Children's Depression Rating Scale Research Articles

Evidence for Altered Electroencephalography Coherence in Depressed Adolescents with Suicidal Ideation and Behaviors.

Introduction: Major depressive disorder (MDD) is a primary risk factor for suicide, which is one of the leading causes of death among adolescents worldwide. Understanding the heterogeneity of suicidality in adolescents with MDD is critical for suicide prevention and intervention discovery. Quantitative electroencephalography (EEG) is a promising tool to address the knowledge gaps related to the neurophysiological characteristics of depression and suicidality. This study sought to examine resting-state EEG coherence differences in adolescents with MDD and suicidal ideation (SI)/behaviors (SB) and healthy controls (HC) to assess the utility of coherence as a biomarker of suicide. Methods: Twenty-six adolescents with MDD who were hospitalized for suicidality and 30 HC were recruited. The clinical sample was divided into SI (n = 9) and SB (n = 19) subgroups. Eyes closed resting-state EEG were recorded, and coherence was calculated. Depression severity and suicidality were assessed with the Children's Depression Rating Scale Revised and the Columbia Suicide Severity Rating Scale, respectively. Results: There were intrahemispheric differences in the right hemisphere across multiple electrode pairs. Delta, alpha, and beta coherence were higher in the SB group over the right prefrontofrontal and left parietooccipital electrode pairs, while alpha coherence was higher in the HC group over the right centroparietal electrode pair. There were no significant differences between HC and SI groups in any electrode pair. Conclusions: Patients with recent SB showed increased coherence in right frontal regions compared with patients with SI, suggesting altered cognitive states between those with SB and SI. These findings may have implications for suicide prevention in adolescents and could serve as useful biomarkers in clinical settings, but larger studies are needed to confirm the results.

Efficacy and safety of repetitive transcranial magnetic stimulation in children and adolescents with depression: A systematic review and preliminary meta-analysis

BackgroundRepetitive transcranial magnetic stimulation (rTMS) benefits adults with depression while its efficacy and safety in children and adolescents with major depressive disorder (MDD) remain unclear. We conducted a preliminary meta-analysis here to objectively appraise rTMS in the youth with MDD to inform future research and clinical practice. MethodsWe searched Pubmed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials from their inception to December 1, 2021. Studies with a control group or self-controlled designs and evaluating the Hamilton Depression Scale (HAM-D) or the Children's Depression Rating Scale–Revised (CDRS-R) at baseline and post-rTMS treatment were included. Two reviewers independently selected eligible studies, retrieved data in a structured fashion and assessed studies' quality. Hedges'g with 95 % confidence intervals and withdrawal rate with 95 % confidential intervals were separately used to evaluate the efficacy and safety of rTMS. ResultsThirteen studies with six datasets (165 patients, 61.8 % female, age range from 10 to 25 years old) were included and our meta-analysis found children and adolescents with MDD benefited from rTMS treatment (Hedges'g 1.37, 95 % CI 0.85 to 1.90, P = 0.001). In addition, 4 % of patients (95 % CI 0.02 to 0.09) withdrew during rTMS treatment for reasons including fear, mood swings, suicide ideation and adverse events. LimitationsThis conclusion is tempered by a small number of studies included and a potentially existing placebo effect. ConclusionsOur findings suggest rTMS could benefit children and adolescents with MDD in a relatively safe manner, and this result may help guide clinical practice.

CARIBOU-1: A pilot controlled trial of an Integrated Care Pathway for the treatment of depression in adolescents.

