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Roussel A, Delbet J, Micheland L, Deschênes G, Decramer S, Ulinski T. Quality of life in children with severe forms of idiopathic nephrotic syndrome in stable remission-A cross-sectional study. Acta Paediatr 2019; 108:2267-2273. [PMID: 31240744 DOI: 10.1111/apa.14912] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 11/27/2022]
Abstract
AIM Severe forms of idiopathic nephrotic syndrome (INS) require immunosuppressive therapy: oral treatment or intravenous therapy (rituximab, RTX). The main objective was to describe quality of life (QOL) in these specific patients. METHODS Cross-sectional, multicentre, observational study analysed QOL using a standardised questionnaire in children from 7 to 17 years, with a steroid-dependent or steroid-resistant INS in stable remission. The questionnaire consisted of 30 questions concerning physical and emotional well-being, self-esteem, family, friends, school and disease resulting in a global score of 0-100. RESULTS A total of 110 patients with a mean age of 11.6 years from three French paediatric nephrology centres were included. A total of 71 patients had oral immunosuppressive treatment, 27 had RTX, and 12 had both. 13.6% of patients had a steroid-resistant INS. The mean number of relapses was 5.8. Seventy-eight patients answered the questionnaire. The global score in the whole study population was 74.7; 72.6 in the RTX group, 76.2 in the oral drugs group, (P = 0.49). The results of sub-dimension 'school' were statistically lower in RTX group (61.6 ± 19.5) compared with oral drugs group (71.4 ± 16; P = 0.02). CONCLUSION Global QOL score was high in 'difficult-to-treat' patients with INS in stable remission on oral immunosuppressive or RTX treatment.
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Affiliation(s)
- Aphaia Roussel
- Service de Néphrologie et Dialyse Pédiatrique Hôpital Trousseau, APHP.6, and DHU i2b Paris France
| | - Jean‐Daniel Delbet
- Service de Néphrologie et Dialyse Pédiatrique Hôpital Trousseau, APHP.6, and DHU i2b Paris France
| | | | - Georges Deschênes
- Service de Néphrologie Pédiatrique Hôpital Robert Debré, AP‐HP Paris France
| | | | - Tim Ulinski
- Service de Néphrologie et Dialyse Pédiatrique Hôpital Trousseau, APHP.6, and DHU i2b Paris France
- Sorbonne Université Paris France
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Khan S, Down J, Aouira N, Bor W, Haywood A, Littlewood R, Heussler H, McDermott B. Current pharmacotherapy options for conduct disorders in adolescents and children. Expert Opin Pharmacother 2019; 20:571-583. [PMID: 30702354 DOI: 10.1080/14656566.2018.1561862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Conduct disorder (CD) is a common mental health disorder of childhood and adolescence. CD's complexity, with its heterogenous clinical manifestations and overlapping comorbidities makes the application of evidence-based management approaches challenging. This article aims to combine a systematic review of the available literature, with a consensus opinion from both child and adolescent psychiatrists and developmental pediatricians on the clinical and pharmacological management of children and adolescents with conduct disorder (CD). AREAS COVERED The authors review the CD population and provide a systematic review and meta-analysis of the effectiveness and safety of pharmacotherapies using preferred reporting items for systematic review and meta-analysis (PRISMA) and strength of evidence recommendation taxonomy (SORT) guidelines. The authors then provide an expert clinical opinion for the use of different pharmacotherapies to address aggressive and disruptive behavior in children. EXPERT OPINION Atypical antipsychotics (e.g. risperidone) demonstrate evidence for efficacy in CD. Other pharmacotherapies (e.g. mood stabilizers, anticonvulsants, psychostimulants and selective norepinephrine reuptake inhibitors) have a low level of evidence for CD alone, however, can sometimes be effective in managing the symptoms of CD when other psychiatric disorders are also present.
