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Themann A, Rodriguez M, Reyes-Arce J, Iñiguez SD. Chlordiazepoxide reduces anxiety-like behavior in the adolescent mouse elevated plus maze: A pharmacological validation study. Pharmacol Biochem Behav 2024; 242:173819. [PMID: 38986686 DOI: 10.1016/j.pbb.2024.173819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/03/2024] [Accepted: 07/07/2024] [Indexed: 07/12/2024]
Abstract
This report evaluates the effects of chlordiazepoxide, a benzodiazepine commonly prescribed to manage anxiety-related disorders in adolescent/pediatric populations, on elevated plus maze (EPM) performance in juvenile mice. This approach was taken because chlordiazepoxide produces anxiolytic-like effects in multiple models in adult rodents, however, less is known about the behavioral effects of this benzodiazepine in juveniles. Thus, we administered a single intraperitoneal injection of chlordiazepoxide (0, 5, or 10 mg/kg) to postnatal day 35 male C57BL/6 mice. Thirty minutes later, mice were allowed to explore the EPM for 5-min. We found that chlordiazepoxide-treated mice (5 and 10 mg/kg) spent more time exploring the open arms of the EPM. No differences in velocity (cm/s) or distance traveled (cm) were observed between the groups. These results indicate that chlordiazepoxide induces anxiolytic-related behavior in adolescent male mice.
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Affiliation(s)
- Anapaula Themann
- Department of Psychology, The University of Texas at El Paso, El Paso, TX 79968, USA
| | - Minerva Rodriguez
- Department of Psychology, The University of Texas at El Paso, El Paso, TX 79968, USA
| | - Joselynn Reyes-Arce
- Department of Psychology, The University of Texas at El Paso, El Paso, TX 79968, USA
| | - Sergio D Iñiguez
- Department of Psychology, The University of Texas at El Paso, El Paso, TX 79968, USA.
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Topchiy I, Mohbat J, Folorunso OO, Wang ZZ, Lazcano-Etchebarne C, Engin E. GABA system as the cause and effect in early development. Neurosci Biobehav Rev 2024; 161:105651. [PMID: 38579901 PMCID: PMC11081854 DOI: 10.1016/j.neubiorev.2024.105651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/05/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
GABA is the primary inhibitory neurotransmitter in the adult brain and through its actions on GABAARs, it protects against excitotoxicity and seizure activity, ensures temporal fidelity of neurotransmission, and regulates concerted rhythmic activity of neuronal populations. In the developing brain, the development of GABAergic neurons precedes that of glutamatergic neurons and the GABA system serves as a guide and framework for the development of other brain systems. Despite this early start, the maturation of the GABA system also continues well into the early postnatal period. In this review, we organize evidence around two scenarios based on the essential and protracted nature of GABA system development: 1) disruptions in the development of the GABA system can lead to large scale disruptions in other developmental processes (i.e., GABA as the cause), 2) protracted maturation of this system makes it vulnerable to the effects of developmental insults (i.e., GABA as the effect). While ample evidence supports the importance of GABA/GABAAR system in both scenarios, large gaps in existing knowledge prevent strong mechanistic conclusions.
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Affiliation(s)
- Irina Topchiy
- Division of Basic Neuroscience, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Julie Mohbat
- Division of Basic Neuroscience, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA; School of Life Sciences, Ecole Polytechnique Federale de Lausanne, Lausanne CH-1015, Switzerland
| | - Oluwarotimi O Folorunso
- Division of Basic Neuroscience, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Ziyi Zephyr Wang
- Division of Basic Neuroscience, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | | | - Elif Engin
- Division of Basic Neuroscience, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA.
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Antoniou T, McCormack D, Kitchen S, Pajer K, Gardner W, Lunsky Y, Penner M, Tadrous M, Mamdani M, Juurlink DN, Gomes T. Impact of a publicly-funded pharmacare program policy on benzodiazepine dispensing among children and youth: a population-based natural experiment. BMC Pediatr 2023; 23:519. [PMID: 37858122 PMCID: PMC10585894 DOI: 10.1186/s12887-023-04331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 09/26/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND In January 2018, the Government of Ontario, Canada, initiated a universal pharmacare program (OHIP+) for all individuals aged 24 years and younger. In April 2019, the program was amended to cover only children and youth without private insurance. Because benzodiazepines are commonly prescribed to children and youth despite their potential hazards, we examined whether changes in publicly-funded drug coverage influenced benzodiazepine dispensing trends in this demographic. METHODS We conducted a population-based natural experiment study of benzodiazepine dispensing to children and youth in Ontario between January 2013 and March 2020. We used interventional autoregressive integrated moving average models to estimate the impact of OHIP + and its subsequent modification on these trends. RESULTS The implementation of OHIP + was associated with an immediate increase in the monthly rate of benzodiazepine dispensing of 12.9 individuals per 100,000 population (95% confidence interval [CI]; 7.5 to 18.3 per 100,000). Benzodiazepine dispensing rates rose from 214.2 to 241.5 per 100,000 from December 2017 to March 2019, a 12.8% (95% CI 9.6-16.0%) increase. In stratified analyses, increases were most pronounced among females, children and youth living in the lowest income neighbourhoods and individuals aged 20 to 24. The April 2019 modification to OHIP + was not associated with changes in monthly benzodiazepine dispensing trends (0.39 individuals per 100,000; 95% CI -1.3 to 2.1 per 100,000). However, rates remained elevated relative to the period preceding OHIP + implementation. CONCLUSIONS Implementation of a publicly-funded pharmacare program resulted in more children and youth being prescribed benzodiazepines.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
- ICES, Toronto, ON, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.
