521/CAPN.2009.14.3.7
D. Gardner
Much has changed in the past two decades in terms of the pharmacotherapy of psychiatric disorders across the lifespan. It was just over 20 years ago that fluoxetine was first marketed in the United States and shortly thereafter clozapine made its remarkable return to patient care. But at the time these medications received marketing approvals from the FDA, Health Canada, and other nations’ regulatory agencies, we were not to know the impact they would have—on clinical practice, the pharmaceutical industry, psychotropic drug research, drug nomenclature, psychiatric nosology, perceptions of psychiatric patients and care, as well as education in clinical psychopharmacology. Prozac® quickly became a household word, supplanting Valium® as the best known psychotropic (Kramer, 1993). It also emerged as a lightning rod in child and adolescent psychopharmacology (Healy, 2003; Teicher et al., 1990). Prozac® was the first of several very successfully marketed SSRIs, which were found to be particularly effective in pediatric anxiety disorders. However, this therapeutic advance was overshadowed by these SSRIs’ uncertain benefit in adolescent depression and the early indications that they could promote rather than thwart suicidality in young patients (Research Unit on Pediatric Psychopharmacology, 2001; Kutcher & Gardner, 2008). The “awakenings” of chronically psychotic patients treated with clozapine generated hope and renewed interest in psychiatric practice, not unlike the pride described by psychiatrists 30 to 40 years earlier when the benefits of lithium, chlorpromazine, iproniazid, and imipramine were serendipitously uncovered, and heralded the modern psychopharmacologic era (Duckworth et al., 1997; Lambert, 1998). It was much easier to teach (and to learn) about psychotropic drugs when our understanding of the pathophysiological processes of mental illness were simple and the proposed mechanisms of how these drugs worked were uncomplicated. It was also easier to teach about psychotropics when their numbers were limited to a few distinct families with simply described pharmacological actions—dopamine antagonism for schizophreina, dopamine agonistic effects for attention, GABAmimetics for anxiety, and enhancement of serotonin or norepinephrine for depression. For bipolar disorder, we seemed content to have found lithium and other so-called mood stabilizers, even if their mechanisms remained mysterious. Never mind that the above psychotropic drugs were incompletely effective for most patients and completely ineffective for some, the proposed pharmacologic mechanisms meshed well with the pathophysiological proposals (though in many cases this was no coincidence) and this suited us just fine (Teicher, 1988). The neuroscientific basis of psychiatric disorders and investigations into the pharmacological effects of their treatments have exploded in the past 20 years coincident with advances in molecular genetics, molecular and cell biology, molecular pharmacolo
在过去的二十年中，精神疾病的药物治疗在整个生命周期中发生了很大的变化。就在20多年前，氟西汀首次在美国上市，此后不久，氯氮平又令人瞩目地回到了病人的护理中。但当这些药物获得FDA、加拿大卫生部和其他国家监管机构的上市许可时，我们并不知道它们会对临床实践、制药业、精神药物研究、药物命名法、精神病分类学、对精神病患者的认知和护理，以及临床精神药理学教育产生什么影响。百忧解(Prozac)迅速成为家喻户晓的词汇，取代安定(Valium)成为最著名的精神药物(Kramer, 1993)。它也成为儿童和青少年精神药理学的避雷针(Healy, 2003;Teicher et al.， 1990)。百忧解®是几个非常成功上市的SSRIs中的第一个，它被发现对儿科焦虑症特别有效。然而，这一治疗进展被这些ssri类药物在青少年抑郁症方面的不确定益处所掩盖，而且早期迹象表明它们可能促进而不是阻止年轻患者的自杀倾向(儿科精神药理学研究单位，2001;库彻&加德纳，2008)。用氯氮平治疗的慢性精神病患者的“觉醒”产生了希望，并重新燃起了对精神病学实践的兴趣，这与30至40年前精神病学家在偶然发现锂、氯丙嗪、异丙肼和丙咪嗪的益处时所描述的自豪感没有什么不同，并预示着现代精神药理学时代的到来(Duckworth等人，1997;兰伯特,1998)。当我们对精神疾病的病理生理过程的理解很简单，这些药物的作用机制也不复杂时，教授(和学习)精神药物就容易得多。当精神类药物的数量被限制在几个不同的家族，并具有简单描述的药理作用时——用于精神分裂症的多巴胺拮抗剂，用于注意力的多巴胺激动剂，用于焦虑的GABAmimetics，以及用于抑郁症的血清素或去甲肾上腺素的增强剂，教授精神类药物也更容易。对于双相情感障碍，我们似乎很满意发现了锂和其他所谓的情绪稳定剂，即使它们的机制仍然很神秘。尽管上述精神药物对大多数患者不完全有效，对某些患者完全无效，但提出的药理学机制与病理生理学建议很好地吻合(尽管在许多情况下这不是巧合)，这很适合我们(Teicher, 1988)。在过去的20年里，随着分子遗传学、分子和细胞生物学、分子药理学、药物基因组学和成像技术的进步，精神疾病的神经科学基础和对其治疗的药理学效应的研究出现了爆炸式增长。新的发现揭示了精神疾病最初的生物学理论过于简单、不完整或错误。然而，尽管取得了许多戏剧性的进展，但用更新的、被广泛接受的理论取代这些老化理论并没有发生(Conn & Roth, 2008)。美国神经精神药理学学院2002年详尽的参考文献《神经精神药理学第五代进展》的内容说明了这一领域的发展及其复杂性。这本书有2010页，由近300位专家撰写，涵盖134章(Davis et al, 2002)。与这些神经科学的进步相比，新药的发现一直缓慢而令人失望。发人深省的是，最常用的精神药物与几十年前发现的作用机制相同。例如，奥氮平、利培酮和喹硫平是比D2更有效的5-HT2拮抗剂，这是1961年发现的氯氮平的作用;文拉辛对5 -羟色胺和去甲肾上腺素的双重再摄取阻断是三环抗抑郁药的一个特点，1977年首次用齐默利定观察到5 -羟色胺再摄取抑制的特异性，但即使在那时也很难说是抗抑郁作用的新机制(Conn & Roth, 2008)。矛盾的是，随着研究基地的扩大，对精神疾病及其治疗的神经科学基础的教学似乎越来越不重视。也就是说，随着信息变得越来越复杂，人们的反应是不再强调它的重要性。