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Affiliation(s)
- Sohil Khan
- a School of Pharmacy and Pharmacology, Quality Use of Medicines Network, Menzies Health Institute , Griffith University , Gold Coast , Australia.,b Mater Research Institute , The University of Queensland , South Brisbane , Australia.,c Manipal College of Pharmaceutical Sciences , Manipal University , Manipal , India
| | - John Down
- d Children's Health Queensland Hospital and Health Service , Lady Cilento Children's Hospital , South Brisbane , Australia
| | - Nisreen Aouira
- a School of Pharmacy and Pharmacology, Quality Use of Medicines Network, Menzies Health Institute , Griffith University , Gold Coast , Australia
| | - William Bor
- b Mater Research Institute , The University of Queensland , South Brisbane , Australia.,e Child and Youth Mental Health Service , Children's Health Queensland Hospital and Health Service , South Brisbane , Australia.,f Centre for Children's Health Research , Children's Health Queensland Hospital and Health Services , South Brisbane , Australia
| | - Alison Haywood
- a School of Pharmacy and Pharmacology, Quality Use of Medicines Network, Menzies Health Institute , Griffith University , Gold Coast , Australia.,b Mater Research Institute , The University of Queensland , South Brisbane , Australia
| | - Robyn Littlewood
- e Child and Youth Mental Health Service , Children's Health Queensland Hospital and Health Service , South Brisbane , Australia.,f Centre for Children's Health Research , Children's Health Queensland Hospital and Health Services , South Brisbane , Australia.,g School of Human Movement and Nutrition Sciences , The University of Queensland , South Brisbane , Australia
| | - Helen Heussler
- b Mater Research Institute , The University of Queensland , South Brisbane , Australia.,d Children's Health Queensland Hospital and Health Service , Lady Cilento Children's Hospital , South Brisbane , Australia.,f Centre for Children's Health Research , Children's Health Queensland Hospital and Health Services , South Brisbane , Australia
| | - Brett McDermott
- h Townsville Clinical School, College of Medicine and Dentistry , James Cook University , Townsville , Australia
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Coghill DR, Banaschewski T, Soutullo C, Cottingham MG, Zuddas A. Systematic review of quality of life and functional outcomes in randomized placebo-controlled studies of medications for attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2017; 26:1283-1307. [PMID: 28429134 PMCID: PMC5656703 DOI: 10.1007/s00787-017-0986-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 04/03/2017] [Indexed: 10/31/2022]
Abstract
Children, adolescents and adults with attention-deficit/hyperactivity disorder (ADHD) experience functional impairment and poor health-related quality of life (HRQoL) in addition to symptoms of inattention/hyperactivity-impulsivity. To synthesize qualitatively the published evidence from randomized, double-blind, placebo-controlled trials of the effectiveness of pharmacotherapy on functional impairment or HRQoL in patients with ADHD, a systematic PubMed searching and screening strategy was designed to identify journal articles meeting pre-specified criteria. Post hoc analyses and meta-analyses were excluded. HRQoL outcomes, functional outcomes and the principal ADHD symptom-based outcome were extracted from included studies. An effect size of 0.5 versus placebo was used as a threshold for potential clinical relevance (unreported effect sizes were calculated when possible). Of 291 records screened, 35 articles describing 34 studies were included. HRQoL/functioning was usually self-rated in adults and proxy-rated in children/adolescents. Baseline data indicated substantial HRQoL deficits in children/adolescents. Placebo-adjusted effects of medication on ADHD symptoms, HRQoL and functioning, respectively, were statistically or nominally significant in 18/18, 10/12 and 7/9 studies in children/adolescents and 14/16, 9/11 and 9/10 studies in adults. Effect sizes were ≥0.5 versus placebo for symptoms, HRQoL and functioning, respectively, in 14/16, 7/9 and 4/8 studies in children/adolescents; and 6/12, 1/6 and 1/8 studies in adults. Effect sizes were typically larger for stimulants than for non-stimulants, for symptoms than for HRQoL/functioning, and for children/adolescents than for adults. The efficacy of ADHD medication extends beyond symptom control and may help reduce the related but distinct functional impairments and HRQoL deficits in patients with ADHD.
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Affiliation(s)
- David R Coghill
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia.
- Department of Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia.
- Division of Neuroscience, University of Dundee, Dundee, UK.
