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Hermans RA, Gangapersad RN, Kloosterboer SM, van Schaik RHN, Hillegers MHJ, Koch BCP, de Winter BCM, Dierckx B. Exploring P-gp as moderator of side effects and effectiveness of risperidone in children and adolescents. Eur Neuropsychopharmacol 2024; 85:5-7. [PMID: 38643629 DOI: 10.1016/j.euroneuro.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024]
Affiliation(s)
- R A Hermans
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - R N Gangapersad
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands; Erasmus School of Economics, Erasmus University, Rotterdam, the Netherlands
| | - S M Kloosterboer
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - R H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - B C P Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - B C M de Winter
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - B Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Gangapersad RN, Zhou G, Garcia-Gomez P, Bos J, Hak E, Koch BCP, Schuiling-Veninga CCM, Dierckx B. Correction to: Comparison of antipsychotic drug use in children and adolescents in the Netherlands before and during the COVID-19 pandemic. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02434-6. [PMID: 38642119 DOI: 10.1007/s00787-024-02434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2024]
Affiliation(s)
- Ravish N Gangapersad
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Erasmus School of Economics, Erasmus University, Rotterdam, The Netherlands.
| | - Guiling Zhou
- Unit of Pharmaco?Therapy, ?Epidemiology and ?Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Pilar Garcia-Gomez
- Erasmus School of Economics, Erasmus University, Rotterdam, The Netherlands
| | - Jens Bos
- Unit of Pharmaco?Therapy, ?Epidemiology and ?Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Unit of Pharmaco?Therapy, ?Epidemiology and ?Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Catharina C M Schuiling-Veninga
- Unit of Pharmaco?Therapy, ?Epidemiology and ?Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
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Hermans RA, Storm AE, Kloosterboer SM, Hillegers MH, Koch BC, Dierckx B, de Winter BC. Therapeutic Drug Monitoring to Optimize Risperidone Treatment in Children with Autism Spectrum Disorder. Ther Drug Monit 2024; 46:259-264. [PMID: 38019457 PMCID: PMC10930352 DOI: 10.1097/ftd.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/04/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Risperidone is an atypical antipsychotic drug used to treat irritability and aggression in children and adolescents with autism spectrum disorder. In an earlier study, the sum trough concentration of risperidone and its metabolite (9-hydroxyrisperidone) was positively correlated with weight gain and effectiveness. The aim of this study was to determine the therapeutic window for risperidone sum trough concentrations that balances weight gain with treatment effectiveness in this population. In addition, the effect of therapeutic drug monitoring (TDM) on treatment optimization was simulated. METHODS In a retrospective cohort (n = 24 children), the target window for risperidone leading to the least increase in body mass index z-scores while retaining effectiveness as measured by the irritability subscale of the Aberrant Behavior Checklist was determined using receiver operating curve analysis. This target range was used to simulate the effect of TDM using a population PK model implemented in the software platform InsightRX. Dosing advice was based on plasma trough concentrations and the dose administered at 12 weeks to simulate whether more children would be on target at 24 weeks after the start of treatment. RESULTS A risperidone sum trough target range of 3.5-7.0 mcg/L would minimize increase in body mass index z-score and optimize effectiveness. Dosing advice using TDM and a population PK model would lead to a larger proportion of children achieving the target concentration range (62.5% versus 16.7%). CONCLUSIONS TDM may be a useful tool for optimizing risperidone treatment in children and adolescents with autism spectrum disorder.
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Affiliation(s)
- Rebecca A. Hermans
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands; and
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Alaya E.M. Storm
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands; and
| | - Sanne M. Kloosterboer
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands; and
| | - Manon H.J. Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Birgit C.P. Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands; and
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Brenda C.M. de Winter
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands; and
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
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Van Vyve L, Dierckx B, Lim CG, Danckaerts M, Koch BCP, Häge A, Banaschewski T. Pharmacotherapy for ADHD in children and adolescents: A summary and overview of different European guidelines. Eur J Pediatr 2024; 183:1047-1056. [PMID: 38095716 DOI: 10.1007/s00431-023-05370-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention, hyperactivity, and impulsivity. It is the most common neurodevelopmental disorder presenting to pediatric services, and pediatricians are often involved in the early assessment, diagnosis, and treatment of children with ADHD. The treatment of ADHD typically involves a multimodal approach that encompasses a combination of psychoeducation, parent/teacher training, psychosocial/psychotherapeutic interventions, and pharmacotherapy. Concerning pharmacotherapy, guidelines vary in drug choice and sequencing, with psychostimulants, such as methylphenidate and (lis)dexamfetamine, generally being the favored initial treatment. Alternatives include atomoxetine and guanfacine. Pharmacotherapy has been proven effective, but close follow-up focusing on physical growth, cardiovascular monitoring, and the surveillance of potential side effects including tics, mood fluctuations, and psychotic symptoms, is essential. This paper presents an overview of current pharmacological treatment options for ADHD and explores disparities in treatment guidelines across different European countries. Conclusion: Pharmacological treatment options for ADHD in children and adolescents are effective and generally well-tolerated. Pharmacotherapy for ADHD is always part of a multimodal approach. While there is a considerable consensus among European guidelines on pharmacotherapy for ADHD, notable differences exist, particularly concerning the selection and sequencing of various medications. What is Known: • There is a significant base of evidence for pharmacological treatment for ADHD in children and adolescents. • Pediatricians are often involved in assessment, diagnosis and management of children with ADHD. What is New: • Our overview of different European guidelines reveals significant agreement in the context of pharmacotherapy for ADHD in children and adolescents. • Discrepancies exist primarily in terms of selection and sequencing of different medications.
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Affiliation(s)
| | - B Dierckx
- Erasmus MC, Rotterdam, The Netherlands
| | - C G Lim
- Institute of Mental Health, Singapore, Singapore
| | | | | | - A Häge
- Zentralinstitut für Seelische Gesundheit, Mannheim, Germany
| | - T Banaschewski
- Zentralinstitut für Seelische Gesundheit, Mannheim, Germany
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Van Vyve L, Dierckx B, Lim CG, Danckaerts M, Koch BCP, Häge A, Banaschewski T. Correction to: Pharmacotherapy for ADHD in children and adolescents: A summary and overview of different European guidelines. Eur J Pediatr 2024; 183:1057. [PMID: 38277002 DOI: 10.1007/s00431-024-05426-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
| | - B Dierckx
- Erasmus MC, Rotterdam, The Netherlands
| | - C G Lim
- Institute of Mental Health, Singapore, Singapore
| | | | | | - A Häge
- Zentralinstitut für Seelische Gesundheit, Mannheim, Germany
| | - T Banaschewski
- Zentralinstitut für Seelische Gesundheit, Mannheim, Germany
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Bracké K, Steegers C, van der Harst T, Pons R, Legerstee J, Dierckx B, de Nijs P, Bax-van Berkel M, van Elburg A, Hekkelaan M, Hokke J, de Jong-Zuidema H, Korthals Altes L, Lengton-van der Spil F, Luijkx J, Schuurmans F, Smeets C, van Wijk L, Woltering C, Vernooij M, Hillegers M, White T, Dieleman G. The implications of the COVID-19 pandemic on eating disorder features and comorbid psychopathology among adolescents with anorexia nervosa and matched controls: a comparative cohort design study. Eat Weight Disord 2024; 29:13. [PMID: 38347293 PMCID: PMC10861646 DOI: 10.1007/s40519-024-01640-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
PURPOSE To examine implications of the COVID-19 pandemic on eating disorder (ED) features and psychopathology in female adolescents with anorexia nervosa (AN). METHOD In total 79 females with first-onset AN (aged 12-22 years) were included and were followed up across a period of 1 year. We assessed AN participants recruited pre-pandemic (n = 49) to those recruited peri-pandemic (n = 30). Pre- (n = 37) and peri-pandemic (n = 38) age-, and education-matched typically developing (TD) girls (n = 75) were used as a reference cohort. ED features and psychopathology were assessed at baseline. After 1 year of follow-up the association between pandemic timing and clinical course was assessed. Analyses of covariance were used to examine differences in ED features and psychopathology. RESULTS Peri-pandemic AN participants experienced less ED symptoms at baseline compared to pre-pandemic AN participants. In particular, they were less dissatisfied with their body shape, and experienced less interpersonal insecurity. In addition, the peri-pandemic AN group met fewer DSM-IV criteria for comorbid disorders, especially anxiety disorders. In contrast, peri-pandemic AN participants had a smaller BMI increase over time. In TD girls, there were no differences at baseline in ED features and psychopathology between the pre- and peri-pandemic group. CONCLUSION Overall, peri-pandemic AN participants were less severely ill, compared to pre-pandemic AN participants, which may be explained by less social pressure and peer contact, and a more protective parenting style during the pandemic. Conversely, peri-pandemic AN participants had a less favorable clinical course, which may be explained by reduced access to health care facilities during the pandemic. LEVEL OF EVIDENCE Level III: Evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Katrien Bracké
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Cathelijne Steegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Tess van der Harst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Rozemarijn Pons
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Jeroen Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Pieter de Nijs
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | | | - Annemarie van Elburg
- Altrecht-Rintveld, Mental Health Care Organisation for Eating Disorders, Zeist, The Netherlands
| | - Marion Hekkelaan
- Department of Pediatrics, Het Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Joke Hokke
- Emergis-Ithaka, Mental Health Care Organisation for Child and Adolescent Psychiatry, Kloetinge, The Netherlands
| | - Hetty de Jong-Zuidema
- GGZ Delfland, Mental Health Care Organisation for Child and Adolescent Psychiatry, Delft, The Netherlands
| | - Lucas Korthals Altes
- LUMC-Curium, Mental Health Care Organisation for Child and Adolescent Psychiatry, Leiden, The Netherlands
| | - Farida Lengton-van der Spil
- Department for Eating Disorders, Emergis, Organisation for Mental Health and Well-Being, Goes, The Netherlands
| | - Judith Luijkx
- GGZ Westelijk Noord Brabant, Mental Health Care Organisation for Child and Adolescent Psychiatry, Roosendaal and Bergen Op Zoom, Bergen Op Zoom, The Netherlands
| | - Femke Schuurmans
- Department of Pediatrics, The Bravis Hospital, Bergen Op Zoom, The Netherlands
| | - Carien Smeets
- Department of Pediatrics, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Lia van Wijk
- Department of Pediatrics, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Claire Woltering
- Department of Pediatrics, Het Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Meike Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Tonya White
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Section on Social and Cognitive Developmental Neuroscience, National Institutes of Mental Health, Bethesda, MD, USA
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands.
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Gangapersad RN, Zhou G, Garcia-Gomez P, Bos J, Hak E, Koch BCP, Schuiling-Veninga CCM, Dierckx B. Comparison of antipsychotic drug use in children and adolescents in the Netherlands before and during the COVID-19 pandemic. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-023-02340-3. [PMID: 38183460 DOI: 10.1007/s00787-023-02340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/28/2023] [Indexed: 01/08/2024]
Abstract
This study aims to describe the patterns and trends in antipsychotic prescription among Dutch youth before and during the corona virus disease 2019 (COVID-19) pandemic (between 2017 and 2022). The study specifically aims to determine whether there has been an increase or decrease in antipsychotic prescription among this population, and whether there are any differences in prescription patterns among different age and sex groups. The study utilized the IADB database, which is a pharmacy prescription database containing dispensing data from approximately 120 community pharmacies in the Netherlands, to analyze the monthly prevalence and incidence rates of antipsychotic prescription among Dutch youth before and during the pandemic. The study also examined the prescribing patterns of the five most commonly used antipsychotics and conducted an autoregressive integrated moving average (ARIMA) analysis using data prior to the pandemic, to predict the expected prevalence rate during the pandemic. The prescription rate of antipsychotics for Dutch youth was slightly affected by the pandemic, with a monthly prevalence of 4.56 [4.50-4.62] per 1000 youths before COVID-19 pandemic and 4.64 [4.59-4.69] during the pandemic. A significant increase in prevalence was observed among adolescent girls aged 13-19 years. The monthly incidence rate remained stable overall, but rose for adolescent girls aged 13-19 years. Aripiprazole, and Quetiapine had higher monthly prevalence rates during the pandemic, while Risperidone and Pipamperon had lower rates. Similarly, the monthly incidence rates of Aripiprazole and Olanzapine went up, while Risperidone went down. Furthermore, the results from the ARIMA analysis revealed that despite the pandemic, the monthly prevalence rate of antipsychotic prescription was within expectation. The findings of this study suggest that there has been a moderate increase in antipsychotic prescription among Dutch youth during the COVID-19 pandemic, particularly in adolescent females aged 13-19 years. However, the study also suggests that factors beyond the pandemic may be contributing to the rise in antipsychotic prescription in Dutch youth.
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Affiliation(s)
- Ravish N Gangapersad
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Guiling Zhou
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Pilar Garcia-Gomez
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jens Bos
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Catharina C M Schuiling-Veninga
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
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Müller AR, den Hollander B, van de Ven PM, Roes KCB, Geertjens L, Bruining H, van Karnebeek CDM, Jansen FE, de Wit MCY, Ten Hoopen LW, Rietman AB, Dierckx B, Wijburg FA, Boot E, Brands MMG, van Eeghen AM. Cannabidiol (Epidyolex®) for severe behavioral manifestations in patients with tuberous sclerosis complex, mucopolysaccharidosis type III and fragile X syndrome: protocol for a series of randomized, placebo-controlled N-of-1 trials. BMC Psychiatry 2024; 24:23. [PMID: 38177999 PMCID: PMC10768432 DOI: 10.1186/s12888-023-05422-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Many rare genetic neurodevelopmental disorders (RGNDs) are characterized by intellectual disability (ID), severe cognitive and behavioral impairments, potentially diagnosed as a comorbid autism spectrum disorder or attention-deficit hyperactivity disorder. Quality of life is often impaired due to irritability, aggression and self-injurious behavior, generally refractory to standard therapies. There are indications from previous (case) studies and patient reporting that cannabidiol (CBD) may be an effective treatment for severe behavioral manifestations in RGNDs. However, clear evidence is lacking and interventional research is challenging due to the rarity as well as the heterogeneity within and between disease groups and interindividual differences in treatment response. Our objective is to examine the effectiveness of CBD on severe behavioral manifestations in three RGNDs, including Tuberous Sclerosis Complex (TSC), mucopolysaccharidosis type III (MPS III), and Fragile X syndrome (FXS), using an innovative trial design. METHODS We aim to conduct placebo-controlled, double-blind, block-randomized, multiple crossover N-of-1 studies with oral CBD (twice daily) in 30 patients (aged ≥ 6 years) with confirmed TSC, MPS III or FXS and severe behavioral manifestations. The treatment is oral CBD up to a maximum of 25 mg/kg/day, twice daily. The primary outcome measure is the subscale irritability of the Aberrant Behavior Checklist. Secondary outcome measures include (personalized) patient-reported outcome measures with regard to behavioral and psychiatric outcomes, disease-specific outcome measures, parental stress, seizure frequency, and adverse effects of CBD. Questionnaires will be completed and study medication will be taken at the participants' natural setting. Individual treatment effects will be determined based on summary statistics. A mixed model analysis will be applied for analyzing the effectiveness of the intervention per disorder and across disorders combining data from the individual N-of-1 trials. DISCUSSION These N-of-1 trials address an unmet medical need and will provide information on the effectiveness of CBD for severe behavioral manifestations in RGNDs, potentially generating generalizable knowledge at an individual-, disorder- and RGND population level. TRIAL REGISTRATION EudraCT: 2021-003250-23, registered 25 August 2022, https://www.clinicaltrialsregister.eu/ctr-search/trial/2021-003250-23/NL .