| | | | | | - Kathleen Pajer
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - William Gardner
- ICES, Toronto, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Yona Lunsky
- ICES, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Melanie Penner
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto Ontario, Canada
| | - Mina Tadrous
- ICES, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Centre for Healthcare Analytics Research & Training, Unity Health, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (Mamdani), University of Toronto, Toronto, ON, Canada
| | - David N Juurlink
- ICES, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (Mamdani), University of Toronto, Toronto, ON, Canada
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Cybulski L, Ashcroft DM, Carr MJ, Garg S, Chew-Graham CA, Kapur N, Webb RT. Management of anxiety disorders among children and adolescents in UK primary care: A cohort study. J Affect Disord 2022; 313:270-277. [PMID: 35803390 DOI: 10.1016/j.jad.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anxiety disorders are common in childhood and adolescence but evidence-based guidance on their management is limited in the UK. In the absence of guidelines, we examined what treatment young people with anxiety disorders receive in primary care in the year following diagnosis. METHOD We delineated a cohort of individuals diagnosed with anxiety disorders aged 10-18 using the Clinical Practice Research Datalink (CPRD). We estimated the annual prevalence of antidepressant and anxiolytic prescribing and referrals to mental health services in the year following diagnosis between 2003 and 2019 via Poisson models, adjusted for age, gender, and practice-level deprivation. RESULTS 34,490 out of 52,358 (66 %) individuals were not prescribed or referred in the year following diagnosis. Those registered to practices in the most deprived compared to the least deprived areas were less likely to be referred (PR 0.80, 95%CI 0.76-0.84) and prescribed antidepressants (PR 0.77, 95%CI 0.72-0.82). Referrals increased 2003-2008 (22-28 %) and then declined until 2019 (28-21 %). Antidepressant prescribing decreased substantially between 2003 and 2005 (18-11 %) and then increased slightly between 2006 and 2019 (11-13 %). Anxiolytic prescribing declined between 2003 and 2019 (10-2 %). LIMITATIONS Prescriptions in the CPRD are not coupled with information about indication. Some prescriptions may therefore have been incorrectly attributed to the treatment of anxiety disorders. CONCLUSION The continued use of antidepressants necessitates the development of evidence-based guidance. The lower likelihood of being prescribed medication and/or referred among young people in more deprived practice populations, where incidence of anxiety disorder and other mental illnesses is higher, must also be investigated and rectified.
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Affiliation(s)
- Lukasz Cybulski
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK; National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Manchester, UK.