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - César Soutullo
- Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, University of Navarra Clinic, Pamplona, Spain
| | | | - Alessandro Zuddas
- Child and Adolescent Psychiatry Unit, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
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Hambly JL, Francis K, Khan S, Gibbons KS, Walsh WJ, Lambert B, Testa C, Haywood A. Micronutrient Therapy for Violent and Aggressive Male Youth: An Open-Label Trial. J Child Adolesc Psychopharmacol 2017; 27:823-832. [PMID: 28481642 DOI: 10.1089/cap.2016.0199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Pharmacotherapy for problematic aggressive and violent behavior disorders in male children and adolescents is associated with significant adverse events. Treatments with more acceptable risk-benefit ratios are critically needed. Micronutrient intervention will be investigated as an alternative to bridge the therapeutic gap in the management of these behaviors. METHODS Males aged 4-14 who displayed ongoing violent and aggressive behaviors received micronutrient intervention containing alpha-tocopherol (vitamin E), ascorbic acid (vitamin C), biotin, chromium, pyridoxal-5-phosphate (P5P), pyridoxine (vitamins B6), selenium, and zinc, in a 16-week open-label trial. Plasma zinc, plasma copper, copper/zinc ratio, and urinary hydroxyhemopyrroline-2-one (HPL) tests were conducted at baseline and endpoint. Participants were examined for changes in aggressive and violent behaviors measured using the Children's Aggression Scale (CAS) and the Modified Overt Aggression Scale (MOAS), improvements in family functioning measured using the Family Functioning Style Scale, improvements in health-related quality of life (HRQoL) measured using the Pediatric Quality of Life Inventory (PedsQL) at baseline, 8 weeks, endpoint, and at 4-6-month follow-up. RESULTS Thirty-two male children and adolescents met inclusion criteria. Thirty-one (mean 8.35 ± standard deviation 2.93 years) completed the study, with one participant lost to follow-up. Micronutrient therapy significantly improved parent-reported aggressive and violent behaviors measured using the CAS for all domains except the use of weapons (p < 0.001 to p = 0.02) with medium to large effect size (Cohen's d = 0.72-1.43) and the MOAS (p < 0.001) with large effect size (Cohen's d = 1.26). Parent-reported HRQoL (p < 0.001; Cohen's d = -1.69) and family functioning (p = 0.03; Cohen's d = -0.41) also significantly improved. CONCLUSION Micronutrient therapy appeared well tolerated, with a favorable side effect profile. It appeared effective in the reduction of parent-reported aggressive and violent behaviors, and showed improvement in family functioning and HRQoL in male youth after 16 weeks. Further research in the form of a double-blinded, randomized controlled trial is required to verify these initial positive observations.
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Affiliation(s)
- Jessica L Hambly
- 1 School of Pharmacy, Menzies Health Institute Queensland, Griffith University , Southport, Australia
| | - Kelly Francis
- 2 Happiness in Health , West Burleigh, Queensland, Australia
| | - Sohil Khan
- 1 School of Pharmacy, Menzies Health Institute Queensland, Griffith University , Southport, Australia .,3 Mater Research Institute-The University of Queensland , Brisbane, Queensland, Australia
| | - Kristen S Gibbons
- 3 Mater Research Institute-The University of Queensland , Brisbane, Queensland, Australia
| | | | - Brett Lambert
- 5 Applied Analytical Laboratories , Meadowbrook, Queensland, Australia
| | - Chris Testa
- 6 Chris Testa's Tugun Compounding Pharmacy , Tugun, Queensland, Australia
| | - Alison Haywood
- 1 School of Pharmacy, Menzies Health Institute Queensland, Griffith University , Southport, Australia .,3 Mater Research Institute-The University of Queensland , Brisbane, Queensland, Australia