To co-ordinate a multidisciplinary team in the delivery of guideline recommendations using a measurement-based care framework, our group previously developed a care pathway for the treatment of depression in adolescents. Core components of the pathway were: assessment, education, cognitive-behavioural therapy, a caregiver intervention group, a medication algorithm, and monthly measurement-based care "team reviews" with the adolescent present. The aim of this study was to test the feasibility of conducting a controlled clinical trial of the pathway. We conducted a 20-week pilot controlled clinical trial of the care pathway relative to treatment as usual. Participants were adolescents (age 14-18) with a primary diagnosis of Major Depressive Disorder recruited from one of two outpatient psychiatric clinics at academic hospitals. Site of presentation was the method of allocation. Thirty-five youth were allocated to the pathway and 31 were allocated to treatment as usual. As this is a pilot study, trial feasibility outcomes were of primary interest, including clinician fidelity to the care pathway. Our target sample size was recruited over a 15-month time interval. Clinician fidelity and adolescent engagement in the care pathway components on a priori checklists were high (95% and 80%, respectively). We collected baseline and 20-week endpoint data for our primary outcome of the Children's Depression Rating Scale - Revised (CDRS-R) for 83% of the sample. On linear mixed effects modelling, we observed a linear decrease in CDRS-R across 4-week intervals up to the 20-week endpoint in both groups (β=-2.07; 95% CI -3.14 to -1.01). A controlled clinical trial of a complex, multi-component intervention for the treatment of depression in adolescents is feasible. Given the need to find optimal strategies to deliver effective care for adolescents with depression, a definitive randomized controlled trial of the pathway is warranted.Trial is registered at Clinicaltrials.gov: NCT03428555.

Therapeutic alliance in family therapy and clinical outcomes among adolescents at risk for mood disorders

BackgroundFamily-focused therapy (FFT) is associated with longer intervals between mood episodes and reductions in suicidal ideation among adolescents at risk for bipolar disorders. However, the mediating processes underlying the efficacy of FFT are not well understood. In an open trial of an 18-week FFT program, we explored the association between the therapeutic alliance of adolescents/parents with their therapists and the symptomatic outcomes of adolescents over 18 weeks. MethodParticipants were enrolled in a treatment development trial of FFT supplemented with a mobile app. We used the System for Observing Family Therapeutic Alliances (SOFTA) to rate alliance between adolescents, parents, and therapists using videotaped FFT sessions from the beginning and end of treatment. Pearson correlations were computed between SOFTA alliance ratings and changes in Children's Depression Rating Scale, Revised (CDRS-R) scores over 18 weeks of treatment. ResultsSOFTA ratings were obtained from sessions conducted with 17 adolescents (mean age 14.9+/-2.0 years; 41.2% female) and 22 parents. CDRS-R ratings were obtained from 16 adolescents at baseline and 18 weeks. Parents had significantly higher levels of engagement and emotional connection with therapists than their offspring. Adolescents’ therapeutic engagement scores were significantly correlated with reductions in CDRS scores over 18 weeks (r(14) = -0.58, p = 0.018; N = 16). LimitationsWe could not draw conclusions about the causal relationship between therapeutic alliance and improvement in depression. ConclusionsAmong high-risk adolescents undergoing FFT, therapeutic alliance is associated with clinical improvement over 4 months. Strategies to enhance adolescent engagement may strengthen the long-term effects of family interventions.

Clinical Effectiveness of Training for Awareness Resilience and Action Online Compared to Standard Treatment for Adolescents and Young Adults With Depression: Study Protocol and Analysis Plan for a Pragmatic, Multi-Center Randomized Controlled Superiority Trial.

Depression in adolescents and young adults is an increasing global health concern. Available treatments are not sufficiently effective and relapse rates remain high. The novel group-treatment program “Training for Awareness, Resilience and Action” (TARA) targets specific mechanisms based on neuroscientific findings in adolescent depression. TARA is framed within the National Institute of Mental Health's Research Domain Criteria and has documented feasibility and preliminary efficacy in the treatment of adolescent depression. Since neurodevelopment continues well into the mid-twenties, age-adapted treatments are warranted also for young adults. Patients 15–22 years old, with either major depressive disorder (MDD) or persistent depressive disorder (PDD) according to the DSM-IV/5 or a rating >40 on the clinician rating scale Children's Depression Rating Scale—Revised (CDRS-R), will be recruited from specialized Child and Adolescent Psychiatry and local Youth-Clinics and randomized to either TARA or standard treatment, including but not limited to antidepressant medication and/or psychotherapy. Outcome measures will be obtained before randomization (T0), after 3 months of treatment (T1) and at 6-months- (T2) and 24-months- (T3) follow-up. Additionally, dose-response measures will be obtained weekly in the TARA-arm and measures for mediation-analysis will be obtained halfway through treatment (T0.5). Primary outcome measure is Reynolds Adolescent Depression Scale (RADS-2) score at T1. Secondary outcome measures include RADS-2 score at T2, Multidimensional Anxiety Scale for Children at T1 and T2, and CDRS-R at T1. Additional outcome measures include self-report measures of depression-associated symptoms, systemic bio-indicators of depression from blood and hair, heartrate variability, brain magnetic resonance imaging, as well as three-axial accelerometry for sleep-objectivization. Qualitative data will be gathered to reach a more comprehensive understanding of the factors affecting adolescents and young adults with depression and the extent to which the different treatments address these factors. In summary, this article describes the design, methods and statistical analysis plan for pragmatically evaluating the clinical effectiveness of TARA. This will be the first RCT to examine the effects of TARA compared to standard treatment for adolescents and young adults with MDD or PDD. We argue that this study will extend the current knowledgebase regarding the treatment of depression.NCT Registration: identifier [NCT04747340].