{"title":"Opinion: Secular Trends and Postgraduate Teaching Challenges in Psychopharmacology","authors":"D. Gardner","doi":"10.1521/CAPN.2009.14.3.7","DOIUrl":"https://doi.org/10.1521/CAPN.2009.14.3.7","url":null,"abstract":"Much has changed in the past two decades in terms of the pharmacotherapy of psychiatric disorders across the lifespan. It was just over 20 years ago that fluoxetine was first marketed in the United States and shortly thereafter clozapine made its remarkable return to patient care. But at the time these medications received marketing approvals from the FDA, Health Canada, and other nations’ regulatory agencies, we were not to know the impact they would have—on clinical practice, the pharmaceutical industry, psychotropic drug research, drug nomenclature, psychiatric nosology, perceptions of psychiatric patients and care, as well as education in clinical psychopharmacology. Prozac® quickly became a household word, supplanting Valium® as the best known psychotropic (Kramer, 1993). It also emerged as a lightning rod in child and adolescent psychopharmacology (Healy, 2003; Teicher et al., 1990). Prozac® was the first of several very successfully marketed SSRIs, which were found to be particularly effective in pediatric anxiety disorders. However, this therapeutic advance was overshadowed by these SSRIs’ uncertain benefit in adolescent depression and the early indications that they could promote rather than thwart suicidality in young patients (Research Unit on Pediatric Psychopharmacology, 2001; Kutcher & Gardner, 2008). The “awakenings” of chronically psychotic patients treated with clozapine generated hope and renewed interest in psychiatric practice, not unlike the pride described by psychiatrists 30 to 40 years earlier when the benefits of lithium, chlorpromazine, iproniazid, and imipramine were serendipitously uncovered, and heralded the modern psychopharmacologic era (Duckworth et al., 1997; Lambert, 1998). It was much easier to teach (and to learn) about psychotropic drugs when our understanding of the pathophysiological processes of mental illness were simple and the proposed mechanisms of how these drugs worked were uncomplicated. It was also easier to teach about psychotropics when their numbers were limited to a few distinct families with simply described pharmacological actions—dopamine antagonism for schizophreina, dopamine agonistic effects for attention, GABAmimetics for anxiety, and enhancement of serotonin or norepinephrine for depression. For bipolar disorder, we seemed content to have found lithium and other so-called mood stabilizers, even if their mechanisms remained mysterious. Never mind that the above psychotropic drugs were incompletely effective for most patients and completely ineffective for some, the proposed pharmacologic mechanisms meshed well with the pathophysiological proposals (though in many cases this was no coincidence) and this suited us just fine (Teicher, 1988). The neuroscientific basis of psychiatric disorders and investigations into the pharmacological effects of their treatments have exploded in the past 20 years coincident with advances in molecular genetics, molecular and cell biology, molecular pharmacolo","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"14 1","pages":"7-10"},"PeriodicalIF":0.0,"publicationDate":"2009-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1521/CAPN.2009.14.3.7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67088750","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 : 2009-04-01DOI: 10.1521/CAPN.2009.14.2.1
L. Propper, H. Orlik
{"title":"Focus: The Use of Psychotropic Drugs in Autism and Other Pervasive Developmental Disorders","authors":"L. Propper, H. Orlik","doi":"10.1521/CAPN.2009.14.2.1","DOIUrl":"https://doi.org/10.1521/CAPN.2009.14.2.1","url":null,"abstract":"","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"14 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1521/CAPN.2009.14.2.1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67088888","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 : 2009-04-01DOI: 10.1521/CAPN.2009.14.2.9
M. Dell
the QTc. The purpose of this study was to collect pilot data on the efficacy and safety of ziprasidone in adolescents with autism, focusing on safety issues of weight gain and QTc. Methods: Twelve adolescents with autism (mean age 14.5 +/1.8 years) were treated in a 6-week open pilot study. Ziprasidone dosage ranged from 20 to 160 mg/day (mean, 98.3 +/40.4 mg/day). The primary efficacy measure was the Clinical Global Impressions-Improvement item (CGI-I); other efficacy measures included the Aberrant Behavior Checklist and the Children’s Psychiatric Rating Scale. Results: Based on the CGI-I, 9 of 12 (75%) patients were treatment responders. Ziprasidone was weight neutral, and the QTc increased by a mean of 14.7 msec. Two subjects had acute dystonic reactions. Cholesterol decreased and prolactin remained the same.
