ABSTRACT
OBJECTIVE: The aim of this multicenter outpatient study was to assess the therapeutic benefits, response patterns, and safety of sertraline in adolescent major depressive disorder (MDD). METHOD: Fifty-three adolescent outpatients with MDD were treated in an open-label, 10-week, acute-phase trial with sertraline and, if responders, for an additional 12-week continuation phase. Diagnostic and response assessments included the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), 17-item K-SADS-derived depression severity score, Hamilton Depression Rating Scale, Beck Depression Inventory, and Clinical Global Impression Scale. RESULTS: By 2 weeks, when analyzed as continuous variables, all severity scores showed significant differences from baseline. This pattern persisted through 10 weeks, with a significantly greater response occurring when treatment was extended from 6 to 10 weeks. Both clinician- and patient-rated improvement was maintained during continuation treatment. Response rates varied considerably when depression rating scales were analyzed categorically. Sertraline was generally well tolerated and did not induce manic symptoms. CONCLUSIONS: In open treatment of adolescent MDD with sertraline, significant improvement occurred early on and was maintained for 22 weeks. Absolute response rates varied depending on the rating scales used, definition of response, and length of treatment. Maximal response rates were obtained by clinician-defined ratings after 10 weeks of treatment.
Subject(s)
Antidepressive Agents/therapeutic use , Depressive Disorder/drug therapy , Sertraline/therapeutic use , Adolescent , Adult , Antidepressive Agents/administration & dosage , Antidepressive Agents/adverse effects , Child , Female , Humans , Male , Psychiatric Status Rating Scales , Sertraline/administration & dosage , Sertraline/adverse effects , Severity of Illness Index , Treatment OutcomeABSTRACT
The physician is uniquely qualified to manage the multiple facets of attention-deficit hyperactivity disorder. This clinically oriented update reviews the current state of the art regarding diagnosis and management of hyperactive children. Three case reports emphasize the wide variation of clinical problems presented by this frequently occurring disorder of childhood. Epidemiology, differential diagnosis, associated features, neurobiologic mechanisms, treatment, long-term outcome, and attention-deficit disorder in adults are addressed. Although medication is an important tool in the treatment of this condition, follow-up studies confirm the importance of a multimodal treatment approach.
Subject(s)
Attention Deficit Disorder with Hyperactivity/diagnosis , Adolescent , Attention Deficit Disorder with Hyperactivity/therapy , Child , Combined Modality Therapy , Diagnosis, Differential , Female , Follow-Up Studies , Humans , MaleABSTRACT
Child abuse is a well-established clinical entity affecting over one million children each year in this country. All physicians are responsible for the recognition of this syndrome and for the initiation of prompt treatment. Presented are some of the classical cutaneous signs of child abuse, including physical abuse, neglect, and sexual assault. The abusive pattern is described and the need for physician awareness noted.