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Clemow DB, Bushe C, Mancini M, Ossipov MH, Upadhyaya H. A review of the efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in children and adult patients with common comorbidities. Neuropsychiatr Dis Treat 2017; 13:357-371. [PMID: 28223809 PMCID: PMC5304987 DOI: 10.2147/ndt.s115707] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder that is often diagnosed during childhood, but has also increasingly been recognized to occur in adults. Importantly, up to 52% of children (including adolescents) and 87% of adults with ADHD also have a comorbid psychiatric disorder. The presence of a comorbid disorder has the potential to impact diagnosis and could affect treatment outcomes. Atomoxetine is a nonstimulant treatment for ADHD. Despite numerous published studies regarding efficacy of atomoxetine in the treatment of ADHD in patients with comorbid disorders, there is limited information about the impact of individual common comorbid disorders on the efficacy of atomoxetine for ADHD, especially with regard to adults. Moreover, a cumulative review and assessment of these studies has not been conducted. For this reason, we performed a literature review to find, identify, and cumulatively review clinical studies that examined the efficacy of atomoxetine in the treatment of patients with ADHD and comorbid psychiatric disorders. We found a total of 50 clinical studies (37 in children; 13 in adults) that examined the efficacy of atomoxetine in patients with ADHD and a comorbid disorder. The comorbidities that were studied in children or in adults included anxiety, depression, and substance use disorder. Overall, the presence of comorbidity did not adversely impact the efficacy of atomoxetine in treatment of ADHD symptoms in both patient populations. In the studies identified and assessed in this review, atomoxetine did not appear to exacerbate any of the comorbid conditions and could, therefore, be an important therapy choice for the treatment of ADHD in the presence of comorbid disorders.
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Hutchison SL, Ghuman JK, Ghuman HS, Karpov I, Schuster JM. Efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in patients with common comorbidities in children, adolescents and adults: a review. Ther Adv Psychopharmacol 2016; 6:317-334. [PMID: 27721971 PMCID: PMC5036135 DOI: 10.1177/2045125316647686] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed mental health disorders and is associated with higher incidence of comorbid oppositional or conduct, mood, anxiety, pervasive developmental, and substance-use disorders. Comorbid mental health conditions may alter the presence of symptoms and treatment of ADHD. Atomoxetine (ATX), a nonstimulant medication for the treatment of ADHD, may be prescribed for individuals with ADHD and comorbid conditions despite some risk for certain undesirable side effects and lower effectiveness for the treatment of ADHD than stimulants. In this paper, we review studies utilizing randomized, placebo-controlled trials (RCTs) as well as within-subject designs to determine the effectiveness of ATX in the treatment of children and adults with ADHD and comorbid conditions. The current review uses an expanded methodology beyond systematic review of randomized controlled trials in order to improve generalizability of results to real-world practice. A total of 24 articles published from 2007 to 2015 were reviewed, including 14 RCTs: n = 1348 ATX, and n = 832 placebo. The majority of studies show that ATX is effective in the treatment of ADHD symptoms for individuals with ADHD and comorbid disorders. Cohen's d effect sizes (ES) for improvement in ADHD symptoms and behaviors range from 0.47 to 2.21. The effectiveness of ATX to improve symptoms specific to comorbidity varied by type but appeared to be most effective for diminishing the presence of symptoms for those with comorbid anxiety, ES range of 0.40 to 1.51, and oppositional defiant disorder, ES range of 0.52 to 1.10. There are mixed or limited results for individuals with ADHD and comorbid substance-use disorders, autism spectrum disorders, dyslexia or reading disorder, depression, bipolar disorder, and Tourette syndrome. Results from this review suggest that ATX is effective in the treatment of some youth and adults with ADHD and comorbid disorders, and may be a treatment option in these patients.
