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Kim S, Kim Y, Cho SH. Effectiveness of Shugan Jieyu capsules for psychiatric symptoms of epilepsy: a systematic review and meta-analysis. BMC Complement Med Ther 2024; 24:63. [PMID: 38287355 PMCID: PMC10825991 DOI: 10.1186/s12906-024-04361-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/16/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The relationship between epilepsy and depression is bidirectional. One condition exacerbates the other. However, there are no current guidelines for treating depression in epilepsy patients. In some cases, seizures worsen when antidepressants (AD) are prescribed or when they are discontinued due to adverse events. The Shugan Jieyu capsule, composed of Acanthopanax senticosus and Hypericum perforatum, is a widely used herbal medicine for treating depression. This study aimed to explore the effectiveness and safety of Shugan Jieyu capsules (SJC) in relieving depression in patients with epilepsy. METHODS We searched English, Korean, Japanese, and Chinese databases in October 2023 to collect all relevant randomized clinical trials (RCTs). The primary outcomes were the depression scale scores and seizure frequency. The secondary outcomes were quality of life (QoL) and adverse events. RESULTS Nine RCTs were included in this meta-analysis. Compared with AD, SJC showed significant differences in the improvement of depression (SMD: 3.82, 95% CI: 3.25, 4.39) and reduction in seizure frequency (MD: 0.39 times/month, 95% CI: 0.28, 0.50). SJC showed more beneficial results than antiepileptic drugs (AED) in terms of antidepressant effects (SMD: 1.10, 95% CI: 0.69, 1.51) and QoL (MD: 11.75, 95% CI: 10.55, 12.95). When patients were prescribed AED, the additional administration of SJC improved depression symptoms (SMD: 0.96, 95% CI: 0.28, 1.63). The SJC treatment group had a lower incidence of side effects than the control group. However, the difference was not statistically significant. CONCLUSIONS Our results suggest that SJC may be effective in treating depression in patients with epilepsy. Additionally, SJC has the potential to help reduce seizure frequency in epilepsy patients with depression.
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Affiliation(s)
- Sejin Kim
- College of Korean Medicine, Kyung Hee University, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Yunna Kim
- College of Korean Medicine, Kyung Hee University, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
- Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University Medical Center, Kyung Hee University, Seoul, 02447, Republic of Korea.
- Research group of Neuroscience, East-West Medical Research Institute, WHO Collaborating Center, Kyung Hee University, Seoul, 02447, Republic of Korea.
| | - Seung-Hun Cho
- College of Korean Medicine, Kyung Hee University, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
- Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University Medical Center, Kyung Hee University, Seoul, 02447, Republic of Korea.
- Research group of Neuroscience, East-West Medical Research Institute, WHO Collaborating Center, Kyung Hee University, Seoul, 02447, Republic of Korea.