Lack of Associations Between C-Reactive Protein and Mood and Anxiety Symptoms in Adolescents.

Introduction: Increased peripheral inflammation has been consistently documented in both adult and pediatric depression. However, elevated levels of C-reactive protein (CRP), a nonspecific biomarker for inflammation, have been primarily reported in adults; whether CRP plays a similar role in adolescent depression has not been conclusively established. In our prior work, we identified relationships between CRP and reward neurocircuitry in adolescents with psychiatric symptoms (N = 64) but not with depressive symptoms. Extending this work, we sought to examine CRP across the full range of mood and anxiety symptom severity in a larger, clinically diverse cohort of psychotropic medication-free adolescents and healthy controls (HCs). Methods: Subjects were adolescents (N = 127, age: 15.17 ± 2.19 years, 78 female) with psychiatric symptoms (n = 96, including previous cohort of 64) and HC (n = 31). All completed a semi-structured psychiatric evaluation and dimensional assessments for depression, anxiety, anhedonia, and suicidality. Group-comparison and correlation analyses utilized nonparametric statistics controlled for body mass index, sex, and age at pFWE < 0.05. Results: No group differences were identified in CRP levels between the clinical cohort and HCs. In addition, correlations between CRP and clinical symptomatology were not significant in either the whole sample or the psychiatric group. Conclusions: We found that, unlike in adults, CRP was not associated with depressive symptoms. This suggests that inflammation in pediatric depression is more narrowly delimited at the onset of psychiatric symptoms and may only become systemic with chronicity.

Systematic Review and Network Meta-analysis: Efficacy and Safety of Second-Generation Antipsychotics in Youths With Bipolar Depression

To assess the relative efficacy and safety of second-generation antipsychotics for treating major depressive episodes in youths with bipolar disorder. A systematic literature review using PRISMA guidelines and network meta-analysis (NMA) of randomized controlled trials (RCTs) of second-generation antipsychotics for bipolar depression in youths 10 to 18 years of age was conducted. Efficacy measures included Children's Depression Rating Scale, Revised (CDRS-R) and Clinical Global Impressions-Bipolar Disorder-Severity Depression (CGI-BP-S-depression) and Overall (CGI-BP-S-overall) scores. Available safety outcomes included discontinuations (all-cause, lack of efficacy, adverse events), metabolic parameters (weight change, cholesterol, triglycerides, glucose), changes in prolactin, and somnolence. Results from the NMA were reported as mean changes from baseline or odds ratios (OR) with 95% credible intervals (CrIs). Four RCTs comparing placebo to lurasidone, quetiapine (1 each for immediate- and extended-release), and the olanzapine-fluoxetine combination (OFC) metall of the inclusion criteria. Lurasidone and OFC demonstrated similar and statistically significant improvements in CDRS-R, but quetiapine did not (lurasidone:-5.70 [-8.66,-2.76]; OFC:-5.01 [-8.63,-1.38]; quetiapine:-1.85 [-5.99, 2.27]). Lurasidone was associated with smaller changes in weight, cholesterol, and triglycerides from baseline compared to OFC and quetiapine. There were no differences in changes in glucose levels among antipsychotics. In addition, lurasidone was associated with smaller change in prolactin levels compared to OFC but not quetiapine. Evidence from 4 studies in this NMA indicated that lurasidone and OFC, but not quetiapine, were efficacious for the treatment of bipolar depression in youths. Lurasidone was associated with less weight gain and smaller impacts on cholesterol and triglycerides compared with quetiapine and OFC.