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Affiliation(s)
- Shari L. Hutchison
- Community Care Behavioral Health, UPMC Insurance Services Division, 339 Sixth Avenue, Suite 1300, Pittsburgh, PA 15222, USA
| | - Jaswinder K. Ghuman
- Community Care Behavioral Health, UPMC Insurance Services Division, Pittsburgh, PA, USA
| | | | - Irina Karpov
- Community Care Behavioral Health, UPMC Insurance Services Division, Pittsburgh, PA, USA
| | - James M. Schuster
- Community Care Behavioral Health, UPMC Insurance Services Division, Pittsburgh, PA, USA
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Hambly JL, Khan S, McDermott B, Bor W, Haywood A. Pharmacotherapy of conduct disorder: Challenges, options and future directions. J Psychopharmacol 2016; 30:967-75. [PMID: 27436231 DOI: 10.1177/0269881116658985] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED There is a critical need for evaluation of the pharmacotherapies used in conduct disorder (CD), due to the high incidence of off-label prescribing. The aim of this review was to identify concerns associated with the safety, efficacy and impact on quality of life (QOL) that pharmacotherapy has in children and adolescents with CD. A systematic review was undertaken using pre-defined search criteria and four databases, including reference searches. We assessed these studies using the Strength of Recommendation Taxonomy, Grading of Recommendations Assessment, Development and Evaluation, and Review Manager Risk of Bias (RevMan®) tools. There were 12 randomised controlled trials that met our inclusion criteria. STUDIES INCLUDED antipsychotics, atomoxetine, lithium, clonidine, divalproex sodium and psychostimulants. The antipsychotics demonstrated efficacy, but were associated with adverse effects. Other agents demonstrated mixed responses, highlighting the lack of clinical significance and increased incidence of adverse effects. The management of related adverse effects was addressed to assist with clinical gaps. Overall, there is limited evidence regarding the role of pharmacotherapy in CD. More research is needed that takes into account the heterogeneity of CD and analysis of pharmacotherapy in pure CD.
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Affiliation(s)
- Jessica L Hambly
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Sohil Khan
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia Mater Research Institute - The University of Queensland, Brisbane, QLD, Australia Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, India
| | - Brett McDermott
- Townsville Clinical School, College of Medicine and Dentistry, James Cook University, Queensland, QLD, Australia
| | - William Bor
- Mater Research Institute - The University of Queensland, Brisbane, QLD, Australia Child and Youth Mental Health Service, Centre for Children's Health Research, Queensland Health, Brisbane, QLD, Australia
| | - Alison Haywood
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia Mater Research Institute - The University of Queensland, Brisbane, QLD, Australia
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Savill NC, Buitelaar JK, Anand E, Day KA, Treuer T, Upadhyaya HP, Coghill D. The efficacy of atomoxetine for the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a comprehensive review of over a decade of clinical research. CNS Drugs 2015; 29:131-51. [PMID: 25698145 DOI: 10.1007/s40263-014-0224-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Atomoxetine was first licensed to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents in the US in 2002. The aim of this paper is to comprehensively review subsequent publications addressing the efficacy of atomoxetine in 6- to 18-year-olds with ADHD. We identified 125 eligible papers using a predefined search strategy. Overall, these papers demonstrate that atomoxetine is an effective treatment for the core ADHD symptoms (effect sizes 0.6-1.3, vs. placebo, at 6-18 weeks), and improves functional outcomes and quality of life, in various pediatric populations with ADHD (i.e., males/females, patients with co-morbidities, children/adolescents, and with/without prior exposure to other ADHD medications). Initial responses to atomoxetine may be apparent within 1 week of treatment, but can take longer (median 23 days in a 6-week study; n=72). Responses often build gradually over time, and may not be robust until after 3 months. A pooled analysis of six randomized placebo-controlled trials (n=618) indicated that responses at 4 weeks may predict response at 6-9 weeks, although another pooled analysis of open-label data (n=338) suggests that the probability of a robust response to atomoxetine [≥40% decrease in ADHD-Rating Scale (ADHD-RS) scores] may continue to increase beyond 6-9 weeks. Atomoxetine may demonstrate similar efficacy to methylphenidate, particularly immediate-release methylphenidate, although randomized controlled trials are generally limited by short durations (3-12 weeks). In conclusion, notwithstanding these positive findings, before initiating treatment with atomoxetine, it is important that the clinician sets appropriate expectations for the patient and their family with regard to the likelihood of a gradual response, which often builds over time.