| | - Darren M Ashcroft
- National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Manchester, UK; Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester and Manchester Academic Health Sciences Centre, UK
| | - Matthew J Carr
- National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Manchester, UK; Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester and Manchester Academic Health Sciences Centre, UK
| | - Shruti Garg
- Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester & and Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation, Manchester, UK
| | - Carolyn A Chew-Graham
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffs, UK
| | - Nav Kapur
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK; National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Roger T Webb
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK; National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
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Snir A, Moskow DM, Hofmann SG. When is it appropriate to treat children with social anxiety, pharmacologically? Expert Opin Pharmacother 2021; 22:2423-2426. [PMID: 34187275 DOI: 10.1080/14656566.2021.1948015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Avigal Snir
- Department of Psychological and Brain Sciences, Boston University, Boston, MA.,Department of Clinical Psychology, Philipps-University Marburg, Marburg/Lahn, Germany
| | - Danielle M Moskow
- Department of Psychological and Brain Sciences, Boston University, Boston, MA.,Department of Clinical Psychology, Philipps-University Marburg, Marburg/Lahn, Germany
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, MA.,Department of Clinical Psychology, Philipps-University Marburg, Marburg/Lahn, Germany
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Chan HY, Cheng SW, Sun HJ. Prescription patterns and trends of anxiolytics and hypnotics/sedatives among child and adolescent patients with psychiatric illnesses in a psychiatric center of northern Taiwan. TAIWANESE JOURNAL OF PSYCHIATRY 2021. [DOI: 10.4103/tpsy.tpsy_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bushnell GA, Crystal S, Olfson M. Prescription Benzodiazepine Use in Privately Insured U.S. Children and Adolescents. Am J Prev Med 2019; 57:775-785. [PMID: 31753258 PMCID: PMC6935869 DOI: 10.1016/j.amepre.2019.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Benzodiazepines are commonly prescribed in the U.S. but entail safety concerns, including dependency. In pediatrics, many indications lack trial data. Authors aimed to describe youth initiating prescription benzodiazepine treatment, identify potential indications and prescribing concerns, estimate the duration of treatment by potential indication, and identify factors that predict long-term use. METHODS The study cohort included children (aged 3-12 years) and adolescents (aged 13-17 years) initiating prescription benzodiazepine treatment (≥3 days' supply) from January 2010 to September 2015 in a U.S. commercial claims database. Potential indications included selected ICD-9-CM diagnoses (≤30 days prior). Long-term (≥6 months) benzodiazepine treatment was estimated with Kaplan-Meier estimation and modified Poisson regression identified independent predictors of long-term benzodiazepine treatment (analysis completed in 2018). RESULTS Of 24,504 children and 61,046 adolescents initiating benzodiazepines, 62% of the children and 68% of the adolescents had a potential indication. Anxiety disorders were the most common indication, with mental health indications more common among adolescents (45%) than children (23%) and epilepsy and movement disorders higher in children. Recent opioid prescriptions were common before benzodiazepine initiation (children, 22%; adolescents, 21%). Six percent of the initiators became long-term benzodiazepine users. Potential indication, provider contact, psychotropic medication, and chronic conditions independently predicted long-term benzodiazepine treatment in adolescents and children. CONCLUSIONS U.S. children and adolescents are prescribed benzodiazepines for various mental health and other medical conditions, many lacking evidence of pediatric efficacy. Long-term benzodiazepine treatment, concurrent opioid prescriptions, psychotropic use, and prior substance use disorder diagnoses suggest safety risks among some youth prescribed benzodiazepines.
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Affiliation(s)
- Greta A Bushnell
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Mark Olfson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
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Baiden P, Graaf G, Zaami M, Acolatse CK, Adeku Y. Examining the association between prescription opioid misuse and suicidal behaviors among adolescent high school students in the United States. J Psychiatr Res 2019; 112:44-51. [PMID: 30852426 DOI: 10.1016/j.jpsychires.2019.02.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 02/07/2019] [Accepted: 02/21/2019] [Indexed: 12/25/2022]
Abstract
Although some studies have examined the association between prescription opioid misuse and mental health outcomes, few studies have examined the effects of prescription opioid misuse on suicidal behaviors among adolescents. The objective of this study was to examine the association between prescription opioid misuse and suicidal ideation, suicide plan, and suicide attempt among adolescents. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 8830 adolescents aged 14-18 years (50.9% female) were analyzed using logistic regression with suicidal ideation, suicide plan, and suicide attempt as outcome variables and prescription opioid misuse as the main explanatory variable. Of the 8830 adolescents, 13.3% ever misused prescription opioids; 17.7% experienced suicidal ideation, 13.3% made a suicide plan, and 6.5% attempted suicide during the past 12 months. In the multivariate logistic regression models, adolescent students who misused prescription opioids were 1.50 times more likely to have experienced suicidal ideation, 1.44 times more likely to have made a suicide plan, and 1.58 times more likely to have attempted suicide during the past 12 months when compared to their counterparts who did not misuse prescription opioids. Other significant predictors of suicidal behaviors include sexual minority, history of sexual assault, traditional bullying and cyberbullying victimization, feeling sad or hopeless, cigarette smoking, and illicit drug use. The findings of the present study demonstrate the harmful effects of prescription opioid misuse and its association with suicidal behaviors among adolescents.
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Affiliation(s)
- Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX, 76019, USA.
