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Schultze-Lutter F, Banaschewski T, Barth GM, Bechdolf A, Bender S, Flechtner HH, Hackler S, Heuer F, Hohmann S, Holzner L, Huss M, Koutsouleris N, Lipp M, Mandl S, Meisenzahl E, Munz M, Osman N, Peschl J, Reissner V, Renner T, Riedel A, Romanos M, Romer G, Schomerus G, Thiemann U, Uhlhaas PJ, Woopen C, Correll CU, Care-Konsortium D. [Ethical Considerations of Including Minors in Clinical Trials Using the Example of the Indicated Prevention of Psychotic Disorders]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2024. [PMID: 38809160 DOI: 10.1024/1422-4917/a000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Ethical Considerations of Including Minors in Clinical Trials Using the Example of the Indicated Prevention of Psychotic Disorders Abstract: As a vulnerable group, minors require special protection in studies. For this reason, researchers are often reluctant to initiate studies, and ethics committees are reluctant to authorize such studies. This often excludes minors from participating in clinical studies. This exclusion can lead to researchers and clinicians receiving only incomplete data or having to rely on adult-based findings in the treatment of minors. Using the example of the study "Computer-Assisted Risk Evaluation in the Early Detection of Psychotic Disorders" (CARE), which was conducted as an 'other clinical investigation' according to the Medical Device Regulation, we present a line of argumentation for the inclusion of minors which weighs the ethical principles of nonmaleficence (especially regarding possible stigmatization), beneficence, autonomy, and fairness. We show the necessity of including minors based on the development-specific differences in diagnostics and early intervention. Further, we present specific protective measures. This argumentation can also be transferred to other disorders with the onset in childhood and adolescence and thus help to avoid excluding minors from appropriate evidence-based care because of insufficient studies.
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Affiliation(s)
- Frauke Schultze-Lutter
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesien
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Schweiz
| | - Tobias Banaschewski
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
| | - Gottfried M Barth
- Abteilung Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Deutschland
| | - Andreas Bechdolf
- Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin, Deutschland
- Klinik für Psychiatrie und Psychotherapie, CCM, Charité - Universitätsmedizin Berlin, Deutschland
- Deutsches Zentrum für Psychische Gesundheit, Standort Berlin, Deutschland
| | - Stephan Bender
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Hans-Henning Flechtner
- Universitätsklinik für Psychiatrie, Psychotherapie und psychosomatische Medizin des Kindes- und Jugendalters, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland
| | - Sandra Hackler
- Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, LVR-Klinik Bonn, Bonn, Deutschland
| | - Fabiola Heuer
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Deutschland
| | - Sarah Hohmann
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikums Hamburg-Eppendorf, Hamburg, Deutschland
| | - Laura Holzner
- Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin, Deutschland
| | - Michael Huss
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz; Mainz, Deutschland
| | - Nikolaos Koutsouleris
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
- Max Planck Institute of Psychiatry, Max Planck Fellow Group Precision Psychiatry, München, Deutschland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael Lipp
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Selina Mandl
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie der Universität München, Klinikum der Universität München, Deutschland
| | - Eva Meisenzahl
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Manuel Munz
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters des Zentrums für Integrative Psychiatrie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Deutschland
| | - Naweed Osman
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Jens Peschl
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Volker Reissner
- Abteilung für Kinder- und Jugendpsychiatrie, LVR-Klinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Deutschland
| | - Tobias Renner
- Abteilung Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Deutschland
| | - Anett Riedel
- Universitätsklinik für Psychiatrie, Psychotherapie und psychosomatische Medizin des Kindes- und Jugendalters, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland
| | - Marcel Romanos
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Deutschland
| | - Georg Romer
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster, Deutschland
| | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Leipzig, Leipzig, Deutschland
| | - Ulf Thiemann
- Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, LVR-Klinik Bonn, Bonn, Deutschland
| | - Peter J Uhlhaas
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Deutschland
- Institute of Neuroscience and Psychology, University of Glasgow, UK
| | | | - Christoph U Correll
- Deutsches Zentrum für Psychische Gesundheit, Standort Berlin, Deutschland
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Deutschland
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - das Care-Konsortium
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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Shah JL, Paquin V, McIlwaine SV, Malla AK, Joober R, Pruessner M. Examining the psychobiological response to acute social stress across clinical stages and symptom trajectories in the early psychosis continuum. Dev Psychopathol 2024; 36:774-786. [PMID: 36852607 DOI: 10.1017/s0954579423000056] [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] [Indexed: 03/01/2023]
Abstract
The stress-vulnerability model has been repeatedly highlighted in relation to the risk, onset and course of psychosis, and has been independently studied in clinical high-risk (CHR) and first-episode psychosis (FEP) populations. Notable in this literature, however, is that there are few studies directly comparing markers of stress response across progressive stages of illness. Here we examined the psychobiological response to the Trier Social Stress Test in 28 CHR (mean age 19.1) and 61 FEP (age 23.0) patients, in order to understand the stage(s) or trajectories in which differences in subjective stress or physiological response occur. The overall clinical sample had greater perceived stress and blunted cortisol (FEP + CHR, n = 89, age 21.7) compared with healthy controls (n = 45, age 22.9). Additional analyses demonstrated elevated heart rate and systolic blood pressure in FEP compared with CHR, but there were no further differences in physiological parameters (cortisol, heart rate, or blood pressure) between stage- or trajectory-based groups. Together, this suggests that individual stress response markers may differentially emerge at particular stages en route to psychosis - and demonstrates how stage-based analyses can shed light on the emergence and evolution of neurobiological changes in mental illness.