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Affiliation(s)
- Nicola C Savill
- Eli Lilly and Co., Lilly House, Priestley Road, Basingstoke, Hampshire, RG24 9NL, UK,
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Ginkgo biloba extract EGb 761® in children with ADHD. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2014; 42:337-47. [PMID: 25163996 DOI: 10.1024/1422-4917/a000309] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The side effects, nonresponse, and prejudices against conventional pharmacological treatments call for complementary or alternative medical treatments (CAM) for ADHD. One possible treatment, at least for cognitive problems, might be the administration of Ginkgo biloba, though evidence is currently rare. This study tests the clinical efficacy of a Ginkgo biloba special extract (EGb 761®) and its correlation with brain electrical activity in children with ADHD combined type according to DSM-IV. METHOD In this open clinical pilot study, EGb 761® was administered to 20 children with ADHD over 3 to 5 weeks. Dosage was increased to a maximum of 240 mg daily if attention problems persisted. Possible drug side effects were assessed using the Side Effect Rating Scale. Efficacy was assessed in a multilevel approach including clinical assessment, quality of life (QoL), as well as performance and preparatory brain-electrical activity evoked during a Continuous Performance Test (Cue-CNV in the CPT). RESULTS A very low rate of mild adverse effects occurred during the observation period. Following EGb 761® administration, possible improvements in QoL, ADHD core symptoms as well as CPT performance were detected. Improved core symptoms were positively related to elevated CNV amplitude. CONCLUSION This preliminary evidence suggests that EGb 761® at a maximal dosage of 240 mg daily might be a clinically useful alternative treatment for children with ADHD, but further evidence is required before firm conclusions can be made.
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Carona C, Silva N, Moreira H. Applying a developmental approach to quality of life assessment in children and adolescents with psychological disorders: challenges and guidelines. Expert Rev Pharmacoecon Outcomes Res 2014; 15:47-70. [DOI: 10.1586/14737167.2015.972377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dehn LB, Korn-Merker E, Pfäfflin M, Ravens-Sieberer U, May TW. The impact on family scale: psychometric analysis of long and short forms in parents of children with epilepsy. Epilepsy Behav 2014; 32:21-6. [PMID: 24463304 DOI: 10.1016/j.yebeh.2013.12.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 11/17/2022]
Abstract
Epilepsy in a child or adolescent can have severe psychosocial impact on the whole family and burdens them, especially the parents. As the familial background is essential for the child's coping and the progression of the epilepsy, parental burden should be considered within a comprehensive treatment approach. This study validated the applicability of the Impact on Family Scale (IOFS), a well-established instrument that assesses the strains of families with chronically ill or disabled children, in parents of children with epilepsy. In a sample of 219 parents, the psychometric properties of the original IOFS version (33 items) and two short forms (15 and 11 items, respectively) were examined. Both short forms revealed good reliability (Cronbach's alpha, test-retest reliability), and construct validity was verified by correlations with epilepsy- and burden-related variables. However, exploratory and confirmatory factor analyses indicated superior characteristics of the short form with 11 items (IOFS-11). In conclusion, the IOFS-11 as well as the IOFS-15 proved to be practicable, reliable, and valid tools to assess the impact of childhood epilepsy on family life in research and clinical practice.
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Affiliation(s)
- L B Dehn
- Society for Epilepsy Research, Epilepsy Centre Bethel, Bielefeld, Germany; Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - E Korn-Merker
- Section of Pediatric Epilepsy, Mara Hospital, Epilepsy Centre Bethel, Bielefeld, Germany
| | - M Pfäfflin
- Society for Epilepsy Research, Epilepsy Centre Bethel, Bielefeld, Germany
| | - U Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T W May
- Society for Epilepsy Research, Epilepsy Centre Bethel, Bielefeld, Germany; Department of Psychology, Bielefeld University, Bielefeld, Germany.
