Breast feeding for over six months could aid mental health

Children who are breastfed for longer than six months could be at lower risk of mental health problems later in life, according to Australian research.

A study by the Telethon Institute for Child Health Research in Perth looked at 2,366 children born to women enrolled in a pregnancy study in the state of Western Australia.

Each of the children underwent a mental health assessment when they were aged two, five, eight, 10, and 14.

The researchers found that breastfeeding could help babies cope better with stress and may signal a stronger mother-child attachment which could provide lasting benefits.

"Breastfeeding for a longer duration appears to have significant benefits for the onward mental health of the child into adolescence," researcher Dr. Wendy Oddy, who led the study, wrote in The Journal of Pediatrics.

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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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Cognitive-Behavioral Therapy for Childhood Anxiety and Depression

For both depression and anxiety disorders in youths, there is increasing evidence of clinical benefit from cognitive-behavioral therapy (CBT).

Anxiety disorders

Both SSRIs and CBT individually have been shown to be effective in the treatment of children with anxiety disorders. A recent large randomized controlled trial examined the combined efficacy of these treatments in 488 children and adolescents (aged 7 to 17 years) who had anxiety disorder (separation anxiety disorder, social phobia, or generalized anxiety disorder).1

Patients were randomized to receive sertraline, CBT, sertraline and CBT, or placebo for 12 weeks. Combination treatment was significantly superior to either sertraline or CBT alone. Response rates were 81% for combination treatment, 60% for CBT, 55% for sertraline, and 24% for placebo. The effect size for combination treatment was 0.86 compared with 0.45 for sertraline and 0.31 for CBT. The investigators concluded that children and adolescents who receive combination treatment for anxiety disorders can consistently expect a significant reduction in anxiety severity.

Is CBT effective for young children with anxiety disorders? Typically, anxiety studies include children older than 8 years. Recently, Freeman and colleagues2 compared the efficacy of family-based CBT with family-based relaxation treatment for children aged 5 to 8 years who have ob-sessive-compulsive disorder (OCD). The 12-session CBT treatment was tailored to younger children to address their developmental stage. CBT had a moderate treatment effect (0.53). Half of the children who received CBT obtained clinical remission compared with 20% in the relaxation treatment group. The authors recommended family-based CBT as an important component when addressing early childhood–onset OCD.

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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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Antidepressant and placebo are equally effective in child pain relief

When used "off-label," the antidepressant amitriptyline works just as well as placebo in treating pain-predominant gastrointestinal disorders in children, according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute. To view this article's video abstract, go to the AGA's YouTube Channel at www.youtube.com/AmerGastroAssn.

"Many pharmaceutical products are prescribed for off-label use in children due to the lack of clinical trials testing the efficacy of the drugs in children and adolescents. Therefore, the pediatric gastroenterologist frequently has to make treatment decisions without the evidence of how drugs work in children," said Miguel Saps, MD, of Children's Memorial Hospital and lead author of the study. "The high placebo effect we identified in this study suggests that further studies of the use of certain antidepressants in children with functional bowel disorders are needed. While several trials have demonstrated a beneficial effect of antidepressants, including amitriptyline, for the treatment of irritable bowel syndrome (IBS) in adults, more research is needed to determine how effective this drug is, if at all, in children."

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Many Kids Suffer Medication Side Effects: Study

More than half a million kids a year are treated for medication side effects in American outpatient clinics and emergency rooms, according to new data.

Researchers at Children's Hospital Boston analyzed National Center for Health Statistics outpatient data between 1995 and 2005. Among children up to age 18, there were 585,922 visits a year for adverse drug events (ADEs). Most visits were to outpatient clinics, but 22 percent were to hospital emergency departments.

"We found that there are as many as 13 outpatient visits for adverse drug events per 1,000 children, indicating that they are a common complication of pediatric care," study leader Dr. Florence Bourgeois, of Children's division of emergency medicine, said in a news release.

The majority of visits were by children 4 and younger (43 percent), followed by youngsters aged 15 to 18 (23 percent). Skin-related (45 percent) and gastrointestinal (16.5 percent) were the most common types of side effects, and 52 percent of the children had symptoms that suggested an allergic reaction.

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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.

READ MORE @ SCIENCE DAILY

Children with emotional difficulties at higher risk for adult obesity

Previous research has shown that low self-esteem and emotional problems are found in people who are overweight or obese– but not which influences which. Research published today in the open access journal BMC Medicine, sheds light on this issue showing that children with emotional difficulties are at higher risk for obesity in adult life.

Andrew Ternouth, David Collier and Barbara Maughan from the MRC Social, Genetic and Developmental Psychiatry Centre at the Institute of Psychiatry, King's College London, studied data from around 6,500 members of the 1970 British Birth Cohort Study who, as 10 year-olds, had been assessed for emotional problems, self-perceptions and BMI, and who reported on their BMI again at age 30. The researchers found that children with a lower self-esteem, those who felt less in control of their lives and those who worried often were more likely to gain weight over the next 20 years. They also found that girls were slightly more affected by these factors than boys.