Cognitive correlates of impulsive aggression in youth with pediatric bipolar disorder and bipolar offspring

BackgroundYouth with bipolar disorder (BD) and offspring of individuals with BD (BD-OFF) are characterized by higher levels of impulsive and overt aggression. The cognitive basis underlying these aggressive behaviors are not clarified in this population. The aim of this study was to investigate the relationship between cognitive alterations and aggressive behavior in youth with BD and BD-OFF. MethodsForty-two youth with BD, 17 BD-OFF and 57 healthy controls (HCs) were administered the Modified Overt Aggression Scale (MOAS), the Cambridge Neuropsychological Test Automated Battery (CANTAB), the Young Mania Rating Scale (YMRS) and the Children's Depression Rating Scale (CDRS). Multiple linear regression analyses were performed in the three groups separately. In each group, tests scores from the CANTAB were predictors. MOAS subscale scores and MOAS total scores were dependent variables. Results are corrected for age, IQ and mood state. ResultsBoth youth with BD and BD-OFF showed positive correlations between impairment in executive functions and levels of verbal aggression. In youth with BD, altered processing of either positive and negative stimuli positively correlated with MOAS total scores, whereas in BD-OFF, such relationship was negative. ConclusionsImpulsive aggressive behaviors in youth with BD arise from a combination of altered affective processing and executive dysfunction. The negative relationship between affective processing and aggression in BD-OFF suggested the presence of possible mechanisms of resilience in this population.

Depression and behavior problems among children residing at welfare hostels and orphanages

Context: Childhood-onset of depression is often associated with childhood family adversity, parental neglect, and problematic peer relationships. Emotional and behavioral problems and high rates of depression were more common in orphans when compared to nonorphan. Aim: The aim was to study and compare the depression and behavioral problems among children residing at welfare hostels and orphanages. Materials and Methods: This study is a cross-sectional and descriptive study. Three welfare hostels and four orphanages run by nongovernment organizations were approached, and children between the ages of six and fourteen were recruited. Children residing at home were taken as controls. Children's Depression Rating Scale and Rutter's Behavior Scale for Children were applied to assess depression and behavioral problems, respectively. Statistical Analysis Used: Statistical analysis was done using Epi Info software. Results: Depression is found to a greater extent among children in the orphanages' group than in the welfare group. Rutter's score ≥9 was observed in 15%, 8.3%, and 5% of children in the welfare hostels' group, orphanages' group, and controls' group, respectively. Conclusions: The prevalence of depression is found to be more among orphanage children, followed by children residing at welfare hostels compared to the control group. Behavior problems are more among children residing at welfare hostels than children residing at orphanages.

A systematic review of therapeutic ketamine use in children and adolescents with treatment-resistant mood disorders.

Suicide is the second leading cause of death in the United States among individuals aged 10-24, and severe youth depression is often refractory to the current standards of care. Many studies have demonstrated the efficacy of ketamine in reducing depressive symptoms in adults with treatment-resistant mood disorders, though few studies utilizing ketamine in youth populations exist. This systematic review examines the current state of evidence for ketamine use in children with treatment-resistant mood disorders. We conducted a search utilizing two electronic databases for English-language studies investigating the therapeutic effects and side effect profile of ketamine in youth ≤ 19years of age with a diagnosis of a treatment-resistant mood disorder. Analysis included subjects with treatment-resistant depression with and without psychotic features and with bipolar disorder. Primary outcome measures included the following scales: Montgomery-Asberg Depression Rating Scale, Children's Depression Rating Scale, Children's Depression Rating Scale Revised, Child Bipolar Questionnaire, Overt Aggression Scale, Yale-Brown Obsessive-Compulsive Scale, and Scale for Suicidal Ideation. Four published studies were identified that investigated therapeutic ketamine use in youth for the primary purpose of treating a treatment-resistant psychiatric disorder. Three additional studies that did not meet eligibility criteria were identified and discussed. Ketamine was shown in youth to generally improve depressive symptoms, decrease acute suicidality, and reduce mood lability, though a number of subjects remained resistant to its treatment. These findings substantiate the need for further longitudinal studies investigating ketamine's long-term safety, its efficacy, and abuse potential in the youth.