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Affiliation(s)
- A R Müller
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- 's Heeren Loo Care Group, Amersfoort, The Netherlands
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - B den Hollander
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands
- United for Metabolic Diseases, Amsterdam, The Netherlands
| | - P M van de Ven
- Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K C B Roes
- Department of Health Evidence, Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L Geertjens
- Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam UMC, Amsterdam Neuroscience, Amsterdam Reproduction and Development, N=You Neurodevelopmental Precision Center, Amsterdam, The Netherlands
| | - H Bruining
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands
- Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam UMC, Amsterdam Neuroscience, Amsterdam Reproduction and Development, N=You Neurodevelopmental Precision Center, Amsterdam, The Netherlands
- Levvel, Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - C D M van Karnebeek
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands
- United for Metabolic Diseases, Amsterdam, The Netherlands
- Department of Human Genetics, Amsterdam UMC, Amsterdam, The Netherlands
| | - F E Jansen
- Department of Pediatric Neurology, Brain, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M C Y de Wit
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - L W Ten Hoopen
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A B Rietman
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Dierckx
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F A Wijburg
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - E Boot
- 's Heeren Loo Care Group, Amersfoort, The Netherlands
- The Dalglish Family 22Q Clinic, Toronto, ON, Canada
- Department of Psychiatry & Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - M M G Brands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands
- United for Metabolic Diseases, Amsterdam, The Netherlands
| | - A M van Eeghen
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
- 's Heeren Loo Care Group, Amersfoort, The Netherlands.
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands.
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9
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Hermans RA, Sassen SDT, Kloosterboer SM, Reichart CG, Kouijzer MEJ, de Kroon MMJ, Bastiaansen D, van Altena D, van Schaik RHN, Nasserinejad K, Hillegers MHJ, Koch BCP, Dierckx B, de Winter BCM. Towards precision dosing of aripiprazole in children and adolescents with autism spectrum disorder: Linking blood levels to weight gain and effectiveness. Br J Clin Pharmacol 2023; 89:3026-3036. [PMID: 37222228 DOI: 10.1111/bcp.15800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/07/2023] [Accepted: 05/04/2023] [Indexed: 05/25/2023] Open
Abstract
AIMS Aripiprazole is one of the most commonly prescribed antipsychotic drugs to children and adolescents worldwide, but it is associated with serious side-effects, including weight gain. This study assessed the population pharmacokinetics of aripiprazole and its active metabolite and investigated the relationship between pharmacokinetic parameters and body mass index (BMI) in children and adolescents with autism spectrum disorder (ASD) and behavioural problems. Secondary outcomes were metabolic, endocrine, extrapyramidal and cardiac side-effects and drug effectiveness. METHODS Twenty-four children and adolescents (15 males, 9 females) aged 6-18 years were included in a 24-week prospective observational trial. Drug plasma concentrations, side-effects and drug effectiveness were measured at several time points during follow-up. Relevant pharmacokinetic covariates, including CYP2D6, CYP3A4, CYP3A5 and P-glycoprotein (ABCB1) genotypes, were determined. Nonlinear mixed-effects modelling (NONMEM®) was used for a population pharmacokinetic analysis with 92 aripiprazole and 91 dehydro-aripiprazole concentrations. Subsequently, model-based trough concentrations, maximum concentrations and 24-h area under the curves (AUCs) were analysed to predict outcomes using generalized and linear mixed-effects models. RESULTS For both aripiprazole and dehydro-aripiprazole, one-compartment models best described the measured concentrations, with albumin and BMI as significant covariates. Of all the pharmacokinetic parameters, higher sum (aripiprazole plus dehydro-aripiprazole) trough concentrations best predicted higher BMI z-scores (P < .001) and higher Hb1Ac levels (P = .03) during follow-up. No significant association was found between sum concentrations and effectiveness. CONCLUSIONS Our results indicate a threshold with regard to safety, which suggests that therapeutic drug monitoring of aripiprazole could potentially increase safety in children and adolescents with ASD and behavioural problems.
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Affiliation(s)
- Rebecca A Hermans
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sebastiaan D T Sassen
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sanne Maartje Kloosterboer
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Catrien G Reichart
- LUMC-Curium Child and Adolescent Psychiatry, Leiden University Medical Center, Oegstgeest, The Netherlands
| | | | | | | | | | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kazem Nasserinejad
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Brenda C M de Winter
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus Medical Center, Rotterdam, The Netherlands
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10
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Liang J, Ringeling LT, Hermans RA, Bayraktar I, Bosch TM, Egberts KM, Kloosterboer SM, de Winter B, Dierckx B, Koch BCP. Clinical pharmacokinetics of antipsychotics in pediatric populations: a scoping review focusing on dosing regimen. Expert Opin Drug Metab Toxicol 2023; 19:501-509. [PMID: 37668177 DOI: 10.1080/17425255.2023.2252340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Achieving optimal clinical responses and minimizing side effects through precision dosing of antipsychotics in children and adolescents with psychiatric disorders remains a challenge. Identifying patient characteristics (covariates) that affect pharmacokinetics can inform more effective dosing strategies and ultimately improve patient outcomes. This review aims to provide greater insight into the impact of covariates on the clinical pharmacokinetics of antipsychotics in pediatric populations. AREAS COVERED A comprehensive literature search was conducted, and the main findings regarding the effects of the covariates on the pharmacokinetics of antipsychotics in children and adolescents are presented. EXPERT OPINION Our study highlights significant covariates, including age, sex, weight, CYP2D6 phenotype, co-medication, and smoking habits, which affect the pharmacokinetics of antipsychotics. However, the findings were generally limited by the small sample sizes of naturalistic, open-label, observational studies, and the homogeneous subgroups. Dosing based on weight and preemptive genotyping could prove beneficial for optimizing the dosing regimen in pediatric populations. Future research is needed to refine dosing recommendations and establish therapeutic reference ranges critical for precision dosing and Therapeutic Drug Monitoring (TDM). The integration of individual patient characteristics with TDM can further optimize the efficacy and safety of antipsychotics for each patient.
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Affiliation(s)
- Jiayi Liang
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Maasstad Hospital, Rotterdam, the Netherlands
| | - Lisa T Ringeling
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rebecca A Hermans
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Izgi Bayraktar
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tessa M Bosch
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Clinical Pharmacology & Toxicology, Maasstad Lab, Maasstad Hospital, Rotterdam, the Netherlands
| | - Karin M Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Sanne M Kloosterboer
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Brenda de Winter
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Birgit C P Koch
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
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11
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Mavragani A, Leeuwenburgh KP, Dremmen M, van Schuppen J, Starreveld D, Dierckx B, Legerstee JS. Comparing Smartphone Virtual Reality Exposure Preparation to Care as Usual in Children Aged 6 to 14 Years Undergoing Magnetic Resonance Imaging: Protocol for a Multicenter, Observer-Blinded, Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e41080. [PMID: 36692931 PMCID: PMC9906306 DOI: 10.2196/41080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A magnetic resonance imaging (MRI) procedure can cause preprocedural and periprocedural anxiety in children. Psychosocial interventions are used to prepare children for the procedure to alleviate anxiety, but these interventions are time-consuming and costly, limiting their clinical use. Virtual reality (VR) is a promising way to overcome these limitations in the preparation of children before an MRI scan. OBJECTIVE The objective of this study is (1) to develop a VR smartphone intervention to prepare children at home for an MRI procedure; and (2) to examine the effect of the VR intervention in a randomized controlled trial, in which the VR intervention will be compared to care as usual (CAU). CAU involves an information letter about an MRI examination. The primary outcome is the child's procedural anxiety during the MRI procedure. Secondary outcomes include preprocedural anxiety and parental anxiety. We hypothesize that the VR preparation will result in a higher reduction of the periprocedural anxiety of both parents and children as compared to CAU. METHODS The VR intervention provides a highly realistic and child-friendly representation of an MRI environment. In this randomized controlled trial, 128 children (aged 6 to 14 years) undergoing an MRI scan will be randomly allocated to the VR intervention or CAU. Children in the VR intervention will receive a log-in code for the VR app and are sent cardboard VR glasses. RESULTS The VR smartphone preparation app was developed in 2020. The recruitment of participants is expected to be completed in December 2022. Data will be analyzed, and scientific papers will be submitted for publication in 2023. CONCLUSIONS The VR smartphone app is expected to significantly reduce pre- and periprocedural anxiety in pediatric patients undergoing an MRI scan. The VR app offers a realistic and child-friendly experience that can contribute to modern care. A smartphone version of the VR app has the advantage that children, and potentially their parents, can get habituated to the VR environment and noises in their own home environment and can do this VR MRI preparation as often and as long as needed. TRIAL REGISTRATION ISRCTN Registry ISRCTN20976625; https://www.isrctn.com/ISRCTN20976625. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41080.
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Affiliation(s)
| | - Koen Pieter Leeuwenburgh
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center Sophia Children's Hospital, Rotterdam, Netherlands
| | - Marjolein Dremmen
- Department of Radiology, Erasmus University Medical Center Sophia Children's Hospital, Rotterdam, Netherlands
| | - Joost van Schuppen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers Emma Children's Hospital, Amsterdam, Netherlands
| | - Daniëlle Starreveld
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center Sophia Children's Hospital, Rotterdam, Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center Sophia Children's Hospital, Rotterdam, Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center Sophia Children's Hospital, Rotterdam, Netherlands
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12
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Cao SC, Legerstee JS, van Bellinghen M, Lemiere J, Sleurs C, Segers H, Danckaerts M, Dierckx B. Effect of chemotherapy (with and without radiotherapy) on the intelligence of children and adolescents treated for acute lymphoblastic leukemia; a meta-analysis. Psychooncology 2023; 32:492-505. [PMID: 36690921 DOI: 10.1002/pon.6103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This meta-analysis assesses cognitive functioning in children with acute lymphoblastic leukemia post-treatment who were treated with either chemotherapy-only (CT-only) or in combination with radiation therapy (CTRT). METHODS The databases Pubmed and PsychInfo were searched between 1-1-2000 and 31-12-2021. Data were analyzed using Comprehensive Meta-Analysis (version 2). RESULTS Mean weighted intelligence after treatment was 100.2 (number of studies n = 51, 95% CI: 98.8-101.5). For CT-only, it was 100.8 (95% CI: 99.5-102.2) and for CTRT 97.8 (95% CI: 95.9-100.2). Compared to recruited healthy controls, treated children had on average lower IQ scores (n = 23, mean difference -7.8, 95% CI: -10.7 to -5.0, p < 0.001). When looking only at studies using controls recruited from the patient's family, results remained significant (n = 5, mean difference -6.0, 95% CI: -8.6 to -3.5, p = 0.001). Meta-regressions aimed at identifying predictors of IQ after treatment failed to find an effect for sex or age. We could demonstrate an effect of time between diagnosis and IQ measurement for the CTRT treated patient (B = -0.26, 95% CI: -0.40 to -0.1, p = 0.002). CONCLUSIONS IQ scores of patients treated with CT-only or CTRT treatment regimens did not differ from the normative population. However, compared to recruited control groups, patients showed lower mean IQ scores. The Flynn effect and/or selection effects may play a role in this discrepancy. Considering time since diagnosis may have a significant impact on IQ, at least in CTRT treated patients, long-term clinical follow-up of neurocognitive development may be prudent to detect possible (late) neurocognitive effects.
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Affiliation(s)
- Shu-Chun Cao
- Department of Child and Adolescent Psychiatry, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marc van Bellinghen
- Department of Child and Adolescent Psychiatry, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Jurgen Lemiere
- Department of Pediatric Oncology, KU Leuven, Leuven, Belgium.,Department of Pediatric Hemato-Oncology, UZ Leuven, Leuven, Belgium
| | | | - Heidi Segers
- Department of Pediatric Oncology, KU Leuven, Leuven, Belgium.,Department of Pediatric Hemato-Oncology, UZ Leuven, Leuven, Belgium
| | - Marina Danckaerts
- Department of Child and Adolescent Psychiatry, KU Leuven, University Psychiatric Centre Leuven, Leuven, Belgium
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
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13
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Hermans RA, Ringeling LT, Liang K, Kloosterboer SM, de Winter BCM, Hillegers MHJ, Koch BCP, Dierckx B. The effect of therapeutic drug monitoring of risperidone and aripiprazole on weight gain in children and adolescents: the SPACe 2: STAR (trial) protocol of an international multicentre randomised controlled trial. BMC Psychiatry 2022; 22:814. [PMID: 36539734 PMCID: PMC9769061 DOI: 10.1186/s12888-022-04445-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Antipsychotic drugs are an important part of the treatment of irritability and aggression in children with an autism spectrum disorder (ASD). However, significant weight gain and metabolic disturbances are clinically relevant side effects of antipsychotic use in children. In the SPACe study, we showed positive correlations between both risperidone and aripiprazole plasma trough concentrations and weight gain over a 6-month period. The trial SPACe 2: STAR is designed as a follow-up study, in which we aim to research whether therapeutic drug monitoring in clinical practice can prevent severe weight gain, while retaining clinical effectiveness. METHODS SPACe 2: STAR is an international, multicentre, randomised controlled trial (RCT). One hundred forty children aged 6 to 18 who are about to start risperidone or aripiprazole treatment for ASD related behavioural problems will be randomised into one of two groups: a therapeutic drug monitoring (TDM) group, and a care as usual (CAU) group. Participants will be assessed at baseline and 4, 10, 24, and 52 weeks follow-up. In the TDM group, physicians will receive dosing advice based on plasma levels of risperidone and aripiprazole and its metabolites at 4 and 10 weeks. Plasma levels will be measured in dried blood spots (DBS). The primary outcome will be BMI z-score at 24 weeks after start of antipsychotic treatment. Among the secondary outcomes are effectiveness, metabolic laboratory measurements, levels of prolactin, leptin and ghrelin, extrapyramidal side effects, and quality of life. DISCUSSION This will be the first RCT evaluating the effect of TDM of antipsychotic drugs in children and adolescents. Thus, findings from SPACe 2: STAR will be of great value in optimising treatment in this vulnerable population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05146245. EudraCT number: 2020-005450-18. Sponsor protocol name: SPACe2STAR. Registered 8 June 2021. Protocol Version 6, Protocol date: 18 august 2022.
