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Young C, Burgess L, Falster K, Zoega H, Banks E, Clapham K, Woolfenden S, Cutmore M, Williamson A. Mental health-related service and medicine use among a cohort of urban Aboriginal children and young people: Data linkage study. Aust N Z J Psychiatry 2024; 58:787-799. [PMID: 38711323 DOI: 10.1177/00048674241248357] [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] [Indexed: 05/08/2024]
Abstract
OBJECTIVE The objective was to describe mental health service and psychotropic medicine use among a cohort of Aboriginal young people and quantify their relation to sociodemographic, family and health factors. METHODS In a prospective cohort study with data linkage, 892 Aboriginal children aged 0-17 years living in urban and regional areas of New South Wales, Australia, were included. We assessed mental health-related service use, paediatric service use and psychotropic medicine dispensing claims covered by the Australian Government Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme from July 2012 to June 2017. RESULTS Most children (71%) did not have a record of mental health service or psychotropic medication use. 18.7% had ⩾1 mental health-related service claim; 26.7% had ⩾1 paediatric service claim; and 20.3% had ⩾1 psychotropic medicine dispensing claim. General practitioner services were the most accessed mental health-related service (17.4%) and 12.7% had been dispensed attention-deficit hyperactivity disorder medicines. Child characteristics associated with treatment included emotional and behavioural problems (prevalence ratio: 1.97, 95% confidence interval = [1.46, 2.64] for mental health services; prevalence ratio: 2.87, 95% confidence interval = [2.07, 3.96] for medicines) and risky behaviour (prevalence ratio: 1.56, 95% confidence interval = [1.12, 2.16] for mental health services; prevalence ratio: 2.28, 95% confidence interval = [1.54, 3.37] for medicines). Parent-related factors included chronic illness (prevalence ratio: 1.42, 95% confidence interval = [1.03, 1.95] for mental health services; prevalence ratio: 2.00, 95% confidence interval = [1.49, 2.69] for medicines) and functional limitations (prevalence ratio: 1.61, 95% confidence interval = [1.16, 2.24] for mental health services; prevalence ratio: 1.86, 95% confidence interval = [1.34, 2.59] for medicines). CONCLUSIONS Most Aboriginal children and young people did not have claims for mental health services or medicines. Aboriginal children with emotional and behavioural problems, or parents with health problems were more likely to have mental health service or medicine claims.
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Affiliation(s)
| | | | - Kathleen Falster
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Helga Zoega
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Emily Banks
- College of Health & Medicine, Australian National University, Canberra, ACT, Australia
| | - Kathleen Clapham
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Sue Woolfenden
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
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Tanana L, Latif A, Nishtala PS, Chen TF. Investigating Variations in Medicine Approvals for Attention-Deficit/Hyperactivity Disorder: A Cross-Country Document Analysis Comparing Drug Labeling. J Atten Disord 2024; 28:1437-1453. [PMID: 38327043 PMCID: PMC11328451 DOI: 10.1177/10870547231224088] [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] [Indexed: 02/09/2024]
Abstract
OBJECTIVE This study aimed to compare the approval of medicines for attention deficit/hyperactivity disorder (ADHD) for pediatric patients across five countries. METHOD A document analysis was completed, using the drug labeling for ADHD medicines from five countries; United Kingdom, Australia, New Zealand, Canada and United States (US). Comparisons of available formulations and approval information for ADHD medicine use in pediatric patients were made. RESULTS The US had the highest number of approved medicines and medicine forms across the studied countries (29 medicine forms for 10 approved medicines). Approved age and dosage variations across countries and missing dosage information were identified in several drug labeling. CONCLUSIONS The discrepancies in approval information in ADHD medicine drug labeling and differing availability of medicine formulations across countries suggest variations in the management of ADHD across countries. The update of drug labeling and further research into reasons for variability and impact on practice are needed.
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Affiliation(s)
- Laila Tanana
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Asam Latif
- University of Nottingham, Nottingham, UK
| | | | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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3
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McLay LK, Hansen SG, Blampied NM, France KG, Rispoli M. The Type, Severity, and Impact of Sleep Problems in Children With Angelman Syndrome and Parental Help-seeking Patterns. Behav Sleep Med 2024; 22:285-297. [PMID: 37592732 DOI: 10.1080/15402002.2023.2241943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Angelman syndrome (AS) is a rare genetic developmental disability that presents with high rates of co-occurring sleep difficulties. Most existing research has focused on the pathophysiology of sleep problems in people with AS, and suggests that sleep problems are the result of genetic and neurobiological factors. However, little is known about the role of the social environment and learning in sleep problems in children with AS. This descriptive study used survey data from 139 parents of children with AS to investigate: 1) the type, topography and severity of children's sleep problems; 2) the collateral child, parent and family impacts of the sleep problems; 3) treatment selection practices and the perceived effectiveness of these treatments; and 4) sources of support and treatment advice received. Parents reported that the majority of children experienced sleep problems, resulting in numerous deleterious effects on child and family functioning. They also reported high levels of concern about these sleep problems, but low levels of perceived support. Study findings highlight the need to establish a disability-specific profile of the type and impact of sleep problems experienced by children with AS, and have further implications for the delivery of clinical services and support provided to parents of children with AS.