Interpersonal Relationship Aspects as Perceived Risk and Social Support Factors in a Clinical Sample of Adolescents With Depression

Abstract The goal of this qualitative study was to explore how adolescents with diagnosed depression describe their social relationships with peers, parents and teachers. Several previous findings have revealed the dual role of interpersonal relationships — as a stressor and contributor to different mental disorders, and also as a source of social support for mental health. Previous studies confirmed the value of a qualitative approach in exploring the self-perceived experiences of adolescents. The research group consisted of 28 adolescents, aged 13–17, with a diagnosis of depression. Individual semistructured interviews (Children's Depression Rating Scale Revised; CDRS-R) were applied in this study, which were analysed using thematic analysis. The results have both scientific and practical value, as well as relevance for the development of preventive interventions targeted at well-being and mental health of adolescents.

Increased circulatory IL-6 during 8-week fluoxetine treatment is a risk factor for suicidal behaviors in youth

ObjectiveSelective serotonin reuptake inhibitors (SSRIs) are commonly used to treat anxiety and/or depression in pediatric populations. However, the response rates are low (approximately 50%). Moreover, SSRI use is frequently associated with adverse events (AE). Currently there are no available biomarkers for treatment response/AE. Identification of biomarkers predicting early response and/or AE could help maximize the benefit-risk ratio for the use of SSRIs, and accelerate matching of treatments to patients. Pro-inflammatory cytokines were proposed as potential biomarkers. MethodNinety-two patients (35 boys and 57 girls) with major depressive disorder and/or anxiety disorders, aged 13.90 ± 2.41 years, were treated with fluoxetine (FLX) for 8 weeks. Plasma concentrations of TNFα, IL-6, and IL-1β were measured by enzyme linked immunosorbent assays before and after FLX treatment. Clinical response and AE were measured using several clinical scales, including the Clinical Global Impression – improvement, Children's Depression Rating Scale–Revised, the Beck Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders, the Columbia suicide severity rating scale, and the Suicide Ideation Questionnaire. ResultsIL-6 levels increased after treatment only in the group of children who developed FLX-associated suicidality. ConclusionAn increase in IL-6 levels during treatment may be a risk factor for the emergence of FLX-associated suicidality (OR = 1.70). Further studies are necessary to clarify the role and mechanism(s) of this cytokine in the pathogenesis of this life-threatening AE.

Improvement in hypersomnia with high frequency repetitive transcranial magnetic stimulation in depressed adolescents: Preliminary evidence from an open-label study

Study objectivesSleep disruption is a significant symptom of major depressive disorder (MDD). To our knowledge, no prior work has examined the impact of repetitive transcranial magnetic stimulation (rTMS) on sleep disturbances in adolescents with MDD. MethodsSeventeen adolescents with treatment-resistant depression received 30 daily sessions of 10-Hz rTMS applied to the left dorsolateral prefrontal cortex (L-DLPFC). Clinical symptoms were assessed at baseline; after 10, 20, and 30 treatments; and at a 6-month follow-up visit. Insomnia was measured with a 3-item subscale of the Quick Inventory of Depressive Symptomatology–Adolescent (17 Item)–Self Report (QIDS-A17-SR). Hypersomnia was measured with a single QIDS-A17-SR item. Depression severity was rated with the Children's Depression Rating Scale, Revised (CDRS-R). The effect of rTMS on sleep was examined via linear mixed model analyses, with fixed effects of time (as a proxy of treatment), depression severity, age, and hypnotic medication use. ResultsNo significant main effect of time was observed on the insomnia subscale (F4,43.442 = 1.078, p = 0 .379). However, there was a significant main effect of time on the QIDS-A17-SR hypersomnia score (F4,46.124 = 2.733, p = 0 .040), with significant improvement from baseline to treatment 10 (padj = 0.019) and from baseline to 6-month follow-up (padj = 0.044). In exploratory sensitivity analyses, response/nonresponse to rTMS for overall depressive symptoms had no significant effect on sleep outcomes. ConclusionsrTMS may have intrinsic effects on hypersomnia apart from its antidepressant effects in depressed adolescents. Future work should utilize sham controls and objective, quantitative measurements of sleep architecture to assess effects of rTMS in depressed adolescents. Clinical trial registryClinicaltrials.gov identifiers are NCT00587639, NCT01502033, NCT01804270.