| | - Genevieve Graaf
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX, 76019, USA
| | - Mariama Zaami
- University of Ghana, Department of Geography & Resource Development, P.O. Box LG 59, Legon, Accra, Ghana
| | - Charles K Acolatse
- University of North Texas Health Science Center, School of Public Health, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Yvonne Adeku
- University of Ghana, Department of Social Work, P. O. Box LG 419, Legon, Accra, Ghana
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Mostafavi SN, Jafari A, Hoseini SG, Khademian M, Kelishadi R. The efficacy of low and moderate dosage of diazepam on sleep bruxism in children: A randomized placebo-controlled clinical trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:8. [PMID: 30815021 PMCID: PMC6383339 DOI: 10.4103/jrms.jrms_131_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/04/2018] [Accepted: 10/15/2018] [Indexed: 11/04/2022]
Abstract
Background Sleep bruxism (SB) in children is commonly a self-limited problem; however, therapy of the condition may be needed to improve sleep quality of parents and children. Benzodiazepines have some success in controlling adult bruxism. The objective of this study was to evaluate the effect and the safety of a short course of diazepam on controlling SB in healthy children. Materials and Methods In this double-blind, randomized placebo-controlled clinical trial, 109 children with SB were randomly assigned to three groups, receiving low or moderate dose of diazepam or placebo for 2 weeks. For children aged 2-8 years, the dose of 2.5 and 5 mg was considered as low and moderate dose consequently. In children >8 years, the doses were doubled. The severity of SB was evaluated at the beginning and also 2, 8, and 12 weeks thereafter. Data were collected by a questionnaire completed by parents including frequency of SB per week and per night and duration of each SB, as bruxism severity score (BSS). A mixed-model ANOVA was used to assess the differences of mean BSS between different groups and measurement times. Results From 109 children recruited, 90 completed the study. After 2 weeks of intervention, the mean BSS decreased significantly in all groups (P = 0.0001), but it was not significantly different between groups in any of follow-ups (P = 0.554). Next-day sleepiness was assessed at week 2 of the study and was significantly higher in the groups using diazepam (P = 0.026). Conclusion Short course of diazepam was not more effective than placebo for long-term control of SB in children.
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Affiliation(s)
- Seyyed-Nassereddin Mostafavi
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azadeh Jafari
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Emam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shervin Ghaffari Hoseini
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Khademian
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Emam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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Sidorchuk A, Isomura K, Molero Y, Hellner C, Lichtenstein P, Chang Z, Franck J, Fernández de la Cruz L, Mataix-Cols D. Benzodiazepine prescribing for children, adolescents, and young adults from 2006 through 2013: A total population register-linkage study. PLoS Med 2018; 15:e1002635. [PMID: 30086134 PMCID: PMC6080748 DOI: 10.1371/journal.pmed.1002635] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/09/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Pharmacoepidemiological studies have long raised concerns on widespread use of benzodiazepines and benzodiazepine-related drugs (BZDs), in particular long-term use, among adults and the elderly. In contrast, evidence pertaining to the rates of BZD use at younger ages is still scarce, and the factors that influence BZD utilisation and shape the different prescribing patterns in youths remain largely unexplored. We examined the prevalence rates, relative changes in rates over time, and prescribing patterns for BZD dispensation in young people aged 0-24 years in Sweden during the period January 1, 2006-December 31, 2013, and explored demographic, clinical, pharmacological, and prescriber-related attributes of BZD prescribing in this group. METHODS AND FINDINGS Through the linkage of 3 nationwide Swedish health and administrative registers, we collected data on 17,500 children (0-11 years), 15,039 adolescents (12-17 years), and 85,200 young adults (18-24 years) with at least 1 dispensed prescription for a BZD during 2006-2013, out of 3,726,818 Swedish inhabitants aged 0-24 years. Age-specific annual prevalence rates of BZD dispensations were adjusted for population growth, and relative changes in rates were calculated between 2006 and 2013. We analysed how BZD dispensation varied by sex, psychiatric morbidity and epilepsy, concurrent dispensation of psychotropic medication, type of dispensed BZD, and type of healthcare provider prescribing the BZD. Prescribing patterns were established in relation to duration (3 months, >3 to ≤6 months, or >6 months), dosage (<0.5 defined daily dosage [DDD]/day, ≥0.5 to <1.5 DDD/day, or ≥1.5 DDD/day), and "user category" ("regular users" [≥0.5 to <1.5 DDD/day for ≥1 year], "heavy users" [≥1.5 DDD/day for ≥1 year], or otherwise "occasional users"). Multinomial regression models were fitted to test associations between BZD prescribing patterns and individual characteristics of study participants. Between 2006 and 2013, the prevalence rate of BZD dispensation among individuals aged 0-24 years increased by 22% from 0.81 per 100 inhabitants to 0.99 per 100 inhabitants. This increase was mainly driven by a rise in the rate among young adults (+20%), with more modest increases in children (+3%) and adolescents (+7%). Within each age category, overall dispensation of BZD anxiolytics and clonazepam decreased over time, while dispensation of BZD hypnotics/sedatives, including Z-drugs, showed an increase between 2006 and 2013. Out of 117,739 study participants with dispensed BZD prescriptions, 65% initiated BZD prescriptions outside of psychiatric services (92% of children, 60% of adolescents, 60% of young adults), and 76% were dispensed other psychotropic drugs concurrently with a BZD (46% of children, 80% of adolescents, 81% of young adults). Nearly 30% of the participants were prescribed a BZD for longer than 6 months (18% of children, 31% of adolescents, 31% of young adults). A high dose prescription (≥1.5 DDD/day) and heavy use were detected in 2.6% and 1.7% of the participants, respectively. After controlling for potential confounding by demographic and clinical characteristics, the characteristics age above 11 years at the first BZD dispensation, lifetime psychiatric diagnosis or epilepsy, and concurrent dispensation of other psychotropic drugs were found to be associated with higher odds of being prescribed a BZD for longer than 6 months, high dose prescription, and heavy use. Male sex was associated with a higher likelihood of high dose prescription and heavy use, but not with being prescribed a BZD on a long-term basis (> 6 months). The study limitations included lack of information on actual consumption of the dispensed BZDs and unavailability of data on the indications for BZD prescriptions. CONCLUSIONS The overall increase in prevalence rates of BZD dispensations during the study period and the unexpectedly high proportion of individuals who were prescribed a BZD on a long-term basis at a young age indicate a lack of congruence with international and national guidelines. These findings highlight the need for close monitoring of prescribing practices, particularly in non-psychiatric settings, in order to build an evidence base for safe and efficient BZD treatment in young persons.