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Affiliation(s)
- Laurie K McLay
- Te Kaupeka Oranga, Faculty of Health, University of Canterbury, Te Whare Wānanga O Waitaha, Christchurch, New Zealand
| | - Sarah G Hansen
- College of Education and Human Development, Georgia State University, Atlanta, GA, USA
| | - Neville M Blampied
- School of Psychology, Speech and Hearing, University of Canterbury, Te Whare Wānanga O Waitaha, Christchurch, New Zealand
| | - Karyn G France
- Te Kaupeka Oranga, Faculty of Health, University of Canterbury, Te Whare Wānanga O Waitaha, Christchurch, New Zealand
| | - Mandy Rispoli
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
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4
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Rice LJ, Cannon L, Dadlani N, Cheung MMY, Einfeld SL, Efron D, Dossetor DR, Elliott EJ. Efficacy of cannabinoids in neurodevelopmental and neuropsychiatric disorders among children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:505-526. [PMID: 36864363 PMCID: PMC10869397 DOI: 10.1007/s00787-023-02169-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
A better understanding of the endocannabinoid system and a relaxation in regulatory control of cannabis globally has increased interest in the medicinal use of cannabinoid-based products (CBP). We provide a systematic review of the rationale and current clinical trial evidence for CBP in the treatment of neuropsychiatric and neurodevelopmental disorders in children and adolescents. A systematic search of MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Trials was performed to identify articles published after 1980 about CBP for medical purposes in individuals aged 18 years or younger with selected neuropsychiatric or neurodevelopmental conditions. Risk of bias and quality of evidence was assessed for each article. Of 4466 articles screened, 18 were eligible for inclusion, addressing eight conditions (anxiety disorders (n = 1); autism spectrum disorder (n = 5); foetal alcohol spectrum disorder (n = 1); fragile X syndrome (n = 2); intellectual disability (n = 1); mood disorders (n = 2); post-traumatic stress disorder (n = 3); and Tourette syndrome (n = 3)). Only one randomised controlled trial (RCT) was identified. The remaining seventeen articles included one open-label trial, three uncontrolled before-and-after trials, two case series and 11 case reports, thus the risk of bias was high. Despite growing community and scientific interest, our systematic review identified limited and generally poor-quality evidence for the efficacy of CBP in neuropsychiatric and neurodevelopmental disorders in children and adolescents. Large rigorous RCTs are required to inform clinical care. In the meantime, clinicians must balance patient expectations with the limited evidence available.
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Affiliation(s)
- Lauren J Rice
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia.
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia.
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia.
| | - Lisa Cannon
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
| | - Navin Dadlani
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia
| | - Melissa Mei Yin Cheung
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
| | - Stewart L Einfeld
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia
| | - Daryl Efron
- Department of General Paediatrics, Health Services, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David R Dossetor
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
| | - Elizabeth J Elliott
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
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5
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Bruni O, Breda M, Malorgio E, Brambilla P, Ceschin F, Di Pilla A, Elia M, Ferri R. An online survey among general pediatricians on melatonin use in children with chronic insomnia. Eur J Paediatr Neurol 2024; 48:40-45. [PMID: 38008002 DOI: 10.1016/j.ejpn.2023.11.004] [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: 05/16/2023] [Revised: 11/08/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVES Although melatonin (MLT) is the molecule most used by pediatricians for sleep problems, scarce evidence exists on its use in healthy pediatric population. The objective of this study was to describe MLT use by Italian pediatricians in healthy children with chronic insomnia. STUDY DESIGN A cross-sectional open survey was administered to Italian pediatricians, between June and November 2022, collecting information about their use of MLT in healthy children: age range of patients, dosages used, time of administration, duration of treatment, association with other treatments, perceived efficacy, and side effects. Data were reported as frequencies with their respective 95% confidence intervals. Chi-square statistics assessed significant differences between pediatricians who had training in pediatric sleep and those who did not. RESULTS Among 428 respondents, 97.4% of pediatricians used MLT; 87.3% of them prescribed MLT in children aged 1-2 years, 62.1% in 2-5 years and 42.5% in 10-18 years. 84.9% of them suggested to take MLT 30 min before bedtime. 37.9% indicated to continue treatment for one month, 30.2% for 2-3 months. 74.1% of pediatricians usually prescribed MLT 1 mg/day. The most frequent treatment associated with MLT was sleep hygiene (85.4%). Almost all pediatricians found MLT effective in reducing difficulties falling asleep. Only 3.2% of them reported mild side effects. CONCLUSIONS MLT is widely prescribed by Italian pediatricians, but no consensus exists about its use in typically developing children. There is a need for clear guidelines to optimize the use of MLT in healthy children.
