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Lopez JD, Daniels W, Joshi SV. Oppositional Defiant Disorder: Clinical Considerations and When to Worry. Pediatr Rev 2024; 45:132-142. [PMID: 38425161 DOI: 10.1542/pir.2022-005922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Juan David Lopez
- San Francisco Department of Public Health, Children, Youth and Families, San Francisco, CA
| | - Whitney Daniels
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Shashank V Joshi
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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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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Chaulagain A, Lyhmann I, Halmøy A, Widding-Havneraas T, Nyttingnes O, Bjelland I, Mykletun A. A systematic meta-review of systematic reviews on attention deficit hyperactivity disorder. Eur Psychiatry 2023; 66:e90. [PMID: 37974470 PMCID: PMC10755583 DOI: 10.1192/j.eurpsy.2023.2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND There are now hundreds of systematic reviews on attention deficit hyperactivity disorder (ADHD) of variable quality. To help navigate this literature, we have reviewed systematic reviews on any topic on ADHD. METHODS We searched MEDLINE, PubMed, PsycINFO, Cochrane Library, and Web of Science and performed quality assessment according to the Joanna Briggs Institute Manual for Evidence Synthesis. A total of 231 systematic reviews and meta-analyses met the eligibility criteria. RESULTS The prevalence of ADHD was 7.2% for children and adolescents and 2.5% for adults, though with major uncertainty due to methodological variation in the existing literature. There is evidence for both biological and social risk factors for ADHD, but this evidence is mostly correlational rather than causal due to confounding and reverse causality. There is strong evidence for the efficacy of pharmacological treatment on symptom reduction in the short-term, particularly for stimulants. However, there is limited evidence for the efficacy of pharmacotherapy in mitigating adverse life trajectories such as educational attainment, employment, substance abuse, injuries, suicides, crime, and comorbid mental and somatic conditions. Pharmacotherapy is linked with side effects like disturbed sleep, reduced appetite, and increased blood pressure, but less is known about potential adverse effects after long-term use. Evidence of the efficacy of nonpharmacological treatments is mixed. CONCLUSIONS Despite hundreds of systematic reviews on ADHD, key questions are still unanswered. Evidence gaps remain as to a more accurate prevalence of ADHD, whether documented risk factors are causal, the efficacy of nonpharmacological treatments on any outcomes, and pharmacotherapy in mitigating the adverse outcomes associated with ADHD.
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Affiliation(s)
- Ashmita Chaulagain
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvild Lyhmann
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Halmøy
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tarjei Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Olav Nyttingnes
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ingvar Bjelland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Arnstein Mykletun
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Centre for Work and Mental Health, Nordland Hospital, Bodø, Norway
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Ziliotto M, Kulmann-Leal B, Kaminski VDL, Nunes GT, Riesgo RDS, Roman T, Schuch JB, Chies JAB. HLA-G*14 bp indel variant in autism spectrum disorder in a population from southern Brazil. J Neuroimmunol 2023; 383:578194. [PMID: 37683302 DOI: 10.1016/j.jneuroim.2023.578194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023]
Abstract
Altered immune response during pregnancy has been associated with ASD susceptibility. HLA-G is expressed by the trophoblast at the maternal/fetal interface and induces allogenic tolerance toward the fetus. A 14-bp insertion in the HLA-G 3'UTR (rs371194629) was associated with reduced levels of HLA-G. We aimed to assess the influence of the HLA-G*14 bp indel variant in ASD susceptibility and symptomatology in a Brazilian admixed sample. The insertion genotype (14 bp+/14 bp+) was firstly associated with hetero aggression, but statistical significance was lost after correction (p = 0.035, pcorrected = 0.35). No association between the HLA-G variant and susceptibility to ASD or differential clinical manifestations were observed.
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Affiliation(s)
- Marina Ziliotto
- Laboratory of Immunobiology and Immunogenetics, Department of Genetics, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brazil; Post Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Bruna Kulmann-Leal
- Laboratory of Immunobiology and Immunogenetics, Department of Genetics, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brazil; Post Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Valéria de Lima Kaminski
- Post Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brazil; Universidade Anhembi Morumbi, São José dos Campos, São Paulo, Brazil
| | - Guilherme Tyska Nunes
- Laboratory of Immunobiology and Immunogenetics, Department of Genetics, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Rudimar Dos Santos Riesgo
- Child Neurology Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Tatiana Roman
- Laboratory of Psychiatric Genetics, Department of Genetics, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Jaqueline Bohrer Schuch
- Laboratory of Psychiatric Genetics, Department of Genetics, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - José Artur Bogo Chies
- Laboratory of Immunobiology and Immunogenetics, Department of Genetics, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brazil.
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Li S, Lu Y, Wu J. Sandplay Therapy as a Complementary Treatment for Children with ADHD: A Scoping Review. Issues Ment Health Nurs 2023; 44:911-917. [PMID: 37699060 DOI: 10.1080/01612840.2023.2249990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
ADHD is a prevalent neurodevelopmental disorder that affects children's behavior, academic performance, and social interactions. This review aims to evaluate the existing evidence for Sandplay therapy, a nonverbal psychodynamic approach, as a complementary treatment for children with ADHD. Ten studies suggest Sandplay therapy improves ADHD symptoms, such as hyperactivity, impulsivity, and inattention, through symbolic expression, play, and mindfulness. Despite its promise, ethical and practical considerations, including therapist training and treatment cost, must be addressed. Further research is needed to determine long-term effectiveness and optimal patient population for this treatment, which may benefit children unresponsive to or experiencing side effects from traditional treatments.
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Affiliation(s)
- Siqi Li
- Department of VIP Clinic Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - You Lu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- Department of Child Health Care Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jinhui Wu
- West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- Department of Child Health Care Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
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Masi G, Carucci S, Muratori P, Balia C, Sesso G, Milone A. Contemporary diagnosis and treatment of conduct disorder in youth. Expert Rev Neurother 2023; 23:1277-1296. [PMID: 37853718 DOI: 10.1080/14737175.2023.2271169] [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: 06/07/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Conduct disorder (CD) is characterized by repetitive and persistent antisocial behaviors, being among the most frequently reported reasons of referral in youth. CD is a highly heterogeneous disorder, with possible specifiers defined according to age at onset, Limited Prosocial Emotions (LPE) otherwise known as Callous-Unemotional (CU) traits, Emotional Dysregulation (ED), and patterns of comorbidity, each with its own specific developmental trajectories. AREAS COVERED The authors review the evidence from published literature on the clinical presentations, diagnostic procedures, psychotherapeutic and psychoeducational approaches, and pharmacological interventions from RCT and naturalistic studies in youth. Evidence from studies including youths with LPE/CU traits, ED and aggression are also reviewed, as response moderators. EXPERT OPINION Due to its clinical heterogeneity, relevant subtypes of CD should be carefully characterized to gain reliable information on prognosis and treatments. Thus, disentangling this broad category in subtypes is crucial as a first step in diagnosis. Psychosocial interventions are the first option, possibly improving LPE/CU traits and ED, especially if implemented early during development. Instead, limited information, based on low-quality studies, supports pharmacological options. Second-generation antipsychotics, mood stabilizers, and stimulants are first-line medications, according to different target symptoms, such as aggression and emotional reactivity. Developmental pathways including ADHD suggest a specific role of psychostimulants.
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Affiliation(s)
- Gabriele Masi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Sara Carucci
- Department of Biomedical Science, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatric Unit, "A. Cao" Paediatric Hospital-ARNAS "G. Brotzu" Hospital Trust, Department of Paediatrics, Cagliari, Italy
| | - Pietro Muratori
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Carla Balia
- Department of Biomedical Science, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatric Unit, "A. Cao" Paediatric Hospital-ARNAS "G. Brotzu" Hospital Trust, Department of Paediatrics, Cagliari, Italy
| | - Gianluca Sesso
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
- Social and Affective Neuroscience Group, Molecular Mind Lab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Annarita Milone
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
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Sesso G, Masi G. Pharmacological strategies for the management of the antisocial personality disorder. Expert Rev Clin Pharmacol 2023; 16:181-194. [PMID: 36787887 DOI: 10.1080/17512433.2023.2181159] [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: 11/21/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Antisocial personality disorder (AsPD) is a pervasive pattern of violation of others' rights, related to the concept of psychopathy. AsPD is stable over time from adolescence, with evidence of conduct disorder (CD) before 15 years. DSM-5 included a specifier 'with limited prosocial emotions' (LPE), which characterizes adolescents with higher developmental vulnerability to develop AsPD. Despite being relatively frequent with considerable societal impact, AsPD is a difficult-to-treat condition with high comorbidity rates and poor evidence for effective pharmacological interventions. AREAS COVERED We conducted a narrative review and searched PubMed up to September 2022. We included RCTs and naturalistic studies evaluating pharmacological interventions on AsPD in adults, including those with comorbid substance use disorder or psychopathic traits. Evidence in youths with CD, callous-unemotional (CU) traits and aggression were also reviewed, exploring the role of CU traits as moderators of response. EXPERT OPINION Psychosocial interventions are the first option, with possible improvement of CU traits, beyond behavioral and affective symptoms, particularly if implemented early during development. Limited information, based on low-quality studies, supports the pharmacological options. Second-generation antipsychotics, lithium, anti-epileptic drugs, and stimulants are first-line medications, according to different target symptoms. Developmental pathways including ADHD suggest a specific role of psychostimulants.
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Affiliation(s)
- Gianluca Sesso
- Social and Affective Neuroscience Group, Molecular Mind Lab, IMT School for Advanced Studies Lucca, Lucca, Italy
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Gabriele Masi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
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Tcherni-Buzzeo M. Increased Prescribing of Psychotropic Drugs or School-Based Services for Children with Disabilities? Associations of These Self-control-Boosting Strategies with Juvenile Violence at the State Level. JOURNAL OF DEVELOPMENTAL AND LIFE-COURSE CRIMINOLOGY 2023; 9:1-35. [PMID: 36789240 PMCID: PMC9910267 DOI: 10.1007/s40865-023-00223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
The increasing rates at which psychotropic drugs have been prescribed to children and adolescents in the USA in the last three decades (since the early 1990s) have prompted questions about whether this trend is associated with the "great American crime decline." Medicalization can be considered one of the strategies to remedy children's neuropsychological deficits and improve their self-control. Another possible remedy is school-based services for children with learning disabilities, mandated by the Individuals with Disabilities Education Improvement Act (IDEA) of 2004. Using state-level panel data analyses for years 1990-2014 (with the main focus on 2000-2014 outcomes), the current study estimates associations between these two developmental self-control remedies-medicalization and school-based services-and minor, moderate, and severe types of juvenile violence, while controlling for relevant covariates (both time-varying and time-invariant). The results of mixed-effects linear regression analyses accounting for powerful time trends show a strong association between increases in school-based services for children with learning disabilities and declines in all types of juvenile violence. Another strong and consistent finding that emerges in the analyses is the link between reductions in child poverty at the state level and decreases in juvenile violence, both contemporaneously and over time. Psychotropic drug prescribing to children (measured using Supplemental Security Income rolls of children with mental health conditions) exhibits inconsistent or insignificant effects. The findings of this study have substantial theoretical and policy implications and indicate the importance of strengthening school-based services for children with disabilities and reducing child poverty as essential violence prevention tools.
