Atypical Antipsychotics Increase Cardiometabolic Risk in Children

A study of the adverse effects of 4 second-generation antipsychotics in children and adolescents documented substantial weight gain during 11 weeks of treatment with each agent, with the increased abdominal fat that has been associated with development of metabolic syndrome in adults. Metabolic abnormalities emerged with 3 of the 4 agents, differing in type and severity with the agent and, in some cases, with the dose.

In this analysis from the Second-Generation Antipsychotic Treatment Indications, Effectiveness and Tolerability in Youth (SATIETY) study, 10% to 36% of 272 patients between 4 and 19 years of age (mean, 13.9 years) who had not previously received antipsychotic medication became overweight or obese. There was minimal weight change in a comparison group of patients who had refused the agent, or who discontinued it within 4 weeks.1

Christoph Correll, MD, Zucker Hillside Hospital, Glen Oaks, NY, and colleagues conducted this observational cohort study as the largest to date of adverse experiences with second-generation antipsychotics in antipsychotic treatment–naive children. The researchers noted that there has been increasing use of these agents in younger patients for psychotic and bipolar disorders as well as nonpsychotic disorders, despite little available age-specific data on adverse reactions.

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Antidepressants cut risk of hospital readmission for suicidal youth

Suicidal adolescents who were prescribed an antidepressant medication during inpatient psychiatric hospital treatment were 85 percent less likely than others to be readmitted within a month after discharge, a new study found.

The results provide additional evidence that antidepressants may play a key role in helping improve the mental health of suicidal youth, said Cynthia Fontanella, co-author of the study and assistant professor of social work at Ohio State University.

The findings are especially important now, because antidepressant use dropped in 2003 after the Food and Drug Administration issued a black box warning that some antidepressants may increase the risk of suicidal behavior for pediatric patients. A black-box warning is the most serious type of warning in prescription drug labeling.

"We found that antidepressant treatment had a protective effect on readmission," Fontanella said. "Although the findings are preliminary, our results should be reassuring to child psychiatrists who may have been concerned about prescribing antidepressants since the FDA warning."

But another key finding from the study showed that hospitalized youth who were prescribed three or more medications from different drug classes for mental health issues had a 3-fold increased risk of being readmitted within a month of discharge.

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Weight Gain Associated With Antipsychotic Drugs

Young children and adolescents who take the newest generation of antipsychotic medications risk rapid weight gain and metabolic changes that could lead to diabetes, hypertension and other illnesses, according to the biggest study yet of first-time users of the drugs.

The study, to be published Wednesday in The Journal of the American Medical Association, found that 257 young children and adolescents in New York City and on Long Island added 8 to 15 percent to their weight after taking the pills for less than 12 weeks.

The patients, ages 4 to 19, added an average of one to one-and-a-half pounds a week.

“The degree of weight gain is alarming,” said Dr. Wayne K. Goodman, head of a Food and Drug Administration advisory panel on the drugs last summer and chairman of psychiatry at Mount Sinai School of Medicine in Manhattan. “The magnitude is stunning,” he said.

Although the drugs’ influence on weight and metabolism had been previously detected, Dr. Goodman, who was not involved in the study, said the speed and magnitude of the effects found in the study were greater than previously reported — findings he said were made possible by looking exclusively at new patients.

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Antidepressant Use in Children With Cancer What We Now Know (and Need to Know) About the Use of Antidepressants

In 2007, cancer was diagnosed in 10,400 children and adolescents under the age of 15 years.1 While cancer remains the second leading cause of death in children, increasing numbers of children with cancer are surviving into adulthood.2 Over the past 30 years, 5-year survival rates for children with cancer have significantly improved, from 59% in 1975 to 1977 to 80% in 1996 to 2004.3 Pediatric cancer, increasingly considered a chronic rather than an acute condition, is an intense emotional and physical experience for patients and their families.4

Comprehensive psychiatric assessment of these children is complicated by symptoms of medical comorbidities that overlap mental health conditions. Few resources exist to guide clinicians in the psychiatric treatment of children with cancer. This article describes the sparse research from small clinical studies on the extent of psychiatric treatment in children with cancer and evidence from outcome studies of medication use in these children. Minimal knowledge on the role of antidepressants in such children motivated us to examine the question in a broad population-based approach.