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Affiliation(s)
- Oliviero Bruni
- Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
| | - Maria Breda
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Emanuela Malorgio
- SICuPP -Società Italiana delle Cure Primarie Pediatriche - (Italian Primary Care Pediatrics Society), Italy
| | - Paolo Brambilla
- SICuPP -Società Italiana delle Cure Primarie Pediatriche - (Italian Primary Care Pediatrics Society), Italy
| | - Flavia Ceschin
- SICuPP -Società Italiana delle Cure Primarie Pediatriche - (Italian Primary Care Pediatrics Society), Italy
| | - Andrea Di Pilla
- Life Sciences and Public Health Department, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Maurizio Elia
- Oasi Research Institute - IRCCS, Via C. Ruggero 73, 94018, Troina, Italy
| | - Raffaele Ferri
- Oasi Research Institute - IRCCS, Via C. Ruggero 73, 94018, Troina, Italy
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6
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Efron D, Taylor K. Medicinal Cannabis for Paediatric Developmental, Behavioural and Mental Health Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085430. [PMID: 37107712 PMCID: PMC10138057 DOI: 10.3390/ijerph20085430] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023]
Abstract
Parents of children with developmental, behavioural and mental health disorders are increasingly asking whether medicinal cannabis might be a therapeutic option for their child. This paper presents the current evidence for medicinal cannabis in this population. Preliminary evidence from open-label studies suggests the potential for medicinal cannabis to ameliorate some symptoms in children with autism spectrum disorder. However, only one double-blind placebo-controlled trial has been completed, with inconclusive findings. Synthetic, transdermal cannabidiol gel has demonstrated efficacy for reducing social avoidance in a sub-group of children with Fragile X syndrome. Studies of medicinal cannabis are planned or underway for children and/or adolescents with autism, intellectual disability, Tourette's syndrome, anxiety, psychosis, anorexia nervosa and a number of specific neurodevelopmental syndromes. High quality evidence from double-blind placebo-controlled trials is needed to guide clinical practice.
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Affiliation(s)
- Daryl Efron
- Murdoch Children’s Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia;
- The Royal Children’s Hospital, 50 Flemington Rd, Parkville, VIC 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
- Correspondence:
| | - Kaitlyn Taylor
- Murdoch Children’s Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia;
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Klau J, Bernardo CDO, Gonzalez-Chica DA, Raven M, Jureidini J. Trends in prescription of psychotropic medications to children and adolescents in Australian primary care from 2011 to 2018. Aust N Z J Psychiatry 2022; 56:1477-1490. [PMID: 34963342 DOI: 10.1177/00048674211067720] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine trends in prescribing psychotropic medications to children and adolescents in Australian primary care from 2011 to 2018. METHOD A retrospective cohort study examined prescriptions written by general practitioners using MedicineInsight, a large Australian primary care database, covering approximately 9% of all general practitioner practices. Numbers of patients receiving prescriptions for five main classes of psychotropics (antipsychotics, antidepressants, attention deficit hyperactivity disorder medications, anxiolytics, and hypnotics/sedatives [including benzodiazepines and Z-drugs, but excluding melatonin]) were examined annually by age-group (0-4, 5-9, 10-14, 15-18 years). Melatonin was analysed separately. RESULTS The number of patients prescribed any psychotropic increased from 25.6 to 36.2 per 1000 individuals from 2011 to 2018 (average annual increase +4.5%, 95% confidence interval [4.1%, 4.9%]; overall +41.4%). Among the five