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Affiliation(s)
- Rebecca A. Hermans
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, 3000 CB Rotterdam, PO Box 2060, the Netherlands ,grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands ,grid.5645.2000000040459992XRotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lisa T. Ringeling
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, 3000 CB Rotterdam, PO Box 2060, the Netherlands ,grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands ,grid.5645.2000000040459992XRotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kajie Liang
- grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands ,grid.5645.2000000040459992XRotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sanne M. Kloosterboer
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, 3000 CB Rotterdam, PO Box 2060, the Netherlands
| | - Brenda C. M. de Winter
- grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands ,grid.5645.2000000040459992XRotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Manon H. J. Hillegers
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, 3000 CB Rotterdam, PO Box 2060, the Netherlands
| | - Birgit C. P. Koch
- grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands ,grid.5645.2000000040459992XRotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bram Dierckx
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, 3000 CB Rotterdam, PO Box 2060, the Netherlands
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14
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Tas FQ, van Eijk CAM, Staals LM, Legerstee JS, Dierckx B. Virtual reality in pediatrics, effects on pain and anxiety: A systematic review and meta-analysis update. Paediatr Anaesth 2022; 32:1292-1304. [PMID: 35993398 PMCID: PMC9804813 DOI: 10.1111/pan.14546] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/23/2022] [Accepted: 08/16/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Medical procedures are often accompanied by pain and anxiety in pediatric patients. A relatively new technique to reduce pediatric pain and anxiety is virtual reality. Virtual reality is both applied as a distraction tool and as an exposure tool to prepare patients for medical procedures. Research into the application of virtual reality in medical settings is rapidly evolving. This meta-analysis is an update of the meta-analysis of Eijlers et al. investigating the effectiveness of virtual reality as an intervention tool on pain and anxiety in pediatric patients undergoing medical procedures. METHODS We searched the databases Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and PsycINFO. For each of these databases, different search strategies were developed. The search period from the meta-analysis from Eijlers et al., reaching until April 2018, was extended to December 2020. Pain and anxiety outcomes during medical procedures were compared for virtual reality and standard care conditions for various medical procedures. RESULTS The search yielded 1824 articles, of which 13 met our inclusion criteria. Combined with 13 articles of Eijlers' review study, this resulted in 26 articles. Virtual reality was applied as distraction (n = 23) during medical procedures or as exposure (n = 4) before medical procedures. The effect of virtual reality distraction was mostly studied in patients during venous access (n = 10). The overall weighted standardized mean difference for virtual reality distraction was -0.67 (95% CI, -0.89 to -0.45; p < .001) on patient-reported pain (based on 21 studies) and -0.74 (95% CI, -1.00 to -0.48; p < .001) on patient-reported anxiety (based on 10 studies). The effect of virtual reality as an exposure tool on patient-reported anxiety was significant too (standardized mean difference = -0.58; 95% CI, -1.15 to -0.01; p < .05). DISCUSSION The current updated systematic review and meta-analysis indicates that virtual reality is a useful tool to reduce pain and anxiety in pediatric patients undergoing a range of medical procedures as it significantly decreases pain and anxiety outcomes when compared to care as usual.
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Affiliation(s)
- Floris Q. Tas
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
| | - Cynthia A. M. van Eijk
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
| | - Lonneke M. Staals
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
| | - Jeroen S. Legerstee
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
| | - Bram Dierckx
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
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15
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Hermans R, Kloosterboer S, Sassen S, Reichart C, Kouijzer M, de Kroon M, van Daalen E, Rieken R, van Schaik R, Nasserinejad K, Hillegers M, de Winter B, Koch B, Dierckx B. Linking pharmacokinetics of aripiprazole to side effects and
effectiveness in children and adolescents. PHARMACOPSYCHIATRY 2022. [DOI: 10.1055/s-0042-1747653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- R.A. Hermans
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The
Netherlands
- Department of Child and Adolescent Psychiatry/Psychology,
Erasmus Medical Center, Rotterdam, the Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus Medical Center,
Rotterdam, The Netherlands
| | - S.M. Kloosterboer
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The
Netherlands
- Department of Child and Adolescent Psychiatry/Psychology,
Erasmus Medical Center, Rotterdam, the Netherlands
| | - S.D.T. Sassen
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The
Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus Medical Center,
Rotterdam, The Netherlands
| | - C.G. Reichart
- LUMC-Curium Child and Adolescent Psychiatry, Leiden University Medical
Center, Oegstgeest, The Netherlands
| | | | | | | | - R. Rieken
- GGZ Delfland, Department of Youth, Delft, The Netherlands
| | - R.H.N. van Schaik
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam,
The Netherlands
| | - K. Nasserinejad
- Department of Hematology, Erasmus Medical Center, Rotterdam, The
Netherlands
| | - M.H.J. Hillegers
- Department of Child and Adolescent Psychiatry/Psychology,
Erasmus Medical Center, Rotterdam, the Netherlands
| | - B.C.M. de Winter
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The
Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus Medical Center,
Rotterdam, The Netherlands
| | - B.C.P. Koch
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The
Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus Medical Center,
Rotterdam, The Netherlands
| | - B. Dierckx
- Department of Child and Adolescent Psychiatry/Psychology,
Erasmus Medical Center, Rotterdam, the Netherlands
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16
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Vlug LE, Verloop MW, Dierckx B, Bosman L, de Graaff JC, Rings EH, Wijnen RM, de Koning BA, Legerstee JS. Cognitive Outcomes in Children With Conditions Affecting the Small Intestine: A Systematic Review and Meta-analysis. J Pediatr Gastroenterol Nutr 2022; 74:368-376. [PMID: 35226646 PMCID: PMC8860224 DOI: 10.1097/mpg.0000000000003368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/09/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of the study was to assess cognitive outcomes in children with intestinal failure (IF) and children at high risk of IF with conditions affecting the small intestine requiring parenteral nutrition. METHODS EMBASE, Cochrane, Web of Science, Google Scholar, MEDLINE, and PsycINFO were searched from inception to October 2020. Studies were included constituting original data on developmental quotient (DQ), intelligence quotient (IQ) and/or severe developmental delay/disability (SDD) rates assessed with standardized tests. We used appropriate standardized tools to extract data and assess study quality. We performed random effects meta-analyses to estimate pooled means of DQ/IQ and pooled SDD rates (general population mean for DQ/IQ: 100, for percentage with SDD: 1.8%) for 4 groups: IF, surgical necrotizing enterocolitis (NEC), abdominal wall defects (AWD), and midgut malformations (MM). Associations of patient characteristics with DQ/IQ were evaluated with meta-regressions. RESULTS Thirty studies met the inclusion criteria. The pooled mean DQ/IQ for IF, NEC, AWD, and MM were 86.8, 83.3, 96.6, and 99.5, respectively. The pooled SDD rates for IF, NEC, AWD and MM were 28.6%, 32.8%, 8.5%, and 3.7%, respectively. Meta-regressions indicated that lower gestational age, longer hospital stay, and higher number of surgeries but not parenteral nutrition duration, were associated with lower DQ/IQ. CONCLUSIONS Adverse developmental outcomes are common in children with IF and NEC, and to a much lesser extent in children with AWD and MM. It is important to monitor cognitive development in children with conditions affecting the small intestine and to explore avenues for prevention and remediation.
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Affiliation(s)
- Lotte E. Vlug
- Division of Gastroenterology, Department of Pediatrics
| | | | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology
| | - Lotte Bosman
- Department of Child and Adolescent Psychiatry/Psychology
| | - Jurgen C. de Graaff
- Department of Anesthesiology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam
| | - Edmond H.H.M. Rings
- Division of Gastroenterology, Department of Pediatrics
- Division of Gastroenterology, Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden
| | - René M.H. Wijnen
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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17
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Bais Y, Hermans RA, Schuiling-Veninga CCM, Bos HJ, Kloosterboer SM, de Winter BCM, Simoons M, Dieleman GC, Hillegers MHJ, Koch BCP, Dierckx B. Comparison of antipsychotic drug use among Dutch Youth before and after implementation of the Youth Act (2010-2019). Eur Child Adolesc Psychiatry 2022:10.1007/s00787-022-01949-0. [PMID: 35138475 PMCID: PMC10326153 DOI: 10.1007/s00787-022-01949-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/19/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The Dutch law on youth care (the Youth Act) was implemented from 2015 onwards. One of the government's aims by implementing this new policy was de-medicalization of youths by separating youth mental healthcare from the rest of the healthcare system. A previous study conducted by our research group showed that prevalence rates of antipsychotic drug prescriptions stabilized among Dutch youth in the period 2005-2015, just before the introduction of the Youth Act. In our study, we aimed to describe antipsychotic drug use among Dutch children aged 0-19 years old before and after implementation of the Youth Act (2010-2019). METHODS We analyzed prescription data of 7405 youths aged 0-19 years using antipsychotic drugs between 2010 and 2019, derived from a large Dutch community pharmacy-based prescription database (IADB.nl). RESULTS Prevalence rates of antipsychotic drug use per thousand youths decreased significantly in youths aged 7-12 years old in 2019 compared to 2015 (7.9 vs 9.0 p < 0.05). By contrast, prevalence rates increased in adolescent females in 2019 compared to 2015 (11.8 vs 9.5 p < 0.05). Incidence rates increased significantly in adolescent youths in 2019 compared to 2015 (3.9 vs 3.0 p < 0.05), specifically among adolescent girls (4.2 per thousand in 2019 compared to 3.0 per thousand in 2015). Dosages in milligram declined for the most commonly prescribed antipsychotic drugs during the study period. The mean duration of antipsychotic drug use in the study period was 5.7 (95% CI 5.2-6.2) months. CONCLUSION Despite the aim of the Youth Act to achieve de-medicalization of youths, no clear reduction was observed in prevalence rates of antipsychotic drugs or treatment duration in all subgroups. Prevalence rates even increased in adolescent females.
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Affiliation(s)
- Y Bais
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R A Hermans
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C C M Schuiling-Veninga
- Department of Pharmacotherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
| | - H J Bos
- Department of Pharmacotherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
| | - S M Kloosterboer
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - B C M de Winter
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Simoons
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - G C Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - B C P Koch
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - B Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands.
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18
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Lubbers K, Stijl EM, Dierckx B, Hagenaar DA, Ten Hoopen LW, Legerstee JS, de Nijs PFA, Rietman AB, Greaves-Lord K, Hillegers MHJ, Dieleman GC, Mous SE. Autism Symptoms in Children and Young Adults With Fragile X Syndrome, Angelman Syndrome, Tuberous Sclerosis Complex, and Neurofibromatosis Type 1: A Cross-Syndrome Comparison. Front Psychiatry 2022; 13:852208. [PMID: 35651825 PMCID: PMC9149157 DOI: 10.3389/fpsyt.2022.852208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/26/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The etiology of autism spectrum disorder (ASD) remains unclear, due to genetic heterogeneity and heterogeneity in symptoms across individuals. This study compares ASD symptomatology between monogenetic syndromes with a high ASD prevalence, in order to reveal syndrome specific vulnerabilities and to clarify how genetic variations affect ASD symptom presentation. METHODS We assessed ASD symptom severity in children and young adults (aged 0-28 years) with Fragile X Syndrome (FXS, n = 60), Angelman Syndrome (AS, n = 91), Neurofibromatosis Type 1 (NF1, n = 279) and Tuberous Sclerosis Complex (TSC, n = 110), using the Autism Diagnostic Observation Schedule and Social Responsiveness Scale. Assessments were part of routine clinical care at the ENCORE expertise center in Rotterdam, the Netherlands. First, we compared the syndrome groups on the ASD classification prevalence and ASD severity scores. Then, we compared individuals in our syndrome groups with an ASD classification to a non-syndromic ASD group (nsASD, n = 335), on both ASD severity scores and ASD symptom profiles. Severity scores were compared using MANCOVAs with IQ and gender as covariates. RESULTS Overall, ASD severity scores were highest for the FXS group and lowest for the NF1 group. Compared to nsASD, individuals with an ASD classification in our syndrome groups showed less problems on the instruments' social domains. We found a relative strength in the AS group on the social cognition, communication and motivation domains and a relative challenge in creativity; a relative strength of the NF1 group on the restricted interests and repetitive behavior scale; and a relative challenge in the FXS and TSC groups on the restricted interests and repetitive behavior domain. CONCLUSION The syndrome-specific strengths and challenges we found provide a frame of reference to evaluate an individual's symptoms relative to the larger syndromic population and to guide treatment decisions. Our findings support the need for personalized care and a dimensional, symptom-based diagnostic approach, in contrast to a dichotomous ASD diagnosis used as a prerequisite for access to healthcare services. Similarities in ASD symptom profiles between AS and FXS, and between NF1 and TSC may reflect similarities in their neurobiology. Deep phenotyping studies are required to link neurobiological markers to ASD symptomatology.