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Abuse of ADHD Drugs on the Rise

As more and more prescriptions are being written for medications to treat attention-deficit hyperactivity disorder (ADHD), more and more children are abusing these drugs.

That's the conclusion of new research in the September issue of Pediatrics that found the rate of ADHD medication abuse was up 76 percent from 1998 to 2005, and at the same time, the rates of prescriptions for these medications rose about 80 percent.

"We looked at all the poison control centers across the nation and found a significant increase in the number of calls for ADHD medication abuse that parallels the amount of prescriptions being written," said Dr. Jennifer Setlik, an emergency physician at Cincinnati Children's Hospital Medical Center in Ohio and a study author.

What's more, Setlik said, is that this study is "not an estimate of the total problem" because it looks only at data from poison control centers, but it gives doctors and parents a snapshot of the trend toward rising abuse of these medications with increasing availability.

ADHD affects between 8 percent and 12 percent of children, and as many as 4 percent of adults worldwide, according to background information in the study. The disorder is commonly treated with stimulant medications, which have a seemingly paradoxical effect on people with ADHD, allowing them to concentrate and function more effectively. The drugs most often prescribed are mixed amphetamine salts (Adderall) and methylphenidate (Ritalin, Concerta), according to the study.

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National Academy Urges Changes in Screening and Treatment of Depression

A National Academy of Sciences (NAS) report urging a more coordinated approach to prevention and treatment of depression in parents—because of its impact on children—hit the streets just as Congress began considering legislation to reform the US health insurance system. The NAS report made a number of recommendations for changing the approach of both public and private health insurers toward depression, although the front-line troops expected to deal with the problem are primary care physicians, who already treat 70% of patients with depression.

According to the report, conventional screening does not consider the impact of a parent’s mental health status on the health and development of the children, nor have models that incorporate multiple interventions (eg, collaborative care) for adults been tested for their effectiveness in serving parents. “In short, parental depression is prevalent, but a comprehensive strategy to treat the depressed adults and to prevent problems in the children in their care is absent.”

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Study Shows Possible Link Between Deaths and ADHD Drugs

Children taking stimulant drugs such as Ritalin to treat attention-deficit hyperactivity disorder are several times as likely to suffer sudden, unexplained death as children who are not taking such drugs, according to a study published yesterday that was funded by the Food and Drug Administration and the National Institute of Mental Health.

While the numbers involved in the study were very small and researchers stopped short of suggesting a cause and effect, the study is the first to rigorously demonstrate a rare but worrisome connection between ADHD drugs and sudden death among children. In doing so, the research adds to the evolving puzzle parents and doctors face in deciding whether to treat children with medication.

Doctors have speculated about such a connection in the past because stimulants increase heart rate and have other cardiovascular effects. Physicians are currently advised to evaluate patients for cardiac risks before prescribing the drugs, and FDA officials said yesterday that those guidelines do not need strengthening in light of the new study. About 2.5 million children in the United States take ADHD medications such as Ritalin and Adderall.

READ MORE @ WASHINGTON POST

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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No Data Supporting Antipsychotic Drug for Low-IQ Kids With ADHD

A new Cochrane review finds no evidence to support the use of risperidone to treat attention- deficit/hyperactivity disorder (ADHD) in people with intellectual disabilities, even though the review authors say this is a common prescribing pattern.

Risperidone, or Risperdal, is a second-generation antipsychotic drug. Long-term use of these drugs is associated with serious side effects, including weight gain and increased risk for type 2 diabetes.

“People who have intellectual disability are more likely to receive treatment with second- generation antipsychotics for ADHD,” said lead review author Dr. Alex Thomson. “Doctors should be aware that there is no research to demonstrate the effectiveness of risperidone for ADHD in people with intellectual disability, and should carefully monitor each case and consider alternative treatments before trying risperidone.”

Laurel Leslie, M.D., an associate professor at Tufts University School of Medicine whose research centers on pediatric mental health, concurred: “This study demonstrates that we have a gap between what we’re doing clinically and what we have any research evidence for. It’s an important study, as it highlights the need for careful consideration of how we treat children’s mental health issues.” Leslie has no affiliation with the Cochrane review.

Thomson’s research group did not find one study that met their criteria for inclusion among more than 2,000 studies that they initially identified. The group analyzed 15 studies in depth, but ultimately rejected them all.