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12
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Schwartz S, Correll CU. Efficacy and safety of atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder: results from a comprehensive meta-analysis and metaregression. J Am Acad Child Adolesc Psychiatry 2014; 53:174-87. [PMID: 24472252 DOI: 10.1016/j.jaac.2013.11.005] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/17/2013] [Accepted: 11/21/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To comprehensively evaluate the efficacy and safety of atomoxetine (ATX) in pediatric attention-deficit/hyperactivity disorder (ADHD). METHOD Meta-analysis of all double-blind randomized controlled trials (DBRCTs) evaluating the efficacy and tolerability of ATX for ADHD. Pooled, random-effects analyses were conducted, calculating standardized mean difference (SMD), yielding effect sizes (ES), relative risk (RR), and number-needed-to-treat/harm (NNT/NNH).Moderator/mediator analyses were also conducted, including metaregression. RESULTS Across 25 DBRCTs (56 treatment arms, N = 3,928), ATX outperformed placebo regarding overall ADHD symptoms (ES = -0.64, 95% confidence interval [CI] = -0.56 to -0.71, p < 0.0001), hyperactivity/impulsivity (ES = -0.67, CI = -0.53 to -0.81, p < 0.0001), and inattention (ES = -0.59, CI = -0.51 to -0.67, p < 0.0001). Altogether, 44.4% versus 21.4% of patients improved by ≥40% (NNT = 4), whereas 39.9% versus 65.9% improved by <25% (NNT = 4). Oppositional defiant disorder symptoms (ES = -0.33) and quality-of-life-related outcomes (ES = -0.48 to -0.25) improved somewhat less. A higher percentage of treatment-naïve patients moderated the efficacy of ATX for overall ADHD symptoms (p = 0.017). All-cause discontinuation with ATX was similar to that for placebo (p = 1.00), with lower discontinuation because of inefficacy (relative risk [RR] = 0.51, CI = 0.36-0.74, p < 0.0001, NNT = 34), but higher discontinuation because of adverse effects (AEs) (RR = 1.89, CI = 1.08-3.31, p = 0.03, NNH = 50) with ATX. At least 1 adverse effect (AE) (70.4% versus 56.1%, p < 0.01, NNH = 6) and ≥1 psychiatric AE (21.5% versus 7.4%, NNH = 7, p < 0.01) were more frequent with ATX, whereas serious AEs (1.5% versus 1.0%), aggression (7.5% versus 6.0%), and suicidal ideation (1.3% versus 0.9%) were not different from placebo. CONCLUSIONS Short-term ATX treatment is safe and superior to placebo for overall ADHD symptoms and key secondary outcomes, with a medium ES. However, a relevant patient subgroup (40%) continues to have significant symptomatology, requiring additional clinical attention.
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Affiliation(s)
- Shimon Schwartz
- Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish (LIJ) Health System, and Montefiore Medical Center
| | - Christoph U Correll
- Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Hofstra North Shore-LIJ School of Medicine, Albert Einstein College of Medicine, and the Feinstein Institute for Medical Research.
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Dehn L, Korn-Merker E, Pfäfflin M, Fischbach H, Frantz M, Hauser A, Ravens-Sieberer U, May T. Erfassung der Belastungen von Eltern anfallskranker Kinder. ZEITSCHRIFT FUR EPILEPTOLOGIE 2013. [DOI: 10.1007/s10309-013-0327-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mazzone L, Postorino V, Reale L, Guarnera M, Mannino V, Armando M, Fatta L, De Peppo L, Vicari S. Self-esteem evaluation in children and adolescents suffering from ADHD. Clin Pract Epidemiol Ment Health 2013; 9:96-102. [PMID: 23878614 PMCID: PMC3715757 DOI: 10.2174/1745017901309010096] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 02/28/2013] [Accepted: 03/24/2013] [Indexed: 11/22/2022]
Abstract
Background: Several recent studies investigated the relationship between self-esteem and ADHD, however, the results are still controversial. In the present study we analyze the characteristics of self-esteem in a sample of children and adolescents suffering from ADHD, with a particular focus on the relationship between ADHD symptoms severity and treatment strategies.
Methods: A total of 85 patients with ADHD (44 drug-free and 41 drug-treated, 23 of which atomoxetine-treated and 18 Methylphenidate-treated) and 26 healthy controls were enrolled in the study in order to evaluate self-esteem using the Self-esteem Multidimensional Test (TMA).