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Strawn JR, Mills JA, Poweleit EA, Ramsey LB, Croarkin PE. Adverse Effects of Antidepressant Medications and their Management in Children and Adolescents. Pharmacotherapy 2023. [PMID: 36651686 PMCID: PMC10378577 DOI: 10.1002/phar.2767] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Selective serotonin reuptake inhibitors (SSRIs) and, to a lesser extent, serotonin-norepinephrine reuptake inhibitors (SNRIs) are the cornerstone of pharmacotherapy for children and adolescents with anxiety and depressive disorders. These medications alleviate symptoms and restore function for many youths; however, they are associated with a distinct adverse effect profile, and their tolerability may complicate treatment or lead to discontinuation. Yet, SSRI/SNRI tolerability has received limited attention in the pediatric literature. METHODS This review examines the early- (e.g., activation, gastrointestinal symptoms, sedation) and late-emerging (e.g., weight gain) adverse effects of SSRIs and some SNRIs in pediatric patients. RESULTS We provide a framework for discussing SSRI/SNRI tolerability with patients and their families and describe the pharmacologic basis, course, and predictors of adverse events in youth. Strategies to address specific tolerability concerns are presented. For selected adverse events, using posterior simulation of mean differences over time, we describe their course based on Physical Symptom Checklist measures in a prospective, randomized trial of anxious youth aged 7-17 years who were treated with sertraline (n = 139) or placebo (n = 76) for 12 weeks in the Child/Adolescent Anxiety Multimodal Study (CAMS). MAIN RESULTS In CAMS, the relative severity/burden of total physical symptoms (p < 0.001), insomnia (p = 0.001), restlessness (p < 0.001), nausea (p = 0.002), abdominal pain (p < 0.001), and dry mouth (p = 0.024) decreased from baseline over 12 weeks of sertraline treatment, raising the possibility that these symptoms are transient. No significant changes were observed for sweating (p = 0.103), constipation (p = 0.241), or diarrhea (p = 0.489). Finally, we review the antidepressant withdrawal syndrome in children and adolescents and provide guidance for SSRI discontinuation, using pediatric pharmacokinetic models of escitalopram and sertraline-two of the most used SSRIs in youth. CONCLUSION SSRI/SNRIs are associated with both early-emerging (often transient) and late-emerging adverse effects in youth. Pharmacokinetically-informed appraoches may address some adverse effects and inform SSRI/SNRI discontinuation strategies.
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Affiliation(s)
- Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, Anxiety Disorders Research Program, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Child and Adolescent Psychiatry, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey A Mills
- Department of Economics, Lindner College of Business, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ethan A Poweleit
- Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Research in Patient Services, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Biomedical Informatics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laura B Ramsey
- Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Research in Patient Services, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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Ghosh P, Martinez J, Shah N, Kenan W, Fowler A, Limdi N, Burns L, Cogan ES, Gardiner A, Hain D, Johnson H, Lewis D, Shelton R, Liebelt E. Pharmacogenomic Profiling of Pediatric Patients on Psychotropic Medications in an Emergency Department. Pediatr Emerg Care 2023; 39:6-12. [PMID: 36413430 PMCID: PMC9815804 DOI: 10.1097/pec.0000000000002871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the ability of a combinatorial pharmacogenomic test to predict medication blood levels and relative clinical improvements in a selected pediatric population. METHODS This study enrolled patients between ages 3 to 18 years who presented to a pediatric emergency department with acute psychiatric, behavioral, or mental health crisis and/or concerns, and had previously been prescribed psychotropic medications. Patients received combinatorial pharmacogenomic testing with medications categorized according to gene-drug interactions (GDIs); medications with a GDI were considered "incongruent," and medications without a GDI were considered "congruent." Blood levels for escitalopram, fluoxetine, aripiprazole, and clonidine were evaluated according to level of GDI. Relative clinical improvements in response to the prescribed psychotropic medications were measured using a parent-rated Clinical Global Impression of Improvement (CGI-I) assessment, where lower scores corresponded with greater improvement. RESULTS Of the 100 patients enrolled, 73% reported taking ≥1 incongruent medication. There was no significant difference in CGI-I scores between patients prescribed congruent versus incongruent medications (3.37 vs 3.68, P = 0.343). Among patients who presented for depression or suicidal ideation, those prescribed congruent medications had significantly lower CGI-I scores compared with those taking incongruent medications ( P = 0.036 for depression, P = 0.018 for suicidal ideation). There was a significant association between medication GDI and blood levels for aripiprazole (n = 15, P = 0.01) and escitalopram (n = 10, P = 0.01). CONCLUSIONS Our preliminary findings suggest that combinatorial pharmacogenomic testing can predict medication blood levels and relative outcomes based on medication congruency in children presenting to an emergency department with acute psychiatric/behavioral crises. Additional studies will be needed to confirm these findings.