Psychopathology

One area of interest in caring for children with cancer is the prevalence of psychiatric diagnoses. Assessment of psychiatric disorders in these children from either research or community settings is difficult because of the complex medical and emotional presentation of illness.5,6 DSM-IV criteria for mood disorders, for example, include both somatic and cognitive symptom criteria, and clinicians must decide which symptoms are caused by the illness and treatment and which are related to a separate psychiatric diagnosis.7

In addition, doctors and nurses may overestimate psychosocial distress and symptoms in children and adolescents with cancer.6 Assessment tools for psychiatric disorders are not often validated in children with medical illnesses, which may lead in part to the varying research prevalence of psychiatric disorders in this population.8

Reports of psychiatric illness in children with cancer range from a high of 17% to rates that do not differ significantly from those for the general population.9 Specific cancers and their treatments may also contribute to the variable rates of depression. Without more precise estimates that generalize to large youth populations, it is unclear whether children with cancer are at higher risk for a psychiatric disorder than children who are not medically ill.

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Psychiatric Symptoms May Predict Internet Addiction In Adolescents

Adolescents with psychiatric symptoms such as attention-deficit/hyperactivity disorder (ADHD), social phobia, hostility and depression may be more likely to develop an Internet addiction, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Although the Internet has become one of the most significant information resources for adolescents, addiction to the Internet can negatively impact school performance, family relationships and adolescents' emotional state, according to background information in the article. "This phenomenon has been described as Internet addiction or problematic Internet use and classified as a possible behavior addiction," the authors write. Previous studies report that 1.4 percent to 17.9 percent of adolescents are addicted to the Internet in both Western and Eastern societies; therefore, there have been suggestions to add Internet and gaming addictions to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. "Identification of the risk factors for Internet addiction is therefore of clinical significance for the prevention of, and early intervention into, Internet addiction in adolescents."

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Bipolar Disorder Amongst Children And Adolescents Receive Late Diagnosis

A new study finds that 75% of the cases of paediatric bipolar disorder are diagnosed late – up to 18 months – due to the symptoms manifesting themselves in a different manner depending on whether the patient is a child or adult. Moreover, 25% of sufferers have a delay in their medical diagnoses of up to three years and four months, according to a study by the Department of Psychiatry and Medical Psychology at the University Hospital of Navarra, in collaboration with the Paediatric Psychopharmacology Unit at the Massachusetts General Hospital at Harvard University (Boston, United States).

As Dr. Inmaculada Escamilla Canales, specialist at the Madrid-based Child and Adolescent Psychiatry Unit of the University Hospital of Navarra explained, the research was based on an article previously published by her department in 2005 in which the perspectives of bipolar disorder amongst children outside the USA were reviewed. A very low incidence was observed in Europe compared to the North American samples, especially amongst certain countries. Also, in Great Britain, a study undertaken with a sufficiently representative sample concluded that the rate for this illness was non-existent.

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Study shows schools could help in reducing depression

Research by the University of Queensland has shown school intervention programs could help radically reduce the amount ofhttp://www.thetechherald.com/article.php/200930/4122/Study-shows-schools-could-help-in-reducing-depression being prescribed to adolescent boys.

School Counsellor Mark Taylor, who led the research, said that schools could help students deal with depression by teaching more conflict resolution and positive thinking, as well as encouraging more outdoor activities.

Dr Taylor said he was concerned not enough was being done to look at underlying conditions of adolescents' depression.

“Working in a school setting as a counsellor I became concerned about the numbers of students who were being prescribed antidepressants, without what I considered to be enough effort to find out what was going on in the lives of these students,” Dr Taylor said in a University of Queensland (UQ) news release.

“I wanted to substantiate that there are viable alternatives to antidepressants which can significantly reduce depressive symptoms.”