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Affiliation(s)
- Anna Sidorchuk
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Yasmina Molero
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Franck
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Patel DR, Feucht C, Brown K, Ramsay J. Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners. Transl Pediatr 2018; 7:23-35. [PMID: 29441280 PMCID: PMC5803020 DOI: 10.21037/tp.2017.08.05] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Anxiety disorders are common in children and adolescents with reported prevalence rates between 10% and 30%. A combined approach to treatment has been found to be the most effective for optimal outcomes and is typically comprised of psychotherapy (especially exposure-based cognitive behavior therapy), family and patient education, and use of medication if indicated. In children and adolescents who might benefit from use of medications, selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice. The safety and efficacy of medications other than SSRIs in the treatment of children and adolescents with anxiety disorders are not fully established. Most children and adolescents respond well to treatment with long lasting resolution of symptoms, although, recurrence of the same, or development of a different type of anxiety disorder, is not uncommon. In most children and adolescents, anxiety disorders tend to persist into adulthood requiring long-term treatment planning. This paper reviews the pharmacological agents used in the treatment of anxiety disorders in children and adolescents.
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Affiliation(s)
- Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Cynthia Feucht
- Cynthia Feucht, Adjunct Faculty, Ferris State University, College of Pharmacy, Clinical Pharmacy Specialist, Borgess Internal Medicine, Portage, MI, USA
| | - Kelly Brown
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Jessica Ramsay
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
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McCabe SE, Veliz P, Boyd CJ, Schulenberg JE. Medical and nonmedical use of prescription sedatives and anxiolytics: Adolescents' use and substance use disorder symptoms in adulthood. Addict Behav 2017; 65:296-301. [PMID: 27569697 DOI: 10.1016/j.addbeh.2016.08.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/24/2016] [Accepted: 08/13/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study assessed the longitudinal associations between medical and nonmedical use of prescription sedatives/anxiolytics (NMPSA) during adolescence (age 18) and substance use disorder (SUD) symptoms during adulthood (age 35). METHODS Multiple cohorts of nationally representative samples of U.S. high school seniors (n=8373) were surveyed via self-administered questionnaires and followed longitudinally from adolescence (age 18, 1976-1996) to adulthood (age 35, 1993-2013). RESULTS An estimated 20.1% of adolescents reported lifetime medical or nonmedical use of prescription sedatives/anxiolytics. Among adolescents who reported medical use of prescription sedatives/anxiolytics, 44.9% also reported NMPSA by age 18. Based on multivariate analyses that included age 18 sociodemographic and other substance use controls, medical use of prescription sedatives/anxiolytics without any history of NMPSA during adolescence was not associated with SUD symptoms in adulthood relative to adolescents with no prescription sedative/anxiolytic use. In contrast, adolescents with a history of both medical and nonmedical use of prescription sedatives/anxiolytics and adolescents who reported only NMPSA had between two to three times greater odds of SUD symptoms in adulthood relative to adolescents with no prescription sedative/anxiolytic use and those who reported only medical use of prescription sedatives/anxiolytics. CONCLUSIONS One in every five U.S. high school seniors reported ever using prescription sedatives/anxiolytics either medically or nonmedically. This study provides compelling evidence that the medical use of prescription sedatives/anxiolytics (without any NMPSA) during adolescence is not associated with increased risk of SUD symptoms in adulthood while any NMPSA during adolescence serves as a signal for SUDs in adulthood.