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A Critical Review of the Psychomotor Agitation Treatment in Youth. Life (Basel) 2023; 13:life13020293. [PMID: 36836652 PMCID: PMC9965751 DOI: 10.3390/life13020293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
(1) Background: To systematically review evidence on the safety and efficacy of psychopharmacological treatments available for psychomotor agitation (PA) in children and adolescents. (2) Methods: Studies assessing the safety and efficacy of psychopharmacological treatments for acute PA in children and adolescents that were published between January 1984 and June 2022 on PubMed were systematically reviewed. We included: (i) papers that presented a combination of the search terms specified in the "Search strategy" sub-paragraph; (ii) manuscripts in English; (iii) original papers; (iv) prospective or retrospective/observational studies and experimental or quasi-experimental reports. The exclusion criteria were: (i) review papers; (ii) non-original studies including editorials and book reviews; (iii) studies not specifically designed and focused on the selected topic. (3) Results: We selected 42 papers: 11 case series (11/42, 26.19%), 8 chart reviews (8/42, 19.05%), 8 case reports (8/42, 19.05%), 6 double-blind placebo-controlled randomized studies (6/42, 14.29%), 4 double-blind controlled randomized studies (4/42, 9.52%), 4 open-label trials (4/42, 9.52%) and 1 case control (1/42, 2.38%). (4) Conclusions: The drugs most frequently used to treat agitation in children and adolescents were ziprasidone, risperidone, aripiprazole, olanzapine and valproic acid. Further studies are needed to evaluate the efficacy/safety ratio, considering the limited number of observations in this field.
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Galvez-Contreras AY, Vargas-de la Cruz I, Beltran-Navarro B, Gonzalez-Castaneda RE, Gonzalez-Perez O. Therapeutic Approaches for ADHD by Developmental Stage and Clinical Presentation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12880. [PMID: 36232180 PMCID: PMC9566361 DOI: 10.3390/ijerph191912880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder with three presentations: inattentive, hyperactive/impulsive and combined. These may represent an independent disease entity. Therefore, the therapeutic approach must be focused on their neurobiological, psychological and social characteristics. To date, there is no comprehensive analysis of the efficacy of different treatments for each presentation of ADHD and each stage of development. This is as narrative overview of scientific papers that summarize the most recent findings and identify the most effective pharmacological and psychosocial treatments by ADHD presentation and age range. Evidence suggests that methylphenidate is the safest and most effective drug for the clinical management of children, adolescents and adults. Atomoxetine is effective in preschoolers and maintains similar efficacy to methylphenidate in adults, whereas guanfacine has proven to be an effective monotherapy for adults and is a worthy adjuvant for the management of cognitive symptoms. The psychosocial treatments with the best results in preschoolers are behavioral interventions that include training of primary caregivers. In adolescents, the combination of cognitive and cognitive-behavioral therapies has shown the best results, whereas cognitive-behavioral interventions are the most effective in adults. Pharmacological and psychosocial treatments must be adjusted to the ADHD presentation and its neurocognitive characteristics through the patient's development.
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Affiliation(s)
- Alma Y. Galvez-Contreras
- Unidad de Atención en Neurociencias, Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Ivette Vargas-de la Cruz
- Unidad de Atención en Neurociencias, Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Beatriz Beltran-Navarro
- Unidad de Atención en Neurociencias, Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Rocio E. Gonzalez-Castaneda
- Instituto de Neurociencias Traslacionales, Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Oscar Gonzalez-Perez
- Laboratorio de Neurociencias, Facultad de Psicología, Universidad de Colima, Colima 28040, Mexico
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Effectiveness of neurofeedback training, behaviour management including attention enhancement training and medication in children with attention-deficit/hyperactivity disorder - A comparative follow up study. Asian J Psychiatr 2022; 76:103133. [PMID: 35551878 DOI: 10.1016/j.ajp.2022.103133] [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: 01/12/2022] [Revised: 03/10/2022] [Accepted: 04/20/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Attention Deficit/ Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental psychiatric disorders of childhood. Treatment of ADHD includes medications and Behavioural interventions. Neurofeedback, a type of biofeedback, has been found to be useful in ADHD. It helps patients to control their brain waves consciously. However, it is not yet conclusive if it is efficacious in comparison to behavioural management training and medication. AIM To compare the efficacy of neurofeedback training, behaviour management including attention enhancement training and medication in children with ADHD. METHOD Ninety children between 6 and 12 years with ADHD were taken and randomly divided into 3 treatment groups equally- neurofeedback, behaviour management and medication (methylphenidate). Conners 3-P Short Scale was applied for baseline assessment. The respective interventions were given and follow up was done at the end of 3 months by using Conners 3-P Short scale to assess the improvement in the symptoms. There were 6 dropouts, the final sample size was 84. RESULTS The medication group showed the greatest reduction of symptoms in inattention, hyperactivity, executive functioning domain (core symptoms of ADHD). No statistically significant difference was observed between Neurofeedback and Behaviour Management in these domains. Learning problems improved in all three groups, neurofeedback being the most effective followed by medication. Both Neurofeedback and Medication groups showed similar effect which was higher than the Behavioural Management group in Peer Relation. CONCLUSION Improvement in core ADHD symptoms have been observed with all 3 interventions with medication showing the greatest improvement Neurofeedback has been superior for learning problems. Thus, Neurofeedback can be an independent or combined intervention tool for children with ADHD in outpatient department of Psychiatry.
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O'Malley KY, Hart CL, Casey S, Downey LA. Methamphetamine, amphetamine, and aggression in humans: A systematic review of drug administration studies. Neurosci Biobehav Rev 2022; 141:104805. [PMID: 35926727 DOI: 10.1016/j.neubiorev.2022.104805] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 07/24/2022] [Accepted: 07/30/2022] [Indexed: 10/16/2022]
Abstract
The relationship between amphetamine use and aggressive or violent behaviour is unclear. This review examined laboratory data collected in humans, who were administered an acute dose of amphetamine or methamphetamine, in order to investigate the link between amphetamines and aggression. It is registered with PROSPERO (CRD42019127711). Included in the analysis are data from twenty-eight studies. Behavioural and/or subjective measures of aggression were assessed in one thousand and sixty-nine research participants, with limited amphetamine-use histories, following a single amphetamine dose (0-35mg). The available published evidence indicates that neither amphetamine nor methamphetamine acutely increased aggression as assessed by traditional laboratory measures. Future research should assess supratherapeutic amphetamine doses as well as include a broader range of multiple aggression measures, facilitating simultaneous assessment of the various components that comprise this complex, multifaceted construct.
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Affiliation(s)
- Kate Y O'Malley
- Centre for Human Psychopharmacology, Swinburne University, 427-451 Burwood Road Hawthorn, Victoria, Australia 3122; Department of Psychology, Columbia University, 1190 Amsterdam Avenue, 406 Schermerhorn, MC 5501, New York, NY 10027.
| | - Carl L Hart
- Department of Psychology, Columbia University, 1190 Amsterdam Avenue, 406 Schermerhorn, MC 5501, New York, NY 10027; Division on Substance Use, New York State Psychiatric Institute, and Department of Psychiatry, 1051 Riverside Drive, MC 120, New York, NY 10032
| | - Sharon Casey
- Centre for Human Psychopharmacology, Swinburne University, 427-451 Burwood Road Hawthorn, Victoria, Australia 3122; Centre for Investigative Interviewing, Griffith, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122
| | - Luke A Downey
- Centre for Human Psychopharmacology, Swinburne University, 427-451 Burwood Road Hawthorn, Victoria, Australia 3122; Institute for Breathing and Sleep, Austin Hospital, 145 Studley Road Heidelberg, Victoria, Australia 3084
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Baweja R, Waxmonsky JG. Updates in Pharmacologic Strategies for Emotional Dysregulation in Attention Deficit Hyperactivity Disorder. Child Adolesc Psychiatr Clin N Am 2022; 31:479-498. [PMID: 35697397 DOI: 10.1016/j.chc.2022.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Emotional dysregulation (ED) manifesting as irritability or aggression produces appreciable impairment in children with attention deficit hyperactivity disorder and a main reason why they present for treatment. Central nervous system (CNS) stimulants seem to be a safe and tolerable treatment of most youth with these presentations. Optimization of CNS stimulants dose in combination with psychosocial interventions led to reductions in ED. Randomized controlled trials support that addition of risperidone further reduces aggression when these treatments are not sufficient. There is evidence for the efficacy of divalproex, molindone and selective serotonin reuptake inhibitor improve these outcomes when used as adjunct to CNS stimulants.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - James G Waxmonsky
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
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Karaosman T, Gumus YY. The Effects of Methylphenidate Treatment on Bullying Perpetration and Victimization in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2022; 32:107-116. [PMID: 35244454 DOI: 10.1089/cap.2021.0119] [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] [Indexed: 11/13/2022]
Abstract
Objective: Although it is known that attention-deficit/hyperactivity disorder (ADHD) increases the risk of bullying perpetration and victimization, the data on the effect of methylphenidate (MPH) treatment, which is frequently used in the treatment of ADHD, on bullying perpetration and victimization, are very limited. The aim of this study was to investigate the effect of MPH treatment on bullying perpetration and victimization in children and adolescents with ADHD. Methods: Children and adolescents with ADHD, aged 8-16 years, who had not been treated for ADHD for at least 1 year and prescribed only MPH treatment were invited to participate in this open-label naturalistic study. After 3 months of MPH treatment, peer bullying involvement status was analyzed in comparison with the pretreatment data. Results: There was a significant decrease in all subscales of the Conners' Parent Rating Scale (CPRS) and Conners' Teacher Rating Scale after MPH treatment. Being a bully decreased from 50% to 18% and being a victim decreased from 80% to 46%. It was determined that for every 1 point decrease in the CPRS Conduct Problems subscale, the risk of being a bully was reduced ∼2-fold, and every 1 point decrease in the CPRS Anxiety subscale reduced the risk of being a victim 2.44-fold. Conclusions: This is the first longitudinal study examining the effect of MPH treatment on bullying perpetration and victimization in children and adolescents with ADHD. It appears that MPH treatment may be effective in improving the situations of bullying perpetration and victimization in ADHD patients. In addition, the fact that the decrease in behavioral problems reduces the risk of being a bully and the decrease in anxiety symptoms reduces the risk of being a victim, suggests that prevention and intervention programs for bullying perpetration and victimization should target these problem areas.