main classes, the largest annual increase was for attention deficit hyperactivity disorder medications (+9.6%, 95% confidence interval [8.8%, 10.5%]; overall +95.8%), followed by antipsychotics (+6.2%, 95% confidence interval [5.0%, 7.3%]; overall +62.8%) and antidepressants (+4.5%, 95% confidence interval [4.0%, 5.0%]; overall +42.8%). Hypnotic/sedative prescribing decreased on average 6.5% per year (95% confidence interval [-8.0%, -5.0%]; overall -40.2%). Anxiolytic prescribing remained steady. Melatonin prescriptions showed the highest increase of all (+24.7%, 95% confidence interval [23.7%, 25.8%]; overall +606.7%). The largest annual increase in antipsychotic, antidepressant or attention deficit hyperactivity disorder medication prescribing occurred in 10- to 14-year-olds (+7.5%, +6.5% and +10.4%, respectively). The largest point prevalence occurred in 2018 among 15- to 18-year-olds, with 98.5 per 1000 prescribed antidepressants. Antidepressants were more frequently prescribed to females; antipsychotics, attention deficit hyperactivity disorder medications and melatonin more often to males. The most prescribed antipsychotics were risperidone (<15 years) and quetiapine (15- to 18-year-olds). Fluoxetine was the most prescribed antidepressant in those aged 5+ years and amitriptyline in 0- to 4-year-olds. CONCLUSION General practitioner prescribing of melatonin, antipsychotics, antidepressants and attention deficit hyperactivity disorder medications to under-19-year-olds increased markedly from 2011 to 2018. Although benzodiazepine and Z-drug prescriptions declined, this was offset by a substantial increase in melatonin prescribing.
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Affiliation(s)
- Julie Klau
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Carla De Oliveira Bernardo
- Discipline of General Practice, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - David Alejandro Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Melissa Raven
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jon Jureidini
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Rolling J, Rabot J, Schroder CM. Melatonin Treatment for Pediatric Patients with Insomnia: Is There a Place for It? Nat Sci Sleep 2022; 14:1927-1944. [PMID: 36325278 PMCID: PMC9621019 DOI: 10.2147/nss.s340944] [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] [Received: 06/16/2022] [Accepted: 09/18/2022] [Indexed: 01/24/2023] Open
Abstract
Sleep is a vital physiological function that is impaired in ranges from 10% in the typically developing pediatric population to over 80% in populations of children with neurodevelopmental disorders and/or psychiatric comorbidities. Pediatric insomnia disorder is an increasing public health concern given its negative impact on synaptic plasticity involved in learning and memory consolidation but also on mood regulation, hormonal development and growth, and its significant impact on quality of life of the child, the adolescent and the family. While first-line treatment of pediatric insomnia should include parental education on sleep as well as sleep hygiene measures and behavioural treatment approaches, pharmacological interventions may be necessary if these strategies fail. Melatonin treatment has been increasingly used off-label in pediatric insomnia, given its benign safety profile. This article aims to identify the possible role of melatonin treatment for pediatric insomnia, considering its physiological role in sleep regulation and the differential effects of immediate release (IR) versus prolonged release (PR) melatonin. For the physician dealing with pediatric insomnia, it is particularly important to be able to distinguish treatment rationales implying different dosages and times of treatment intake. Finally, we discuss the benefit-risk ratio for melatonin treatment in different pediatric populations, ranging from the general pediatric population to children with different types of neurodevelopmental disorders, such as autism spectrum disorder or ADHD.