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Cognitive Impairments Found With Attention-Deficit/Hyperactivity Disorder

Over the past century, the syndrome currently referred to as attention-deficit/hyperactivity disorder (ADHD) has been conceptualized in relation to varying cognitive problems including attention, reward response, executive functioning, and other cognitive processes.1 More recently, it has become clear that whereas ADHD is associated at the group level with a range of cognitive impairments, no single cognitive dysfunction characterizes all children with ADHD.2,3 In other words, ADHD is not a one-size-fits-all phenomenon. Patients with this syndrome do not fit into any one category and present with widely differing co-occurring disorders—including varying cognitive profiles.

Thus, ADHD represents not a single disease entity but a heterogeneous group of patients who require differentiated analysis, assessment, and treatment. This article focuses on the cognitive presentation of children (and, to a lesser extent, adults) with ADHD.

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Common antidepressants cut adult suicide risk -study

Common antidepressants suspected of raising suicide risk among children reduce the risk for adults, Italian scientists reported on Monday.

The findings that the drugs cut suicide risk by more than 40 percent among adults and over 50 percent for elderly people should reassure doctors, the researchers said.

But the study confirmed the drugs seriously raise the suicide risk for children, Corrado Barbui of the University of Verona and colleagues reported in the Canadian Medical Journal.

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Antipsychotics in Children: Experts Report Mixed Results

Studies of antipsychotics in child prenpresented at the 48th Annual New Clinical Drugs Evaluation Unit (NCDEU) Meeting, conducted by the NIMH in Phoenix, May 27-30, provide some data where there have been relatively little on the increasing use of these agents.

In a panel discussion on ethics applications in child and adolescent psychopharmacology research and practice, panel chair Christopher Kratochvil, MD, University of Nebraska, noted, “while children have additional protections as a vulnerable population in research, recognition of underserved treatment needs is driving demand for psychopharmacology progress.”

As psychopharmacotherapy in children may be expanding faster than its evidence base, however, there is also increasing concern that risk-benefit is not being adequately assessed. In the October issue of the Archives of Pediatric and Adolescent Medicine, a retrospective cohort study of antipsychotic use in children and adolescents reveals that these agents are associated with increased risk of adverse metabolic and cardiovascular events.[1] Neurological adverse events in this cohort were reported separately in the Journal of Child Neurology.[2]

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FDA Panel Slams Rising Antipsychotic Use In Kids

After a steady stream of reports that antipsychotics are increasingly prescribed to children, often for unapproved uses, such as treating attention deficit disorders (back story), an FDA advisory committee yesterday chastised the FDA for not doing more to discourage such prescribing.

For instance, more than 389,000 youngsters last year were given Johnson & Johnson’s Risperdal, and 240,000 were 12 or younger, The New York Times writes. Often, the drug was prescribed to treat attention deficit disorders, but Risperdal is not approved for that use and its risks - weight gain, metabolic disorders and possibly permanent muscular tics - aren’t justified, panel members said.

“This committee is frustrated,” Leon Dure, a pediatric neurologist from the University of Alabama School of Medicine and panel member, told the meeting. “And we need to find a way to accommodate this concern of ours.”

However, Tom Laughren, director of the FDA’s division of psychiatry products, told the panel that the agency could do little to fix the problem and, instead, pointed the finger at medical specialty societies, which he insisted must do a better job educating doctors about side effects.

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ADHD Medications Do Not Cause Genetic Damage in Children

In contrast to recent findings, two of the most common medications used to treat attention deficit hyperactivity disorder (ADHD) do not appear to cause genetic damage in children who take them as prescribed, according to a new study by researchers at the National Institutes of Health (NIH) and Duke University Medical Center.

The study published online this month in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) provides new evidence that therapeutic doses of stimulant medications, such as methylphenidate and amphetamine, do not cause cytogenetic (chromosomal) damage in humans. The researchers looked at three measures of cytogenetic damage in white blood cells of each child participating in the study and found no evidence of any changes after three months of continuous treatment.

"This is good news for parents," said Kristine L. Witt, M.Sc., a genetic toxicologist at the National Institute of Environmental Health Sciences (NIEHS) and co-author on the study, which was funded through the Best Pharmaceuticals for Children Act by NIEHS and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), both parts of NIH. "Our results indicate that methylphenidate- and amphetamine-based products do not induce cytogenetic damage in children."

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Use of Antipsychotics in Children Is Criticized

Powerful antipsychotic medicines are being used far too cavalierly in children, and federal drug regulators must do more to warn doctors of their substantial risks, a panel of federal drug experts said Tuesday.

More than 389,000 children and teenagers were treated last year with Risperdal, one of five popular medicines known as atypical antipsychotics. Of those patients, 240,000 were 12 or younger, according to data presented to the committee. In many cases, the drug was prescribed to treat attention deficit disorders.

But Risperdal is not approved for attention deficit problems, and its risks — which include substantial weight gain, metabolic disorders and muscular tics that can be permanent — are too profound to justify its use in treating such disorders, panel members said.

READ MORE @ NY TIMES