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Affiliation(s)
- Kyra Lubbers
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Eefje M Stijl
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Bram Dierckx
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Doesjka A Hagenaar
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of General Paediatrics, Erasmus MC, Rotterdam, Netherlands
| | - Leontine W Ten Hoopen
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jeroen S Legerstee
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Pieter F A de Nijs
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - André B Rietman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Kirstin Greaves-Lord
- Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Clinical Psychology and Experimental Psychopathology Unit, Department of Psychology, Rijksuniversiteit Groningen, Groningen, Netherlands.,Yulius Mental Health, Dordrecht, Netherlands.,Jonx Autism Team Northern-Netherlands, Lentis Mental Health, Groningen, Netherlands
| | - Manon H J Hillegers
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Gwendolyn C Dieleman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sabine E Mous
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Child Brain Center, Erasmus University Medical Center, Rotterdam, Netherlands
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19
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Cao SC, Legerstee JS, van Bellinghen M, Danckaerts M, Dierckx B. [Meta-analysis: effect of chemotherapy on intelligence of children treated for leukemia]. Tijdschr Psychiatr 2022; 64:94-100. [PMID: 35420152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Leukemia is the most common pediatric malignancy. Acute lymphoblastic leukemia (ALL) is the most commonly observed subtype. AIM To assess cognitive functioning in children and adolescents with ALL post-treatment: chemotherapy-only (CT-only) or in combination with radiation therapy (CTRT). METHODS We searched in PubMed and PsycINFO (OvidSP). Relevant data were analyzed using statistical program Comprehensive Meta-Analysis (version 2). RESULTS 44 studies were included in the overall meta-analysis with a total of 5059 patients. A weighted mean IQ of 100.1 (95% CI 99.1-101.0) was found overall after ALL treatment. In subanalyses, we found for CT-only a weighted mean IQ of 100.7 (95% CI: 99.5-101.9) and for CTRT-treatment a weighted mean IQ of 98.2 (95%100.7 (95% CI: 96.3-100.3). There was no significant difference from the normative control (mean: 100.0; SD: 15). CONCLUSION No significant cognitive sequelae were shown in childhood survivors of leukemia who were exposed to either CT-only or CTRT therapy. Prospective studies are needed with inclusion of pre-and post-treatment IQ measurements, ideally compared to age and socio-economic status matched control groups.
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20
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Cheung K, Dierckx B, El Marroun H, Hillegers MHJ, Stricker BH, Visser LE. Methylphenidate Treatment Adherence and Persistence in Children in the Netherlands. J Child Adolesc Psychopharmacol 2021; 31:205-213. [PMID: 33470894 DOI: 10.1089/cap.2020.0125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives: Numerous studies have examined determinants contributing to methylphenidate adherence and persistence, but these were mainly conducted in adults. These determinants are likely to be different in children as they usually rely on their parents to provide them with the care they need. The objective was to study child and family characteristics as determinants of methylphenidate adherence and persistence in children. Methods: The study population consists of 307 children from the Generation R Study in the Netherlands, who had at least one dispensing record of methylphenidate until the age of 16 years. Adherence was defined as a medication possession ratio ≥0.80 up to 2 years after treatment initiation. Persistence was defined as the duration of treatment until a discontinuation period of ≥6 months. Family and child characteristics were tested as determinants of adherence with multivariable logistic regression analysis. Persistence was evaluated using a Kaplan-Meier analysis. Results: Children of mothers with one child (adjusted odds ratio [OR]: 2.31, 95% confidence interval [CI]: 1.17-4.54) or of mothers with an average household income (compared to high) were more likely to be adherent (adjusted OR: 3.45, 95% CI: 1.43-8.31). Children who started treatment at the age of 12-16 years (compared to <12 years) (adjusted hazard ratio [HR]: 3.55, 95% CI: 2.54-4.98) and girls (adjusted HR: 1.44, 95% CI: 1.07-1.95) were more often nonpersistent. Conclusion: Both child and family characteristics may play a role in methylphenidate treatment adherence. Furthermore, gender and the start age of treatment were found to be associated with nonpersistence. These findings may be important for health care professionals when initiating methylphenidate treatment in children.
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Affiliation(s)
- Kiki Cheung
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Health and Youth Care Inspectorate, Utrecht, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry, University Medical Center, Erasmus MC, Rotterdam, The Netherlands
| | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry, University Medical Center, Erasmus MC, Rotterdam, The Netherlands.,Department of Pediatrics, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands.,Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry, University Medical Center, Erasmus MC, Rotterdam, The Netherlands.,The Generation R Study, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Health and Youth Care Inspectorate, Utrecht, The Netherlands
| | - Loes E Visser
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Haga Teaching Hospital, The Hague, The Netherlands.,Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
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21
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Cheung K, El Marroun H, Dierckx B, Visser LE, Stricker BH. Maternal Sociodemographic Factors Are Associated with Methylphenidate Initiation in Children in the Netherlands: A Population-Based Study. Child Psychiatry Hum Dev 2021; 52:332-342. [PMID: 32566998 PMCID: PMC7973638 DOI: 10.1007/s10578-020-01016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Multiple factors may contribute to the decision to initiate methylphenidate treatment in children such as maternal sociodemographic factors of which relatively little is known. The objective was to investigate the association between these factors and methylphenidate initiation. The study population included 4243 children from the Generation R Study in the Netherlands. Maternal sociodemographic characteristics were tested as determinants of methylphenidate initiation through a time-dependent Cox regression analysis. Subsequently, we stratified by mother-reported ADHD symptoms (present in 4.2% of the study population). When ADHD symptoms were absent, we found that girls (adjusted HR 0.25, 95%CI 0.16-0.39) and children born to a mother with a non-western ethnicity (compared to Dutch-Caucasian) (adjusted HR 0.42, 95%CI 015-0.68) were less likely to receive methylphenidate. They were more likely to receive methylphenidate when their mother completed a low (adjusted HR 2.29, 95%CI 1.10-4.77) or secondary (adjusted HR 1.71, 95%CI 1.16-2.54) education. In conclusion, boys and children born to a mother of Dutch-Caucasian ethnicity were more likely to receive methylphenidate, irrespective of the presence of ADHD symptoms.
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Affiliation(s)
- K Cheung
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Health and Youth Care Inspectorate, Utrecht, The Netherlands.
| | - H El Marroun
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, University Medical Center Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - B Dierckx
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - L E Visser
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Haga Teaching Hospital, The Hague, The Netherlands
| | - B H Stricker
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Health and Youth Care Inspectorate, Utrecht, The Netherlands
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22
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Van Remmerden MC, Hoogland L, Mous SE, Dierckx B, Coesmans M, Moll HA, Lubbers K, Lincken CR, Van Eeghen AM. Growing up with Fragile X Syndrome: Concerns and Care Needs of Young Adult Patients and Their Parents. J Autism Dev Disord 2020; 50:2174-2187. [PMID: 30879259 PMCID: PMC7261272 DOI: 10.1007/s10803-019-03973-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Little is known about care needs of young adults with Fragile X Syndrome (FXS). Patient-driven information is needed to improve understanding and support of young adults with FXS. A qualitative study was performed in 5 young adult patients (aged 18–30), and 33 parents of young adults. Concerns and care needs were categorized using the International Classification of Functioning, Disability, and Health. Results indicated concerns on 14 domains for males, and 13 domains for females, including physical, psychological and socio-economical issues. In both groups parents reported high stress levels and a lack of knowledge of FXS in adult care providers. This study revealed concerns on various domains, requiring gender-specific, multidisciplinary transitional care and adult follow-up for patients with FXS.
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Affiliation(s)
- M C Van Remmerden
- The Hartekamp Groupe, Care and Service Center for People with Intellectual Disabilities, Haarlem, The Netherlands
| | - L Hoogland
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands.,ASVZ, Care and Service Center for People with Intellectual Disabilities, Sliedrecht, The Netherlands
| | - S E Mous
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - B Dierckx
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M Coesmans
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - H A Moll
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Department of General Pediatrics, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - K Lubbers
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - C R Lincken
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Department of General Pediatrics, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - A M Van Eeghen
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands. .,Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands. .,'s Heeren Loo Zorggroep, Care and Service Center for People with Intellectual Disabilities, Amersfoort, The Netherlands.
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23
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Kloosterboer SM, de Winter BCM, Reichart CG, Kouijzer MEJ, de Kroon MMJ, van Daalen E, Ester WA, Rieken R, Dieleman GC, van Altena D, Bartelds B, van Schaik RHN, Nasserinejad K, Hillegers MHJ, van Gelder T, Dierckx B, Koch BCP. Risperidone plasma concentrations are associated with side effects and effectiveness in children and adolescents with autism spectrum disorder. Br J Clin Pharmacol 2020; 87:1069-1081. [PMID: 32643213 PMCID: PMC9328651 DOI: 10.1111/bcp.14465] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022] Open
Abstract
AIM Risperidone is the most commonly prescribed antipsychotic drug to children and adolescents worldwide, but it is associated with serious side effects, including weight gain. This study assessed the relationship of risperidone and 9-hydroxyrisperidone trough concentrations, maximum concentrations and 24-hour area under the curves (AUCs) with body mass index (BMI) z-scores in children and adolescents with autism spectrum disorder (ASD) and behavioural problems. Secondary outcomes were metabolic, endocrine, extrapyramidal and cardiac side effects and effectiveness. METHODS Forty-two children and adolescents (32 males) aged 6-18 years were included in a 24-week prospective observational trial. Drug plasma concentrations, side effects and effectiveness were measured at several time points during follow-up. Relevant pharmacokinetic covariates, including medication adherence and CYP2D6, CYP3A4, CYP3A5 and P-glycoprotein (ABCB1) genotypes, were measured. Nonlinear mixed-effects modelling (NONMEM®) was used for a population pharmacokinetic analysis with 205 risperidone and 205 9-hydroxyrisperidone concentrations. Subsequently, model-based trough concentrations, maximum concentrations and 24-hour AUCs were analysed to predict outcomes using generalized and linear mixed-effects models. RESULTS A risperidone two-compartment model combined with a 9-hydroxyrisperidone one-compartment model best described the measured concentrations. Of all the pharmacokinetic parameters, higher risperidone sum trough concentrations best predicted higher BMI z-scores during follow-up (P < .001). Higher sum trough concentrations also predicted more sedation (P < .05), higher prolactin levels (P < .001) and more effectiveness measured with Aberrant Behavior Checklist irritability score (P < .01). CONCLUSION Our results indicate a therapeutic window exists, which suggests that therapeutic drug monitoring of risperidone might increase safety and effectiveness in children and adolescents with ASD and behavioural problems.
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Affiliation(s)
- Sanne Maartje Kloosterboer
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC- Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Brenda C M de Winter
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Catrien G Reichart
- Curium-LUMC Child and Adolescent Psychiatry, Leiden University Medical Center, Oegstgeest, The Netherlands
| | | | | | | | - Wietske A Ester
- Curium-LUMC Child and Adolescent Psychiatry, Leiden University Medical Center, Oegstgeest, The Netherlands.,Sarr Expert Centre for Autism, Youz Child and Adolescent Psychiatry, Rotterdam, The Netherlands.,Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Rob Rieken
- GGZ Delfland, Department of Youth, Delft, The Netherlands
| | - Gwen C Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC- Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Daphne van Altena
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC- Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Beatrijs Bartelds
- Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Kazem Nasserinejad
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC- Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Teun van Gelder
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC- Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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24
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van Dalen M, Dierckx B, Pasmans SGMA, Aendekerk EWC, Mathijssen IMJ, Koudstaal MJ, Timman R, Williamson H, Hillegers MHJ, Utens EMWJ, Okkerse JME. Anxiety and depression in adolescents with a visible difference: A systematic review and meta-analysis. Body Image 2020; 33:38-46. [PMID: 32092507 DOI: 10.1016/j.bodyim.2020.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 12/24/2022]
Abstract
Living with a visible difference can entail challenging social situations, associated with psychosocial symptoms. However, it is not clear whether adolescents with a visible difference experience more anxiety and depression than unaffected peers. We aim to determine whether adolescents with a visible difference experience more symptoms of anxiety and depression than unaffected peers. A literature search was conducted in Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, PsycINFO Ovid, and Google Scholar. Meta-analyses were done using random-effects models to calculate a standardised mean difference. Analyses for subgroups were used to study causes of visible difference. Eleven studies were identified (n = 1075, weighted mean age = 15.80). Compared to unaffected peers, adolescents with a visible difference experience more symptoms of anxiety (SMD = 0.253, 95 % CI [0.024, 0.482], p = .030), but not depression (SMD = 0.236, 95 % CI [-0.126, 0.599], p = .202). Adolescents with a skin condition did not experience more symptoms of anxiety (SMD = 0.149, 95 % CI [-0.070, 0.369], p = .182) or depression (SMD = 0.090, 95 % CI [-0.082, 0.262], p = .305) when compared to unaffected peers. Overall, more symptoms of anxiety are found in adolescents with a visible difference compared to peers. No differences in anxiety or depression were found for skin differences. Screening for anxiety is recommended.
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Affiliation(s)
- M van Dalen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - B Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC - Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - E W C Aendekerk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - I M J Mathijssen
- Department of Plastic and Reconstructive Surgery and Hand Surgery, The Dutch Craniofacial Centre, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - R Timman
- Department of Psychiatry, Unit of Medical Psychology and Psychotherapy, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - H Williamson
- Department of Health and Social Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - M H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - E M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands; Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15780, 1001 NG, Amsterdam, the Netherlands; Academic Center for Child Psychiatry the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, P.O. Box 303, 1115 ZG, Duivendrecht, the Netherlands
| | - J M E Okkerse
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands.