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Affiliation(s)
- Julie Rolling
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France
- CNRS UPR3212- Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, Strasbourg, France
- Sleep Disorders Centre & International Research Centre for ChronoSomnology (Circsom), University Hospitals Strasbourg, Strasbourg, France
| | - Juliette Rabot
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France
- CNRS UPR3212- Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, Strasbourg, France
- Expert Centre for High-Functioning Autism, Fondation FondaMental, Strasbourg, France
- Autism Resources Centre 67 for Children and Adolescents, Strasbourg, France
| | - Carmen M Schroder
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France
- CNRS UPR3212- Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, Strasbourg, France
- Sleep Disorders Centre & International Research Centre for ChronoSomnology (Circsom), University Hospitals Strasbourg, Strasbourg, France
- Expert Centre for High-Functioning Autism, Fondation FondaMental, Strasbourg, France
- Autism Resources Centre 67 for Children and Adolescents, Strasbourg, France
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9
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Bruno C, Havard A, Gillies MB, Coghill D, Brett J, Guastella AJ, Pearson SA, Zoega H. Patterns of attention deficit hyperactivity disorder medicine use in the era of new non-stimulant medicines: A population-based study among Australian children and adults (2013-2020). Aust N Z J Psychiatry 2022; 57:675-685. [PMID: 35999695 DOI: 10.1177/00048674221114782] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS New therapeutic options such as lisdexamfetamine and guanfacine have recently become available for the treatment of attention deficit hyperactivity disorder. We described contemporary patterns of attention deficit hyperactivity disorder medicine use among children, adolescents and adults in Australia. METHODS This population-based study used dispensing data for a 10% random sample of Australian residents between July 2012 and December 2020. We estimated the annual prevalence and incidence of attention deficit hyperactivity disorder medicines, second-line guanfacine use and examined concurrent medicine use of both stimulants and non-stimulants. We followed incident users for up to 5 years and analysed treatment persistence using a novel proportion of people covered method. Analyses were stratified by attention deficit hyperactivity disorder medicine, sex and age group; young children (0-5 years), children (6-12 years), adolescents (13-17 years), young adults (18-24 years) and adults (⩾25 years). RESULTS We observed a twofold increase in the overall prevalence of attention deficit hyperactivity disorder medicine use between 2013 and 2020, from 4.9 to 9.7 per 1000 persons. Incident use also increased across all age groups and both sexes, with the most pronounced increases among adolescent females (from 1.4 to 5.3 per 1000 persons). Stimulant treatment persistence after 5 years was highest among those initiating treatment as young children (64%) and children (69%) and lowest among those initiating treatment in adolescence (19%). Concurrent use of stimulants and non-stimulants was more common among males and younger age groups. Most children (87%) initiating guanfacine had prior dispensings of attention deficit hyperactivity disorder medicines. CONCLUSION We observed increasing attention deficit hyperactivity disorder medicine use in Australia, especially among young females. Nevertheless, treatment rates remain lower than the estimated prevalence of attention deficit hyperactivity disorder across all subpopulations. Poor long-term treatment persistence in adolescence may warrant improved clinical monitoring of attention deficit hyperactivity disorder in patients transitioning from paediatric to adult care. Reassuringly, use of newly approved guanfacine appeared to be in accordance with guidelines among children.
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Affiliation(s)
- Claudia Bruno
- Centre for Big Data Research in Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia.,School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Alys Havard
- Centre for Big Data Research in Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia.,National Drug and Alcohol Research Centre, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Malcolm B Gillies
- Centre for Big Data Research in Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Jonathan Brett
- Centre for Big Data Research in Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Adam J Guastella
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Helga Zoega
- Centre for Big Data Research in Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia.,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
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10
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Mayall M, Teoh Y, McDermott B, Sadhu R, Bosanquet M. Child and adolescent mental health multiaxial classification: A useful biopsychosocial framework for paediatrics? J Paediatr Child Health 2022; 58:1130-1135. [PMID: 35638189 DOI: 10.1111/jpc.16026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/12/2021] [Accepted: 04/06/2022] [Indexed: 12/01/2022]
Abstract
In child and adolescent psychiatry, the multiaxial classification approach has been developed over some decades and remains very relevant as it encapsulates the biopsychosocial approach, an approach which is also central to paediatric practice. There is considerable overlap between developmental-behavioural paediatrics and child and adolescent mental health, including presenting clinical problems, diagnoses, multidisciplinary and holistic approach to assessment and management, and similar use of pharmacological agents and psychosocial interventions. Multiaxial classification can be of use to paediatricians in a variety of ways, both in clinical practice and for teaching purposes. It can improve communication between the two disciplines and promotes a more holistic diagnostic representation in a structured and consistent format. Presented here are a number of practical ways in which the multiaxial biopsychosocial framework can be used, including case description, formulation, timeline and interventions, training and teaching.