Results: ADHD subjects revealed lower scores on all self-esteem domains compared to controls. Both ADHD drug-free (47.1%) and ADHD drug-treated (44.1%) groups showed significantly higher rates of subjects in the pathological range as compared to normal control group (8.8%) (p <.001) with a higher percentage of subjects in the pathological range. Among ADHD drug-treated subjects, the methylphenidate group showed higher self-esteem scores as compared to the atomoxetine group.
Conclusion: A lower self-esteem profile is more common in subjects suffering from ADHD than in healthy controls, suggesting the importance of an early detection of psychological well-being in these children in order to reduce the ADHD symptoms long-term impacts.
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Affiliation(s)
- Luigi Mazzone
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesu', Rome, Italy
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15
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Dey M, Landolt MA, Mohler-Kuo M. Health-related quality of life among children with mental disorders: a systematic review. Qual Life Res 2013; 21:1797-1814. [PMID: 22298200 DOI: 10.1007/s11136-012-0109-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE To systematically review studies about the quality of life (QOL) of children with various mental disorders relative to healthy controls and to describe limitations in these studies. METHODS Relevant articles were searched using different databases, by checking reference lists and contacting experts. We included articles that either compared children with mental disorders to healthy controls/norm values or made such a comparison possible. RESULTS Sixteen out of 4,560 articles met the pre-defined inclusion criteria. These studies revealed that the QOL of children with various mental disorders is compromised across multiple domains. The largest effect sizes were found for psychosocial and family-related domains and for the total QOL score, whereas physical domains generally were less affected. The most important limitations in the existing literature include the lack of study samples drawn from the general population, the failure to use self-ratings, not considering item overlap between measuring QOL and assessing for the presence of a particular mental disorder, and not determining whether the children were receiving medication for their mental disorder. CONCLUSIONS Children with mental disorders experience a considerable reduction in QOL across various domains. Research studies that avoid previous limitations are crucial to fill existing knowledge gaps.
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Affiliation(s)
- Michelle Dey
- Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.
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16
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Kohn MR, Tsang TW, Clarke SD. Efficacy and Safety of Atomoxetine in the Treatment of Children and Adolescents with Attention Deficit Hyperactivity Disorder. CLINICAL MEDICINE. PEDIATRICS 2012; 6:95-162. [PMID: 23641171 PMCID: PMC3620814 DOI: 10.4137/cmped.s7868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Several non-stimulant medications have been used in the treatment of attention deficit hyperactivity disorder (ADHD). Atomoxetine, was introduced in 2002. The safety and efficacy of atomoxetine in the treatment of ADHD for children, adolescents, and adults has been evaluated in over 4000 patients in randomized controlled studies and double blinded studies as well as in recent large longitudinal studies. This paper provides an updated summary of the literature on atomoxetine, particularly in relation to findings on the short- and long-term safety of atomoxetine in children and adolescents arising from recent large longitudinal cohort studies. Information is presented about the efficacy, safety, and tolerability of this medication.
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Affiliation(s)
- Michael R. Kohn
- Centre for Research into Adolescents’ Health (CRASH), The Sydney Children's Hospital Network and Westmead Hospital, Westmead, NSW, Australia
- Brain Dynamics Centre, Westmead Millennium Institute for Medical Research and University of Sydney Medical School—Westmead, Westmead, NSW, Australia
- Department of Psychiatry and Medicine, University of Sydney Medical School—Westmead, NSW, Australia
| | - Tracey W. Tsang
- Brain Dynamics Centre, Westmead Millennium Institute for Medical Research and University of Sydney Medical School—Westmead, Westmead, NSW, Australia
- Department of Psychiatry and Medicine, University of Sydney Medical School—Westmead, NSW, Australia
| | - Simon D. Clarke
- Centre for Research into Adolescents’ Health (CRASH), The Sydney Children's Hospital Network and Westmead Hospital, Westmead, NSW, Australia
- Brain Dynamics Centre, Westmead Millennium Institute for Medical Research and University of Sydney Medical School—Westmead, Westmead, NSW, Australia
- Department of Psychiatry and Medicine, University of Sydney Medical School—Westmead, NSW, Australia
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