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25
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Kloosterboer SM, Vierhout D, Stojanova J, Egberts KM, Gerlach M, Dieleman GC, Hillegers MHJ, Passe KM, Gelder TV, Dierckx B, Koch BCP. Psychotropic drug concentrations and clinical outcomes in children and adolescents: a systematic review. Expert Opin Drug Saf 2020; 19:873-890. [PMID: 32421365 DOI: 10.1080/14740338.2020.1770224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The use of psychotropic drugs in children and adolescents is widespread but associated with suboptimal treatment effects. Therapeutic drug monitoring (TDM) can improve safety of psychotropic drugs in children and adolescents but is not routinely performed. A major reason is that the relationship between drug concentrations and effects is not well known. AREAS COVERED This systematic review evaluated studies assessing the relationship between psychotropic drug concentrations and clinical outcomes in children and adolescents, including antipsychotics, psychostimulants, alpha-agonists, antidepressants, and mood-stabilizers. PRISMA guidelines were used and a quality assessment of the retrieved studies was performed. Sixty-seven eligible studies involving 24 psychotropic drugs were identified from 9,298 records. The findings were generally heterogeneous and the majority of all retrieved studies were not of sufficient quality. For 11 psychotropic drugs, a relationship between drug concentrations and side-effects and/or effectiveness was evidenced in reasonably reported and executed studies, but these findings were barely replicated. EXPERT OPINION In order to better support routine TDM in child- and adolescent psychiatry, future work must improve in aspects of study design, execution and reporting to demonstrate drug concentration-effect relationships. The quality criteria proposed in this work can guide future TDM research. Systematic review protocol and registration PROSPERO CRD42018084159.
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Affiliation(s)
- Sanne M Kloosterboer
- Department of Hospital Pharmacy, Erasmus Medical Center , Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Denise Vierhout
- Department of Hospital Pharmacy, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Jana Stojanova
- Interdisciplinary Center for Health Studies (CIESAL), Universidad de Valparaíso , Valparaíso, Chile
| | - Karin M Egberts
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg , Würzburg, Germany
| | - Manfred Gerlach
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg , Würzburg, Germany
| | - Gwen C Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Kimberly M Passe
- Department of Psychiatry, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Teun van Gelder
- Department of Hospital Pharmacy, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus Medical Center , Rotterdam, The Netherlands
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26
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Eijlers R, Staals LM, Legerstee JS, Berghmans JM, Strabbing EM, van der Schroeff MP, Wijnen RMH, Kind LS, Hillegers MHJ, Dierckx B, Utens EMWJ. Predicting Intense Levels of Child Anxiety During Anesthesia Induction at Hospital Arrival. J Clin Psychol Med Settings 2020; 28:313-322. [PMID: 32306238 PMCID: PMC8192387 DOI: 10.1007/s10880-020-09716-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In children, intense levels of anxiety during anesthetic induction are associated with a higher risk of pain, poor recovery, and emergence delirium. Therefore, it is important to identify these high-risk children at hospital arrival. The current study examined internalizing behavior (Child Behavior Checklist, CBCL) and state anxiety measures (modified Yale Preoperative Anxiety Scale, mYPAS, and State Trait Anxiety Inventory for Children, STAIC) at hospital arrival as predictors of anxiety during induction of anesthesia. One hundred children (aged 4 to 12 years) undergoing elective daycare surgery were included. The STAIC and mYPAS at hospital arrival were significant predictors of anxiety during induction, whereas CBCL was not. The STAIC state form at hospital arrival was the strongest predictor and could be used to identify children who will experience intense levels of anxiety during anesthetic induction, with sufficient to good diagnostic accuracy. Using the STAIC at hospital arrival allows targeted interventions to reduce anxiety in children.
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Affiliation(s)
- Robin Eijlers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Lonneke M Staals
- Department of Anaesthesiology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Johan M Berghmans
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
- Department of Anaesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Elske M Strabbing
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marc P van der Schroeff
- Dutch Craniofacial Centre, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - René M H Wijnen
- Intensive Care and Department of Paediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Laura S Kind
- Centre for Special Care Dentistry, CBT Rijnmond, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands.
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
- Academic Centre for Child Psychiatry De Bascule, Department of Child and Adolescent Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands.
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27
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Eijlers R, Utens EMWJ, Staals LM, de Nijs PFA, Berghmans JM, Wijnen RMH, Hillegers MHJ, Dierckx B, Legerstee JS. Systematic Review and Meta-analysis of Virtual Reality in Pediatrics: Effects on Pain and Anxiety. Anesth Analg 2020; 129:1344-1353. [PMID: 31136330 PMCID: PMC6791566 DOI: 10.1213/ane.0000000000004165] [Citation(s) in RCA: 217] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Medical procedures often evoke pain and anxiety in pediatric patients. Virtual reality (VR) is a relatively new intervention that can be used to provide distraction during, or to prepare patients for, medical procedures. This meta-analysis is the first to collate evidence on the effectiveness of VR on reducing pain and anxiety in pediatric patients undergoing medical procedures.
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Affiliation(s)
- Robin Eijlers
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Elisabeth M W J Utens
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Child Psychiatry, The Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Lonneke M Staals
- Department of Anesthesiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Pieter F A de Nijs
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Johan M Berghmans
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Anesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium
| | - René M H Wijnen
- Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Manon H J Hillegers
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Bram Dierckx
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jeroen S Legerstee
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
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28
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de Lijster J, Dierckx B, Utens E, Verhulst F, Zieldorff C, Dieleman G, Legerstee J. The age of onset of anxiety disorders in samples from the general population: A meta-analysis. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2016.01.936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
WorkshopAge of onset of mental disorders: etiopathogenetic and treatment implications.BackgroundAge of onset (AOO) of anxiety disorders could serve as a vital statistic in the formulation of mental health policy. Previous reviews have reported on the AOO of anxiety disorders in the general population. However, these review studies did not systematically estimate the AOO of different anxiety disorder subtypes, and did not examine factors that might have influenced reported AOO.ObjectiveThe aims of the present study were (1) to estimate the AOO for all anxiety disorders and for specific subtypes, (2) to examine gender differences in AOO of anxiety disorders, and (3) to examine the influence of study characteristics on reported AOO.MethodSeven electronic databases were searched with keywords representing anxiety disorder subtypes, AOO and study design. The inclusion criteria were studies using a general population sample that provided data on AOO for all anxiety disorders, or specific anxiety disorders, according to DSM-III-R, DSM-IV or ICD-10 criteria. Meta-analysis was used to estimate AOO and gender differences, while meta-regression was used to examine the influence of study characteristics.ResultsA total of 1028 titles were examined, which yielded 24 studies meeting the inclusion criteria. Meta-analysis found an average AOO of all anxiety disorders of 21.3 years (95% CI: 17.46 to 25.07). Separation anxiety disorder, specific phobia and social phobia had their mean onset before the age of 15 years, whereas AOO of agoraphobia, obsessive compulsive disorder, post-traumatic stress disorder, panic disorder and generalized anxiety disorder began on average between 21.1 and 34.9 years. Anxiety disorder is more common in women, but meta-analysis revealed no difference in AOO between genders. Prospective study design and higher developmental level of the study country were associated with earlier AOO.ConclusionResults from this meta-analysis indicate that anxiety disorder subtypes differ in mean AOO, with onsets ranging from early adolescence to young adulthood. These findings suggest that prevention strategies of anxiety disorders should be directed towards the factors associated with the development of subtypes of anxiety disorder in the age groups with the greatest vulnerability for developing those disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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29
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Kloosterboer SM, Koch BCP, Hillegers MHJ, Dierckx B. [Use of antipsychotics in children; too much or too long?]. Ned Tijdschr Geneeskd 2019; 163:D3666. [PMID: 31483589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Antipsychotics have an important role in the treatment of children with severe behavioural problems. Use of antipsychotics in the Netherlands increased dramatically up until 2009. In recent years, however, the side-effects of antipsychotics in children have received increasing attention. One in eight children uses antipsychotics for at least 4 years. This long-term use increases the risk of side-effects, but these are often not optimally monitored. There should also be more attention for the timely tapering off of antipsychotics in children.
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Affiliation(s)
- Sanne M Kloosterboer
- Erasmus MC, afd. Kinder- en jeugdpsychiatrie, Rotterdam
- Contact: S.M. Kloosterboer
| | | | | | - Bram Dierckx
- Erasmus MC, afd. Kinder- en jeugdpsychiatrie, Rotterdam
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30
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Eijk S, Mous SE, Dieleman GC, Dierckx B, Rietman AB, de Nijs PFA, Ten Hoopen LW, van Minkelen R, Elgersma Y, Catsman-Berrevoets CE, Oostenbrink R, Legerstee JS. Autism Spectrum Disorder in an Unselected Cohort of Children with Neurofibromatosis Type 1 (NF1). J Autism Dev Disord 2019; 48:2278-2285. [PMID: 29423604 PMCID: PMC5995999 DOI: 10.1007/s10803-018-3478-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In a non-selected sample of children with Neurofibromatosis type 1 (NF1) the prevalence rate of autism spectrum disorder (ASD) and predictive value of an observational (ADOS)—and questionnaire-based screening instrument were assessed. Complete data was available for 128 children. The prevalence rate for clinical ASD was 10.9%, which is clearly higher than in the general population. This prevalence rate is presumably more accurate than in previous studies that examined children with NF1 with an ASD presumption or solely based on screening instruments. The combined observational- and screening based classifications demonstrated the highest positive predictive value for DSM-IV diagnosis, highlighting the importance of using both instruments in children with NF1.
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Affiliation(s)
- S Eijk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - S E Mous
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - G C Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - B Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - A B Rietman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - P F A de Nijs
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - L W Ten Hoopen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - R van Minkelen
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Y Elgersma
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus Medical Centre Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - C E Catsman-Berrevoets
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,Department of Pediatric Neurology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - R Oostenbrink
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.,Department of General Paediatrics, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - J S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. .,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. .,Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Room Sp-2509, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
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Al-Hassany L, Kloosterboer SM, Dierckx B, Koch BCP. Assessing methods of measuring medication adherence in chronically ill children-a narrative review. Patient Prefer Adherence 2019; 13:1175-1189. [PMID: 31413546 PMCID: PMC6660631 DOI: 10.2147/ppa.s200058] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/13/2019] [Indexed: 12/24/2022] Open
Abstract
Nonadherence in children who use long-term medication is a serious problem and assessing adherence is an important step to provide solutions to this problem. Medication adherence can be measured by several methods, including (a) self-report questionnaires or structured interviews, (b) therapeutic drug monitoring (TDM), (c) electronic devices, and (d) pick-up/refill rates. The objective of this narrative review is to provide an overview of the literature about methods for the measurement of medication adherence in chronically ill children and adolescents. Therefore, we conducted a literature search by using multiple databases. Four methods of monitoring medication adherence are presented for the most described chronic diseases: asthma, HIV/AIDS, epilepsy, diabetes mellitus and ADHD. First, 10 commonly used self-report questionnaires and structured interviews are described, including the main characteristics, (dis)advantages and their validation studies. Second, the use of TDM in pediatric trials for medication adherence measurement is discussed. New sampling methods (e.g. dried blood spot) and sampling matrices (e.g. hair, saliva and urine) have shown their benefits for TDM in children. Third, electronic devices to measure medication adherence in children are presented, being developed for several drug administration routes. Fourth, the analyses, advantages and disadvantages of pharmacy data are discussed. The usage of this data requires specific calculations and interpretations to assess adherence. As presented in this review, every adherence method has specific (dis)advantages. When deciding which adherence method is applicable, validity and generalizability should be taken into account. Combining multiple methods seems to offer the best solution in the daily clinical practice.
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Affiliation(s)
- Linda Al-Hassany
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, Rotterdam, The Netherlands
- Correspondence: Linda Al-HassanyDepartment of Hospital Pharmacy, University Medical Center Rotterdam, Postal Box 2040, Rotterdam3000 CA, The NetherlandsTel +3 110 703 3202Email
| | - Sanne M Kloosterboer
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, Rotterdam, The Netherlands
| | - Bram Dierckx
- Erasmus MC, University Medical Center Rotterdam, Department Child and Adolescent Psychiatry, Rotterdam, The Netherlands
| | - Birgit CP Koch
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, Rotterdam, The Netherlands
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Ista E, van Beusekom B, van Rosmalen J, Kneyber MCJ, Lemson J, Brouwers A, Dieleman GC, Dierckx B, de Hoog M, Tibboel D, van Dijk M. Validation of the SOS-PD scale for assessment of pediatric delirium: a multicenter study. Crit Care 2018; 22:309. [PMID: 30458826 PMCID: PMC6247513 DOI: 10.1186/s13054-018-2238-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 10/15/2018] [Indexed: 11/13/2022] Open
Abstract
Backgrounds Reports of increasing incidence rates of delirium in critically ill children are reason for concern. We evaluated the measurement properties of the pediatric delirium component (PD-scale) of the Sophia Observation Withdrawal Symptoms scale Pediatric Delirium scale (SOS-PD scale). Methods In a multicenter prospective observational study in four Dutch pediatric ICUs (PICUs), patients aged ≥ 3 months and admitted for ≥ 48 h were assessed with the PD-scale thrice daily. Criterion validity was assessed: if the PD-scale score was ≥ 4, a child psychiatrist clinically assessed the presence or absence of PD according to the Diagnostic and statistical manual of mental disorders (DSM)-IV. In addition, the child psychiatrist assessed a randomly selected group to establish the false-negative rate. The construct validity was assessed by calculating the Pearson coefficient (rp) for correlation between the PD-scale and Cornell Assessment Pediatric Delirium (CAP-D) scores. Interrater reliability was determined by comparing paired nurse-researcher PD-scale assessments and calculating the intraclass correlation coefficient (ICC). Results Four hundred eighty-five patients with a median age of 27.0 months (IQR 8–102) were included, of whom 48 patients were diagnosed with delirium by the child psychiatrist. The PD-scale had overall sensitivity of 92.3% and specificity of 96.5% compared to the psychiatrist diagnosis for a cutoff score ≥4 points. The rp between the PD-scale and the CAP-D was 0.89 (CI 95%, 0.82–0.93; p < 0.001). The ICC of 75 paired nurse-researcher observations was 0.99 (95% CI, 0.98–0.99). Conclusions The PD-scale has good reliability and validity for early screening of PD in critically ill children. It can be validly and reliably used by nurses to this aim. Electronic supplementary material The online version of this article (10.1186/s13054-018-2238-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erwin Ista
- Intensive Care Unit, Departments of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Office Sb-2704, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
| | - Babette van Beusekom
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Martin C J Kneyber
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Critical Care, Anaesthesiology, Peri - operative & Emergency medicine (CAPE), University of Groningen, Groningen, The Netherlands
| | - Joris Lemson
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arno Brouwers
- Department of Pediatrics, Division Pediatric Intensive Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Gwen C Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Matthijs de Hoog
- Intensive Care Unit, Departments of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Office Sb-2704, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - Dick Tibboel
- Intensive Care Unit, Departments of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Office Sb-2704, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - Monique van Dijk
- Intensive Care Unit, Departments of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Office Sb-2704, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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34
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de Lijster JM, Dieleman GC, Utens EMWJ, Dierckx B, Wierenga M, Verhulst FC, Legerstee JS. Social and academic functioning in adolescents with anxiety disorders: A systematic review. J Affect Disord 2018; 230:108-117. [PMID: 29407534 DOI: 10.1016/j.jad.2018.01.008] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/30/2017] [Accepted: 01/22/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Anxiety disorders are highly prevalent during adolescence. Although literature points out that anxiety symptoms are related to problems in social and academic functioning, the extent of these problems among adolescents with clinical anxiety disorders has not been systematically reviewed before. METHODS Electronic databases were searched up to October 2017, with keywords representing anxiety disorders, adolescents, and social or academic functioning. The inclusion criteria were studies with a sample of adolescents (10-19 years) with anxiety disorders that provided data regarding their social or academic functioning. 3431 studies were examined, of which 19 met the inclusion criteria. RESULTS Adolescents with anxiety disorders had a lower social competence relative to their healthy peers. They reported more negativity within interpersonal relationships, higher levels of loneliness, and victimization. Most adolescents with anxiety disorders felt impaired at school, however, findings of their average school results, compared to peers, were mixed. In addition, they had a higher risk for school refusal and entered higher education less often. Impairments in social and academic functioning differed across type and the number of anxiety disorders. LIMITATIONS Most studies examined social phobia or anxiety disorders in general and methodological approaches varied widely between studies. CONCLUSIONS This systematic review indicates that adolescents with anxiety disorders experience a range of significant problems in both social and academic functioning. These findings suggest that the assessment and treatment of anxiety disorders in adolescence should focus on improving functioning across domains.