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Affiliation(s)
- Tolga Karaosman
- Department of Child and Adolescent Psychiatry, Sabuncuoğlu Şerefeddin Research and Training Hospital, Amasya University, Amasya, Turkey
| | - Yusuf Yasin Gumus
- Department of Child and Adolescent Psychiatry, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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15
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Sorter M, Chua J, Lamy M, Barzman D, Ryes L, Shekhtman JA. Management of Emotion Dysregulation and Outbursts in Children and Adolescents. Curr Psychiatry Rep 2022; 24:213-226. [PMID: 35316849 DOI: 10.1007/s11920-022-01325-4] [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] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Emotion dysregulation and outbursts are very common reasons for referral to child and adolescent mental health services and a frequent cause of admission to hospitals and residential programs. Symptoms of emotion dysregulation and outburst are transdiagnostic, associated with many disorders, have the potential to cause severe impairment and their management presents a major challenge in clinical practice. RECENT FINDINGS There are an increasing number of psychosocial interventions that demonstrate promise in improving emotion dysregulation and outbursts. Acute care systems to manage the most severely ill patients have limited best practice guidelines but program advancements indicate opportunities to improve care models. Pharmacotherapy may be of assistance to psychosocial interventions but must be used with caution due to potential adverse effects. Much remains to be discovered however evidence informed, targeted treatments for specific populations show potential for future improvements in outcomes.
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Affiliation(s)
- Michael Sorter
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. .,University of Cincinnati College of Medicine, Cincinnati, USA.
| | - Jaclyn Chua
- Children's Hospital of Philadelphia, Philadelphia, USA
| | - Martine Lamy
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
| | - Drew Barzman
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
| | - Louis Ryes
- Xavier University, Cincinnati, USA.,University of Kentucky College of Medicine, Lexington, USA
| | - Joshua Abraham Shekhtman
- The Ohio State University, Columbus, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
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16
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Mansell H, Quinn D, Kelly LE, Szafron M, Alcorn J. Pharmacokinetics and Perceptions of Children and Young Adults Using Cannabis for Attention-Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder: Protocol for a Mixed Methods Proof-of-Concept Study. JMIR Res Protoc 2021; 10:e31281. [PMID: 34661540 PMCID: PMC8561403 DOI: 10.2196/31281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Despite the lack of evidence on the use of cannabis for the treatment of attention-deficit/hyperactivity disorder (ADHD), the growing perception that cannabis is safe has led more patients and caregivers to self-medicate. Some psychiatrists now authorize medicinal cannabis for patients with ADHD with features of oppositional defiant disorder (ODD) to curtail the unregulated (ie, self-medicated) use of recreational cannabis or to offer a therapeutic option to those who continue to experience symptoms after exhausting all other treatment options. Objective This protocol aims to explore the perceived effectiveness and pharmacokinetics of cannabis in youth and young adults, who are currently taking it as part of their treatment plan for ADHD with features of ODD, under the supervision of a psychiatrist. Methods Patients between the ages of 12 and 25 years with a diagnosis of ADHD and features of ODD, who are currently taking cannabis herbal extract (at a Δ9-tetrahydrocannabinol [THC]:cannabidiol [CBD] ratio of 1:20) as a treatment adjunct to stimulant pharmacotherapy will be recruited. A sample size of 10-20 individuals is estimated. The study interview will consist of (1) validated symptom rating scales (Swanson, Nolan, and Pelham-IV Questionnaire [SNAP-IV], 90-item; Patient Health Questionnaire, 9-item [PHQ-9]; and Screen for Child Anxiety Related Emotional Disorders [SCARED] tool to measure symptoms of ADHD and ODD, depression, and anxiety, respectively); (2) a semistructured interview to probe the experiences of using cannabis; and (3) a cannabis side effects survey. A cannabis product sample as well as 2 blood samples (a trough level and 2-hour postdose level) will be collected to measure plasma concentrations of cannabinoids and relevant metabolites (THC, CBD, 11-hydroxy-THC, 7-hydroxy-CBD, cannabichromene, and 11-nor-9-carboxy-THB) using liquid chromatography–tandem mass spectrometry (LC–MS/MS). Self-report rating scales (SNAP-IV, SCARED, and PHQ-9) will be scored in accordance with standard protocols and compared to retrospective scores obtained from the participant’s chart. Demographic variables (age, weight, and race), symptom scores, and blood levels (peaks and troughs) of THC, CBD, cannabichromene (CBC), and metabolites will be summarized using descriptive statistics. Relationships between plasma concentrations and symptom scores will be determined using analysis of variance, and multiple regression analysis will be performed to determine associations between plasma concentrations and demographic variables (age, weight, and ethnicity). The qualitative data will be audio-recorded and transcribed and organized into themes. Results The protocol was approved by the Biomedical Research Ethics Board at the University of Saskatchewan (protocol #1726), and recruitment began in May 2021. Conclusions This proof-of-concept study will explore the potential treatment effectiveness of medical cannabis in participants with ADHD and ODD through a mixed methods approach to inform future research in this area. International Registered Report Identifier (IRRID) DERR1-10.2196/31281
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Affiliation(s)
- Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Declan Quinn
- Division of Child and Adolescent Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lauren E Kelly
- Department of Pediatrics and Child Health and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Michael Szafron
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jane Alcorn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
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17
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Muratori P, Conversano C, Levantini V, Masi G, Milone A, Villani S, Bögels S, Gemignani A. Exploring the Efficacy of a Mindfulness Program for Boys With Attention-Deficit Hyperactivity Disorder and Oppositional Defiant Disorder. J Atten Disord 2021; 25:1544-1553. [PMID: 32338110 DOI: 10.1177/1087054720915256] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective: This study was the first attempt to explore the efficacy of a mindfulness protocol for children with attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), and their parents. Method: Fifty male children with ADHD and ODD diagnosis, aged 8 to 12, were randomly assigned to the mindfulness intervention (n = 25) or the wait-list (n = 25) group. Outcome measures included children, parents', and teachers' reports and objective measures of attention. Results: Children from the intervention group had a greater reduction in hyperactive behaviors in the school context (effect size [ES] = 0.59) and a greater improvement in visual sustained attention (ES = 0.77) and in Avoidance and Fusion Questionnaire scores (ES = 0.43) than those in the wait-list control group. No significant effect of the intervention on aggressive behaviors was revealed. Conclusion: A mindfulness intervention for children and their parents showed partial beneficial effects in children with ADHD + ODD.
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18
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Ceresoli-Borroni G, Nasser A, Adewole T, Liranso T, Xu J, Schwabe S, Findling RL. A Double-Blind, Randomized Study of Extended-Release Molindone for Impulsive Aggression in ADHD. J Atten Disord 2021; 25:1564-1577. [PMID: 32338106 DOI: 10.1177/1087054720909084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To evaluate efficacy and safety of SPN-810 (extended-release molindone) in a Phase-2b, randomized, double-blind, placebo-controlled, dose-ranging study of children (6-12 years) with ADHD and persistent impulsive aggression (IA). Method: After lead-in, children were randomized to (a) placebo (N = 31); (b) low-dose (N = 29, 12/18 mg/day); (c) medium-dose (N = 30, 24/36 mg/day); and (4) high-dose (N = 31, 36/54 mg/day) groups. Treatment included ~2.5-week titration, 3-week maintenance, and 1-week tapering/conversion, alongside existing monotherapy (stimulants/nonstimulants) and behavioral therapy. The primary endpoint was change in Retrospective-Modified Overt Aggression Scale (R-MOAS) score at end of study, with safety monitored. Results: A total of 95 (78.5%) children completed the study. Aggression (R-MOAS) improved with low and medium doses (low dose: p = .031; medium dose: p = .024; high dose: p = .740). The most common adverse events were headache (10.0%), sedation (8.9%), and increased appetite (7.8%). Conclusion: These results suggest SPN-810 may be effective in reducing residual IA behaviors in children with ADHD. Research is still needed to support the benefit-risk profile of SPN-810 in pediatric populations.
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Affiliation(s)
| | - Azmi Nasser
- Supernus Pharmaceuticals, Inc., Rockville, MD, USA
| | | | | | - Jiahong Xu
- Supernus Pharmaceuticals, Inc., Rockville, MD, USA
| | | | - Robert L Findling
- Johns Hopkins University, Baltimore, MD, USA.,Virginia Commonwealth University, Richmond, VA, USA
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19
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Dashbozorgi Z, Ghaffari A, Karamali Esmaili S, Ashoori J, Moradi A, Sarvghadi P. Effect of Neurofeedback Training on Aggression and Impulsivity in Children With Attention-Deficit/Hyperactivity Disorder: A Double-Blinded Randomized Controlled Trial. Basic Clin Neurosci 2021; 12:693-702. [PMID: 35173923 PMCID: PMC8818111 DOI: 10.32598/bcn.2021.2363.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 12/28/2020] [Accepted: 01/06/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction Aggression and impulsivity are some of the behavioral symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). Neurofeedback (NF) training has been suggested as a promising treatment in these children. This study aimed to investigate the effect of NF training on aggression and impulsivity in schoolchildren with ADHD. Methods A total of 40 male elementary school children with ADHD (aged 11.17±0.97 years) were randomized into the NF and sham groups. The NF group received 12 NF training sessions, each taking about 60 minutes for six consecutive weeks (twice a week), based on the Hammond protocol. The subjects' parents were questioned to evaluate the outcomes, including aggression and impulsivity, using the Buss-Perry Aggression Questionnaire (BPAQ) and Barratt Impulsiveness Scale (BIS). Results After the intervention, in the NF group, the BPAQ score changed from 87.60±9.33 to 81±7.23 and the BIS score from 94.7±7.25 to 88.05±5.4, which were significant (P=0.001). The results indicated the large effect size of NF on aggression and impulsivity in ADHD. Conclusion Our findings suggest NF training as a clinically applicable method for decreasing aggression and impulsivity, also support concurrent use of medication and NF training in children with ADHD.
