Advances in pharmacotherapy for pediatric anxiety disorders.

Pediatric anxiety disorders are prevalent, chronic, and often lead to significant impaired functioning that impacts both short- and long-term outcomes for children and adolescents. Treatment options include pharmacotherapy and psychosocial interventions. This presentation will review treatment advances specifically for pharmacotherapy. Current research supports serotonin reuptake inhibitors as the medication class to be the first-line treatment option for pediatric anxiety disorders. Available evidence for the efficacy of other classes of medications will be reviewed, along with the available approaches to manage partial responders and nonresponders. The risks and benefits of pharmacotherapy will also be reviewed. In addition, recent research has shown the potential promise of novel agents that act upon other neural systems implicated in the development of pediatric anxiety disorders. Novel compounds that affect the glutamate system will be discussed.

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and ongoing management.

OBJECTIVES: To develop clinical practice guidelines to assist primary care clinicians in the management of adolescent depression. This second part of the guidelines addresses treatment and ongoing management of adolescent depression in the primary care setting. METHODS: Using a combination of evidence- and consensus-based methodologies, guidelines were developed in 5 phases as informed by (1) current scientific evidence (published and unpublished), (2) a series of focus groups, (3) a formal survey, (4) an expert consensus workshop, and (5) revision and iteration among members of the steering committee. RESULTS: These guidelines are targeted for youth aged 10 to 21 years and offer recommendations for the management of adolescent depression in primary care, including (1) active monitoring of mildly depressed youth, (2) details for the specific application of evidence-based medication and psychotherapeutic approaches in cases of moderate-to-severe depression, (3) careful monitoring of adverse effects, (4) consultation and coordination of care with mental health specialists, (5) ongoing tracking of outcomes, and (6) specific steps to be taken in instances of partial or no improvement after an initial treatment has begun. The strength of each recommendation and its evidence base are summarized. CONCLUSIONS: These guidelines cannot replace clinical judgment, and they should not be the sole source of guidance for adolescent depression management. Nonetheless, the guidelines may assist primary care clinicians in the management of depressed adolescents in an era of great clinical need and a shortage of mental health specialists. Additional research concerning the management of youth with depression in primary care is needed, including the usability, feasibility, and sustainability of guidelines and determination of the extent to which the guidelines actually improve outcomes of youth with depression.

Barriers and facilitators to adolescent HIV testing.

This study examined the barriers and facilitators of HIV counseling, testing, and referral service (HIV CTR) acceptance among 278 youth aged 12-24 years old. Participants completed a questionnaire before health education sessions with trained counselors. Information was collected on individual characteristics, HIV testing acceptance, risk behaviors, reasons for having never been tested, and what would make it easier to get tested for HIV. Ninety percent of the respondents were minority and 52% were female with an average age of 15 years. High-risk minority youth who had never received HIV CTR listed low perception of risk and never having been offered a test as reasons for not having been tested. Increased availability of oral and rapid testing methods as well as free testing services were listed as facilitating their acceptance of HIV testing. Older youth aged 18-24 years reported that HIV tests in which results can be received rapidly and confidentially would encourage them to obtain HIV testing services. Early identification approaches should be tailored to increase the access to and acceptance of HIV-testing services among the adolescent and young adult populations.

AIDS and Islam in America.

Islam is the fastest growing religion in the United States. African Americans make up the largest part of the Muslim community in America, and they are also the individuals at greatest risk for contracting HIV. With the objective of understanding the impact of religious and cultural beliefs on HIV risk behaviors, this article reviews the literature on HIV and AIDS in Muslim communities in America. While no specific data exists regarding HIV seroprevalence or the risk factors for transmission of HIV in specifically American Muslim communities, the available information is presented describing American Muslims' attitudes and beliefs regarding HIV. Furthermore, in order to help clinicians improve the delivery of HIV preventive services to members of these communities, Islamic doctrine is described in relation to the three main risk factors for acquiring HIV: sexual activity, drug use and perinatal transmission. American Muslims make up a diverse population which have unique needs regarding prevention of HIV and AIDS. These needs must be more fully investigated and understood in order to minimize rates of HIV transmission in these rapidly growing communities.