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Antipsychotic drugs appear to work in kids: FDA staff

Three antipsychotic drugs appear to work in children and teens but their risks must be weighed as the makers seek to promote them for younger patients, the head of the U.S. Food and Drug Administration's psychiatric division said in a memo released on Friday.

The FDA has yet to make a final decision on whether to approve drugs made by AstraZeneca, Pfizer and Eli Lilly and Co for children and teens with schizophrenia or bipolar disorder.

An FDA panel is to meet next week to give recommendations on the companies' bid to promote the drugs for children and teenagers with schizophrenia or bipolar disorder.

Doctors can already prescribe the medications for children, but FDA approval would allow the manufacturers to market them more widely.

The drugs, known as atypical antipsychotics, are widely used to treat various psychiatric conditions but have come under scrutiny for links to weight gain.

"We generally are in agreement that the sponsors have provided adequate support to suggest effectiveness," FDA's Thomas Laughren wrote in the memo released on Friday.

He added that the safety of the drugs in children appeared "to be qualitatively similar to those observed with these drugs in adult patients."

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The Depression Test By screening all teens, doctors hop to identify those with mental disorders

Soon after her sister committed suicide, Caroline Downing started doing poorly at school. During math tests she would freeze up, and she found her mind wandering constantly. Officials at St. Andrew's Episcopal School in Potomac gently suggested that the high school sophomore get a mental health screening.

The idea of a psychiatric evaluation sent chills down the spine of Caroline's mother, Mathy Milling Downing, who believed that her younger daughter, Candace, had committed suicide because of an adverse reaction linked to a psychiatric drug -- the antidepressant Zoloft. Shortly after Candace's death, the Food and Drug Administration placed black-box warnings on several antidepressants to say they elevated suicidal thinking among some children. If Caroline were going to get the same kind of mental health care as Candace, Downing wanted no part of it.

Downing's family offers a powerful case study into the pros and cons of new guidelines recommending widespread screening of adolescents for mental disorders: Last month, the U.S. Preventive Services Task Force, a federal group that makes public health recommendations, said that all adolescents between ages 12 and 18 should be screened for major depression. In March, the Institute of Medicine, which advises Congress on scientific matters, told policymakers that early screening was key to reducing the financial and medical burden of mental disorders in the United States.

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FDA approves antidepressant Lexapro for adolescents

The decision comes after Justice Department allegations that the drug's maker, Forest Laboratories, had improperly induced pediatricians to prescribe it and a similar pill, Celexa.


Just weeks after prosecutors accused Forest Laboratories Inc. of illegally marketing its antidepressants Celexa and Lexapro to children and paying pediatricians kickbacks, U.S. health regulators Friday approved Lexapro for depression in kids.

Forest said Lexapro was approved by the U.S. Food and Drug Administration to treat major depressive disorder in adolescents aged 12 to 17 and as a maintenance therapy to control symptoms. It is already approved for adults, and registers annual sales of more than $2 billion.

The FDA on Friday approved Lexapro's use for adolescents based on favorable results in two clinical trials -- one involving adolescents taking Lexapro and another involving children and adolescents taking the chemically similar Celexa, Forest said.

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No Long-Term Harm From Short-Term Placebo in Adolescent Depression Trials

Delaying active therapy for teens with major depression didn't impair long-term outcomes in the context of a clinical trial.

Patients on placebo for 12 weeks before switching to antidepressants or cognitive behavioral therapy showed no difference in 36-week response rate (82% versus 83%) compared with those on active treatment from the start of a large randomized trial, said Betsy D. Kennard, Psy.D., of the University of Texas Southwestern Medical Center at Dallas, and colleagues.

The 12-week delay in active therapy also had little impact on rates of suicidal events and symptom worsening, the researchers reported online in the American Journal of Psychiatry.

Although these findings support placebo treatment as an ethical course of action in a well-run pediatric clinical trial, Dr. Kennard emphasized that its use was not simply a matter of "wait and see" if a teen gets better.