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Affiliation(s)
- Zahra Dashbozorgi
- Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran
| | - Amin Ghaffari
- Department of Occupational Therapy, School of Rehabilitation Science, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Karamali Esmaili
- Department of Occupational Therapy, School of Rehabilitation Science, Iran University of Medical Sciences, Tehran, Iran
| | - Jamal Ashoori
- Department of Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University
| | - Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pooria Sarvghadi
- Department of Occupational Therapy, School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Abstract
Explosive and aggressive behavior in children can pose safety risks, disturb family functioning, and lead to significant impairments. Pharmacologic management should be based on the first-line treatment of the primary psychiatric diagnoses of the patient and initiated in combination with appropriate psychosocial interventions. Review of the literature suggests that risperidone has the most supporting evidence in the treatment of explosive behavior. Stimulants have been shown to be helpful in the treatment of explosive behavior in attention-deficit/hyperactivity disorder. Medication treatment can be associated with significant side effects and therefore the risks and benefits of medication management must be weighed carefully.
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21
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Oerbeck B, Overgaard KR, Hjellvik V, Lien L, Bramness JG. The Use of Antidepressants, Antipsychotics, and Stimulants in Youth Residential Care. J Child Adolesc Psychopharmacol 2021; 31:350-357. [PMID: 33635152 PMCID: PMC8233215 DOI: 10.1089/cap.2020.0123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objectives: To assess the use of three commonly prescribed psychotropic medications in youth placed in residential care (RC). Methods: Participants were youth aged 0-20 years placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of antidepressants, antipsychotics, and stimulants in RC with the age- and gender-adjusted general child population (GenPop) and how this co-varied with reasons for RC placement, age, and gender. Results: One thousand eight hundred fifty-six children and adolescents were identified in RC, with mean age 14 (range 0-20 years), 46% girls, 81% ≥ 13 years. Among those, 423 or 23% used any of the 3 psychotropics, which was significantly more than the 3.7% in GenPop. The prevalence ratios RC/GenPop were 6.6 for antidepressants, 17.9 for antipsychotics, and 4.4 for stimulants. The median number of days per year for the dispensed defined daily doses varied from 8.3 to 244.0 for the different antipsychotics, indicating short time use for most of the people. Polypharmacy was not frequent in RC, as only 26% used ≥2 classes of medication, but still significantly more frequent than the 10% in GenPop. Youth placed in RC for serious behavior problems had significantly higher use of stimulants than those with other placement reasons. Psychotropics were not used below age 6 years, and although the use of antidepressants and antipsychotics overall increased with age, stimulants were mostly used by 6-16-year olds. The girl/boy ratio for any psychotropic medication use in RC was 1.4 (95% confidence interval [95% CI]: 1.1-1.6), significantly higher than the corresponding ratio in GenPop: 1.0 (95% CI: 0.9-1.0). Conclusion: The present findings do not necessarily suggest an overtreatment with medication in RC. However, the frequent short-term use of antipsychotics, presumably for non-psychotic symptoms, is a concern, as it may reflect that the youth are not provided with the recommended first-line psychological treatments.
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Affiliation(s)
- Beate Oerbeck
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Address correspondence to: Beate Oerbeck, PhD, Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4959 Nydalen, Oslo 0424, Norway
| | | | - Vidar Hjellvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.,Faculty of Health and Social Science, Inland University College of Applied Science, Elverum, Norway
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.,Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway.,Institute of Clinical Medicine, UiT—The Arctic University of Norway, Tromsø, Norway
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22
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Ashurova M, Budman C, Coffey BJ. Ticked Off: Anger Outbursts and Aggressive Symptoms in Tourette Disorder. Child Adolesc Psychiatr Clin N Am 2021; 30:361-373. [PMID: 33743944 DOI: 10.1016/j.chc.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Tourette disorder is a complex neuropsychiatric syndrome of childhood onset characterized by multiple motor and phonic tics and is associated with high rates of psychiatric comorbidity. Symptoms of impulsive aggression (explosive outbursts or "rage") are commonly encountered in the clinical setting, cause significant morbidity, and pose diagnostic and treatment challenges. These symptoms may be multifactorial in etiology and result from a complex interplay of illness severity and psychosocial factors. Treatment strategies require careful differential diagnostic evaluation and include both behavioral and pharmacologic interventions.
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Affiliation(s)
- Marianna Ashurova
- Zucker Hillside Hospital, ACP Building Basement, 75-59 263rd Street, Glen Oaks, NY 11004, USA; Child & Adolescent Psychiatry Consultation Liaison Service, Cohens Children's Medical Center, 268-01 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Cathy Budman
- Long Island Center for Tourette, 1615 Northern Boulevard, Suite #306, Manhasset, NY 11030, USA; Zucker School of Medicine, 500 Hofstra Boulevard, Hempstead, NY 11549, USA
| | - Barbara J Coffey
- Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, Tourette Association Center of Excellence, University of Miami Miller School of Medicine, 1120 Northwest Fourteenth Street, Suite 1442, Miami, FL 33136, USA
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23
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Attention-Deficit/Hyperactivity Disorder (ADHD), antisociality and delinquent behavior over the lifespan. Neurosci Biobehav Rev 2020; 120:236-248. [PMID: 33271164 DOI: 10.1016/j.neubiorev.2020.11.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/28/2020] [Accepted: 11/26/2020] [Indexed: 12/24/2022]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is closely linked to the development of conduct problems during socialization in early life and to an increased risk for antisocial activities and delinquency over the lifespan. The interaction between ADHD and common comorbid disorders like substance use disorders as well as changing environmental conditions could mediate the course of antisocial and delinquent behavior with increasing age. However, this complex interaction is only partially understood so far. This review presents current knowledge about the association of ADHD with antisociality and the development of delinquent behavior. Thereby, the relationships between ADHD, conduct disorder and antisocial personality disorder in offenders are discussed, as well as the impact of comorbid psychiatric disorders and psychosocial conditions on offending behavior. Also, treatment studies in offender populations with ADHD are presented. Although our understanding of the role of ADHD in the development of criminal behavior has substantially improved during the last two decades, more research is needed to further elucidate the mechanisms generating unfavorable outcomes and to engender adequate treatment strategies for this population at risk. Moreover, more attention is needed on children with conduct problems in order to avoid antisocial or delinquent behaviors over the lifespan.
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24
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Pharmacotherapy of attention-deficit hyperactivity disorder: common quandaries, dilemmas and challenges. Int Clin Psychopharmacol 2020; 35:300-304. [PMID: 32694317 DOI: 10.1097/yic.0000000000000323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Multiple studies have shown that pharmacologic treatments for attention-deficit hyperactivity disorder (ADHD), especially stimulants, are generally effective. There is yet a paucity of empirical data, however, for some common clinical conditions overlooked in the ADHD treatment guidelines. Some examples include: in cases of first line treatment failure, it is unclear whether switching from one type of stimulant to another is beneficial. In cases of comorbid ADHD and severe aggressive/disruptive behavior in children, it is unclear whether the best first-line treatment is stimulants or atypical antipsychotics like risperidone. In cases of ADHD with comorbid anxiety disorders, there is no clear evidence regarding optimal treatment. The objectives of this article are to review these issues and propose possible answers for such clinical dilemmas.
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25
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Higdon C, Blader J, Kalari VK, Fornari VM. Measurement-Based Care in the Treatment of Attention-Deficit/Hyperactivity Disorder and Disruptive Behavior Disorders. Child Adolesc Psychiatr Clin N Am 2020; 29:663-674. [PMID: 32891368 DOI: 10.1016/j.chc.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric diagnoses. The core symptoms of ADHD include inattention, impulsivity, and hyperactivity. ADHD entails impairments that have extensive and profound detrimental effects on many critical developmental areas. As a valid neurobiologic condition that causes significant impairments in those affected, it is one of the best-researched disorders in medicine. Measurement-based care in treatment of ADHD is critical in establishing a diagnosis, determining a treatment target, and assessing treatment response. This article highlights the rationale for measurement-based care in ADHD, how to implement measurement-based care in clinical practice, and common challenges encountered.
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Affiliation(s)
- Claudine Higdon
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, 7559 263rd Street, Glen Oaks, NY 11004, USA.
| | - Joseph Blader
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MS 7719, San Antonio, TX 78229, USA
| | - Vamsi K Kalari
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, 7559 263rd Street, Glen Oaks, NY 11004, USA
| | - Victor M Fornari
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, 7559 263rd Street, Glen Oaks, NY 11004, USA
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26
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Efficacy of Guanfacine Extended Release in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder and Comorbid Oppositional Defiant Disorder. J Dev Behav Pediatr 2020; 41:565-570. [PMID: 32482970 DOI: 10.1097/dbp.0000000000000822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the efficacy of the non-stimulant guanfacine extended release (GXR) on attention-deficit/hyperactivity disorder (ADHD) symptoms in children and adolescents, with and without comorbid oppositional defiant disorder (ODD). METHODS Data were derived from 4 phase 3, randomized, placebo-controlled trials of dose-optimized GXR monotherapy, in which at least 10% of participants had a diagnosis of comorbid ODD. SPD503-312 and SPD503-316 were 10- to 13-week studies of GXR (1-7 mg/d). SPD503-314 and SPD503-307 were 8-week studies of GXR (1-4 mg/d). Efficacy was assessed using the ADHD Rating Scale IV (ADHD-RS-IV) total scores. RESULTS In total, 1,084 participants were included (SPD503-312 and SPD503-316, n = 537; SPD503-314, n = 333; and SPD503-307, n = 214). GXR was associated with significant improvements in ADHD core symptoms at endpoint in participants with and without ODD (p < 0.01 in all studies). Placebo-adjusted least-squares mean (95% confidence interval) changes from baseline to endpoint in the ADHD-RS-IV total scores in participants with and without ODD were -8.6 (-14.4, -2.8) and -7.3 (-9.5, -5.0) in the pooled data from SPD503-312 and SPD503-316, -12.6 (-19.6, -5.7) and -8.7 (-11.8, -5.5) in SPD503-314, and -12.7 (-17.3, -8.1) and -11.8 (-19.3, -4.4) in SPD503-307, respectively. The corresponding effect sizes were 0.688 and 0.598 in SPD503-312 and SPD503-316, 0.876 and 0.729 in SPD503-314, and 0.962 and 0.842 in SPD503-307. CONCLUSION The findings demonstrate the efficacy of GXR for treating ADHD in children and adolescents with comorbid ODD.