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Affiliation(s)
- Mark Mayall
- Child and Youth Mental Health Service, Kirwan Health Campus, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Yvonne Teoh
- Child and Youth Mental Health Service, Kirwan Health Campus, Townsville Hospital and Health Service, Townsville, Queensland, Australia.,Child, Youth and Family Health Service, Kirwan Health Campus, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Brett McDermott
- James Cook University, College of Medicine and Dentistry, Townsville, Queensland, Australia
| | - Raja Sadhu
- Child and Youth Mental Health Service, Kirwan Health Campus, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Margot Bosanquet
- Child, Youth and Family Health Service, Kirwan Health Campus, Townsville Hospital and Health Service, Townsville, Queensland, Australia
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11
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Ani C, Ayyash HF, Ogundele MO. Community paediatricians' experience of joint working with child and adolescent mental health services: findings from a British national survey. BMJ Paediatr Open 2022; 6:e001381. [PMID: 36053646 PMCID: PMC9020286 DOI: 10.1136/bmjpo-2021-001381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/30/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Children and young people (CYP) presenting to paediatric or child and adolescent mental health services (CAMHS) often have needs spanning medical and psychiatric diagnoses. However, joint working between paediatrics and CAMHS remains limited. We surveyed community paediatricians in the UK to inform better strategies to improve joint working with CAMHS. METHODS We conducted an online survey of community paediatricians through the British Association for Community Child Health (BACCH) on how much joint working they experienced with CAMHS, any hindrances to more collaborative working, and the impact on service users and service provision. This paper is based on thematic analysis of 327 free-text comments by paediatricians. RESULTS A total of 245 community paediatricians responded to the survey (22% of BACCH members). However, some responses were made on behalf of teams rather than for individual paediatricians. The following were the key themes identified: a strong support for joint working between community paediatrics and CAMHS; an acknowledgement that current levels of joint working were limited; the main barriers to joint working were splintered commissioning and service structures (eg, where integrated care systems fund different providers to meet overlapping children's health needs); and the most commonly reported negative impact of non-joint working was severely limited access to CAMHS for CYP judged by paediatricians to require mental health support, particularly those with autism spectrum disorder. CONCLUSION There is very limited joint working between community paediatrics and CAMHS in the UK, which is associated with many adverse impacts on service users and providers. A prointegration strategy that includes joint commissioning of adequately funded paediatric and CAMHS services that are colocated and within the same health management organisations is crucial to improving joint working between paediatrics and CAMHS.
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Affiliation(s)
- Cornelius Ani
- Division of Psychiatry, Imperial College London, Faculty of Medicine, London, UK
- Child and Adolescent Mental Health Service, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
- Executive Committee Member, Child and Adolescent Psychiatric Surveillance System, Royal College of Psychiatry, London, UK
| | - Hani F Ayyash
- Executive Committee Member, Child and Adolescent Psychiatric Surveillance System, Royal College of Psychiatry, London, UK
- Integrated Department of Paediatrics, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
- Scientific Committee Member, British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, UK
| | - Michael Oladipo Ogundele
- Halton Community Paediatrics Unit, Bridgewater Community Healthcare NHS Foundation Trust, Runcorn, UK
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12
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Abstract
Melatonin is a hormonal product of the pineal gland, a fact that is often forgotten. Instead it is promoted as a dietary supplement that will overcome insomnia, as an antioxidant and as a prescription only drug in most countries outside the United States of America and Canada. The aim of this review is to step back and highlight what we know about melatonin following its discovery 60 years ago. What is the role of endogenous melatonin; what does melatonin do to sleep, body temperature, circadian rhythms, the cardiovascular system, reproductive system, endocrine system and metabolism when administered to healthy subjects? When used as a drug/dietary supplement, what safety studies have been conducted? Can we really say melatonin is safe when it has not been systematically studied and many studies show interactions with a wide range of physiological processes? Finally the results of studies investigating the efficacy of melatonin as a drug to alleviate insomnia are critically evaluated. In summary, melatonin is an endogenous pineal gland hormone with specific physiological functions in animals and humans, with its primary role in humans to maintain synchrony of sleep with the day/night cycle. When administered as a drug it affects a wide range of physiological systems and has clinically important drug interactions. With respect to efficacy for treating sleep disorders, melatonin can advance the time of sleep onset but the effect is modest and variable. In children with neurodevelopmental disabilities melatonin appears to have the greatest impact on sleep onset but little effect on sleep efficiency.
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Affiliation(s)
- David J Kennaway
- Robinson Research Institute and Adelaide School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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13
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McLay LK, Schluter PJ, Eggleston MJF, Woodford EC, Bowden N. Melatonin dispensing among New Zealand children aged 0-18 years with autism: a nationwide cross-sectional study. Sleep Med 2021; 80:184-192. [PMID: 33601231 DOI: 10.1016/j.sleep.2021.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE/BACKGROUND Sleep problems in children on the autism spectrum are prevalent and persistent. Such problems are the result of a combination of biopsychosocial factors, including abnormal melatonin secretion. Exogenous melatonin is an empirically supported and popular treatment for sleep problems. However, we know little about rates of melatonin dispensing and associated variables. This study investigated rates of melatonin dispensing and the sociodemographic and child characteristics associated with its use in New Zealand. METHODS This nationwide cross-sectional study used linked administrative health data obtained via the Integrated Data Infrastructure (IDI). Data were obtained for 11,202, 0-18 year old children on the autism spectrum. Descriptive data, and adjusted and unadjusted risk ratios, were calculated for sociodemographic and child characteristics. RESULTS Melatonin is accessed by almost one quarter of children on the autism spectrum in New Zealand, with higher observed rates among females and those aged between 5 and 11 years, of European ethnicity, and presenting with co-occurring mental health conditions. CONCLUSIONS Findings are largely consistent with research investigating both sleep disturbances and psychotropic drug use among children on the autism spectrum. High rates of melatonin use, age- and sex-related differences in its use, and the complexity associated with the presence of co-occurring conditions necessitates development of practice guidelines for melatonin dispensing. Further investigation into the duration of melatonin use and the interaction between child characteristics, co-occurring conditions, sociodemographic variables and melatonin dispensing is warranted.