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Affiliation(s)
- Pallavi Ghosh
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine
| | - Jesse Martinez
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham Heersink School of Medicine
| | - Nipam Shah
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine
| | - Will Kenan
- Department of Biomedical and Health Sciences, The University of Alabama at Birmingham, School of Health Processions, Birmingham, AL
| | - Andrew Fowler
- Pediatric Residency Program at Arkansas Children's Hospital, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, AR
| | - Nita Limdi
- Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | | | | | | | | | | | | | - Richard Shelton
- Department of Psychiatry, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | - Erica Liebelt
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine
- Department of Pediatrics, Section of Pediatric Emergency Medicine and Pharmacology and Medical Toxicology, University of Arkansas for Medical Sciences, Little Rock, AR
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Elmaadawi AZ, Patel R, Almaaitah Y, Logsdon MG. Effect of pharmacogenomic testing on pediatric mental health outcome: a 6-month follow-up. Pharmacogenomics 2023; 24:73-82. [PMID: 36468359 DOI: 10.2217/pgs-2022-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: This retrospective, case-control study evaluated the effect of pharmacogenomic testing (PGT) on the management of pediatrics with anxiety, major depressive disorder (MDD) and attention-deficit/hyperactivity disorder (ADHD). Methods: The authors examined psychiatric diagnoses, medication histories, CYP450 profiles, SLC6A4, HTR2A, COMT and MTHFR. Results: The authors found no difference in clinical improvement between the two groups. However, the number of medication changes was significantly larger after PGT. The treatment response in MDD and anxiety was not different between the groups, while ADHD treatment response was substantially improved in PGT and correlated with COMT status. Conclusion: PGT had some value with ADHD with doubtful benefit for MDD or anxiety disorders. Accordingly, pediatric indications must be weighed against cost, utility and clinician experience. Limitations included sample size and selection bias.
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Affiliation(s)
- Ahmed Z Elmaadawi
- Department of Psychiatry, Indiana University School of Medicine-South Bend Campus, Beacon Health System, 707 N. Michigan Street, Suite 400, South Bend, IN 46601, USA
| | - Rikin Patel
- Department of Child & Adolescent Psychiatry, Duke University Medical Center, Durham, NC 27708, USA
| | - Yarob Almaaitah
- Department of Psychiatry, Beacon Medical Group Behavioral Health, 707 N. Michigan Street, South Bend, IN 46601, USA
| | - Matthew G Logsdon
- Internal Medicine Program, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, USA
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Robberegt SJ, Kooiman BEAM, Albers CJ, Nauta MH, Bockting C, Stikkelbroek Y. Personalised app-based relapse prevention of depressive and anxiety disorders in remitted adolescents and young adults: a protocol of the StayFine RCT. BMJ Open 2022; 12:e058560. [PMID: 36521888 PMCID: PMC9756181 DOI: 10.1136/bmjopen-2021-058560] [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] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Youth in remission of depression or anxiety have high risks of relapse. Relapse prevention interventions may prevent chronicity. Aim of the study is therefore to (1) examine efficacy of the personalised StayFine app for remitted youth and (2) identify high-risk groups for relapse and resilience. METHOD AND ANALYSIS In this Dutch single-blind parallel-group randomised controlled trial, efficacy of app-based monitoring combined with guided app-based personalised StayFine intervention modules is assessed compared with monitoring only. In both conditions, care as usual is allowed. StayFine modules plus monitoring is hypothesised to be superior to monitoring only in preventing relapse over 36 months. Participants (N=254) are 13-21 years and in remission of depression or anxiety for >2 months. Randomisation (1:1) is stratified by previous treatment (no treatment vs treatment) and previous episodes (1, 2 or >3 episodes). Assessments include diagnostic interviews, online questionnaires and monitoring (ecological momentary assessment with optional wearable) after 0, 4, 12, 24 and 36 months. The StayFine modules are guided by certified experts by experience and based on preventive cognitive therapy and ingredients of cognitive behavioural therapy. Personalisation is based on shared decision-making informed by baseline assessments and individual symptom networks. Time to relapse (primary outcome) is assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia-lifetime version diagnostic interview. Intention-to-treat survival analyses will be used to examine the data. Secondary outcomes are symptoms of depression and anxiety, number and duration of relapses, global functioning, and quality of life. Mediators and moderators will be explored. Exploratory endpoints are monitoring and wearable outcomes. ETHICS, FUNDING AND DISSEMINATION The study was approved by METC Utrecht and is funded by the Netherlands Organisation for Health Research and Development (636310007). Results will be submitted to peer-reviewed scientific journals and presented at (inter)national conferences. TRIAL REGISTRATION NUMBER NCT05551468; NL8237.