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Affiliation(s)
- Sean Esteban McCabe
- University of Michigan, Institute for Research on Women and Gender, Substance Abuse Research Center, Ann Arbor 48109, MI, USA.
| | - Philip Veliz
- University of Michigan, Institute for Research on Women and Gender, Ann Arbor 48109, MI, USA
| | - Carol J Boyd
- University of Michigan, School of Nursing, Department of Psychiatry, Institute for Research on Women and Gender, Ann Arbor 48109, MI, USA
| | - John E Schulenberg
- University of Michigan, Institute for Social Research, Department of Psychology, Ann Arbor 48106, MI, USA
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Abstract
Like their peers in the general youth population, youth with chronic medical conditions (YCMC) are at risk for substance use, including nonmedical use of prescription medications. However, given dangerous disease-substance interactions, the stakes for detecting and intervening on substance use are perhaps even higher for YCMC. Given the risk for nonadherence with chronic disease management, it is incumbent on primary care providers, specialty providers, and behavioral health specialists to be vigilant in asking about substance use and providing brief counseling and referral to substance use treatment when appropriate.
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Affiliation(s)
- Scott E Hadland
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Kresge Building, 677 Huntington Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Leslie Renee Walker
- Division of Adolescent Medicine, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA; Department of Pediatrics, University of Washington, 1959 Northeast Pacific Street, Box 356320, Seattle, WA 98195, USA
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Weis JR, Greene JA. Mental Health in Pregnant Adolescents: Focus on Psychopharmacology. J Pediatr 2016; 169:297-304. [PMID: 26616248 DOI: 10.1016/j.jpeds.2015.10.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/24/2015] [Accepted: 10/21/2015] [Indexed: 11/19/2022]
Affiliation(s)
- J Rebecca Weis
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY; Early Childhood Mental Health, Bellevue Hospital Center, New York, NY.
| | - Judy A Greene
- Department of Psychiatry, New York University School of Medicine, New York, NY; Women's Mental Health, Bellevue Hospital Center, New York, NY
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O'Sullivan K, Reulbach U, Boland F, Motterlini N, Kelly D, Bennett K, Fahey T. Benzodiazepine prescribing in children under 15 years of age receiving free medical care on the General Medical Services scheme in Ireland. BMJ Open 2015; 5:e007070. [PMID: 26059522 PMCID: PMC4466624 DOI: 10.1136/bmjopen-2014-007070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To examine the prevalence and secular trends in benzodiazepine (BZD) prescribing in the Irish paediatric population. In addition, we examine coprescribing of antiepileptic, antipsychotic, antidepressant and psychostimulants in children receiving BZD drugs and compare BZD prescribing in Ireland to that in other European countries. SETTING Data were obtained from the Irish General Medical Services (GMS) scheme pharmacy claims database from the Health Service Executive (HSE)--Primary Care Reimbursement Services (PCRS). PARTICIPANTS Children aged 0-15 years, on the HSE-PCRS database between January 2002 and December 2011, were included. PRIMARY AND SECONDARY OUTCOME MEASURES Prescribing rates were reported over time (2002-2011) and duration (≤ or >90 days). Age (0-4, 5-11, 12-15) and gender trends were established. Rates of concomitant prescriptions for antiepileptic, antipsychotics, antidepressants and psychostimulants were reported. European prescribing data were retrieved from the literature. RESULTS Rates decreased from 2002 (8.56/1000 GMS population: 95% CI 8.20 to 8.92) to 2011 (5.33/1000 GMS population: 95% CI 5.10 to 5.55). Of those children currently receiving a BZD prescription, 6% were prescribed BZD for >90 days. Rates were higher for boys in the 0-4 and 5-11 age ranges, whereas for girls they were higher in the 12-15 age groups. A substantial proportion of children receiving BZD drugs are also prescribed antiepileptic (27%), antidepressant (11%), antipsychotic (5%) and psychostimulant (2%) medicines. Prescribing rates follow a similar pattern to that in other European countries. CONCLUSIONS While BZD prescribing trends have decreased in recent years, this study shows that a significant proportion of the GMS children population are being prescribed BZD in the long term. This study highlights the need for guidelines for BZD prescribing in children in terms of clinical indication and responsibility, coprescribing, dosage and duration of treatment.