{"title":"Autism and Sleep: Basics for the Clinician","authors":"M. Dell","doi":"10.1521/CAPN.2009.14.2.9","DOIUrl":"https://doi.org/10.1521/CAPN.2009.14.2.9","url":null,"abstract":"the QTc. The purpose of this study was to collect pilot data on the efficacy and safety of ziprasidone in adolescents with autism, focusing on safety issues of weight gain and QTc. Methods: Twelve adolescents with autism (mean age 14.5 +/1.8 years) were treated in a 6-week open pilot study. Ziprasidone dosage ranged from 20 to 160 mg/day (mean, 98.3 +/40.4 mg/day). The primary efficacy measure was the Clinical Global Impressions-Improvement item (CGI-I); other efficacy measures included the Aberrant Behavior Checklist and the Children’s Psychiatric Rating Scale. Results: Based on the CGI-I, 9 of 12 (75%) patients were treatment responders. Ziprasidone was weight neutral, and the QTc increased by a mean of 14.7 msec. Two subjects had acute dystonic reactions. Cholesterol decreased and prolactin remained the same.","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"14 1","pages":"9-11"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1521/CAPN.2009.14.2.9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67089013","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 : 2009-02-01DOI: 10.1521/CAPN.2009.14.1.6
A. Robb, L. Foster
{"title":"The Black Box Warning and Its Unintended Consequences","authors":"A. Robb, L. Foster","doi":"10.1521/CAPN.2009.14.1.6","DOIUrl":"https://doi.org/10.1521/CAPN.2009.14.1.6","url":null,"abstract":"","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"14 1","pages":"6-9"},"PeriodicalIF":0.0,"publicationDate":"2009-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1521/CAPN.2009.14.1.6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67088528","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 : 2008-12-01DOI: 10.1521/CAPN.2008.13.6.1
N. Akhtar, A. Khan
In the past, treatment of psychosis was centered on conventional agents, whose tolerability was limited by extrapyramidal side effects (EPS). The past decade has seen emergence of newer antipsychotic agents, first with clozapine and then with risperidone, olanzapine, quetiapine and ziprasidone. In general, while demonstrating similar efficacies to traditional agents, use of these compounds may be associated with lower risk of extrapyramidal symptoms (EPS) and possibly less cognitive impairment and better effects on negative symptoms. However, evolving evidence suggests that several drugs in this class may be associated with significant weight gain, lipid, and other metabolic abnormalities. Aripiprazole, a quinolinone derivative, is an atypical antipsychotic drug, displaying clinical efficacy similar to that of haloperidol and risperidone and superior to that of placebo in numerous clinical trials. Aripiprazole use is also associated with lower rate of clinically significant weight gain compared with other atypical antipsychotics. Patients receiving aripiprazole may experience EPS at a rate similar to that seen with placebo. Within the antipsychotic medication class, the introduction of aripiprazole may provide an alternative therapeutic option to traditional antipsychotics without some use limiting side effects of other atypical medications.
{"title":"Prescriptions Into Practice: Aripiprazole (Abilify): A Novel Atypical Antipsychotic Medication","authors":"N. Akhtar, A. Khan","doi":"10.1521/CAPN.2008.13.6.1","DOIUrl":"https://doi.org/10.1521/CAPN.2008.13.6.1","url":null,"abstract":"In the past, treatment of psychosis was centered on conventional agents, whose tolerability was limited by extrapyramidal side effects (EPS). The past decade has seen emergence of newer antipsychotic agents, first with clozapine and then with risperidone, olanzapine, quetiapine and ziprasidone. In general, while demonstrating similar efficacies to traditional agents, use of these compounds may be associated with lower risk of extrapyramidal symptoms (EPS) and possibly less cognitive impairment and better effects on negative symptoms. However, evolving evidence suggests that several drugs in this class may be associated with significant weight gain, lipid, and other metabolic abnormalities. Aripiprazole, a quinolinone derivative, is an atypical antipsychotic drug, displaying clinical efficacy similar to that of haloperidol and risperidone and superior to that of placebo in numerous clinical trials. Aripiprazole use is also associated with lower rate of clinically significant weight gain compared with other atypical antipsychotics. Patients receiving aripiprazole may experience EPS at a rate similar to that seen with placebo. Within the antipsychotic medication class, the introduction of aripiprazole may provide an alternative therapeutic option to traditional antipsychotics without some use limiting side effects of other atypical medications.","PeriodicalId":89750,"journal":{"name":"Child & adolescent psychopharmacology news","volume":"13 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1521/CAPN.2008.13.6.1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67088316","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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