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27
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Biederman J, Fried R, DiSalvo M, Driscoll H, Green A, Biederman I, Woodworth KY, Faraone SV. A novel digital health intervention to improve patient engagement to stimulants in adult ADHD in the primary care setting: Preliminary findings from an open label study. Psychiatry Res 2020; 291:113158. [PMID: 32559669 DOI: 10.1016/j.psychres.2020.113158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022]
Abstract
AIMS We piloted the effectiveness and acceptability of a novel text messaging-based (SMS) digital health intervention aimed at addressing the previously documented poor rate of patient engagement in stimulant treatment in the primary care setting. METHODS 117 adults ages 18-55 from primary care and psychiatric practices who were prescribed a stimulant medication for ADHD treatment received the SMS intervention. Comparators were age-, race-, and sex-matched patients from the same health care organization's electronic medical record who had been prescribed stimulant medications over a similar time period. Using documented prescription records, we determined whether patients had timely prescription refills. RESULTS Ninety-six percent (N = 112) of participants completed our a priori metric of patient engagement consisting of 37 days of the SMS program. Eighty-one percent of participants refilled their index prescriptions in a timely manner compared to only 36% of patients receiving treatment as usual (OR=7.54, 95% CI: 4.46, 12.77; p<0.001). We found no significant interaction between prescribing source (non-psychiatry vs. psychiatry) and intervention group (SMS vs. treatment as usual). CONCLUSIONS These data suggest that an ADHD-centric, digital health intervention using text messaging significantly improves patient engagement in stimulant treatment in adults with ADHD.
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Affiliation(s)
- Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Ronna Fried
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Haley Driscoll
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Allison Green
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Itai Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - K Yvonne Woodworth
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
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Parsley I, Zhang Z, Hausmann M, Lerdahl A, Vaughan B, Edwards R, Hwang S. Effectiveness of Stimulant Medications on Disruptive Behavior and Mood Problems in Young Children. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:402-411. [PMID: 32702219 PMCID: PMC7383001 DOI: 10.9758/cpn.2020.18.3.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/14/2020] [Accepted: 05/06/2020] [Indexed: 11/20/2022]
Abstract
Objective There are very few studies on the effectiveness of stimulant medications for the treatment of disruptive mood and behavior problems in young children (less than 7 years) with Disruptive Behavior Disorders (DBD). The current study aims to determine whether young children (ages 4−7) in a long-term, intensive outpatient behavioral treatment program who are receiving stimulant medications show greater improvement in mood and behavior problems compared to peers who did not. Methods A retrospective chart review was conducted for 97 participants diagnosed with DBD, aged 4−7 years old who were enrolled in an intensive outpatient behavioral intervention program. Pre- and post-intervention Child Behavior Checklist (CBCL) scores for disruptive behavior and mood problems were compared between the children who received stimulant medications and those who did not. Results Paired t tests showed a statistically significant improvement in CBCL outcomes between pre- and post-intervention scores of disruptive behavior and mood problems. ANCOVA analysis, however, showed no clear further improvement in those same CBCL scores in the participants who received stimulant medications compared to the participants who did not. CBCL scores for Conduct Disorder were marginally significant for less improvement for the participants who received stimulant medications. Conclusion This retrospective review suggests a possibility that stimulant medications may not provide additional benefit for the long-term treatment of disruptive behavior and mood problems in young children under age 7. Future study is warranted to evaluate the efficacy/effectiveness of stimulant medications in the treatment of disruptive behavior and mood problems in this population.
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Affiliation(s)
- Ian Parsley
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Zhuo Zhang
- China University of Political Science and Law, School of Psychology, Beijing, China
| | - Mark Hausmann
- Daybreak Mental and Behavioral Health, Papillion, NE, USA
| | - Arica Lerdahl
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
| | - Brigette Vaughan
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ryan Edwards
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
| | - Soonjo Hwang
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
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Hendrickson B, Girma M, Miller L. Review of the clinical approach to the treatment of disruptive mood dysregulation disorder. Int Rev Psychiatry 2020; 32:202-211. [PMID: 31775528 DOI: 10.1080/09540261.2019.1688260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Though a decade of research led to the creation of disruptive mood dysregulation disorder (DMDD), it was not until the 2013 publication of the DSM-5 that DMDD became an official diagnosis. The conception of DMDD was largely due to increasing rates of paediatric bipolar disorder (PBD) diagnoses, which significantly impacted treatment for these youth. The core symptoms of DMDD include persistent irritability and recurrent outbursts; the absence of a previous diagnostic category for youth experiencing these symptoms may have led to the over diagnosis of PBD. Due to the chronicity of symptoms, these youth are impaired in multiple areas of functioning. This article will present background information about DMDD, discuss clinical assessment strategies including scales for measuring irritability and aggression, and review pharmacologic and psychosocial treatments for youth with DMDD and clinical phenotypes similar to DMDD.
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Affiliation(s)
- Brian Hendrickson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mahlet Girma
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leslie Miller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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A Novel Text Message Intervention to Improve Adherence to Stimulants in Adults With Attention Deficit/Hyperactivity Disorder. J Clin Psychopharmacol 2020; 39:351-356. [PMID: 31162154 DOI: 10.1097/jcp.0000000000001055] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) is a prevalent neurobiological disorder associated with a wide range of adverse outcomes. Although large data sets document that stimulants decrease the risks for many ADHD-associated adverse outcomes, compliance with stimulants remains very poor. The main aim of this study was to assess the effectiveness of a novel text messaging-based intervention aimed at improving the poor rate of adherence to stimulant medications in adults with ADHD. METHODS Subjects were adults with ages 18 to 55, prescribed a stimulant medication for ADHD treatment. For comparators, we identified at a 5-to-1 ratio (age and sex matched) adult patients from the Partners HealthCare electronic medical record who had been prescribed stimulant medications over a 1-year period. We determined whether patients had timely prescription refills, defined as refilled within 37 days, using prescriptions documented in their electronic medical record. RESULTS Our results showed that 68% of the SMS intervention group refilled their prescriptions in a timely manner. In contrast, only 34% of patients receiving treatment as usual refilled their prescriptions in a timely fashion (odds ratio, 4.04; 95% confidence interval, 2.49-6.56; P < 0.001). CONCLUSIONS These data indicate that an innovative ADHD-centric text messaging intervention significantly improved patient engagement to treatment with stimulants in adults with ADHD. Findings provide strong support for the use of a readily accessible, inexpensive, and widely available technology to improve the poor rate of adherence to stimulant treatment in adults with ADHD. To the best of our knowledge, this study is the first digital health intervention aimed at improving adherence to stimulant medication for adults with ADHD.
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Pisano S, Masi G. Recommendations for the pharmacological management of irritability and aggression in conduct disorder patients. Expert Opin Pharmacother 2019; 21:5-7. [PMID: 31663786 DOI: 10.1080/14656566.2019.1685498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Simone Pisano
- Department of Neuroscience, AORN Santobono-Pausilipon, Naples, Italy
| | - Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
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Zoratto F, Franchi F, Macrì S, Laviola G. Methylphenidate administration promotes sociability and reduces aggression in a mouse model of callousness. Psychopharmacology (Berl) 2019; 236:2593-2611. [PMID: 30955107 DOI: 10.1007/s00213-019-05229-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 03/18/2019] [Indexed: 01/06/2023]
Abstract
RATIONALE Deficits in empathy constitute a distinctive feature of several psychopathologies, including conduct disorder (CD). The co-occurrence of callous-unemotional (CU) traits, excess rates of aggression and violation of societal norms confers specific risk for adult psychopathy. To date, the off-label use of methylphenidate (MPH) constitutes the drug treatment of choice. OBJECTIVES Herein, we tested the therapeutic potential of MPH in a recently devised mouse model recapitulating the core phenotypic abnormalities of CD. METHODS Two subgroups of BALB/cJ male mice exhibiting opposite profiles of emotional contagion (i.e. socially transmitted adoption of another's emotional states) were investigated for reactive aggression, sociability, attention control, anxiety-related behaviours and locomotor activity, in response to MPH administration (0.0, 3.0 or 6.0 mg/kg). RESULTS Our data indicate that mice selected for excess callousness exhibit phenotypic abnormalities isomorphic to the symptoms of CD: stability of the low emotional contagion trait, increased aggression and reduced sociability. In accordance with our predictions, MPH reduced aggression and increased sociability in callous mice; yet, it failed to restore the low responsiveness to the emotions of a conspecific in pain, isomorphic to CU traits. CONCLUSIONS Although our data support the notion that MPH may contribute to the management of excess aggression in CD patients, additional studies shall identify specific treatments to target the callousness domain. The latter, unaffected by MPH in our experimental model, demands focused consideration whereby it constitutes a specifier associated with a worse prognosis.
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Affiliation(s)
- Francesca Zoratto
- Reference Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, I-00161, Rome, Italy.
| | - Francesca Franchi
- Reference Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, I-00161, Rome, Italy
| | - Simone Macrì
- Reference Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, I-00161, Rome, Italy
| | - Giovanni Laviola
- Reference Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, I-00161, Rome, Italy.
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Fenning RM, Erath SA, Baker JK, Messinger DS, Moffitt J, Baucom BR, Kaeppler AK. Sympathetic-Parasympathetic Interaction and Externalizing Problems in Children with Autism Spectrum Disorder. Autism Res 2019; 12:1805-1816. [PMID: 31397547 DOI: 10.1002/aur.2187] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/05/2019] [Accepted: 07/17/2019] [Indexed: 11/09/2022]
Abstract
Children with autism spectrum disorder (ASD) exhibit significant difficulties with emotion regulation and reactivity, which may be linked to underlying psychophysiology. The present study examined associations between autonomic nervous system activity and individual differences in externalizing behavior problems in children with ASD. A multisystem approach was adopted to consider the interplay between markers of sympathetic (electrodermal reactivity-EDA-R) and parasympathetic reactivity (respiratory sinus arrhythmia reactivity-RSA-R) in relation to behavioral challenges. Fifty-two children with ASD ages 6-10 years contributed complete psychophysiological data. Measures of EDA-R and RSA-R (RSA withdrawal) were obtained in response to a laboratory challenge task and parents reported on child externalizing behavior problems using a standardized questionnaire and a structured clinical interview. An equifinality model was supported, with two distinct psychophysiological pathways linked to heightened externalizing behavior problems. Greater RSA-R was associated with more externalizing problems in the context of higher levels of EDA-R, and lower EDA-R was associated with increased externalizing problems at lower levels of RSA-R. Findings underscore the importance of considering the role of psychophysiology in the unfolding of comorbid externalizing problems in children with ASD. Potential implications for tailoring coregulatory supports are discussed. Autism Res 2019, 12: 1805-1816. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Children with autism spectrum disorder (ASD) exhibit elevated rates of challenging behavior. This study identified specific psychophysiological profiles (low sympathetic-low parasympathetic reactivity, and high sympathetic-high parasympathetic reactivity) that may place these children at greater risk for behavior problems. Findings have implications for better understanding behavioral challenges in children with ASD, and for tailoring supports to address underlying psychophysiology.