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Affiliation(s)
- L K McLay
- School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand.
| | - P J Schluter
- School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand; School of Clinical Medicine, Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia.
| | - M J F Eggleston
- Mental Health Division, Canterbury District Health Board, New Zealand.
| | - E C Woodford
- School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand
| | - N Bowden
- A Better Start National Science Challenge, New Zealand; Department of Women's and Children's Health, University of Otago, New Zealand.
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14
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Efron D, Freeman JL, Cranswick N, Payne JM, Mulraney M, Prakash C, Lee KJ, Taylor K, Williams K. A pilot randomised placebo-controlled trial of cannabidiol to reduce severe behavioural problems in children and adolescents with intellectual disability. Br J Clin Pharmacol 2020; 87:436-446. [PMID: 32478863 DOI: 10.1111/bcp.14399] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 01/07/2023] Open
Abstract
AIMS Severe behavioural problems (SBP) are a major contributor to morbidity in children with intellectual disability (ID). Medications used to treat SBP in ID are associated with a high risk of side effects. Cannabidiol has potential therapeutic effects in SBP. This pilot study aimed to investigate the feasibility of conducting a randomised placebo-controlled trial of cannabidiol to reduce SBP in children with ID. METHODS This is a double-blind, placebo-controlled, two-armed, parallel-design, randomised controlled trial of cannabidiol in children aged 8-16 years with ID and SBP. Participants were randomised 1:1 to receive either 98% cannabidiol in oil (Tilray, Canada) or placebo orally for 8 weeks. The dose was up-titrated over 9 days to 20 mg/kg/day in two divided doses, with a maximum dose of 500 mg twice/day. The feasibility and acceptability of all study components were assessed. RESULTS Eight children were randomised, and all completed the full study protocol. There were no serious adverse events or drop-outs. Protocol adherence for key study components was excellent: study visits 100%, medication adherence 100%, blood tests 92% and questionnaire completion 88%. Parents reported a high degree of acceptability with the study design. All parents reported they would recommend the study to other families with children with similar problems. There was an efficacy signal in favour of active drug. CONCLUSIONS The findings suggest that the study protocol is feasible and acceptable to patients with ID and SBP and their families.
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Affiliation(s)
- Daryl Efron
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Australia
| | - Jeremy L Freeman
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia
| | - Noel Cranswick
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Australia
| | - Jonathan M Payne
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Australia
| | - Melissa Mulraney
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Australia
| | | | - Katherine J Lee
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Australia
| | - Kaitlyn Taylor
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
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15
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Efron D, Taylor K, Payne JM, Freeman JL, Cranswick N, Mulraney M, Prakash C, Lee KJ, Williams K. Does cannabidiol reduce severe behavioural problems in children with intellectual disability? Study protocol for a pilot single-site phase I/II randomised placebo controlled trial. BMJ Open 2020; 10:e034362. [PMID: 32152170 PMCID: PMC7064134 DOI: 10.1136/bmjopen-2019-034362] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/30/2020] [Accepted: 02/11/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Severe behavioural problems (SBPs) are a common contributor to morbidity and reduced quality of life in children with intellectual disability (ID). Current medication treatment for SBP is associated with a high risk of side effects. Innovative and safe interventions are urgently needed. Anecdotal reports and preliminary research suggest that medicinal cannabis may be effective in managing SBP in children with developmental disabilities. In particular, cannabidiol (CBD) may be a plausible and safe alternative to current medications. Families who are in urgent need of solutions are seeking cannabis for their ID children with SBP. However there is no evidence from randomised controlled trials to support the use of CBD for SBP. This pilot study aims to investigate the feasibility of conducting a randomised placebo-controlled trial of CBD to improve SBP in children with ID. METHODS AND ANALYSIS This is a single-site, double-blind, parallel-group, randomised, placebo-controlled pilot study of 10 participants comparing 98% CBD oil with placebo in reducing SBP in children aged 8-16 years with ID. Eligible participants will be randomised 1:1 to receive either CBD 20 mg/kg/day or placebo for 8 weeks. Data will be collected regarding the feasibility and acceptability of all study components, including recruitment, drop-out rate, study visit attendance, protocol adherence and the time burden of parent questionnaires. Safety outcomes and adverse events will be recorded. All data will be reported using descriptive statistics. These data will inform the design of a full scale randomised controlled trial to evaluate the efficacy of CBD in this patient group. ETHICS AND DISSEMINATION This protocol has received ethics approval from the Royal Children's Hospital ethics committee (Human Research Ethics Committee no. 38236). Results will be disseminated through peer-reviewed journals, professional networks, conferences and social media. TRIAL REGISTRATION NUMBER ACTRN12618001852246.