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Affiliation(s)
- Suzanne J Robberegt
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Depression Expertise Centre-Youth, GGZ Oost Brabant, Boekel, The Netherlands
| | - Bas E A M Kooiman
- Depression Expertise Centre-Youth, GGZ Oost Brabant, Boekel, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Casper J Albers
- Department of Psychometrics and Statistics, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
- Child Study Centre, Accare, Groningen, The Netherlands
| | - Claudi Bockting
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Yvonne Stikkelbroek
- Depression Expertise Centre-Youth, GGZ Oost Brabant, Boekel, The Netherlands
- Department of Clinical Child and Family Studies, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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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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7
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Strawn JR, Vaughn S, Ramsey LB. Pediatric Psychopharmacology for Depressive and Anxiety Disorders. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:184-190. [PMID: 37153132 PMCID: PMC10153505 DOI: 10.1176/appi.focus.20210036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Anxiety and depressive disorders are the most common psychiatric illnesses among children and adolescents. These disorders are associated with impairments in social, family, and educational functioning. This article summarizes the evidence base for psychopharmacologic interventions; the developmental pharmacology of selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs); and pharmacokinetic and pharmacodynamic differences between youths and adults that call for differences in dosage and affect response and tolerability. The authors also review the efficacy and tolerability of SSRIs and SNRIs in children and adolescents with depressive and anxiety disorder diagnoses, as well as data related to duration of therapy and SSRI/SNRI discontinuation in this population. Taken together, the current evidence suggests that SSRIs are the first-line psychopharmacologic intervention for youths with depressive and anxiety disorders, with SNRIs having a more limited role. These medications are safe and well tolerated, although emerging data and developmental pharmacologic concepts may help clinicians to choose from available SSRIs and to improve the efficacy and tolerability of these medications in children and adolescents.
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Affiliation(s)
- Jeffrey R Strawn
- Anxiety Disorders Research Program, Department of Psychiatry and Behavioral Neuroscience (Strawn), and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati (Strawn, Vaughn); Division of Clinical Pharmacology (Strawn, Ramsey), Division of Child and Adolescent Psychiatry (Strawn, Vaughn), and Division of Research in Patient Services (Ramsey), Cincinnati Children's Hospital Medical Center, Cincinnati
| | - Samuel Vaughn
- Anxiety Disorders Research Program, Department of Psychiatry and Behavioral Neuroscience (Strawn), and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati (Strawn, Vaughn); Division of Clinical Pharmacology (Strawn, Ramsey), Division of Child and Adolescent Psychiatry (Strawn, Vaughn), and Division of Research in Patient Services (Ramsey), Cincinnati Children's Hospital Medical Center, Cincinnati
| | - Laura B Ramsey
- Anxiety Disorders Research Program, Department of Psychiatry and Behavioral Neuroscience (Strawn), and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati (Strawn, Vaughn); Division of Clinical Pharmacology (Strawn, Ramsey), Division of Child and Adolescent Psychiatry (Strawn, Vaughn), and Division of Research in Patient Services (Ramsey), Cincinnati Children's Hospital Medical Center, Cincinnati
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8
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Alcaniz L, Martínez-Pampliega A, Herrero M. Cost-Benefit Analysis of an Intervention in Divorced Parents: Implications for Society, Public Administrations and Family Visitation Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063484. [PMID: 35329168 PMCID: PMC8955351 DOI: 10.3390/ijerph19063484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/06/2022] [Accepted: 03/12/2022] [Indexed: 02/04/2023]