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Affiliation(s)
- Jasmijn M de Lijster
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Gwen C Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands; Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands; Academic Center for Child psychiatry the Bascule /Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Milou Wierenga
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.
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35
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Zeidler S, Dierckx B, Lubbers K, van Eeghen AM, Lincke CR, Kievit JA, Willemsen R, Rietman A. [Fragile X syndrome: new therapeutic strategies]. Tijdschr Psychiatr 2018; 60:338-342. [PMID: 29766482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Fragile X syndrome (fxs) is the most common hereditary cause of intellectual disability and autism spectrum disorders. Targeted treatment is currently lacking. In the past decades an enormous amount of knowledge has been obtained concerning the involved molecular pathways, introducing potential targets for disease modifying therapy.<br/> AIM: To present an overview of the development of targeted treatment for fxs.<br/> METHOD: Several important publications were collected and indexed.<br/> RESULTS: While preclinical animal model studies with targeted interventions are promising, the translation to the clinic has been disappointing.<br/> CONCLUSION: Targeted treatment for fxs is necessary and could be applied in other causes of autism spectrum disorders and intellectual disability. Factors relating to translation, study design and outcome measures are possibly contributing to the disappointing results. The clustering of patient care in a center of expertise is required to clinically implement future therapeutic strategies and to facilitate research. In addition, this improves patient care, one example being the recent medical guideline for children with fxs.
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36
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Eijlers R, Legerstee JS, Dierckx B, Staals LM, Berghmans J, van der Schroeff MP, Wijnen RM, Utens EM. Development of a Virtual Reality Exposure Tool as Psychological Preparation for Elective Pediatric Day Care Surgery: Methodological Approach for a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e174. [PMID: 28893727 PMCID: PMC5613189 DOI: 10.2196/resprot.7617] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/09/2017] [Accepted: 06/11/2017] [Indexed: 01/18/2023] Open
Abstract
Background Preoperative anxiety in children is highly prevalent and is associated with adverse outcomes. Existing psychosocial interventions to reduce preoperative anxiety are often aimed at distraction and are of limited efficacy. Gradual exposure is a far more effective way to reduce anxiety. Virtual reality (VR) provides a unique opportunity to gradually expose children to all aspects of the operating theater. Objective The aims of our study are (1) to develop a virtual reality exposure (VRE) tool to prepare children psychologically for surgery; and (2) to examine the efficacy of the VRE tool in a randomized controlled trial (RCT), in which VRE will be compared to care as usual (CAU). Methods The VRE tool is highly realistic and resembles the operating room environment accurately. With this tool, children will not only be able to explore the operating room environment, but also get accustomed to general anesthesia procedures. The PREoperative Virtual reality Intervention to Enhance Wellbeing (PREVIEW) study will be conducted. In this single-blinded RCT, 200 consecutive patients (aged 4 to 12 years) undergoing elective day care surgery for dental, oral, or ear-nose-throat problems, will be randomly allocated to the preoperative VRE intervention or CAU. The primary outcome is change in child state anxiety level between baseline and induction of anesthesia. Secondary outcome measures include child’s postoperative anxiety, emergence delirium, postoperative pain, use of analgesics, health care use, and pre- and postoperative parental anxiety. Results The VRE tool has been developed. Participant recruitment began March 2017 and is expected to be completed by September 2018. Conclusions To our knowledge, this is the first RCT evaluating the effect of a VRE tool to prepare children for surgery. The VRE intervention is expected to significantly diminish preoperative anxiety, postoperative pain, and the use of postoperative analgesics in pediatric patients. The tool could create a less stressful experience for both children and their parents, in line with the modern emphasis on patient- and family-centered care. Trial Registration Netherlands Trial Registry: NTR6116; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6116 (Archived by WebCite at http://www.webcitation.org/6ryke7aep)
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Affiliation(s)
- Robin Eijlers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center (Erasmus MC) Sophia Children's Hospital, Rotterdam, Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center (Erasmus MC) Sophia Children's Hospital, Rotterdam, Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center (Erasmus MC) Sophia Children's Hospital, Rotterdam, Netherlands
| | - Lonneke M Staals
- Department of Anesthesiology, Erasmus University Medical Center (Erasmus MC) Sophia Children's Hospital, Rotterdam, Netherlands
| | - Johan Berghmans
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center (Erasmus MC) Sophia Children's Hospital, Rotterdam, Netherlands.,Department of Anesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Marc P van der Schroeff
- Dutch Craniofacial Center, Erasmus University Medical Center (Erasmus MC), Rotterdam, Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center (Erasmus MC) Sophia Children's Hospital, Rotterdam, Netherlands
| | - Rene Mh Wijnen
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center (Erasmus MC) Sophia Children's Hospital, Rotterdam, Netherlands
| | - Elisabeth Mwj Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center (Erasmus MC) Sophia Children's Hospital, Rotterdam, Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands.,Academic Center for Child Psychiatry De Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, Netherlands
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37
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Nolte IM, Munoz ML, Tragante V, Amare AT, Jansen R, Vaez A, von der Heyde B, Avery CL, Bis JC, Dierckx B, van Dongen J, Gogarten SM, Goyette P, Hernesniemi J, Huikari V, Hwang SJ, Jaju D, Kerr KF, Kluttig A, Krijthe BP, Kumar J, van der Laan SW, Lyytikäinen LP, Maihofer AX, Minassian A, van der Most PJ, Müller-Nurasyid M, Nivard M, Salvi E, Stewart JD, Thayer JF, Verweij N, Wong A, Zabaneh D, Zafarmand MH, Abdellaoui A, Albarwani S, Albert C, Alonso A, Ashar F, Auvinen J, Axelsson T, Baker DG, de Bakker PIW, Barcella M, Bayoumi R, Bieringa RJ, Boomsma D, Boucher G, Britton AR, Christophersen I, Dietrich A, Ehret GB, Ellinor PT, Eskola M, Felix JF, Floras JS, Franco OH, Friberg P, Gademan MGJ, Geyer MA, Giedraitis V, Hartman CA, Hemerich D, Hofman A, Hottenga JJ, Huikuri H, Hutri-Kähönen N, Jouven X, Junttila J, Juonala M, Kiviniemi AM, Kors JA, Kumari M, Kuznetsova T, Laurie CC, Lefrandt JD, Li Y, Li Y, Liao D, Limacher MC, Lin HJ, Lindgren CM, Lubitz SA, Mahajan A, McKnight B, Zu Schwabedissen HM, Milaneschi Y, Mononen N, Morris AP, Nalls MA, Navis G, Neijts M, Nikus K, North KE, O'Connor DT, Ormel J, Perz S, Peters A, Psaty BM, Raitakari OT, Risbrough VB, Sinner MF, Siscovick D, Smit JH, Smith NL, Soliman EZ, Sotoodehnia N, Staessen JA, Stein PK, Stilp AM, Stolarz-Skrzypek K, Strauch K, Sundström J, Swenne CA, Syvänen AC, Tardif JC, Taylor KD, Teumer A, Thornton TA, Tinker LE, Uitterlinden AG, van Setten J, Voss A, Waldenberger M, Wilhelmsen KC, Willemsen G, Wong Q, Zhang ZM, Zonderman AB, Cusi D, Evans MK, Greiser HK, van der Harst P, Hassan M, Ingelsson E, Järvelin MR, Kääb S, Kähönen M, Kivimaki M, Kooperberg C, Kuh D, Lehtimäki T, Lind L, Nievergelt CM, O'Donnell CJ, Oldehinkel AJ, Penninx B, Reiner AP, Riese H, van Roon AM, Rioux JD, Rotter JI, Sofer T, Stricker BH, Tiemeier H, Vrijkotte TGM, Asselbergs FW, Brundel BJJM, Heckbert SR, Whitsel EA, den Hoed M, Snieder H, de Geus EJC. Genetic loci associated with heart rate variability and their effects on cardiac disease risk. Nat Commun 2017; 8:15805. [PMID: 28613276 PMCID: PMC5474732 DOI: 10.1038/ncomms15805] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/08/2017] [Indexed: 01/15/2023] Open
Abstract
Reduced cardiac vagal control reflected in low heart rate variability (HRV) is associated with greater risks for cardiac morbidity and mortality. In two-stage meta-analyses of genome-wide association studies for three HRV traits in up to 53,174 individuals of European ancestry, we detect 17 genome-wide significant SNPs in eight loci. HRV SNPs tag non-synonymous SNPs (in NDUFA11 and KIAA1755), expression quantitative trait loci (eQTLs) (influencing GNG11, RGS6 and NEO1), or are located in genes preferentially expressed in the sinoatrial node (GNG11, RGS6 and HCN4). Genetic risk scores account for 0.9 to 2.6% of the HRV variance. Significant genetic correlation is found for HRV with heart rate (-0.74<rg<-0.55) and blood pressure (-0.35<rg<-0.20). These findings provide clinically relevant biological insight into heritable variation in vagal heart rhythm regulation, with a key role for genetic variants (GNG11, RGS6) that influence G-protein heterotrimer action in GIRK-channel induced pacemaker membrane hyperpolarization.