Subjective sleep problems and sleep hygiene among adolescents having depression: A case-control study.

Sleep research has often focussed heavily on polysomnography while ignoring subjective sleep complaints of individuals, especially the young ones. Discordance has been seen between objective and subjective parameters of sleep among children and adolescents. There has been a trend towards worsening of sleep hygiene among adolescents, which may predispose to psychiatric disorders like depression. So, we compared the subjective sleep quality and sleep hygiene among depressed and normal adolescents. A sample of 31 depressed adolescents and 32 healthy controls were compared on sleep parameters using Adolescent Sleep Wake Scale (ASWS), Adolescent Sleep Hygiene Scale (ASHS) and School Sleep Habits Survey. Depressed adolescents were found to have significantly worse sleep quality [ASWS score 3.72 ± 0.952 vs 4.79 ± 0.552, p < 0.001], longer sleep onset latency [68.23 ± 62.98 vs 19.53 ± 19.48 minutes, p < 0.001], and shorter sleep duration [414.19 ± 110.78 vs 498.28 ± 56.86 minutes, p < 0.001]. Sleep quality significantly correlated with depression severity (measured on Children's Depression Rating Scale- revised), i.e., higher the severity of depression, poorer was the sleep quality (r = -0.605, p < 0.01). But sleep hygiene was statistically similar between the two groups [ASHS score 3.21 ± 0.60 vs 3.36 ± 0.51, p = 0.293], and was inadequate (< 3.8) among all adolescents irrespective of depression. Hence, despite the lack of evidence from objective sleep measures, there seem to be subjective sleep impairments among adolescents having depression. Future research needs to address the underlying etiological factors and causal directions for depression and sleep impairments among adolescents. Sleep hygiene education must be a part of broader primary prevention strategies for psychiatric disorders.

CHILDREN’S DEPRESSION RATING SCALE-REVISED (CDRS-R) – DEVELOPMENT OF THE LATVIAN VERSION AND PSYCHOMETRIC PROPERTIES IN A CLINICAL AND NON-CLINICAL SAMPLE OF ADOLESCENTS

Depression is one of the most widespread mental disorders worldwide. Adolescence is a vulnerable period for developing depression. It is associated with a number of challenges in biological, psychological and social areas. Valid and reliable measurement instruments are required for assessment of symptoms of depression in clinical samples of adolescents in Latvia. Children's Depression Rating Scale Revised (CDRS-R, Posnanski &amp; Mokros, 1996) is a semi-structured, clinician-rated interview for assessment of depression in children and adolescents. While the CDRS-R is the most widely used rating scale for research and clinicians’ practical use worldwide, there's no validated version in Latvian language available yet. The aim of this study is to present the reliability and validity of the Latvian version of CDRS-R in the adolescent age group. Twenty-five adolescents (aged 12-17) with diagnosis of depressive disorder (inpatients and outpatients) and twenty healthy controls were assessed with CDRS-R by clinical psychologist. Reliability and validity were calculated and analyzed: Cronbach’s alpha, Weighted Kappa, Spearman's rank correlation coefficient, Receiver operating characteristic (ROC). The Latvian translation of CDRS-R showed good psychometrical properties. Internal consistency for the CDRS-R was high. CDRS-R total score was significantly correlated with CDI both in nonclinical and clinical sample. There was a significant concordance with the reference standard of ICD-10 diagnosis.

A comparative study of temperamental, behavioral, and cognitive changes in thalassemia major, thalassemia minor, and normal population.

