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1.
Clin Child Psychol Psychiatry ; 21(4): 634-648, 2016 Oct.
Article in English | MEDLINE | ID: mdl-26614572

ABSTRACT

There are significant controversies regarding rising antipsychotic prescription trends in children and adolescents. Many pharmacoepidemiology trend studies have been published, and interpretations of these data are helpful in explaining what is happening in prescribing practices, but not why these patterns exist. There is a lack of qualitative data in this area, and the experience of prescribing antipsychotics to children and adolescents has not been adequately researched. We conducted a qualitative study using an interpretive phenomenological analysis of physicians' experiences of antipsychotic prescribing to children and adolescents. Prescribers participated in individual interviews and a focus group. We used a staged approach for data analysis of transcriptions. In all, 11 physicians including psychiatrists and general practitioners participated in our study. We identified themes related to context, role and identity, and decision-making and filtering Struggles with health system gaps were significant leading to the use of antipsychotics as substitutes for other treatments. Physicians prescribed antipsychotics to youth for a range of indications and had significant concerns regarding adverse effects. Our results provide knowledge regarding the prescribers' experience of antipsychotics for children and adolescents. Important gaps exist within the health system that are creating opportunities for the initiation and continued use of these agents.


Subject(s)
Antipsychotic Agents/therapeutic use , Drug Prescriptions/standards , General Practitioners/standards , Psychiatry/standards , Adolescent , Child , Humans , Qualitative Research
5.
Oxford; Blackwell;Lundbeck Institute; 2007. x, 134 p. ilus.
Monography in Portuguese | Sec. Munic. Saúde SP, HSPM-Acervo | ID: sms-6071
6.
J Am Acad Child Adolesc Psychiatry ; 43(12): 1521-39, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15564821

ABSTRACT

Electroconvulsive therapy (ECT) may be an effective treatment for adolescents with severe mood disorders and other Axis I psychiatric disorders when more conservative treatments have been unsuccessful. ECT may be considered when there is a lack of response to two or more trials of pharmacotherapy or when the severity of symptoms precludes waiting for a response to pharmacological treatment. The literature on ECT in adolescents, including studies and case reports, was reviewed and then integrated into clinically relevant guidelines for practitioners. Mood disorders have a high rate of response to ECT (75%-100%), whereas psychotic disorders have a lower response rate (50%-60%). Consent of the adolescent's legal guardian is mandatory, and the patient's consent or assent should be obtained. State legal guidelines and institutional guidelines must be followed. ECT techniques associated with the fewest adverse effects and greatest efficacy should be used. The presence of comorbid psychiatric disorder is not a contraindication. Systematic pretreatment and posttreatment evaluation, including symptom and cognitive assessment, is recommended.


Subject(s)
Electroconvulsive Therapy/history , Mental Disorders/therapy , Adolescent , Adolescent Psychiatry/history , Adolescent Psychiatry/instrumentation , Contraindications , History, 20th Century , Humans , Referral and Consultation
8.
J Am Acad Child Adolesc Psychiatry ; 43(1): 119-22, 2004 Jan.
Article in English | MEDLINE | ID: mdl-14691369

ABSTRACT

Electroconvulsive therapy (ECT) may be an effective treatment for adolescents with severe mood disorders and other Axis I psychiatric disorders when more conservative treatments have been unsuccessful. ECT may be considered when there is a lack of response to two or more trials of pharmacotherapy or when the severity of symptoms precludes waiting for a response to pharmacological treatment. The literature on ECT in adolescents, including studies and case reports, was reviewed and then integrated into clinically relevant guidelines for practitioners. Mood disorders have a high rate of response to ECT (75-100%), whereas psychotic disorders have a lower response rate (50-60%). Consent of the adolescent's legal guardian is mandatory, and the patient's consent or assent should be obtained. State legal guidelines and institutional guidelines must be followed. ECT techniques associated with the fewest adverse effects and greatest efficacy should be used. The presence of comorbid psychiatric disorder is not a contraindication. Systematic pretreatment and posttreatment evaluation, including symptom and cognitive assessment, is recommended.


Subject(s)
Depressive Disorder/therapy , Electroconvulsive Therapy , Psychotic Disorders/therapy , Adolescent , Contraindications , Electroconvulsive Therapy/adverse effects , Electroconvulsive Therapy/ethics , Female , Humans , Male , Practice Guidelines as Topic
9.
Bipolar Disord ; 5(5): 330-9, 2003 Oct.
Article in English | MEDLINE | ID: mdl-14525553

ABSTRACT

OBJECTIVE: The purpose of this study was to determine the presence or absence of attentional problems and prior diagnosis of ADHD in a cohort of stabilized bipolar I relative to unipolar and normal control. METHOD: Indices of attention were obtained from bipolar (n = 44), unipolar (n = 30), and normal controls (n = 45). Measures included: Freedom from Distractibility (FD) Composite Index of the WISC III, Conners' Continuous Performance Test (CPT), Wisconsin Card Sorting Test (WCST), and a checklist measure of subjective cognitive/attentional problems (SIP-AV). RESULTS: Bipolar (6.8%), unipolar (10%), and no control youth report a prior diagnosis of ADHD. No significant group or sex differences were observed on FD Composite Index, various CPT indices, or the WCST. Despite normative attentional function by objective testing, subjectively experienced cognitive problems in the clinical probands were reported. CONCLUSIONS: This cohort of well-functioning bipolar youth diagnosed on average 3-4 years prior to assessment do not possess attentional deficits based on a variety of objective tests compared to unipolar or control youth, but self report subjective difficulties in attentional/problem solving ability. In contrast to other authors, we do not find that bipolar youth have high rates of comorbid ADHD.