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Affiliation(s)
- Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - M Loretto Munoz
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Vinicius Tragante
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands
| | - Azmeraw T Amare
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands.,Department of Epidemiology, School of Medicine, University of Adelaide, Adelaide, South Australia 5005, Australia.,College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar 6000, Ethiopia
| | - Rick Jansen
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center/GGZ inGeest, Amsterdam 1081 BT, The Netherlands
| | - Ahmad Vaez
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands.,School of Medicine, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Benedikt von der Heyde
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala 75237, Sweden.,Science for Life Laboratory, Uppsala University, Uppsala 75237, Sweden
| | - Christy L Avery
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington 98104, USA
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Department of Child and Adolescent Psychiatry, PO Box 2060, Rotterdam 3000 CB, The Netherlands.,The Generation R Study Group, Erasmus MC, PO Box 2060, Rotterdam 3000 CB, The Netherlands
| | - Jenny van Dongen
- Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands
| | - Stephanie M Gogarten
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA
| | | | - Jussi Hernesniemi
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere 33520, Finland.,Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere 33014, Finland.,Department of Cardiology, Heart Hospital, Tampere University Hospital, Tampere 33521, Finland
| | - Ville Huikari
- Center for Life Course Health Research, University of Oulu, Oulu 90014, Finland
| | - Shih-Jen Hwang
- Framingham Heart Study, Framingham, Massachusetts 01702, USA.,Population Sciences Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland 20892, USA
| | - Deepali Jaju
- Department of Clinical Physiology, Sultan Qaboos University Hospital, Muscat-Al Khoudh 123, Sultanate of Oman
| | - Kathleen F Kerr
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale) 06097, Germany
| | - Bouwe P Krijthe
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2060, Rotterdam 3000 CB, The Netherlands
| | - Jitender Kumar
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala 75237, Sweden.,Science for Life Laboratory, Uppsala University, Uppsala 75237, Sweden
| | - Sander W van der Laan
- Laboratory of Experimental Cardiology, Department of Heart and Lung, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere 33520, Finland.,Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere 33014, Finland
| | - Adam X Maihofer
- Department of Psychiatry, University of California, San Diego, San Diego, California 92093, USA.,Center for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, California 92161, USA
| | - Arpi Minassian
- Department of Psychiatry, University of California, San Diego, San Diego, California 92093, USA.,Center for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, California 92161, USA
| | - Peter J van der Most
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Martina Müller-Nurasyid
- Institute of Genetic Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg 85764, Germany.,Department of Medicine, University Hospital Munich, Ludwig-Maximilians-University, Munich 80539, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich 80336, Germany
| | - Michel Nivard
- Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands.,EMGO+ Institute for Health and Care Research, VU University &VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Erika Salvi
- Department of Health Sciences, University of Milano, Milano 20122, Italy
| | - James D Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599, USA.,Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Julian F Thayer
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, Ohio 43210, USA
| | - Niek Verweij
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing, University College London, 33 Bedford Place, London WC1B 5JU, UK
| | - Delilah Zabaneh
- Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK.,University College London Genetics Institute, University College London, London WC1E 6BT, UK
| | - Mohammad H Zafarmand
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam 1105 AZ, The Netherlands.,Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Abdel Abdellaoui
- Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands.,EMGO+ Institute for Health and Care Research, VU University &VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Sulayma Albarwani
- Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat Al-Khoudh 123, Sultanate of Oman
| | - Christine Albert
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA
| | - Foram Ashar
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, Oulu 90014, Finland.,Unit of Primary Health Care, Oulu University Hospital, Oulu 90220, Finland
| | - Tomas Axelsson
- Department of Medical Sciences, Molecular Medicine, Uppsala University, Uppsala 75237, Sweden
| | - Dewleen G Baker
- Center for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, California 92161, USA.,Department of Psychiatry, University of California, San Diego, San Diego, California 92093, USA
| | - Paul I W de Bakker
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matteo Barcella
- Department of Health Sciences, University of Milano, Milano 20122, Italy
| | - Riad Bayoumi
- College of Medicine, Mohammed Bin Rashid University, PO Box 505055, Dubai Healthcare City, United Arab Emirates
| | - Rob J Bieringa
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Dorret Boomsma
- Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands.,EMGO+ Institute for Health and Care Research, VU University &VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | | | - Annie R Britton
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Ingrid Christophersen
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.,Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02114, USA.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Rud 1346, Norway
| | - Andrea Dietrich
- Department of Child- and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - George B Ehret
- Center for Complex Disease Genomics, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.,Cardiology, Department of Specialties of Internal Medicine, Geneva University Hospital, Geneva 1211, Switzerland
| | - Patrick T Ellinor
- Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02114, USA.,Cardiac Arrhythmia Service &Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Markku Eskola
- Department of Cardiology, Heart Hospital, Tampere University Hospital, Tampere 33521, Finland.,Department of Cardiology, University of Tampere School of Medicine, Tampere 33014, Finland
| | - Janine F Felix
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2060, Rotterdam 3000 CB, The Netherlands
| | - John S Floras
- University Health Network and Mount Sinai Hospital Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada M5S.,Toronto General Research Institute, University Health Network, Toronto, Canada
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2060, Rotterdam 3000 CB, The Netherlands
| | - Peter Friberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Maaike G J Gademan
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Mark A Geyer
- Department of Psychiatry, University of California, San Diego, San Diego, California 92093, USA
| | - Vilmantas Giedraitis
- Department of Public Health and Caring Sciences, Molecular Geriatrics, Uppsala University, Uppsala 75237, Sweden
| | - Catharina A Hartman
- Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Daiane Hemerich
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands.,CAPES Foundation, Ministry of Education of Brazil, Brasília DF 70040-020, Brazil
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2060, Rotterdam 3000 CB, The Netherlands
| | - Jouke-Jan Hottenga
- Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands.,EMGO+ Institute for Health and Care Research, VU University &VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu 90220, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, Tampere University Hospital, Tampere 33521, Finland.,Department of Pediatrics, University of Tampere School of Medicine, Tampere 33014, Finland
| | - Xavier Jouven
- INSERM U970, Paris Descartes University, Paris 75006, France
| | - Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu 90220, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku 20520, Finland.,Division of Medicine, Turku University Hospital, Turku 20521, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu 90220, Finland
| | - Jan A Kors
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam 3015 CE, The Netherlands
| | - Meena Kumari
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK.,ISER, Essex University, Colchester, Essex CO4 3SQ, UK
| | - Tatiana Kuznetsova
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven 3000, Belgium
| | - Cathy C Laurie
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA
| | - Joop D Lefrandt
- Department of Internal Medicine, Division of Vascular Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Yong Li
- Division of Genetic Epidemiology, Institute for Medical Biometry and Statistics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79110, Germany
| | - Yun Li
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina 27599, USA.,Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina 27599, USA.,Department of Computer Science, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Duanping Liao
- Division of Epidemiology, Department of Public Health Sciences, Penn State University College of Medicine, Hershey, Pennsylvania 17033, USA
| | - Marian C Limacher
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida 32611, USA
| | - Henry J Lin
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA.,Division of Medical Genetics, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - Cecilia M Lindgren
- Li Ka Shing Centre for Health Information and Discovery, The Big Data Institute, University of Oxford, Oxford OX3 7BN, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Steven A Lubitz
- Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02114, USA.,Cardiac Arrhythmia Service &Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Anubha Mahajan
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Barbara McKnight
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington 98104, USA.,Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA
| | | | - Yuri Milaneschi
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center/GGZ inGeest, Amsterdam 1081 BT, The Netherlands
| | - Nina Mononen
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere 33520, Finland.,Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere 33014, Finland
| | - Andrew P Morris
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK.,Department of Biostatistics, University of Liverpool, Liverpool L69 3GL, UK
| | - Mike A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Melanie Neijts
- Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands.,EMGO+ Institute for Health and Care Research, VU University &VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Kjell Nikus
- Department of Cardiology, Heart Hospital, Tampere University Hospital, Tampere 33521, Finland.,Department of Cardiology, University of Tampere, School of Medicine, Tampere 33014, Finland
| | - Kari E North
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599, USA.,Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Daniel T O'Connor
- Department of Medicine, University of California, San Diego, San Diego, California 92093, USA
| | - Johan Ormel
- Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Siegfried Perz
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg 85764, Germany
| | - Annette Peters
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich 80336, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg 85764, Germany.,German Center for Diabetes Research, Neuherberg 85764, Germany
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington 98104, USA.,Departments of Epidemiology and Health Services, University of Washington, Seattle, Washington 98195, USA.,Group Health Research Institute, Group Health Cooperative, Seattle, Washington 98101, USA
| | - Olli T Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku 20521, Finland.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku 20520, Finland
| | - Victoria B Risbrough
- Department of Psychiatry, University of California, San Diego, San Diego, California 92093, USA.,Center for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, California 92161, USA
| | - Moritz F Sinner
- Department of Medicine, University Hospital Munich, Ludwig-Maximilians-University, Munich 80539, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich 80336, Germany
| | - David Siscovick
- The New York Academy of Medicine, New York, New York 10029, USA
| | - Johannes H Smit
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center/GGZ inGeest, Amsterdam 1081 BT, The Netherlands
| | - Nicholas L Smith
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington 98101, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington 98195, USA.,Seattle Epidemiologic Research and Information Center, Veterans Affairs Office of Research and Development, Seattle, Washington 98108, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Division of Cardiology, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington 98101, USA
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven 3000, Belgium
| | - Phyllis K Stein
- Heart Rate Variability Lab, Washington University School of Medicine, St Louis, Missouri 63108, USA
| | - Adrienne M Stilp
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Cracow 31-008, Poland
| | - Konstantin Strauch
- Institute of Genetic Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg 85764, Germany.,Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich 81377, Germany
| | - Johan Sundström
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala 751 85, Sweden
| | - Cees A Swenne
- Department of Cardiology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - Ann-Christine Syvänen
- Department of Medical Sciences, Molecular Medicine, Uppsala University, Uppsala 75237, Sweden
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montreal, Quebec, Canada H1T 1C8.,Université de Montréal, Montreal, Quebec, Canada H3T IJ4
| | - Kent D Taylor
- Institute for Translational Genomics and Population Sciences, Departments of Pediatrics and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90509, USA
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald 17475, Germany
| | - Timothy A Thornton
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA
| | - Lesley E Tinker
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2060, Rotterdam 3000 CB, The Netherlands.,Department of Internal Medicine, Erasmus University Medical Center, Rotterdam 3015 CE, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging NCHA), Leiden 2300 RC, The Netherlands
| | - Jessica van Setten
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands
| | - Andreas Voss
- Institute of Innovative Health Technologies-IGHT Jena Ernst-Abbe-Hochschule Jena, Jena 07745, Germany
| | - Melanie Waldenberger
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg 85764, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg 85764, Germany
| | - Kirk C Wilhelmsen
- Departments of Genetics and Neurology University of North Carolina, Chapel Hill, North Carolina 27599, USA.,The Renaissance Computing Institute, Chapel Hill, North Carolina 27599, USA
| | - Gonneke Willemsen
- Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands.,EMGO+ Institute for Health and Care Research, VU University &VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Quenna Wong
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA
| | - Zhu-Ming Zhang
- Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA.,Department of Epidemiology &Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland 21224, USA
| | - Daniele Cusi
- Institute of Biomedical Technologies, CNR-Italian National Research Council, Milan 20090, Italy.,KOS Genetic SRL, Bresso (Milano) 20091, Italy
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland 21224, USA
| | - Halina K Greiser
- German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg 69210, Germany
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Mohammad Hassan
- Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat Al-Khoudh 123, Sultanate of Oman
| | - Erik Ingelsson
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala 75237, Sweden.,Science for Life Laboratory, Uppsala University, Uppsala 75237, Sweden.,Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California 94305, USA
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, University of Oulu, Oulu 90014, Finland.,Unit of Primary Health Care, Oulu University Hospital, Oulu 90220, Finland.,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, St Mary's campus, Imperial College London, London W2 1PG, UK.,Biocenter Oulu University of Oulu, Oulu 90014, Finland
| | - Stefan Kääb
- Department of Medicine, University Hospital Munich, Ludwig-Maximilians-University, Munich 80539, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich 80336, Germany
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, Tampere 33521, Finland.,Department of Clinical Physiology, University of Tampere, School of Medicine, Tampere 33014, Finland
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Charles Kooperberg
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing, University College London, 33 Bedford Place, London WC1B 5JU, UK
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere 33520, Finland.,Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere 33014, Finland
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala 751 85, Sweden
| | - Caroline M Nievergelt
- Department of Psychiatry, University of California, San Diego, San Diego, California 92093, USA.,Center for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, California 92161, USA
| | - Chris J O'Donnell
- Framingham Heart Study, Framingham, Massachusetts 01702, USA.,Population Sciences Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland 20892, USA.,Cardiology Section, Boston Veteran's Administration Healthcare, Boston, Maryland 02132, USA
| | - Albertine J Oldehinkel
- Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Brenda Penninx
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center/GGZ inGeest, Amsterdam 1081 BT, The Netherlands
| | - Alexander P Reiner
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington 98195, USA
| | - Harriëtte Riese
- Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Arie M van Roon
- Department of Internal Medicine, Division of Vascular Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - John D Rioux
- Montreal Heart Institute, Montreal, Quebec, Canada H1T 1C8.,Université de Montréal, Montreal, Quebec, Canada H3T IJ4
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Departments of Pediatrics and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90509, USA
| | - Tamar Sofer
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington 98195, USA
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2060, Rotterdam 3000 CB, The Netherlands.,Inspectorate for Health Care, The Hague 2511 VX, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Department of Child and Adolescent Psychiatry, PO Box 2060, Rotterdam 3000 CB, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2060, Rotterdam 3000 CB, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands.,Institute of Cardiovascular Science, University College London, 222 Euston Road, London NW1 2DA, UK.,Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht 3501 DG, The Netherlands
| | - Bianca J J M Brundel
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1118, Amsterdam 1081 HV, The Netherlands
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington 98104, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington 98195, USA
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599, USA.,Department of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Marcel den Hoed
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala 75237, Sweden.,Science for Life Laboratory, Uppsala University, Uppsala 75237, Sweden
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Eco J C de Geus
- Department of Biological Psychology, Behavioral and Movement Sciences, VU University, Amsterdam 1081 BT, The Netherlands.,EMGO+ Institute for Health and Care Research, VU University &VU University Medical Center, Amsterdam 1081 HV, The Netherlands
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Abstract
OBJECTIVE The objective was to estimate the age of onset (AOO) for all anxiety disorders and for specific subtypes. Gender differences in the AOO of anxiety disorders were examined, as were the influence of study characteristics on reported AOOs. METHODS Seven electronic databases were searched up to October 2014, with keywords representing anxiety disorder subtypes, AOO, and study design. The inclusion criteria were studies using a general population sample that provided data on the AOO for all anxiety disorders, or specific anxiety disorders, according to DSM-III-R, DSM-IV, or ICD-10 criteria. RESULTS There were 1028 titles examined, which yielded 24 studies meeting the inclusion criteria. Eight studies reported the AOO and gender. Meta-analysis found a mean AOO of all anxiety disorders of 21.3 years (95% CI 17.46 to 25.07). Separation anxiety disorder, specific phobia, and social phobia had their mean onset before the age of 15 years, whereas the AOO of agoraphobia, obsessive-compulsive disorder, posttraumatic stress disorder, panic disorder, and generalized anxiety disorder began, on average, between 21.1 and 34.9 years. Meta-analysis revealed no difference in the AOO between genders. A prospective study design and higher developmental level of the study country were associated with an earlier AOO. CONCLUSIONS Results from this meta-analysis indicate that anxiety disorder subtypes differ in the mean AOO, with onsets ranging from early adolescence to young adulthood. These findings suggest that prevention strategies of anxiety disorders should be directed towards factors associated with the development of anxiety disorder subtypes in the age groups with the greatest vulnerability for developing those disorders.
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Affiliation(s)
- Jasmijn M. de Lijster
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Elisabeth M.W.J. Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Frank C. Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Carola Zieldorff
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Gwen C. Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Jeroen S. Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
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Landuyt G, Dierckx B, de Nijs PFA, Dieleman GC. [Treatment options for paediatric trichotillomania]. Tijdschr Psychiatr 2016; 58:463-470. [PMID: 27320510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Trichotillomania (TTM) is a psychiatric condition that first manifests itself in infancy and adolescence. If untreated, the condition can become chronic. TTM places a considerable burden on the individual patient. The condition is often linked to social isolation and the emergence of somatic and psychiatric comorbidity. Nevertheless, investment in research, particularly in the pharmacotherapeutical area, has been rather limited. AIM To provide an overview of the phenomenology of TTM, the associated comorbidity and the therapies available for treating this underexposed child psychiatric disorder. METHOD We searched PubMed using the the MeSH term 'trichotillomania/therapy' and located 49 relevant articles. RESULTS We found 49 usable articles. Selective serotonine reuptake inhibitors (SSRIs) are the most frequently prescribed drugs for the treatment of pediatric TTM, although their efficacy is not yet proven. The results of a meta-analysis of several SSRIs did not differ significantly from the results obtained with patients who had been prescribed only placebos. The efficacy of SSRIs in youths has not been studied yet. A meta-analysis of clomipramine with adult TTM patients did show a statistical difference with the control group. The efficacy of clomipramine in youths has not yet been studied. In a randomised controlled trial (RCT), treatment of adult TTM patients with olanzapine proved to be more effective than placebos. Despite this RCT and the positive results of open-label studies with pimozide and haloperidol in adults, there is no research available concerning the efficacy of antipsychotics in children and youths. In an RCT with 7-8 year-olds, cognitive behavioural therapy was found to decrease the symptoms in 75% of the participants. CONCLUSION For now there's only evidence for HRT as effective intervention in children and youths with TTM.
