Use Of Psychopharmacologic Agents Research Articles

Sleep Disturbances in Children and Adolescents with Autism Spectrum Disorder: An Overview for Clinicians

Background: Sleep disorders in autism spectrum disorders (ASD/SD) are distinct, broad, and highly variable clinical entities that ubiquitously affect core symptomatology, development of comorbid disorders, and overall quality of life for affected children and families. High genetic predisposition and the presence of co-occurring disorders present significant challenges in assessment and appropriate interventions. Objective: The study aimed to review the best available evidence and address the clinical gaps in the knowledge about sleep disorders in children and adolescents with autism spectrum disorders. Methods: The review provides a comprehensive literature search of 1622 articles and summarizes 110 selected for empirical evidence to methodically consider critical aspects of sleep disorders in ASD for informing clinicians of useful information. Results: Clinicians have insufficient guidance and support to effectively manage sleep disruptions in ASD youth in practice. Prevalence of sleep disruption in ASD, close to 80%, is characterized by unique subtypes, including but not limited to obstructive sleep apnea, circadian rhythm disorders, and sleep-related movement disorders. Greater awareness of sleep disruption, its neurodevelopmental basis, scope, and impact allows for improved treatment and prevention efforts of these conditions, and is critical for clinical practice and future research. The bidirectional nature of disruptive sleep and ASD is considered a major area requiring further clarification. Conclusion: Clinician-friendly screening tools are needed for everyday office practice to identify ASD/SD conditions and interventions, and mitigate harmful effects. Psychoeducational and cognitive-behavioral approaches for improving and supporting healthy sleep hygiene, considered the first line of treatment, are detailed. The weak database for the use of psychopharmacologic agents is summarized, and the strength of prescribing prolonged-release melatonin for optimal results is described. The promise of other medications is discussed.

Psychotropic medications around perioperative period: How to go about?

Background: Medical comorbidities are frequent in patients suffering from psychiatric disorders. Many of these patients would need emergency or elective surgeries in their lifetime. The perioperative period is a unique and critical phase, and thoughtful, informed management can prevent various medical misadventures in this period, thus improving the postoperative outcomes. Aim: This article attempts to provide an overview of the use of psychopharmacological agents during the perioperative period, the current recommendations about continuing or discontinuing various psychotropics in the perioperative period, and how to restart medications in the postsurgical period. Material and Methods: For this narrative review, literature search was done on PubMed and Google Scholar and relevant articles were identified and included. Results: For elective surgery, the psychiatrist should review the available investigation, severity of the physical illness, physical health status of the patient as per the American Society of Anaesthesiology (ASA) category, severity and stability of psychiatric disorder, comorbid substance use, and the ongoing psychotropics and their interactions with ongoing medications. In patients with ASA categories I and II, psychotropic medications can be continued. For patients with ASA categories V and VI, preferably psychotropics should be stopped. For patients belonging to ASA categories III and IV, antipsychotics except for clozapine can be continued; however, if feasible antidepressants and lithium should be stopped. For elective surgery, clozapine needs to be stopped 12 h before surgery, lithium 48–72 h before surgery, antidepressants to be tapered about 7–10 days before surgery, and monoamine oxidase inhibitors to be tapered and stopped 14 days before surgery. Other antipsychotics, mood stabilizers, and benzodiazepines can be continued till the day of surgery. When there is lack of time due to emergency surgery then a proper discussion with the primary team and the anesthetist need to be done about the possible risks. Conclusion: The psychiatrists handling patients in the perioperative period should have an idea about how psychotropics interact with different anesthetic agents and ensure that the anesthesiologist and the surgeon are made aware of the possible complications that might occur during the surgical and anesthetic procedure due to the concurrent use of specific psychotropics.

Patients With Prenatal Alcohol Exposure Frequently Misdiagnosed, Face Multiple Challenges

Patients With Prenatal Alcohol Exposure Frequently Misdiagnosed, Face Multiple Challenges

Psychopharmacology of patients with multiple sclerosis in Greece during the period 2017-2019.