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Affiliation(s)
- K O'Sullivan
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
| | - U Reulbach
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland Department of Public Health and Primary Care, Trinity College Centre for Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - F Boland
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
| | - N Motterlini
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
| | - D Kelly
- Department of Public Health and Primary Care, Trinity College Centre for Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - K Bennett
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - T Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
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Psychotropic drugs and their impact on the treatment of paediatric dental patients. Eur Arch Paediatr Dent 2013; 14:197-206. [DOI: 10.1007/s40368-013-0053-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 12/12/2012] [Indexed: 10/26/2022]
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Nguyen ML, Shapiro MA, Welch SJ. A case of severe adolescent obsessive-compulsive disorder treated with inpatient hospitalization, risperidone and sertraline. J Behav Addict 2012; 1:78-82. [PMID: 26165310 DOI: 10.1556/jba.1.2012.2.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The initial treatment of obsessive-compulsive disorder (OCD) has generally been limited to serotonergic agents, cognitive-behavioral therapy (CBT), or a combination of the two. These findings were supported by the POTS study for OCD in children and adolescents. However, treatment with serotonergic agents or CBT can take several weeks before benefit is seen; severe cases of OCD may require more immediate treatment. CASE REPORT The authors present a case of severe OCD in an adolescent that required immediate treatment due to her critical medical condition. The patient's symptoms included not eating or taking medications or fluids by mouth due to fears of contamination. A medical hospitalization was previously required due to dehydration. As treatment with an SSRI would not have quick enough onset and the patient was initially resistant to participating in CBT, the patient was psychiatrically hospitalized and first started on liquid risperidone. After several doses of risperidone, the patient was able to participate in CBT and start sertraline. DISCUSSION The authors discuss the differential diagnosis of such a patient, including the continuum of OCD symptoms and psychotic symptoms. The authors discuss the different treatment options, including the utilization of inpatient psychiatric hospitalization. The authors discuss the potential risks and benefits of using atypical antipsychotics in lieu of benzodiazepines for the initial treatment of severe adolescent OCD. The authors also discuss other current treatment recommendations and rationale for the treatment that was pursued. CONCLUSIONS This patient received benefit of her symptoms relatively quickly with psychiatric hospitalization and an atypical antipsychotic. The diagnosis of a psychotic disorder should be considered. These treatment options must be weighed against the risks of atypical antipsychotics, including extrapyramidal symptoms, weight gain, and metabolic syndrome; benzodiazepines also have their risks and benefits. Additionally, the cost of time and finances of inpatient hospitalization must be considered. More research is needed regarding the short- and long-term efficacy and safety of antipsychotics in the treatment of OCD in the child and adolescent population.
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Acquaviva E, Peyre H, Falissard B. Panorama de la prescription et de la consommation des psychotropes chez l’enfant et l’adolescent en France. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.neurenf.2011.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
The neurotransmitter GABA (γ-aminobutyric acid), acting via inotropic GABA(A) and metabotropic GABA(B) receptors, plays an essential role in a variety of distinct neuronal processes, including regulation of neuronal excitability, determination of temporal aspects of spike trains, control of the size and propagation of neuronal assemblies, generation of oscillatory activity, and neuronal plasticity. Although the developmental switch between excitatory and inhibitory GABA(A) receptor-mediated responses is widely appreciated, the fact that the postnatal maturation of the GABAergic system lasts until late adolescence is not so persuasively promoted. This review summarizes recent knowledge of the maturation of various aspects of the GABAergic systems, like functional expression of GABA synthesizing/degrading enzymes and transporters, density of GABAergic synapses, GABAergic projection patterns, GABA receptor subunit composition, and properties of GABAergic interneurons, with an emphasis on the late developmental alterations. In addition, some aspects of the development of mental capabilities during adolescence and their relation the delayed maturation of the GABAergic system are presented.
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Affiliation(s)
- Werner Kilb
- Institute of Physiology and Pathophysiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
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Abstract
Untreated sleep disturbances and sleep disorders pose significant adverse daytime consequences and place children at considerable risk for poor health outcomes. Sleep disturbances occur at a greater frequency in children with acute and chronic medical conditions compared with otherwise healthy peers. Sleep disturbances in medically ill children can be associated with sleep disorders, comorbid with acute and chronic conditions, or secondary to underlying disease-related mechanisms, treatment regimens, or hospitalization. Clinical management should include a multidisciplinary approach with particular emphasis on routine, regular sleep assessments and prevention of daytime consequences, and promotion of healthy sleep habits and health outcomes.
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Ilomäki R, Ilomäki E, Hakko H, Räsänen P. Psychotropic medication history of inpatient adolescents--is there a rationale for benzodiazepine prescription? Addict Behav 2011; 36:161-5. [PMID: 21035951 DOI: 10.1016/j.addbeh.2010.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 08/24/2010] [Accepted: 09/16/2010] [Indexed: 10/19/2022]
Abstract
We evaluated the pre-hospitalization psychotropic medication of adolescents with different psychiatric disorders, and examined possible differences in medication history in relation to lifetime psychiatric diagnoses of study subjects. The study sample consisted of 300 girls and 208 boys (age 12-17) admitted to psychiatric inpatient hospital between April 2001 and March 2006. The information on drug therapy history and psychiatric diagnoses were obtained from the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime (K-SADS-PL). Adolescents with drug use disorders had elevated rates of pre-hospitalization prescribed benzodiazepines (BZDs). Antidepressants and antipsychotics were mainly used by depressed and psychotic adolescents. Previously prescribed BZD medication was associated with 3-fold increased rates of sedative abuse or dependence. Girls had been prescribed antidepressants and BZDs statistically significantly more commonly than boys. The results of our study underline the importance of careful consideration of the use of benzodiazepines, especially in the outpatient treatment of adolescents.