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Wijma RA, van der Nagel BCH, Dierckx B, Dieleman GC, Touw DJ, van Gelder T, Koch BCP. Identification and quantification of the antipsychotics risperidone, aripiprazole, pipamperone and their major metabolites in plasma using ultra-high performance liquid chromatography-mass spectrometry. Biomed Chromatogr 2015; 30:794-801. [PMID: 26447610 DOI: 10.1002/bmc.3610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/12/2015] [Accepted: 08/31/2015] [Indexed: 01/07/2023]
Abstract
The antipsychotics risperidone, aripiprazole and pipamperone are frequently prescribed for the treatment in children with autism. The aim of this study was to validate an ultra-high performance liquid chromatography-mass spectrometry method for the quantification of these antipsychotics in plasma. An ultra-high performance liquid chromatography-mass spectrometry assay was developed for the determination of the drugs and metabolites. Gradient elution was performed on a reversed-phase column with a mobile phase consisting of ammonium acetate, formic acid in methanol or in Milli-Q ultrapure water at a flow rate of 0.5 mL/min. The method was validated according to the US Food and Drug Administration guidelines. The analytes were found to be stable enough after reconstitution and injection of only 5 μL improved the accuracy and precision in combination with the internal standard. Calibration curves of all five analytes were linear. All analytes were stable for at least 72 h in the autosampler and the high quality control of 9-OH-risperidone was stable for 48 h. The method allows quantification of all analytes. The advantage of this method is the combination of a minimal injection volume, a short run-time, an easy sample preparation method and the ability to quantify all analytes in one run. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rixt A Wijma
- Department of Hospital Pharmacy, Erasmus MC, Postal Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Bart C H van der Nagel
- Department of Hospital Pharmacy, Erasmus MC, Postal Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry, Erasmus MC, Postal box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Gwen C Dieleman
- Department of Child and Adolescent Psychiatry, Erasmus MC, Postal box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology University Medical Center Groningen, Postal Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Teun van Gelder
- Department of Hospital Pharmacy and Internal Medicine, Erasmus MC, Postal Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus MC, Postal Box 2040, 3000 CA, Rotterdam, The Netherlands
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Dierckx B, Kok R, Tulen JH, Jaddoe VW, Hofman A, Verhulst FC, Bakermans-Kranenburg MJ, van Ijzendoorn MH, Tiemeier H. A prospective study of heart rate and externalising behaviours in young children. Int J Psychophysiol 2014. [DOI: 10.1016/j.ijpsycho.2014.08.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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42
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Dierckx B, Kok R, Tulen JH, Jaddoe VW, Hofman A, Verhulst FC, Bakermans-Kranenburg MJ, van Ijzendoorn MH, Tiemeier H. A prospective study of heart rate and externalising behaviours in young children. J Child Psychol Psychiatry 2014; 55:402-10. [PMID: 24795956 DOI: 10.1111/jcpp.12175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Low heart rate predicts externalising and delinquent behaviour in adults, adolescents and school-age children. In younger children the evidence is less clear. Moreover, the specificity of the relation between the autonomic nervous system and different forms of externalising behaviour is uncertain. We investigated the longitudinal relation between resting mean heart rate and different externalising behaviours. METHODS In 412 children of the Generation R Study, we measured resting mean heart rate at 14 months. At 3 years, child problem behaviour was assessed by the mother with the Child Behavior Checklist. In a gift delay task, we observed whether children were compliant and whether they lied about their noncompliance. The association of heart rate with behaviour was contrasted with the effect of harsh parenting. RESULTS In our main analysis, we examined the association between heart rate and reported and observed child behaviour. For comparison, the association of heart rate with behaviour was contrasted with the effect of harsh parenting. Mean heart rate was positively associated with Anxious/Depressed scale scores (β = .1, 95% CI = 0.01; 0.2, p = .04), but not with Aggressive Behaviour (β = .02; 95% CI = −0.1; 0.1, p = .8) nor Attention Problem scale scores (β = .08, 95% CI = −0.3; 0.5, p = .8). We could not demonstrate an association between mean heart rate and noncompliance during the gift delay task (OR = 1.14, 95% CI = 0.9; 1.1, p = .2), but lower heart rate predicted higher odds of the child lying (OR = 0.56, 95% CI = 0.3; 0.9, p = .03). In contrast, harsh parenting was associated with mother-reported Aggressive Behaviour (β = .7, 95% CI = 0.4; 0.9, p < .001) and Attention Problems (β = .2, 95% CI = 0.1; 0.3, p < .001), but not with observed lying (OR = 1.03, 95% CI = 0.8; 1.4, p = .8). CONCLUSIONS Lower resting mean heart rate at age 14 months predicts low anxiety symptoms and higher odds of lying at age 3 years. Low resting mean heart rate may be less an indicator of early childhood aggression than of fearless behaviour.
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Affiliation(s)
- Bram Dierckx
- The Generation R Study Group; Erasmus MC University Medical Centre; Rotterdam The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology; Erasmus MC University Medical Centre; Rotterdam The Netherlands
| | - Rianne Kok
- Centre for Child and Family Studies; Leiden University; Leiden The Netherlands
| | - Joke H.M. Tulen
- Department of Psychiatry; Erasmus MC University Medical Centre; Rotterdam The Netherlands
| | - Vincent W. Jaddoe
- The Generation R Study Group; Erasmus MC University Medical Centre; Rotterdam The Netherlands
- Department of Epidemiology; Erasmus MC University Medical Centre; Rotterdam The Netherlands
- Department of Paediatrics; Erasmus MC University Medical Centre; Rotterdam The Netherlands
| | - Albert Hofman
- Department of Epidemiology; Erasmus MC University Medical Centre; Rotterdam The Netherlands
| | - Frank C. Verhulst
- Department of Child and Adolescent Psychiatry/Psychology; Erasmus MC University Medical Centre; Rotterdam The Netherlands
| | | | - Marinus H. van Ijzendoorn
- Centre for Child and Family Studies; Leiden University; Leiden The Netherlands
- School for Pedagogical and Educational Sciences; Erasmus University Rotterdam; Rotterdam The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology; Erasmus MC University Medical Centre; Rotterdam The Netherlands
- Department of Psychiatry; Erasmus MC University Medical Centre; Rotterdam The Netherlands
- Department of Epidemiology; Erasmus MC University Medical Centre; Rotterdam The Netherlands
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Tharner A, Dierckx B, Luijk MPCM, van Ijzendoorn MH, Bakermans-Kranenburg MJ, van Ginkel JR, Moll HA, Jaddoe VWV, Hofman A, Hudziak JJ, Verhulst FC, Tiemeier H. Attachment disorganization moderates the effect of maternal postnatal depressive symptoms on infant autonomic functioning. Psychophysiology 2012; 50:195-203. [PMID: 23252764 DOI: 10.1111/psyp.12003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 09/27/2012] [Indexed: 11/29/2022]
Abstract
We examined associations of disorganized attachment and maternal depressive symptoms with infant autonomic functioning in 450 infant-mother dyads enrolled in the Generation R study. Maternal depressive symptoms were measured 2 months postpartum with the Brief Symptom Inventory. At 14 months, we assessed infant attachment with a slightly shortened Strange Situation and measured infant resting heart rate. Respiratory sinus arrhythmia (RSA) was calculated using spectral analysis. Higher levels of maternal postnatal depressive symptoms predicted lower resting RSA in disorganized infants (B = -0.31, SE = 0.15, p = .04, R(2) = .05) but not in nondisorganized infants (B = 0.05, SE = 0.06, p = .36). This effect was buffered in disorganized infants with a secondary secure attachment classification. Disorganized infants were more vulnerable to the effect of maternal postnatal depressive symptoms on the physiological stress systems.
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Affiliation(s)
- Anne Tharner
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
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Dierckx B, Dieleman G, Tulen JHM, Treffers PDA, Utens EMWJ, Verhulst FC, Tiemeier H. Persistence of anxiety disorders and concomitant changes in cortisol. J Anxiety Disord 2012; 26:635-41. [PMID: 22609471 DOI: 10.1016/j.janxdis.2012.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 04/16/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
Abstract
In a clinical sample of 116 children and adolescents we studied the relation between the course of an anxiety disorder during treatment and the concomitant changes in cortisol levels. Assessments at baseline, after three months, and at one-year follow-up were performed with the Anxiety Disorders Interview Schedule. When we compared cortisol levels at baseline and one-year follow-up, persistence of the anxiety disorder was associated with both increased daytime cortisol production (F=3.2, p=0.04) and a trend towards a decreased cortisol morning rise (F=2.4, p=0.09). At one-year follow-up daytime cortisol production was lowest in the early remitters (109.7±29.2 h mmol/l), higher in the late remitters (121.0±40.0 h mmol/l) and highest in the non-remitters (131.1±48.9 h mmol/l). Early remitters had the highest cortisol morning rise (1.1±1.5 h mmol/l), followed by the late remitters (0.8±1.8 h mmol/l), the non-remitters had the lowest cortisol morning rise (0.07±1.7 h mmol/l). Persistence of an anxiety disorder may thus lead to changes in HPA-axis functioning, underscoring the importance adequate treatment of anxiety disorders.
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Affiliation(s)
- Bram Dierckx
- Department of Child and Adolescent Psychiatry, Erasmus MC, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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Abstract
OBJECTIVE Bipolar major depression differs considerably from unipolar major depression with regard to the efficacy of treatment with antidepressants. In bipolar depression, response to treatment with antidepressants is disappointing. Whether response to electroconvulsive therapy (ECT) differs between bipolar and unipolar depression remains unclear. Therefore, this systematic review investigates the relative efficacy of ECT in both forms of depression. METHODS Relevant cohort studies were identified from a systematic search of the PubMed electronic database. Six studies were included in this meta-analysis. RESULTS In this meta-analysis, the overall remission rate was 50.9% (n = 402/790) for patients with unipolar depression and 53.2% (n = 168/316) for patients with bipolar major depression. A pooled odds ratio (OR) and confidence interval (CI) were calculated using random-effects meta-analysis with the Mantel-Haenzel method. This analysis shows similar efficacy of ECT in patients with unipolar and bipolar depression (OR = 1.08, 95% CI: 0.75-1.57). CONCLUSION ECT appears to be equally effective for both bipolar and unipolar depression and the remission rates are encouraging, especially for bipolar depression.
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Affiliation(s)
- Bram Dierckx
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
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Dierckx B, Tharner A, Tulen JHM, Jaddoe VW, Hofman A, Verhulst FC, Tiemeier H. Spot the red herring: breastfeeding, fruitpurée, and infant autonomic functioning-the generation R study. Pediatr Res 2011; 70:417-22. [PMID: 21705963 DOI: 10.1203/pdr.0b013e31822a3389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Several studies have suggested that breastfeeding is related to infant autonomic functioning. The authors investigated whether this is a causal relation. In all, 444 mothers reported breastfeeding practices 2 mo postpartum. Infant autonomic functioning was assessed by heart rate variability at age 14 mo, after discontinuation of breastfeeding. The dose-dependent association between breastfeeding and infant autonomic functioning was tested with linear regression models adjusted for multiple confounders. The authors investigated the relation of fruitpurée consumption with infant autonomic functioning. Fruitpurée consumption has similar socioeconomic epiphenomena but is not related via the same causal mechanism to autonomic regulation as breastfeeding. Nonbreastfed infants had high sympathetic modulation [7.87 log (ms)/SD, 95% CI: 7.71-8.02], partially breastfed infants had intermediate sympathetic modulation [7.75 log (ms)/SD, 95% CI: 7.51-7.82], sympathetic modulation of exclusively breastfed infants was low [7.63 log (ms)/SD, 95% CI: 7.50-7.77]. However, this association could be explained by socioeconomic confounders. Furthermore, fruitpurée consumption was similarly associated with reduced infant sympathetic modulation. The association between breastfeeding practices and infant sympathetic modulation was accounted for by socioeconomic and environmental factors. We found a similar association between fruitpurée consumption and autonomic functioning, further suggesting that the association between breastfeeding and infant autonomic functioning is noncausal.
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Affiliation(s)
- Bram Dierckx
- The Generation R Study Group, Erasmus MC University Medical Center, Rotterdam, Zuid-Holland, 3000 CA, The Netherlands
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Legerstee JS, Tulen JHM, Dierckx B, Treffers PDA, Verhulst FC, Utens EMWJ. CBT for childhood anxiety disorders: differential changes in selective attention between treatment responders and non-responders. J Child Psychol Psychiatry 2010; 51:162-72. [PMID: 19744254 DOI: 10.1111/j.1469-7610.2009.02143.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study examined whether treatment response to stepped-care cognitive-behavioural treatment (CBT) is associated with changes in threat-related selective attention and its specific components in a large clinical sample of anxiety-disordered children. METHODS Ninety-one children with an anxiety disorder were included in the present study. Children received a standardized stepped-care CBT. Three treatment response groups were distinguished: initial responders (anxiety disorder free after phase one: child-focused CBT), secondary responders (anxiety disorder free after phase two: child-parent-focused CBT), and treatment non-responders. Treatment response was determined using a semi-structured clinical interview. Children performed a pictorial dot-probe task before and after stepped-care CBT (i.e., before phase one and after phase two CBT). RESULTS Changes in selective attention to severely threatening pictures, but not to mildly threatening pictures, were significantly associated with treatment success. At pre-treatment assessment, initial responders selectively attended away from severely threatening pictures, whereas secondary responders selectively attended toward severely threatening pictures. After stepped-care CBT, initial and secondary responders did not show any selectivity in the attentional processing of severely threatening pictures. Treatment non-responders did not show any changes in selective attention due to CBT. CONCLUSIONS Initial and secondary treatment responders showed a reduction of their predisposition to selectively attend away or toward severely threatening pictures, respectively. Treatment non-responders did not show any changes in selective attention. The pictorial dot-probe task can be considered a potentially valuable tool in assigning children to appropriate treatment formats as well as for monitoring changes in selective attention during the course of CBT.
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Affiliation(s)
- Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry, Erasmus Medical Centre Rotterdam/Children's Hospital, Dr. Molewaterplein 60, Rotterdam, The Netherlands
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