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Sultan RS, Wang S, Crystal S, Olfson M. Antipsychotic Treatment Among Youths With Attention-Deficit/Hyperactivity Disorder. JAMA Netw Open 2019; 2:e197850. [PMID: 31348506 PMCID: PMC6661708 DOI: 10.1001/jamanetworkopen.2019.7850] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Significant concern exists over treating youths with attention-deficit/hyperactivity disorder (ADHD) with antipsychotic medications, yet little is known about the factors associated with antipsychotic treatment. OBJECTIVES To describe the percentage of youths who fill antipsychotic prescriptions in the year following a new diagnosis of ADHD and characterize the clinical and demographic factors associated with antipsychotic initiation. DESIGN, SETTING, AND PARTICIPANTS A retrospective longitudinal cohort analysis of antipsychotic treatment was performed in 187 563 youths, aged 3 to 24 years, with a new diagnosis of ADHD (without recent diagnosis of any US Food and Drug Administration [FDA]-indicated conditions for antipsychotic treatment). The sample was derived from the 2010 to 2015 MarketScan Commercial Database, with the analysis completed between November 1, 2018, and May 30, 2019. MAIN OUTCOMES AND MEASURES The percentage of youths prescribed an antipsychotic in the first year following a new diagnosis of ADHD. Among those prescribed antipsychotic medications, the percentage who received a diagnosis of conduct disorder, oppositional defiant disorder, or a disorder for which 1 or more antipsychotic medication has received an indication for use in youths from the FDA (schizophrenia, bipolar disorder, and Tourette disorder) and the percentage that filled an antipsychotic prescription before filling a stimulant prescription (methylphenidate or amphetamine derivative). RESULTS Of the 187 563 youths included in the study, 114 305 (60.9%) were male with a mean (SD) age of 13.74 (5.61) years. In the year following a new ADHD diagnosis, 4869 youths (2.6%; 95% CI, 2.5%-2.7%) with ADHD were prescribed an antipsychotic. Youths treated with antipsychotics with ADHD were more likely than their peers who were not receiving an antipsychotic to have recently received diagnoses of self-harm and/or suicidal ideation (adjusted odds ratio [aOR], 7.5; 95% CI, 5.9-9.6), oppositional defiant disorder (aOR, 4.4; 95% CI, 3.9-4.9), and substance use disorder (aOR, 4.0; 95% CI, 3.6-4.5). The youths who received antipsychotics were also more likely to have received inpatient treatment (aOR, 7.9; 95% CI, 6.7-9.3). During the year following the new ADHD diagnosis, 52.7% (95% CI, 51.3%-54.1%) of youths treated with antipsychotics received a diagnosis for which antipsychotics have either an FDA or evidence-supported indication for their use. Among youths who initiated antipsychotic medications, 47.9% (95% CI, 46.5%-49.3%) did not receive a stimulant prescription between their ADHD diagnosis and antipsychotic initiation. Antipsychotic prescribing was proportionally highest for preschool-aged children (4.3%) and associated with neurodevelopmental disorders (aOR, 3.9; 95% CI, 1.3-11.2) and recent inpatient mental health treatment (aOR, 8.9; 95% CI, 1.7-45.8). CONCLUSIONS AND RELEVANCE Approximately half of youths with a new ADHD diagnosis may have an evidence-supported indication for an antipsychotic medication. Less than half of these youths received a stimulant; the evidence-supported first line treatment for ADHD, before the antipsychotic was initiated. Use of antipsychotic prescribing appears to be associated with high levels of psychiatric comorbidity.
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Affiliation(s)
- Ryan S. Sultan
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
| | - Shuai Wang
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
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Hsu YC, Chen CT, Yang HJ, Chou P. Family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD). Soc Psychiatry Psychiatr Epidemiol 2019; 54:661-670. [PMID: 30535676 DOI: 10.1007/s00127-018-1624-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/02/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the associations between family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD). METHODS We conducted a matched case-control study. Data were retrieved from medical records at a psychiatry center in northern Taiwan. School-aged boys with ADHD who first visited the outpatient department at the psychiatric center between 2000 and 2011 were identified. The Child Behavior Checklist was used for aggressive behavior assessment. Boys with ADHD with T scores higher than 70 on the aggressive subscale were classified as cases and others with T scores lower than 70 were classified as controls at a 1:4 ratio. After controlling for other familial, personal, and parental factors, a multivariate conditional logistic regression was performed to evaluate the effects of family structure and birth order on aggressive behaviors of boys with ADHD. RESULTS 277 cases and 1108 controls were included in the final analysis. Compared with living in a traditional family with both parents, living in a non-traditional family in which one or both parents were absent increased the risk of aggressive behaviors by 1.47-fold, with the highest risk for those in single parent families. Being the firstborn increased risk by 1.45-fold and the risk was higher when the firstborn had siblings. CONCLUSIONS Living in non-traditional families in which one or both parents were absent, and being the firstborn increased risk of aggression in school-aged boys with ADHD. Identification of this high-risk population and development of adequate preventive strategies are warranted.
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Affiliation(s)
- Yuan-Chang Hsu
- Department of Child and Adolescent Psychiatry, Tao-Yuan Psychiatric Center, Ministry of Health and Welfare, Taoyüan, Taiwan.,Institute of Public Health, National Yang-Ming University, 155 Li-Nong St., Sec. 2 Beitou, Taipei, Taiwan
| | - Chih-Tsai Chen
- Department of Child and Adolescent Psychiatry, Tao-Yuan Psychiatric Center, Ministry of Health and Welfare, Taoyüan, Taiwan
| | - Hao-Jan Yang
- Department of Public Health, Chung-Shan Medical University, Taichung, Taiwan
| | - Pesus Chou
- Institute of Public Health, National Yang-Ming University, 155 Li-Nong St., Sec. 2 Beitou, Taipei, Taiwan. .,Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.
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Shih HH, Shang CY, Gau SSF. Comparative Efficacy of Methylphenidate and Atomoxetine on Emotional and Behavioral Problems in Youths with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2019; 29:9-19. [PMID: 30457349 DOI: 10.1089/cap.2018.0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Methylphenidate and atomoxetine are efficacious in reducing core symptoms of attention-deficit/hyperactivity disorder (ADHD), but little is known about their efficacy in improving emotional/behavioral problems among youths with ADHD. METHODS One hundred sixty drug-naïve youths with DSM-IV-defined ADHD, aged 7-16 years, were recruited and randomly assigned to osmotic-release oral system methylphenidate (OROS-methylphenidate; n = 80) and atomoxetine (n = 80) in a 24-week, open-label, head-to-head clinical trial. The primary efficacy measure was parent-reported Child Behavior Checklist (CBCL), and the secondary efficacy measures included Youth Self Report (YSR) and Strengths and Difficulties Questionnaire (SDQ), which was based on the ratings of parents, teachers, and subjects. RESULTS For CBCL, both methylphenidate and atomoxetine groups showed significant improvement in all scores at weeks 8 and 24 except Somatic Complaints in the atomoxetine group. For SDQ, both treatment groups showed significant improvements in the Hyperactive and Conduct subscales for parent ratings, and the Externalizing subscale for teacher ratings at week 24. Methylphenidate was associated with greater improvements in Aggressive Behavior and Somatic Complaints of CBCL and in Conduct subscale of self-reported SDQ at week 24 compared with atomoxetine. CONCLUSIONS Our findings provide evidence to support that both methylphenidate and atomoxetine were effective in improving a wide range of emotional/behavioral problems in youths with ADHD after 24 weeks of treatment, with greater improvement in aggressive behavior, somatic complaints, and conduct problems in the methylphenidate group.
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Affiliation(s)
- Hsien-Hsueh Shih
- 1 Department of Psychiatry, National Taiwan University Hospital , Taipei, Taiwan
| | - Chi-Yung Shang
- 1 Department of Psychiatry, National Taiwan University Hospital , Taipei, Taiwan .,2 Department of Psychiatry, College of Medicine, National Taiwan University , Taipei, Taiwan
| | - Susan Shur-Fen Gau
- 1 Department of Psychiatry, National Taiwan University Hospital , Taipei, Taiwan .,2 Department of Psychiatry, College of Medicine, National Taiwan University , Taipei, Taiwan .,3 Department of Psychology, Graduate Institute of Brain and Mind Sciences, Institute of Clinical Medicine, National Taiwan University , Taipei, Taiwan
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Jager A, Kanters D, Geers F, Buitelaar JK, Kozicz T, Glennon JC. Methylphenidate Dose-Dependently Affects Aggression and Improves Fear Extinction and Anxiety in BALB/cJ Mice. Front Psychiatry 2019; 10:768. [PMID: 31708820 PMCID: PMC6823535 DOI: 10.3389/fpsyt.2019.00768] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/24/2019] [Indexed: 12/22/2022] Open
Abstract
Overt aggression, increased anxiety, and dysfunctional fear processing are often observed in individuals with conduct disorder (CD) and attention-deficit hyperactivity disorder (ADHD). Methylphenidate (MPH), a psychostimulant increasing dopamine and noradrenaline tone, is effective in reducing aggression in both CD and ADHD individuals. However, it is unclear to which extent these effects of MPH are dose dependent. Here, the effects of acute intraperitoneal MPH (3 and 10 mg/kg) on aggression, anxiety, social behavior, and fear extinction were investigated in BALB/cJ mice. Previous studies in BALB/cJ mice have revealed high levels of aggression and anxiety that are associated with reduced top-down cortical control. Administration of 3 mg/kg MPH prolonged the attack latency and prevented escalation of aggression over time compared to vehicle-treated mice, while 10 mg/kg MPH increased number of bites and attacks. In addition, 3 mg/kg MPH decreased social interaction slightly. A strong anxiolytic effect was found after administration of both the 3 and 10 mg/kg doses in the elevated plus maze and the open-field test. In addition, while vehicle-treated BALB/cJ animals showed intact freezing, both doses of MPH decreased freezing to the unconditioned stimulus in a fear-conditioning paradigm. A long-lasting effect on fear extinction was visible after treatment with the 10 mg/kg dose. The data support a role for MPH in the regulation of anxiety, fear processing, and aggression in BALB/cJ mice, with the latter effect in a dose-dependent manner. The findings provide a further context for examining the effects of MPH in clinical disorders such as ADHD and CD.