Multiple Sclerosis (MS) is highly comorbid with mental disorders in any disease stage, while psychiatric manifestations may precede the onset of neurological symptoms as well as diagnosis. Neuropsychiatric comorbidities are associated with an elevated risk of MS disability progression, and therefore, people with multiple sclerosis (PwMS) with psychiatric comorbidities often experience a significantly lower functional status, perform worse in objective neuropsychological assessment, are less likely to adhere to pharmacological treatment, and exhibit higher levels of disruption of their supportive social environment as compared with "non-psychiatric" PwMS. The present study aims to estimate the nationwide use of psychopharmacological agents by PwMS in Greece. Prescription records of the nationwide digital prescription database were analyzed, in order to identify PwMS that have received prescriptions of an antipsychotic, an antidepressant, an anxiolytic or a psychostimulant during a 2-year study period. Pseudo-anonymized prescription records of PwMS (n=21218) were extracted from the Greek nationwide prescription database, dating from June 2017 to May 2019. According to this national level study, psychopharmacological agents are frequently prescribed in PwMS. Antidepressants were prescribed in 36.1% of the study sample, followed by anxiolytics (16.23%), psychostimulants (4.97%) and antipsychotics (3.76%). The proportion of patients under treatment with these agents was increasing with age. Selective serotonin reuptake inhibitors, second generation antipsychotics and benzodiazepines were the most often prescribed agents in each drug category and especially in younger age groups, possibly indicating a better efficacy/side-effect equilibrium, while modafinil was the only psychostimulant prescribed aiming to ameliorate levels of fatigue. A pharmacological preference for antidepressants and psychostimulants was observed in the 40-60 age group (p = 0.02), while antipsychotics and anxiolytics were more frequently prescribed in the >60 age group (p<0.001). Serotonin-norepinephrine reuptake inhibitors were mostly prescribed within the 40-60 age-group. Benzodiazepines were less favored among the >60 age-group. This study highlights the increased prevalence of mental disorders in this patient group. Adequate treatment and monitoring of psychiatric symptomatology, may improve long-term outcomes of the disease, however caution is needed regarding potential drug interactions and side effects.

Treatment algorithm for the use of psychopharmacological agents in individuals prenatally exposed to alcohol and/or with diagnosis of fetal alcohol spectrum disorder (FASD).

Psychotropic medication treatment of individuals who have experienced prenatal alcohol exposure (PAE) has lagged behind psychosocial interventions. Multiple psychotropic medications are often prescribed for those diagnosed with a range of neurodevelopmental disabilities and impairments of PAE (neurodevelopmental disorder associated with prenatal alcohol exposure and/or fetal alcohol spectrum disorder [ND-PAE/FASD]). Despite the diverse comorbid mental disorders, there are no specific guidelines for psychotropic medications for individuals with ND-PAE/FASD. When prescribed, concerned family members and caregivers of individuals with ND-PAE/FASD reported that polypharmacy, which was typical and adverse effects render the psychotropic medications ineffective. The objective of this work was to generate a treatment algorithm for the use of psychopharmacological agents specifically for individuals with ND-PAE/FASD. The development of decision tree for use to prescribe psychotropic medications incorporated findings from previous research and the collective clinical experience of a multidisciplinary and international panel of experts who work with individuals with ND-PAE/FASD, including an algorithm specialist. After multiple meetings and discussions, the experts reached consensus on how best to streamline prescribing along neurodevelopmental clusters. These were subdivided into four ligand-specific, receptor-acting medication targets (hyperarousal, emotional dysregulation, hyperactive/neurocognitive, and cognitive inflexibility). Each cluster is represented by a list of common symptoms. The experts recommended that prescribers first ensure adequate psychosocial and environmental, including sufficient dietary, exercise, and sleep support before prescribing psychotropic medications. Treatment then progresses through three steps of psychotropic medications for each cluster. To support established treatment goals, the most function impairing clusters are targeted first.

A Study of the Use of Psychopharmacologic Agents by Acutely Medically Ill Older Adults

ABSTRACTThis retrospective study sought to investigate issues related to the safety of psychopharmacological agents used by acutely medically ill hospitalized older adults. It explored if there were any associations between commonly prescribed psychiatric medications that medically ill hospitalized older adults received and adverse events. It also sought to compare the safety of antidepressants, sedative/hypnotics, and antipsychotics, when used as a standing (on a preset schedule) and as needed pro re nata (PRN) basis. The study found that psychopharmacological agents are frequently prescribed for medically ill hospitalized older adults. No statistically significant difference was found as far as safety was concerned. The number of PRN medications that were used, and the total number of medications was associated with increased risk of transfer within the hospital to a higher level of care or transfer upon discharge to long-term-care/rehabilitation or hospice. Overall, the use of psychopharmacological agents did not appear to be related to serious adverse events.

Musical Hallucinations Treated with Atypical Antipsychotics in a Geriatric Population – A Case Series

Musical hallucinations have been likened to the auditory equivalent of Charles Bonnet Syndrome, which involves complex visual hallucinations, most often in the context of visual impairment. Musical hallucination frequently take the form of hymns, carols, and show-tunes and are strongly associated with hearing loss, with some studies suggesting a prevalence of 2.5–3.6% in the hearing impaired. Musical hallucinations are typically treated with anticonvulsant and anticholinesterase medications, with some studies having evaluated the efficacy of sedative hypnotics, antipsychotics and antidepressants in various psychiatric and medical subpopulations suggesting a heterogeneous spectrum of causes for this disorder. We present two cases of musical hallucinations in both a 70-year-old African American female with past psychiatric history of major depressive disorder who developed hymnal auditory hallucinations during an acute medical and psychiatric admission and an 86-year-old Caucasian female, who complained of hearing gospel music with eventual onset of visual hallucinations after a fall at age 80. Our patients were successfully treated in both the inpatient and outpatient settings with atypical antipsychotics. The presented cases add to the paucity of literature regarding utilization of atypical antipsychotics for treatment of musical hallucinations and demonstrate efficacy to this effect. This study lends further validity to the use of psychopharmacologic agents for novel purposes that have yet to be fully explored.