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Affiliation(s)
- Jai L Shah
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Vincent Paquin
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Sarah V McIlwaine
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Ashok K Malla
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, Canada
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Orsolini L, Longo G, Cicolini A, Volpe U. An expert opinion on the pharmacological interventions for Disruptive Mood Dysregulation Disorder (DMDD). Expert Opin Pharmacother 2024; 25:67-78. [PMID: 38186365 DOI: 10.1080/14656566.2024.2303422] [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: 09/13/2023] [Accepted: 01/05/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Disruptive Mood Dysregulation Disorder (DMDD) was officially introduced as a new diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5), under the category of depressive disorders. AREAS COVERED A comprehensive overview and a critical commentary on the currently investigated psychopharmacological approaches for the treatment of DMDD have been here provided. EXPERT OPINION Behavioral and psychosocial interventions should be considered as first-line treatment strategies. When ineffective or partially effective, psychopharmacological strategy is recommended. Overall, pharmacological strategy should be preferred in those individuals with psychiatric comorbidities (e.g. ADHD). Indeed, so far published studies on pharmacological strategies in DMDD are scant and heterogeneous (i.e. age, assessment tools, symptomatology profile, comorbidity, and so forth). Therefore, DMDD psychopharmacological guidelines are needed, particularly to guide clinicians toward the patient's typical symptom profile who could benefit from psychopharmacological strategy.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Giulio Longo
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Angelica Cicolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
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Pelizza L, Leuci E, Quattrone E, Paulillo G, Pellegrini P. The 'Parma At-Risk mental states' (PARMS) program: General description and process analysis after 5 years of clinical activity. Early Interv Psychiatry 2023. [PMID: 36639137 DOI: 10.1111/eip.13399] [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: 07/25/2022] [Revised: 11/28/2022] [Accepted: 01/01/2023] [Indexed: 01/15/2023]
Abstract
AIM From January 2016, the Parma Department of Mental Health developed a specialized care protocol - the 'Parma At-Risk Mental States' (PARMS) program - as a diffused service for early intervention in individuals at Clinical High Risk for Psychosis (CHR-P). The aims of this investigation were (1) to describe the PARMS structural organization and (2) to examine specific process indicators during the first 5 years of its clinical activity. METHODS All participants were adolescent and young adult help-seekers (aged 12-25 years) at CHR-P in accordance with well-defined psychometric criteria. RESULTS At entry, 52 subjects were provided with a dedicated protocol of care and only 14 dropped out during the first year of treatment. The Duration of Untreated Illness (DUI) overall decreased over time. Most of CHR-P participants suffered from 'Attenuated Psychotic Symptoms' and 'Brief, Limited, Intermittent Psychotic Symptoms' in the same percentage (48.1% [n = 25]). The most common DSM-IV-TR diagnosis was schizotypal personality disorder, followed by borderline personality disorder and brief psychotic disorder. CONCLUSIONS A specialized, evidence-based care protocol for CHR-P individuals within Italian adult and child/adolescent psychiatric services is feasible, also in adolescents, who have a high risk of falling through the child/adult service gap.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy.,Department of Biomedical and NeuroMotor Sciences, "Alma Mater Studiorum", Università degli Studi di Bologna, Bologna, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
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