Background:Temperament in children and adolescents acts as a trait marker which can predict behavioral abnormalities. There was no systemic study in India which has compared the temperamental, behavioral and cognitive changes associated with this hemoglobinopathy among thalassemia major (TM) group.Materials and Methods:The specific objectives of this study were to find the clinicodemographic profile of individuals and parents, the behavioral, temperamental profile of children of beta TM and correlation of temperamental profile with number of blood transfusions, cognitive profile of children having beta TM, minor and age-matched control children and adolescents.Results:Child and adolescents having TM have more temperamental and behavioral problems (P < 0.001) and have more psychopathology in comparison to Tm group. Descriptive statistics of the groups and group comparison (ANOVA) shows statistically significant difference in Temperament Measurement Schedule (TMS) total, CPMS total, TMT A, TMT B, and Children's Depression Rating Scale (CDRS) scales (P = 0.000). Descriptive statistics and group comparison (Chi-square test) show significance in number of blood transfusions not with other parameters (P < 0.001). Comparison between TM (Case) and Tm (Control) (t-test) shows significance with only TMS total and CPMS scales, not in other scales. The correlation matrix showed significant correlation in-between all the parameters (blood transfusion, TMS, CPMS, TMT A, TMT B, and CDRS).Discussion:Those who have been diagnosed as TM have more behavioral and cognitive problems than their comparators. Youngsters receiving more blood transfusions due to their ailments scored higher in childhood depression rating scale.Conclusion:The temperamental, behavioural and cognitive profile are key determinants of both internalizing and externalizing symptoms and management plan can be guided accordingly as reflected in this study.

Clinical profile of obsessive-compulsive disorder in children and adolescents: A multicentric study from India.

Context:Data from the Western countries suggest that obsessive-compulsive disorder (OCD) in children and adolescents is associated with male preponderance, comorbid neurodevelopmental disorders, and high family loading. However, data are limited from the developing countries with respect to the demographic and clinical characteristics of OCD in children and adolescents.Aims:To study the demographic and clinical characteristics of children and adolescents (age ≤18 years) with OCD.Setting and Design:This was a cross-sectional study, conducted in outpatient treatment setting, across six centers in India.Materials and Methods:Participants were assessed using a semi-structured pro forma for sociodemographic information, clinical characteristics, the Children's Yale Brown Obsessive Compulsive Scale (CYBOCS), Structured Clinical Interview for Diagnostic and Statistical Manual, 5th Edition Research Version, Children's Depression Rating Scale, and Family Interview for Genetic Studies.Results:The sample was largely male with a moderate illness severity. Nearly 75% of the sample had illness onset before the age of 14 years. Aggressive, contamination-related obsessions and washing, checking, and repeating compulsions were the most common symptoms. CYBOCS assessment revealed that >2/3rd of children and adolescents endorsed avoidance, pathological doubting, overvalued sense of responsibility, pervasive slowness, and indecisiveness. Family history and comorbidity rates were low. OC-related disorders were present in about 10% of the sample.Conclusions:This study suggests that the clinical characteristics of OCD in children and adolescents in developing countries differ on certain aspects as reported from developed countries.

Psychometric Properties of the Patient Health Questionnaire-9 Modified for Major Depressive Disorder in Adolescents.

The Patient Health Questionnaire-9 Modified (PHQ-9M) is a self-report tool used to assess the presence and severity of depressive symptoms in teenagers. Despite widespread use in primary care clinics and psychiatric settings, the PHQ-9M has not been validated nor are its psychometric properties adequately understood for the adolescent population. This study sought to examine the psychometrics of the PHQ-9M in treatment-seeking, depressed adolescents at a psychiatric psychopharmacology clinic who were concurrently assessed with the Children's Depression Rating Scale Revised (CDRS-R) and Quick Inventory of Depressive Symptomatology-Adolescent (17-item) Self-Report (QIDS-A17-SR). Adolescents (N = 160) aged 13 through 18 years with a diagnosis of major depressive disorder, determined on the basis of a clinical interview and semi-structured interview using the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, were assessed for severity of depressive symptoms with the PHQ-9M, CDRS-R (adolescent interview only), and QIDS-A17-SR assessments at baseline, 4, and 8 weeks. Classical test theory analysis was used to evaluate the internal consistency and dimensionality of the PHQ-9M. Convergent validity was evaluated via intraclass correlations of the PHQ-9M with the CDRS-R and QIDS-A17-SR. Sensitivity to treatment response was also evaluated. The internal consistency (Cronbach's coefficient α) at baseline, 4, and 8 weeks was 0.879, 0.859, and 0.827 for the PHQ-9M; 0.739, 0.835, and 0.867 for CDRS-R; and 0.712, 0.777, and 0.804 for QIDS-A17-SR, respectively. The PHQ-9M had moderate convergent validity with the CDRS-R but good convergent validity with the QIDS-A17-SR. The PHQ-9M was less sensitive to changes in symptom severity than the CDRS-R and QIDS-A17-SR. The PHQ-9M appears to be a valid and reliable assessment tool for the severity of depressive symptoms in a psychiatric clinic setting. However, its utility as a treatment outcome measure may be limited compared with other available rating scales.