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Preemies face some risk of psychiatric disorders

Results of a Swedish population-wide study hint that children born prematurely have some risk of developing anxiety, depression or other psychiatric disorder in adolescence and young adulthood.

Children born "preterm" should therefore be watched more closely for these disorders, the investigators suggest.

Among 545,628 Swedish residents born in the 1970s and followed up until 23 to 29 years of age, Dr. Karolina Lindstrom from Sachs Children's Hospital, Stockholm, and colleagues observed a stepwise increase in psychiatric hospital admissions with an increasing degree of preterm birth.

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Teen suicides have risen alarmingly. It doesn't have to be that way.

Yet the view persists that adolescents are somehow immune to the debilitating clinical depression that afflicts many adults. And such carefree-days-of-youth thinking on the part of some parents and caregivers can yield tragic results.

Teen suicides, which had been on a downward trajectory for the previous two decades, showed an 18 percent rise in 2004 over the previous year, according to a recent report by Journal of the American Medical Association. Although the rate dipped slightly in 2005, the most recent year charted, the number remains well above predicted levels.

As for depression, the World Health Organization reports that one in 33 children and, among them, one in eight teens, is clinically depressed. The organization predicts those numbers could double by 2020.

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Study rejects cost-effectiveness of CBT for adolescents

Cognitive behavioural therapy (CBT) for clinically depressed adolescents is not cost effective, researchers have found.

For those with moderate to severe major depression, the addition of CBT to drug therapy and active clinical care does not improve wellbeing enough to justify the cost, researchers have found.

The research team at the National Institute for Health Research Health Technology Assessment (NIHR HTA) compared the clinical benefits and cost-effectiveness of two treatments for depression.

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Study of Newer Antipsychotics Finds Risks for Youths

A new government study published Monday has found that the medicines most often prescribed for schizophrenia in children and adolescents are no more effective than older, less expensive drugs and are more likely to cause some harmful side effects. The standards for treating the disorder should be changed to include some older medications that have fallen out of use, the study’s authors said.

The results, being published online by The American Journal of Psychiatry, are likely to alter treatment for an estimated one million children and teenagers with schizophrenia and to intensify a broader controversy in child psychiatry over the newer medications, experts said.

Prescription rates for the newer drugs, called atypical antipsychotics, have increased more than fivefold for children over the past decades and a half, and doctors now use them to settle outbursts and aggression in children with a wide variety of diagnoses, despite serious side effects.

A consortium of state Medicaid directors is currently evaluating the use of these drugs in children on state Medicaid rolls, to ensure they are being prescribed properly.

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Youth Suicides Continue to Rise in U.S. - One reason may be reluctance to prescribe antidepressants, study suggests

Suicides among U.S. children appear to be on the rise after a 15-year decline, and the trend may owe, in part, to fewer teens being prescribed antidepressants, a new study suggests.

Researchers thought a spike in youth suicides in 2004 may have been an anomaly. But the new study found the increase in suicides continued during 2005.

Looking at suicide trends among youngsters over a 15-year period, Jeff Bridge, from Nationwide Children's Hospital in Columbus, Ohio, found the rates of suicide among youths aged 10 to 19 were higher in 2004 and 2005 than would have been expected, based on suicide rate trends from 1996 to 2003.

"This is significant, because pediatric suicide rates in the U.S. had been declining steadily for a decade until 2004, when the suicide rate among U.S. youth younger than 20 years of age increased by 18 percent, the largest single-year increase in the past 15 years," said Bridge, an investigator in the Center for Innovation in Pediatric Practice.

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Risks and benefits of antipsychotics in children and adolescents

Many of the psychiatric disorders observed in adults have their onset in childhood or adolescence. In fact some studies show that at least 20% of children and adolescents will fulfil a diagnostic criterion for a mental disorder before reaching adulthood. The presence of a major mental illness is certainly no less serious in children than in adults – in fact, childhood onset of several psychiatric disorders predicts a worse illness course. Early manifestations of mental disorders may substantially impact the child´s academic performance and achievement as well as his/her ability to develop age-appropriate social skills. Thus, appropriate identification and treatment of signs and symptoms of psychiatric illnesses during childhood and adolescence is critical for minimizing continued or additional psychiatric problems that put these children at risk later in life.