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Patel DR, Omar H, Terry M. Sport-related performance anxiety in young female athletes. J Pediatr Adolesc Gynecol 2010; 23:325-35. [PMID: 20869282 DOI: 10.1016/j.jpag.2010.04.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 04/10/2010] [Accepted: 04/21/2010] [Indexed: 11/16/2022]
Abstract
The prevalence of anxiety disorders in adolescents range from 6% to 20%, and it is much higher for anxiety symptoms not meeting criteria for a specific anxiety disorder. The prevalence is much higher in females. Athletes participating in sports experience different levels of stress from competitive sports. For most young athletes (generally 13 to 24 years old, i.e., high-school and college age group) sport participation is reported to be no more stressful than many other activities of daily student or work life in general where competition is involved and performance is measured. Some level of sport related performance anxiety is considered to be normal and healthy; however, extreme anxiety in athletes can be detrimental in these performance situations. A number of factors may contribute to the development, severity, and persistence of performance anxiety related to sport participation. This article reviews the definitions, theories, clinical presentation, evaluation, and management principles of performance anxiety symptoms in young athletes.
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Affiliation(s)
- Dilip R Patel
- Michigan State University College of Human Medicine, Kalamazoo Center for Medical Studies, Kalamazoo, Michigan, USA.
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Owens JA, Rosen CL, Mindell JA, Kirchner HL. Use of pharmacotherapy for insomnia in child psychiatry practice: A national survey. Sleep Med 2010; 11:692-700. [DOI: 10.1016/j.sleep.2009.11.015] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 10/27/2009] [Accepted: 11/01/2009] [Indexed: 11/25/2022]
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Devulapalli KK, Nasrallah HA. An analysis of the high psychotropic off-label use in psychiatric disorders The majority of psychiatric diagnoses have no approved drug. Asian J Psychiatr 2009; 2:29-36. [PMID: 23051015 DOI: 10.1016/j.ajp.2009.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 01/07/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The authors' goals were to determine the extent of unapproved indications in the DSM-IV-TR, to highlight common off-label uses of psychotropic medications and offer insights into the rationale of the widespread off-label prescribing in psychiatry. METHOD Indications for approved psychotropic agents, obtained from the Physicians Desk Reference and the Drug Information Handbook, Clinical Handbook of Psychotropic Drugs, 15th edition, and the Drugs@FDA online database were analyzed in the context of the DSM-IV-TR to determine the percent of DSM-IV-TR disorders that are indications for psychotropic agents. A literature search was performed to determine common off-label uses of major classes of psychotropic medications. RESULTS 88.5% of all DSM-IV-TR categorized disorders lack an approved medication for their treatment. Atypical Antipsychotics had the most extensive off-label use for DSM-IV-TR categorized disorder, whereas Mood Stabilizers showed the greatest off-label use with regards to disorders and symptoms that are not DSM-IV classified. For each class of medications, more off-label uses exist than FDA-approved uses. CONCLUSIONS The vast majority of DSM-IV-TR categorized disorders lack approved medications for their treatment. The large unmet need for approved psychiatric indications may explain the widespread off-label use of psychotropic medications in clinical practice.
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Abstract
A significant component of palliative care is the prompt diagnosis and management of distress, anxiety, and depression. This article reviews the symptoms and treatment of anxiety and depressive disorders in children at the end of life. Distinguishing between symptoms and disorders, the importance of open communication, consideration of the child's understanding of death, diagnostic challenges in chronically ill children, and suicidality are discussed. Because treatment options are available, it is imperative that symptoms are recognized and addressed. Understanding the issues involved in screening and diagnosis and the risks and benefits of available treatments can lead to an informed approach to the management of these disorders in the palliative care setting.
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Affiliation(s)
- Leslie S Kersun
- Division of Oncology, The Children's Hospital of Philadelphia, 4th Floor Wood Building, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Abstract
Psychotropic medications for the violent adolescent can be used safely and effectively as long as a thorough evaluation is conducted beforehand,and appropriate monitoring is attended to for the duration of treatment. Table 1 summarizes several clinical conditions associated with aggressive and violent behaviors, and the recommendations for first-, second-, and third-line pharmacotherapeutic agents to treat them.
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Affiliation(s)
- Joseph L Calles
- Department of Psychiatry, College of Human Medicine, Michigan State University, A236 East Fee Hall, East Lansing, 48824, USA.
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