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Affiliation(s)
- Daryl Efron
- Health Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kaitlyn Taylor
- Health Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jonathan M Payne
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroscience, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jeremy L Freeman
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Neuroscience, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Noel Cranswick
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Melissa Mulraney
- Health Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Katherine J Lee
- Clinical Epidemiology & Biostatistics, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Katrina Williams
- Health Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Monash Children's Hospital, Clayton, Victoria, Australia
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16
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Bastiampillai T, Parry P, Allison S. Can antipsychotic medication administered for paediatric emotional and behavioural disorders lead to brain atrophy? Aust N Z J Psychiatry 2019; 53:499-500. [PMID: 30191724 DOI: 10.1177/0004867418797419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tarun Bastiampillai
- 1 College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,2 Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Peter Parry
- 1 College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,3 Children's Health Queensland Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Stephen Allison
- 1 College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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17
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Cairns R, Brown JA, Buckley NA. Clonidine exposures in children under 6 (2004-2017): a retrospective study. Arch Dis Child 2019; 104:287-291. [PMID: 30425077 DOI: 10.1136/archdischild-2018-316026] [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: 08/09/2018] [Revised: 10/11/2018] [Accepted: 10/26/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To describe trends in clonidine exposures in children under 6. Clonidine has become increasingly popular for management of paediatric behavioural disorders. Clonidine has a narrow therapeutic index, and toxicity can occur with inadvertent double dosing. Clonidine is not recommended for use in children under 6 years. DESIGN AND SETTING A retrospective review of clonidine exposures in children under 6 reported to the New South Wales Poisons Information Centre (NSWPIC, Australia's largest poison centre), 2004-2017. This was compared with community clonidine utilisation using dispensing data from Australian Statistics on Medicines, 2004-2015. Australian trends were compared with clonidine exposure calls to US poison centres, 2006-2016. MAIN OUTCOME MEASURES Trends in poisonings and dispensing; demographics, dose, exposure type, clonidine source, symptoms, disposition. RESULTS There were 802 clonidine exposures in the NSWPIC database, increasing 4.9% per year, 2004-2017 (95% CI 3.1% to 6.7%, p<0.001), correlated with increased dispensing, r=0.846 (95% CI 0.529 to 0.956, p<0.001). 78.6% were hospitalised and medical toxicologists were consulted in 7.2%, indicating high risk and/or morbidity. Clonidine was prescribed for the patient in at least 27.8%, providing evidence for prescribing outside of recommendations. US data reveals 19 056 clonidine exposures, with 3.7% increase per year, 2006-2016 (95% CI 2.2% to 5.3%, p<0.001). CONCLUSIONS Clonidine exposures in children under 6 are increasing, and this trend is not isolated to Australia. Exposures have a high hospital referral rate and high morbidity. Caution should be exercised when prescribing clonidine, and parent/carer education is important for safe storage and increased vigilance when dosing.
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Affiliation(s)
- Rose Cairns
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Pharmacology, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jared A Brown
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Nicholas A Buckley
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Pharmacology, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
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18
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Efron D, Freeman J. Medical cannabis for paediatric developmental-behavioural and psychiatric disorders. J Paediatr Child Health 2018; 54:715-717. [PMID: 29614206 DOI: 10.1111/jpc.13902] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/26/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Daryl Efron
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeremy Freeman
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia
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19
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Tew M, Efron D, Hiscock H, Dalziel K. What Medications are Australian Children Prescribed? Evidence from the Longitudinal Study of Australian Children. J Paediatr Child Health 2018; 54:335-336. [PMID: 29504222 DOI: 10.1111/jpc.13867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Michelle Tew
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Daryl Efron
- Population Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Health Services Research Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.,Community Health Services Research Centre for Community Child Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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