For many years old antipsychotics have been used for the treatment of conditions such as severe conduct disorders, Tourette syndrome, bipolar disorder and schizophrenia in children and adolescents. Treatment advances, particularly with the introduction of new-generation antipsychotic medications, have created a lot of expectations in the search for long-term, clinically effective treatments for this young population. The prescription of new-generation antipsychotics has become a widely accepted practice in the treatment of children and adolescents with psychotic disorders (Armenteros & David, 2006) and many other psychiatric conditions (Findling et al., 2005; Olfson et al., 2006). In fact, prescribing of new-generation antipsychotics has increased dramatically in recent years in the paediatric population (160% in the USA between 1990 and 2000) (Patel et al., 2005).

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Clues to Role of Brain Development as Risk for Mental Disorders May Also Lead to Better Treatments

Increasing evidence points to links between the timing and growth rates of specific brain areas in the young brain and the likelihood of developing a wide range of mental disorders later in life, say researchers convened by the National Institute of Mental Health ( NIMH ), a part of the National Institutes of Health. Included among these mental disorders are autism, anxiety, bipolar disorder, eating disorders, substance abuse, and attention deficit hyperactivity disorder ( ADHD ).

"Most psychiatric disorders, including those with adult onset such as schizophrenia, are increasingly recognized as being neurodevelopmental in origin," says NIMH's Jay Giedd, MD. "A greater understanding of the specifics of brain development, and where the path of development goes awry in illnesses, may be a key factor in devising better therapies."

The scientists spoke today at a press conference during the American Psychiatric Association Annual Meeting being held here.

A twenty-year ongoing longitudinal neuroimaging project of healthy children and adolescents being conducted at NIMH's child psychiatry branch shows the relationship between dynamic brain changes and the emergence of several classes of psychiatric disorders during adolescence.

The data set, which tracks participants aged three to 30 years every two years, consists of more than 6,000 magnetic resonance imaging ( MRI ) scans from 2,000 subjects. About half are from typically developing subjects and half have disorders such as attention deficit hyperactivity disorder, and childhood-onset schizophrenia. "The large number of typically developing subjects serves not only to provide a yardstick from which to assess developmental deviations but also because understanding the timing, mechanisms, and influences of healthy brain development may illuminate paths to intervention in illness," says Giedd, who oversees the study.

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Antipsychotic Prescribing For Children Has Risen Sharply

A research team set out to investigate the epidemiologic features of antibiotic prescribing to patients under the age of 18 by GPs (general practitioners, primary care doctors) in Great Britain. They gathered data from the UK General Practice Research Database, involving 384 participating general practices, to identify how many child/adolescent patients were prescribed at least one antipsychotic drug between the beginning of 1992 to the end of 2005. They calculated age-specific prevalences and incidences of antipsychotic prescribing.

You can read about this in the journal Pediatrics.

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Antidepressant Found To Alleviate Symptoms Of Irritable Bowel Syndrome In Adolescents

Researchers at Mattel Children's Hospital UCLA have found that low-dose antidepressant therapy can significantly improve the overall quality of life for adolescents suffering from irritable bowel syndrome, or IBS. The syndrome affects 6 percent of middle school students and 14 percent of high school kids in the United States.

he study, published in the May issue of the peer-reviewed Journal of Pediatrics, is the first of its kind to look at the effects of amitriptyline, a tricyclic antidepressant, in the pediatric IBS population, researchers said.

The research was conducted between 2002 and 2005 and involved 33 newly diagnosed IBS patients, including 24 girls, between the ages of 12 and 18.

Irritable bowel syndrome causes discomfort in the abdomen, along with diarrhea, constipation or both. Currently, there is no cure, and treatments only lessen the symptoms.

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