Subject(s)
Attention Deficit Disorder with Hyperactivity/etiology , Attention/physiology , Bipolar Disorder/physiopathology , Depressive Disorder/physiopathology , Adolescent , Adult , Bipolar Disorder/classification , Case-Control Studies , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Intelligence Tests , Learning , Male , Neuropsychological Tests , Pattern Recognition, Visual , Problem Solving , Psychometrics , Psychomotor Performance
10.
Am J Psychiatry ; 160(1): 100-4, 2003 Jan.
Article in English | MEDLINE | ID: mdl-12505807

ABSTRACT

OBJECTIVE: This study examined mathematical ability in adolescents with bipolar I disorder, compared to adolescents with major depressive disorder and psychiatrically healthy comparison subjects. METHOD: Participants (N=119) included adolescents in remission from bipolar disorder (N=44) or major depressive disorder (N=30), as well as comparison subjects (N=45) with no psychiatric history. Participants were assessed with the following measures: the Wide-Range Achievement Test, Revised 2 (WRAT-R2), Peabody Individual Achievement Test, Bay Area Functional Performance Evaluation Task-Oriented Assessment (functional mathematics subtest), Test of Nonverbal Intellegence-2, and a self-report of mathematics performance. RESULTS: WRAT-R2 and Peabody Individual Achievement Test scores for spelling, mathematics, and reading revealed that adolescents with bipolar disorder had significantly lower achievement in mathematics, compared to subjects with major depressive disorder and comparison subjects. Results for the Test of Nonverbal Intellegence-2 were not significantly different between groups. Adolescents with bipolar disorder took significantly longer to complete the Bay Area Functional Performance Evaluation mathematics task. Significantly fewer adolescents with bipolar disorder (9%) reported above-average mathematics performance, compared with the other groups. CONCLUSIONS: Adolescents with remitted bipolar disorder have a specific profile of mathematics difficulties that differentiates them from both adolescents with unipolar depression and psychiatrically healthy comparison subjects. These mathematics deficits may not derive simply from more global deficits in nonverbal intelligence or executive functioning, but may be associated with neuroanatomical abnormalities that result in cognitive deficits, including a slowed response time. These deficits suggest the need for specialized assessment of mathematics as part of a comprehensive clinical follow-up treatment plan.


Subject(s)
Bipolar Disorder/diagnosis , Learning Disabilities/diagnosis , Mathematics , Adolescent , Bipolar Disorder/classification , Bipolar Disorder/psychology , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Educational Status , Female , Humans , Intelligence Tests , Learning Disabilities/psychology , Male , Problem Solving , Reference Values
11.
Biol Psychiatry ; 51(6): 446-56, 2002 Mar 15.
Article in English | MEDLINE | ID: mdl-11922878

ABSTRACT

BACKGROUND: Previous work has indicated that low temporal coherence of ultradian sleep electroencephalographic rhythms is characteristic of depressed patients and of depressed women, in particular. It may also be evident in one quarter of those at high risk, based on a family history of depression. METHODS: The present study evaluated temporal coherence of sleep electroencephalographic rhythms in 41 adolescent girls with a maternal history of depression (high risk) and 40 healthy controls (low risk). The entire sample was followed clinically every 6 months for 2 years. RESULTS: Temporal coherence was significantly lower among the high-risk girls than in controls. Regression analyses predicted group from coherence values and correctly classified 70% of the high-risk group with a false-positive rate of 5% among controls. Moreover, 54% of the high-risk girls were identified with extreme low coherence. On clinical follow up, 14 girls showed depressive symptoms, 9 in the high-risk group (22.5%) and 5 controls (12.2%). Six met DSM-IV criteria for first-episode major depressive disorder, five high-risk and one control. Most importantly, 41% of those identified as having the most abnormal coherence values either showed symptoms of depression or met diagnostic criteria upon follow up. CONCLUSIONS: Low temporal coherence is evident in adolescent girls at high risk for depression. The more abnormal the coherence, the greater the risk of a first episode of major depressive disorder within 2 years of sleep study, approximately 10 times greater than in controls.


Subject(s)
Activity Cycles/physiology , Depressive Disorder, Major/genetics , Electroencephalography , Sleep Stages/physiology , Adolescent , Cerebral Cortex/physiopathology , Child , Cohort Studies , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/physiopathology , Female , Follow-Up Studies , Genetic Predisposition to Disease/genetics , Humans , Psychiatric Status Rating Scales , Risk
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