Abstract
Families going through conflictive divorce processes are at increased risk of developing mental health problems. The Egokitzen program is a group intervention for parents who have undergone a divorce process, funded by the public administration. Budgetary constraints cause funding institutions to be interested in the effectiveness and economic efficiency of these programs. Therefore, the objective of this research is to carry out an efficiency analysis of the Egokitzen program, implemented by family visitation centers in Spain, through a cost-benefit analysis, to determine whether the positive impact on symptomatology (measured using CBCL and SCL-90 instruments) is translated into a positive economic impact for society. A sample of 382 parents participated. Costs will be first identified and valued; secondly, benefits achieved with the program will be identified through a prevalence analysis and, finally, the cost-benefit comparative analysis will be carried out. Additionally, a sensitivity analysis will be performed. The results obtained in the analysis indicate that for every euro spent on this program, the public administration and society save 3.10 euros in future interventions through medical costs and productivity losses. The study has practical implications for public administration, organizations, and the family visitation centers that implement the program.
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Affiliation(s)
- Leire Alcaniz
- Department of Finance and Economics, Deusto Business School, University of Deusto, 48007 Bilbao, Spain
- Correspondence:
| | - Ana Martínez-Pampliega
- Department of Psychology, Faculty of Health Science, University of Deusto, 48007 Bilbao, Spain; (A.M.-P.); (M.H.)
| | - Marta Herrero
- Department of Psychology, Faculty of Health Science, University of Deusto, 48007 Bilbao, Spain; (A.M.-P.); (M.H.)
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Abstract
The COVID-19 pandemic has aroused a level of anxiety and uncertainty that spans demographics and diagnoses. Because the coronavirus is a novel variant, the expert scientific community presents to the public as uncertain and inconsistent in information and ways to deal with potential infection, which creates disbelief and uncertainty. The most consistent recommendation is physical distancing and self-imposed isolation to reduce the spread. However, such isolation also adds to individual and community distress. This column focuses on the neurobiological explanations for anxiety, complications to pre-existing psychiatric disorders, sub diagnostic states of stress and anxiety generally and with health care providers, and pharmacological and nonpharmacological ways of addressing this anxiety. [Journal of Psychosocial Nursing and Mental Health Services, 58(7), 7-10.].
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Naveed S, Amray AN, Jahan N, Moti-Wala FB, Majeed MH. Psychopharmacology in Pediatric Mixed Anxiety Disorder: An Evidence-based Review. INNOVATIONS IN CLINICAL NEUROSCIENCE 2019; 16:36-43. [PMID: 32082949 PMCID: PMC7009326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Anxiety disorders are the most prevalent psychiatric disorders among youth, with prevalence rates ranging from 25 to 32 percent. These disorders are under-recognized and often undertreated in this population. Anxiety disorders in youth exhibit a chronic and persistent course of symptoms with a higher risk of comorbidities, functional impairment, and worsening of severity. The early recognition and treatment of anxiety disorders in children and adolescents are vital for better long-term outcomes. This article summarizes the evidence-based pharmacologic treatments for mixed anxiety disorders including generalized anxiety disorder, social anxiety disorder, and separation anxiety disorder in children and adolescents based on case reports, case series, open-label trials, and randomized, controlled trials.