High-frequency repetitive TMS for suicidal ideation in adolescents with depression

Background: This exploratory study sought to examine the effect of an acute course of high-frequency repetitive TMS on suicidal ideation in adolescents.Methods: Data were pooled from 3 prior protocols providing a 30-session course of open-label TMS treatment for adolescents with treatment-resistant depression. All participants (n = 19) were outpatients taking antidepressant medication, with TMS provided as adjunctive treatment. Suicidality was assessed at baseline, after 10 treatments, after 20 treatments, and after 30 treatments. Outcome measures of suicidal ideation included the Columbia Suicide Severity Rating Scale (C-SSRS) “Intensity of Ideation” subscale and Item 13 “Suicidality” on the Children's Depression Rating Scale, Revised (CDRS-R).Results: The predicted odds of suicidal ideation (CDRS-R Item 13 and C-SSRS Intensity of Ideation subscale) significantly decreased over 6 weeks of acute TMS treatment without adjustments for illness (depression) severity. However, the magnitude of the decrease in the predicted odds of suicidal ideation across 6 weeks of treatment was attenuated and rendered non-significant in subsequent analyses that adjusted for illness (depression) severity.Limitations: This was an exploratory study with a small sample size and no sham control. Regulatory and ethical barriers constrained enrollment of adolescents with severe suicidality.Conclusions: The present findings suggest that open-label TMS mitigated suicidal ideation in adolescents through the treatment and improvement of depressive symptom severity. Although caution is warranted in the interpretation of these results, the findings can inform the design and execution of future interventional trials targeting suicidal ideation in adolescents.

Correlations Between Neuroendocrine Disorders and Biochemical Brain Metabolites Alterations in Antidepressant Treatment

We approach the theme of modern investigation and treatment strategies, based on biochemical, clinical-biological, metabolic, pharmacogenetic, neuro-imagistic, and neuroendocrine integrative correlations in the management of depressive disorders. Our main objective was to investigate: the biochemical brain metabolites [N-acetyl-aspartate (NAA), gamma-aminobutyric acid (GABA), aspartate (Asp), creatine (CR), glutamine (Gln), glicerophosphocholine (GPC), phosphocholine (PC), phosphocreatine (PCr), taurine (Tau), N-methyl-D-aspartate (N-MDA), serine, glycine, choline (Cho)]; the neuroimagistic and neurobiological markers and the metabolic abnormalities in correlation with the molecular pharmacogenetic testing in children and adolescents treated with antidepressant medication. Our research was conducted between 2009-2016 on 90 children and adolescents with depressive disorders -45 children-G1, who benefited of pharmacogenetic testing tailored pharmacotherapy, and 45 without pharmacogenetic testing-G2. The patients were also evaluated by MR spectroscopy at baseline and after pharmacotherapy. The efficacy of the chosen therapy in correlation with the pharmacogenetic testing was evaluated by the mean change in the CDRS (Child Depression Rating Scale) total scores, in the CGI-S/I (Clinical Global Impression Severity/Improvement), CGAS (Clinical Global Assessment of Functioning) and by the change of the relevant neurobiological markers and MR spectroscopy biochemical brain metabolites. Our results showed statistically significant differences in the clinical scores between the studied groups. Our research could represent a proof that the biochemical brain metabolites registered in depressive disorders modified values in the MR spectroscopy and the administration of antidepressants could determine metabolic and neuroendocrine abnormalities (changed lipid profiles, high insulin and plasma glucose levels, weight gain, obesity), especially when chosen without prior pharmacogenetic testing.