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Affiliation(s)
- Amanda Jager
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, Netherlands
| | - Doranda Kanters
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, Netherlands
| | - Femke Geers
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, Netherlands
| | - Tamas Kozicz
- Department of Anatomy, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, Netherlands.,Department of Clinical Genomics, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jeffrey C Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, Netherlands
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Tarrant N, Roy M, Deb S, Odedra S, Retzer A, Roy A. The effectiveness of methylphenidate in the management of Attention Deficit Hyperactivity Disorder (ADHD) in people with intellectual disabilities: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 83:217-232. [PMID: 30266025 DOI: 10.1016/j.ridd.2018.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The effectiveness of psychostimulants, primarily methylphenidate (MPH), in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in the general population of typically growing children and adolescents is well established through many Randomised Controlled Trials (RCTs). AIMS AND METHODS We carried out a systematic review of all the RCTs in people with intellectual disabilities (ID) that assessed effectiveness of MPH on the core ADHD symptoms. OUTCOMES AND RESULTS We included 15 papers from 13 studies that were all on children and adolescents with ID (315 participants were on MPH and placebo respectively), 12 of which used a cross over design, and one used a parallel design. On average around 40-50% responded to MPH in the ID group whereas around 70-80% response rate is reported among the non-ID children. Because of the heterogeneity of the outcome data it was not possible to carry out a meta-analysis. Significant adverse events included sleep difficulties and poor appetite along with weight loss and also irritability, social withdrawal and increased motor activities including tic. CONCLUSIONS AND IMPLEMENTATION On the basis of the poor quality evidence that is available, it seems that MPH may be effective in some but not all children and adolescents with ID and ADHD.
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Affiliation(s)
- Nick Tarrant
- Specialty Registrar in Forensic Psychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, UK.
| | - Meera Roy
- Consultant Psychiatrist, Leicestershire Partnership NHS Trust, UK
| | - Shoumitro Deb
- Clinical Professor of Neuropsychiatry, Division of Brain Sciences, Imperial College London, UK
| | - Smita Odedra
- Trials Co-ordinator, Birmingham Children's Hospital, UK
| | | | - Ashok Roy
- Consultant Psychiatrist, Coventry and Warwickshire Partnership NHS Trust, UK
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Stringaris A, Vidal-Ribas P, Brotman MA, Leibenluft E. Practitioner Review: Definition, recognition, and treatment challenges of irritability in young people. J Child Psychol Psychiatry 2018; 59:721-739. [PMID: 29083031 DOI: 10.1111/jcpp.12823] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Irritability is one of the most common reasons for referral to child and adolescent mental health services and is the main characteristic of the new diagnosis of disruptive mood dysregulation disorder (DMDD). However, the recognition and management of irritability presents a major challenge in clinical practice and may be partly responsible for the dramatic increase in antipsychotic prescribing in recent years. METHODS In this review, we provide up-to-date information on the definition and mechanisms underlying irritability, and its assessment in clinical practice. We aim to discuss the latest research on DMDD, and the presence of severe irritability in the context of other disorders, as well as to recommend a treatment algorithm. RESULTS Severe irritability is associated with aberrant reward processing and bias toward threatening stimuli. Several measures are available to easily assess irritability. The recent diagnosis of DMDD captures children whose main problem is severe irritability and differ from those with bipolar disorder in longitudinal outcomes, family history, and behavioral and neural correlates. Treatment of irritability might depend on the context it appears. Indirect evidence suggests that parent management training (PMT) and cognitive behavioral therapy (CBT) are the most supported psychological treatments for irritability. CONCLUSIONS Irritability, recognized as a mood problem rather than a purely behavioral manifestation, is a common condition for young people. Practitioners should not ignore irritability as it is associated with substantial morbidity and impairment. Although there are no trials with irritability as main outcome, clinicians can apply several existing pharmacological and psychological interventions for its treatment. Also, new promising approaches relying on pathophysiological findings, such as exposure-based cognitive behavioral therapy techniques and interpretation bias training (IBT), are being currently investigated.
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Affiliation(s)
- Argyris Stringaris
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Pablo Vidal-Ribas
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.,Institute of Psychiatry, Psychology and Neuroscience, Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Melissa A Brotman
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Ellen Leibenluft
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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Gerson R, Malas N, Mroczkowski MM. Crisis in the Emergency Department: The Evaluation and Management of Acute Agitation in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2018; 27:367-386. [PMID: 29933788 DOI: 10.1016/j.chc.2018.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute agitation in children and adolescents in the emergency department carries significant risks to patients and staff and requires skillful management, using both nonpharmacologic and pharmacologic strategies. Effective management of agitation requires understanding and addressing the multifactorial cause of the agitation. Careful observation and multidisciplinary collaboration is important. Medical work-up of agitated patients is also critical. Nonpharmacologic deescalation strategies should be first line for preventing and managing agitation and should continue during and after medication administration. Choice of medication should focus on addressing the cause of the agitation and any underlying psychiatric syndromes.
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Affiliation(s)
- Ruth Gerson
- Department of Child and Adolescent Psychiatry, New York University Langone, 462 1st Avenue, New York, NY 10016, USA.
| | - Nasuh Malas
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, C.S. Mott Children's Hospital, University of Michigan Hospital System, 1500 East Medical Center Drive, L5023, SPC 5277, Ann Arbor, MI 48109-5277, USA; Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan Hospital System, 1500 East Medical Center Drive, L5023, SPC 5277, Ann Arbor, MI 48109-5277, USA
| | - Megan M Mroczkowski
- Department of Psychiatry, Columbia University Medical Center, 3959 Broadway CHONY 6N, New York, NY 10032, USA
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Kloosterboer SM, Schuiling-Veninga CCM, Bos JHJ, Kalverdijk LJ, Koch BCP, Dieleman GC, Hillegers MHJ, Dierckx B. Antipsychotics in Dutch Youth: Prevalence, Dosages, and Duration of Use from 2005 to 2015. J Child Adolesc Psychopharmacol 2018; 28:173-179. [PMID: 29641239 DOI: 10.1089/cap.2017.0155] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objectives: The use of antipsychotic drugs by youth is associated with serious side effects, especially when prescribed in higher dosages and for a longer period. Despite this, little is known about recent trends in the dosages and duration of use of antipsychotic drugs in children and adolescents. The aim of this study was to describe trends in prevalence, incidence, dosages, duration of use, and preceding psychotropic medication in Dutch youth who had been prescribed antipsychotic drugs from 2005 to 2015. Methods: We analyzed 84,828 antipsychotic prescriptions of youths aged 0-19 years between 2005 and 2015, derived from a large Dutch community pharmacy-based prescription database (IADB.nl). Results: Since a peak of 9.8 users per 1000 youths in 2009, prevalence rates stabilized. Dosages in milligram per kilogram declined for the most frequently prescribed antipsychotic drugs during the study period. The median duration of use was 6.0 (95% CI 5.4-6.6) months. Boys used antipsychotic drugs significantly longer than girls, with a median of 6.9 (95% CI 6.1-7.7) versus 4.6 (95% CI 3.9-5.3) months (p < 0.01). Of the youths prescribed antipsychotics, 12.4% used them for at least 48 months. The majority of youths had used other psychotropic agents in the year before the start of an antipsychotic drug (62.4% in 2005 and 64.7% in 2015). Conclusions: Despite a stabilization of usage rates and decline in dosages and duration of use, one in eight youths still used antipsychotic drugs for 4 years or longer. A substantial share of youths may, therefore, be at high risk for serious side effects.
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Affiliation(s)
- Sanne M Kloosterboer
- Department of Hospital Pharmacy, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Jens H J Bos
- Department of Pharmacotherapy, -Epidemiology and -Economics, University of Groningen, Groningen, The Netherlands
| | - Luuk J Kalverdijk
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Gwen C Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Rotterdam, The Netherlands
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42
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Takahashi A, Flanigan ME, McEwen BS, Russo SJ. Aggression, Social Stress, and the Immune System in Humans and Animal Models. Front Behav Neurosci 2018; 12:56. [PMID: 29623033 PMCID: PMC5874490 DOI: 10.3389/fnbeh.2018.00056] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/06/2018] [Indexed: 01/25/2023] Open
Abstract
Social stress can lead to the development of psychological problems ranging from exaggerated anxiety and depression to antisocial and violence-related behaviors. Increasing evidence suggests that the immune system is involved in responses to social stress in adulthood. For example, human studies show that individuals with high aggression traits display heightened inflammatory cytokine levels and dysregulated immune responses such as slower wound healing. Similar findings have been observed in patients with depression, and comorbidity of depression and aggression was correlated with stronger immune dysregulation. Therefore, dysregulation of the immune system may be one of the mediators of social stress that produces aggression and/or depression. Similar to humans, aggressive animals also show increased levels of several proinflammatory cytokines, however, unlike humans these animals are more protected from infectious organisms and have faster wound healing than animals with low aggression. On the other hand, subordinate animals that receive repeated social defeat stress have been shown to develop escalated and dysregulated immune responses such as glucocorticoid insensitivity in monocytes. In this review we synthesize the current evidence in humans, non-human primates, and rodents to show a role for the immune system in responses to social stress leading to psychiatric problems such as aggression or depression. We argue that while depression and aggression represent two fundamentally different behavioral and physiological responses to social stress, it is possible that some overlapped, as well as distinct, pattern of immune signaling may underlie both of them. We also argue the necessity of studying animal models of maladaptive aggression induced by social stress (i.e., social isolation) for understanding neuro-immune mechanism of aggression, which may be relevant to human aggression.
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Affiliation(s)
- Aki Takahashi
- Laboratory of Behavioral Neuroendocrinology, University of Tsukuba, Tsukuba, Japan.,Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY, United States
| | - Meghan E Flanigan
- Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bruce S McEwen
- Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY, United States
| | - Scott J Russo
- Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Abstract
Childhood conduct disorder casts a long shadow over adulthood, often leading
to antisocial personality, drug misuse, increased rates of psychosis and
earlier death. This article reviews a range of effective treatments, and
shows what is ineffective. The common theme underlying interventions that
work is that they change the environment around the young person, with
parent training emerging as the most effective. Medication is largely
ineffective. The task now is to enable more of these interventions to be
available at a reasonably early age.
