The Impact of a One-Day Workshop on Good Psychiatric Management for Adolescent (GPM-A) Borderline Personality Disorder.

OBJECTIVE: Despite evidence validating the diagnosis of borderline personality disorder (BPD) in youth, specifically showing persistence of BPD symptoms and morbidity similar to adults, there is reluctance to diagnose this in teens. Further, there is a belief among many trainees and academic child and adolescent psychiatrists (CAPs) that only specialty programs are effective, leading to treatment delays. This study charts the impact of a full-day workshop offered to an entire academic CAP department. METHODS: A Good Psychiatric Management for Adolescent (GPM-A) Borderline Personality Disorder in-person workshop was offered to department members. Participants were asked to complete a pre-survey, an immediate post-training survey, and a survey at 6 months post-training. Utilizing a Qualtrics questionnaire, both linear mixed-effect models and paired t-tests were used to estimate the immediate and sustained effects of the training. RESULTS: Thirty-two participants completed the workshop, with 31 answering the pre-survey, 27 the post-training survey, and 23 the 6-month follow-up survey. Immediately after the training and 6 months later, participants demonstrated statistically significant (p < .05) improvements in willingness to disclose the diagnosis of BPD, a reduced negative attitude around BPD, and an enhanced sense of confidence in addressing the needs of adolescents with BPD. CONCLUSIONS: GPM-A training can make a positive impact on groups of clinicians who work with youth who meet criteria for BPD, specifically reducing stigma, encouraging trainees and faculty members to make the diagnosis more readily, and helping them feel more competent in addressing the treatment needs of adolescents with BPD.

Sofinicline: a novel nicotinic acetylcholine receptor agonist in the treatment of attention-deficit/hyperactivity disorder.

INTRODUCTION: Psychostimulants are first-line treatments for attention-deficit/hyperactivity disorder (ADHD), but their tolerability profiles and individual response variability fuel a continuing search for alternative medications. The observation that nicotinic agents improve cognition has led pharmaceutical companies to explore the potential utility of agonists of the nicotinic acetylcholine receptor (nAChR) system for ADHD treatments. AREAS COVERED: This article reviews Phase I and Phase II trials of sofinicline (ABT-894), an agonist of the nAChR α4ß2 subtype, as a potential non-stimulant treatment for ADHD. This includes one Phase II trial that compared sofinicline with atomoxetine, a noradrenergic reuptake inhibitor currently approved as a non-stimulant ADHD treatment. This article also reviews the chemistry, pharmacodynamics and pharmacokinetics of sofinicline. EXPERT OPINION: Sofinicline appears to be well tolerated and showing efficacy similar to that of atomoxetine. Although the number of patients studied to date is small, further evaluation of sofinicline in Phase II, and possibly Phase III, trials appears to be warranted. Additional studies are needed to explore the efficacy and tolerability of sofinicline with respect to: i) optimal dosing; ii) its use in combination with other medications for ADHD; and iii) its use in children and adolescents, who more commonly experience adverse effects when taking psychostimulant medications.

A comparison of divalproex and oxcarbazepine in aggressive youth with bipolar disorder.

BACKGROUND: Divalproex (DVP) and oxcarbazepine (OXC) are used to treat pediatric bipolar disorder (PBPD) with severe aggression but these agents have not been compared in head to head trials. METHODS: Electronic medical records were reviewed for those (age < 18) who received DVP (n = 20) or OXC (n = 11) for the treatment of PBPD with severe aggression. Change in prospectively rated Clinical Global Impressions-Severity (CGI-S) scores that measured global improvement of mental illness from baseline and rates of discontinuation due to adverse effects at approximately 4 months were the primary outcomes. CGI-S specific to aggression (CGI-Ag-S), which was rated retrospectively and blinded to treatment, was a secondary outcome. RESULTS: Greater reduction in CGI-S scores occurred with DVP compared with OXC at 4 months (p = 0.007). Both CGI-S and CGI-Ag-S scores improved significantly from baseline to the 4-month timepoint with DVP but not OXC. There were no significant differences in weight changes between the groups. Rates of discontinuation due to adverse events were similar. However, more discontinuations due to worsening aggression occurred with OXC (DVP 0%, OXC 27.3%, p = 0.037). More patients receiving DVP had a decrease of 1 point or more on the CGI-S and had not discontinued due to adverse events as of the patient's last recorded visit on the index medication (DVP 13 (65%), OXC 2 (18%), p = 0.023). CONCLUSIONS: OXC appeared less effective than DVP for PBPD with aggression in this study. Limitations included the small sample size and the open, nonrandomized, retrospective study design. Future prospective, double-blind studies are warranted to determine the place of OXC in the treatment of PBPD.

No seizure exacerbation from risperidone in youth with comorbid epilepsy and psychiatric disorders: a case series.

OBJECTIVE: The aim of this study was to study risperidone use in pediatric patients with comorbid epilepsy and psychiatric disorders. METHOD: We retrospectively reviewed the outpatient psychopharmacology medical records of patients with epilepsy, aged 19 and younger, who received risperidone for psychiatric disorders. RESULTS: Twenty-one (21) youths (mean age, 12.0 +/- 4.2 years) met our criteria for review. Mean risperidone dosage was 2.4 +/- 3.5 mg/day. Target symptoms included severe aggression, severe agitation, psychosis, and self-injurious behavior. Diagnoses included attention-deficit hyperactivity disorder (ADHD), learning disorder, and impulse control disorder. Seizure type was partial complex in 12 patients, generalized in 6 patients, neonatal in 1 patient, myoclonic in 1 patient, and unclassified in 1 patient. The average number of previous psychotropic trials was 3.5 +/- 3.0. Using a definition of response of a Clinical Global Impressions (CGI) improvement score of 2 or less, 15 patients (71%) were considered responders. Adverse effects were none to slight in 16 patients, moderate in 4 patients, and severe in 1 patient. Seizures did not worsen in any patient. CONCLUSIONS: Risperidone was associated with a clinically significant global improvement, without seizure exacerbation in youths with epilepsy and psychiatric disorders. Despite the limitations of the study design, the 71% responder rate is noteworthy in this treatment-refractory group.