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Affiliation(s)
- Sadiq Naveed
- Dr. Naveed is with the University of Kansas Medical Center in Kansas City, Kansas
- Dr. Amray is with Dow University of Health Sciences in Karachi, Pakistan
- Dr. Jahan is with Rush University Medical Center in Chicago, Illinois
- Dr. Motiwala is with the Texas Tech University Health Sciences Center in Lubbock, Texas
- Dr. Majeed is with Johns Hopkins Hospital in Baltimore, Maryland
| | - Afshan Naz Amray
- Dr. Naveed is with the University of Kansas Medical Center in Kansas City, Kansas
- Dr. Amray is with Dow University of Health Sciences in Karachi, Pakistan
- Dr. Jahan is with Rush University Medical Center in Chicago, Illinois
- Dr. Motiwala is with the Texas Tech University Health Sciences Center in Lubbock, Texas
- Dr. Majeed is with Johns Hopkins Hospital in Baltimore, Maryland
| | - Nusrat Jahan
- Dr. Naveed is with the University of Kansas Medical Center in Kansas City, Kansas
- Dr. Amray is with Dow University of Health Sciences in Karachi, Pakistan
- Dr. Jahan is with Rush University Medical Center in Chicago, Illinois
- Dr. Motiwala is with the Texas Tech University Health Sciences Center in Lubbock, Texas
- Dr. Majeed is with Johns Hopkins Hospital in Baltimore, Maryland
| | - Fatima Bilal Moti-Wala
- Dr. Naveed is with the University of Kansas Medical Center in Kansas City, Kansas
- Dr. Amray is with Dow University of Health Sciences in Karachi, Pakistan
- Dr. Jahan is with Rush University Medical Center in Chicago, Illinois
- Dr. Motiwala is with the Texas Tech University Health Sciences Center in Lubbock, Texas
- Dr. Majeed is with Johns Hopkins Hospital in Baltimore, Maryland
| | - Muhammad Hassan Majeed
- Dr. Naveed is with the University of Kansas Medical Center in Kansas City, Kansas
- Dr. Amray is with Dow University of Health Sciences in Karachi, Pakistan
- Dr. Jahan is with Rush University Medical Center in Chicago, Illinois
- Dr. Motiwala is with the Texas Tech University Health Sciences Center in Lubbock, Texas
- Dr. Majeed is with Johns Hopkins Hospital in Baltimore, Maryland
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11
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Amray AN, Munir K, Jahan N, Motiwala FB, Naveed S. Psychopharmacology of Pediatric Anxiety Disorders: A Narrative Review. Cureus 2019; 11:e5487. [PMID: 31656713 PMCID: PMC6812941 DOI: 10.7759/cureus.5487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Anxiety disorders are common among children and adolescents; almost one-third of this population has an anxiety disorder. The most common anxiety disorders in this population are specific phobia (19.3%), social anxiety disorder/ social phobia (9.1 %), and separation anxiety disorder (7.6 %). Pediatric anxiety disorders are often associated with poor psychosocial functioning, academic underachievement, learning difficulties, substance abuse, relationship problems, and suicide behaviors. Psychotherapy, particularly cognitive behavioral therapy as a stand-alone treatment or in combination with medication, is found to be efficacious in the treatment of various anxiety disorders. The early recognition and treatment of anxiety disorders result in better long-term outcomes in children and adolescents. This article summarizes the evidence-based pharmacologic treatments for anxiety disorders in youth, including social anxiety disorder generalized anxiety disorder, separation anxiety disorder, and panic disorder.
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Affiliation(s)
- Afshan N Amray
- Medicine, Dow Medical College and Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Khurram Munir
- Physiology, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, PAK
| | - Nusrat Jahan
- Internal Medicine, Rush University Medical Center, Chicago, USA
| | - Fatima B Motiwala
- Psychiatry, Texas Tech University Health Science Center, Midland, USA
| | - Sadiq Naveed
- Psychiatry, University of Kansas Medical Center, Kansas City, USA
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Smith A. Commentary: Recent Advances in Pediatric Psychopharmacology. Curr Probl Pediatr Adolesc Health Care 2018; 48:63-64. [PMID: 29477219 DOI: 10.1016/j.cppeds.2017.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Andrew Smith
- Department of Psychiatry, Dayton Children's Hospital, Wright State University Boonshoft School of Medicine, Dayton, OH.
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