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44
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Barterian JA, Arnold LE, Brown NV, Farmer CA, Williams C, Findling RL, Kolko DJ, Bukstein OG, Molina BSG, Townsend L, Aman MG. Clinical Implications From the Treatment of Severe Childhood Aggression (TOSCA) Study: A Re-Analysis and Integration of Findings. J Am Acad Child Adolesc Psychiatry 2017; 56:1026-1033. [PMID: 29173736 PMCID: PMC5847292 DOI: 10.1016/j.jaac.2017.09.426] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 09/05/2017] [Accepted: 09/28/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The Treatment of Severe Childhood Aggression (TOSCA) project examined augmentation of stimulant treatment and parent training (PT) with risperidone for severe physical aggression. This article summarizes the clinical implications; reanalyzes the data to examine the utility of 4 criteria for deciding to augment; and presents a treatment algorithm. METHOD The newly analyzed 4 criteria for augmenting after 3 weeks of stimulant and PT treatment consisted of not meeting a Clinical Global Impressions-Improvement (CGI-I) score of 1 and a normal score (≤15) on the Nisonger Child Behavior Rating Form Disruptive-Total (D-Total); a CGI-I score of 1 or 2 plus 25% improvement in D-Total score; a D-Total score no higher than 15; and a CGI-Severity score of 3 (mild) or better. Effect sizes were calculated. Prior TOSCA publications were reviewed for clinically relevant findings. RESULTS All 4 criteria resulted in medium or better effect sizes (d = 0.59-0.72) when comparing risperidone with placebo. Providing risperidone to children who did not reach a CGI-I score of 1 plus a D-Total score no higher than 15 resulted in the greatest benefit. In addition, a review of clinically relevant data suggests that stimulant plus PT shows further improvement after 3 weeks even without augmentation. CONCLUSION For those children who did not attain a CGI-I score of 1 and a D-total score no higher than 15, adding risperidone maximized the number of children benefitting from treatment and the average amount of benefit. Unless clinical circumstances dictate otherwise, practitioners should delay an antipsychotic drug for at least 1 month after the optimal stimulant dose is achieved and PT has commenced. Clinical trial registration information-Treatment of Severe Childhood Aggression (The TOSCA Study); http://clinicaltrials.gov; NCT00796302.
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Affiliation(s)
| | | | | | | | - Craig Williams
- The Ohio State University-Wexner Medical Center, Columbus
| | | | | | - Oscar G Bukstein
- University of Pittsburgh and currently is with the Boston Children's Hospital and Harvard Medical School, Boston
| | | | | | - Michael G Aman
- The Ohio State University-Wexner Medical Center, Columbus
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45
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A Naturalistic Comparison of Methylphenidate and Risperidone Monotherapy in Drug-Naive Youth With Attention-Deficit/Hyperactivity Disorder Comorbid With Oppositional Defiant Disorder and Aggression. J Clin Psychopharmacol 2017; 37:590-594. [PMID: 28806385 DOI: 10.1097/jcp.0000000000000747] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/PURPOSE Attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are frequently co-occurring in youth, but data about the pharmacological management of this comorbidity are scarce, especially when impulsive aggression is prominent. Although stimulants are the first-line medication for ADHD, second-generation antipsychotics, namely, risperidone, are frequently used. We aimed to assess effectiveness and safety of monotherapy with the stimulant methylphenidate (MPH) and risperidone in a consecutive sample of 40 drug-naive male youths diagnosed as having ADHD-combined presentation, comorbid with ODD and aggression, without psychiatric comorbidities, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria and a structured clinical interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version). METHODS Twenty males treated with MPH (mean age, 8.95 ± 1.67 years) and 20 males treated with risperidone (mean age, 9.35 ± 2.72 years), followed up to 6 months, were assessed according to efficacy measures (Child Behavior Checklist [CBCL], Clinical Global Impression-Severity [CGI-S] and Improvement [CGI-I], Children Global Assessment Scale), and safety measures. At the end of the follow-up, both medications were similarly effective based on CBCL subscales of aggression and rule-breaking behaviors, on Diagnostic and Statistical Manual of Mental Disorders-oriented oppositional defiant problems and conduct problems, and on CGI-S, CGI-I, and Children Global Assessment Scale, but only MPH was effective on CBCL attention problems and attention-deficit/hyperactivity problems. Risperidone was associated with weight gain and elevated prolactin levels. IMPLICATIONS/CONCLUSIONS Although the nonrandomized, nonblind design limits the conclusions of our exploratory study, our findings suggest that when ADHD is comorbid with ODD and aggression MPH and risperidone are both effective on aggressive behavior, but only stimulants are effective on ADHD symptoms.
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46
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Chang C, Gau SSF, Huang WS, Shiue CY, Yeh CB. Abnormal serotonin transporter availability in the brains of adults with conduct disorder. J Formos Med Assoc 2017; 116:469-475. [DOI: 10.1016/j.jfma.2016.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 07/17/2016] [Accepted: 07/20/2016] [Indexed: 10/20/2022] Open
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47
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Affiliation(s)
- Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland 20892;, ,
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland 20892;, ,
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland 20892;, ,
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48
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Balia C, Carucci S, Coghill D, Zuddas A. The pharmacological treatment of aggression in children and adolescents with conduct disorder. Do callous-unemotional traits modulate the efficacy of medication? Neurosci Biobehav Rev 2017; 91:218-238. [PMID: 28137460 DOI: 10.1016/j.neubiorev.2017.01.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 12/07/2016] [Accepted: 01/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children and adolescents with conduct disorder (CD) show repetitive and persistent patterns of aggressive behaviour and the more severe forms are often associated with callous-unemotional (CU) traits. OBJECTIVES To systematically review and, where data are adequate, conduct meta-analyses on the efficacy of medication on aggression in children and adolescent with CD considering the impact of CU traits. RESULTS Few studies have investigated patients with CD as primary diagnosis, and few of these have discriminated between different types of aggression or reported measures of CU traits. Methylphenidate and risperidone showed the largest effects on aggression in randomized controlled trials; other antipsychotics showed clinical efficacy on CD but this evidence is mainly revealed by open label trials. There is some low quality evidence to support a small effect of mood stabilizers and other agents. There were only two papers describing the effects of CU traits thus providing inconclusive results. CONCLUSION Considering heterogeneity of the disorder, more proof-of-concept clinical studies are needed to define effects of medication and role of CU traits.
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Affiliation(s)
- Carla Balia
- Child & Adolescent Neuropsychiatric Unit, Department of Biomedical Science, University of Cagliari & "A. Cao" Microcitemico Paediatric Hospital, Cagliari, Italy
| | - Sara Carucci
- Child & Adolescent Neuropsychiatric Unit, Department of Biomedical Science, University of Cagliari & "A. Cao" Microcitemico Paediatric Hospital, Cagliari, Italy.
| | - David Coghill
- Division of Neuroscience, University of Dundee, Dundee, UK; Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Alessandro Zuddas
- Child & Adolescent Neuropsychiatric Unit, Department of Biomedical Science, University of Cagliari & "A. Cao" Microcitemico Paediatric Hospital, Cagliari, Italy
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49
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Venables M, Ntzani E, Hsia Y, Gillies D. Alpha2 adrenergic agonists for attention deficit hyperactivity disorder (ADHD). Hippokratia 2017. [DOI: 10.1002/14651858.cd010016.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Michael Venables
- Child and Adolescent Mental Health Services; New Park House North Street Horsham Sussex UK RH12 1RJ
| | - Evangelia Ntzani
- University of Ioannina School of Medicine; Department of Hygiene and Epidemiology; 45 110 Ioannina Greece 45110
| | - Yingfen Hsia
- School of Pharmacy, University College London; Department of Practice and Policy; University of London l Level, BMA House Tavistock Square London UK WC1H 9JP
| | - Donna Gillies
- Western Sydney Local Health District - Mental Health; Cumberland Hospital Locked Bag 7118 Parramatta NSW Australia 2124
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50
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Benarous X, Consoli A, Guilé JM, Garny de La Rivière S, Cohen D, Olliac B. Evidence-based treatments for youths with severely dysregulated mood: a qualitative systematic review of trials for SMD and DMDD. Eur Child Adolesc Psychiatry 2017; 26:5-23. [PMID: 27662894 DOI: 10.1007/s00787-016-0907-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 09/16/2016] [Indexed: 01/14/2023]
Abstract
The aim of this literature review was to examine the evidence for psychotherapeutic and pharmacological treatments in subjects with severely dysregulated mood and to identify potential areas for improvements in research designs. A literature search was conducted using several databases for published (PubMed, PsycINFO) and ongoing (clinical trial registries) studies conducted in youths who met NIMH's criteria for Severe Mood Dysregulation (SMD) or the DSM-5 diagnosis of Disruptive Mood Dysregulation Disorder (DMDD). Eight completed studies were identified: three randomized trials, four open pilot studies and one case report. Seven ongoing studies were found in trial registries. The available evidence suggests potential efficacy of psychotherapies which have previously been developed for internalizing and externalizing disorders. The two main pharmacological strategies tested are, first, a monotherapy of psychostimulant or atypical antipsychotic such as risperidone, already used in the treatment of severe irritability in youths with developmental disorders; and second, the use of a serotonergic antidepressant as an add-on therapy in youths treated with psychostimulant. Ongoing studies will further clarify the effectiveness of psychotherapeutic interventions for DMDD individuals and whether they should be given alone or in conjunction with other treatments. The short duration of the trials for a chronic disorder, the low number of studies, the lack of placebo or active comparator arm, and restrictive inclusion criteria in most of the controlled trials dramatically limit the interpretation of the results. Finally, future research should be conducted across multiple sites, with standardized procedures to measure DMDD symptoms reduction, and include a run-in period to limit placebo effect.
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Affiliation(s)
- Xavier Benarous
- Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France.
| | - Angèle Consoli
- Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France.,INSERM U-669, PSIGIAM, Paris, France
| | - Jean-Marc Guilé
- Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France.,Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale, INSERM U1105, CHU, Université Picardie Jules Verne, Amiens, France.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Sébastien Garny de La Rivière
- Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale, INSERM U1105, CHU, Université Picardie Jules Verne, Amiens, France
| | - David Cohen
- Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France.,CNRS UMR 7222, Institute for Intelligent Systems and Robotics-ISIR, Paris, France
| | - Bertrand Olliac
- Department of Child And Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France.,Pôle Hospitalo-Universitaire de psychiatrie de l'enfant et de l'adolescent, Centre Hospitalier Esquirol, Limoges, France
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