Effectiveness of Rational Emotive Behaviour Therapy in Clinical Social Work: Impact on Frequency of Visits and Use of Psychopharmacological Treatment

Introduction : Over 70% of mental health problems are exclusively managed in Primary Care. The yearly prevalence of depression and anxiety in Primary Care patients in Catalonia is 30% in women and 14% in men. The prevalence of major depressive disorder and of dysthymia is 1.3/1000 and 1.9/1000. As a consequence of their emotional distress, patients with dysthymia are typically frequent users of social and medical services and they are often prescribed psychopharmacological agents, which results in an increased risk of chronification and high pharmacy costs. Objective : The objective of this study is to evaluate the effectiveness of Rational Emotive Behavior Therapy (REBT) administered by a social worker in patients with dysthymia (Intervention Group) in reducing social and primary care (S&PC) attendance and prescription of psychopharmacological agents when compared with standard care (Control Group). Methods : Nonrandomized clinical trial with a 12month followup period from October 2009 to May 2013. Participants were patients with a diagnosis of dysthymia according to the Diagnostic and Statistical Manual of Mental Disorders–IV (DSMIV), recruited from two Primary Care Centers with similar sociodemographic characteristics in the Barcelona metropolitan area. Exclusion criteria were: cognitive impairment, illiteracy, refusal of treatment, severe psychiatric disorder and participation in psychoeducational groups and similar therapies. The Social Worker carried out the individual psychosocial intervention, with a maximum of 8 fortnightly sessions of 30 minutes in the Intervention Group while Control Group was treated as usual only by the general practitioner. Each session is aimed at identifying and analyzing the dysfunctional thoughts of the patients in order to suggest healthier alternatives. The treatment is active, directive, dynamic, and oriented towards psychosocial issues with the goal of empowering the person, group or community. Outcome variables were the frequency of use of primary care services related to the diagnosis of dysthymia and the prescription of psychopharmacological agents as registered in the electronic medical records during the previous 12 months. Other were sociodemographic variables, living arrangements, Beck Depression Inventory and comorbidities at baseline, mesured at baseline, 4 and 12 months. Baseline data from participants in the Intervention Group and Control Group were compared using a chi-square test and the t test. Two logistic regression analyses with adjustment for the propensity scores were carried out to evaluate the effect of the intervention in the improvement of attendance and of prescription of psychopharmacological agents. Ethical Aspects : This study was approved by the Ethics Committee of the Institute of Primary Care Research (IDIAP) Jordi Gol (Protocol: 13/035) and is registered in Clinical Trial Registries with the number IDNCT02112708. Results : The reduction in attendance was 47.9% in the Control Group (n=39) and 77.5% in the Intervention Group (n=51) (OR=3.75, p=0.021). The proportion of patients with a reduced prescription of psychopharmacological agents was 11.4% in the Control Group and 47.8% in the Intervention Group (OR=7.14, p=0.006). Discussion : The results of this study indicate that REBT carried out by clinical Social Worker at S&PC is effective in the treatment of dysthymia, as reflected in the decreased use of psychopharmacological agents and in the reduction of attendance to primary care. Based on the adjusted results, standard medical care and standard prescription of psychopharmacological agents decrease number of visits in 47.9% of patients. This study shows a significant decrease in the number of visits and in the prescription of psychopharmacological agents after a year of the REBT intervention. The results of this study show that these indicators are adequate to evaluate the efficacy of REBT in patients with dysthymia. This study shows that the Social Worker can assume the implementation of REBT in S&PC. This one translates into a great improvement in the healthcare of the patient with dysthymia, which is usually on chronic medication, because other comorbidities, and never prioritized by mental health specialists. We suggest for Rational Emotive Behavior Therapy to be included in the training program of Social Worker so that they are prepared to deliver REBT when required by their colleagues in S&PC, and included in integrated care. Taking into account a broader, biopsychosocial perspective on health, further studies on the effectiveness of REBT to improve quality of life and mood states are needed. Despite that patient perception of REBT has been excellent during the study, it should be evaluated and the qualitative and quantitative results compared by means of methodological triangulation. Finally, cost-effectiveness of REBT in the medium and long term in Primary Care must be studied. Conclusions : Rational Emotive Behavior Therapy decreases the proportion of patients that need prescription of psychopharmacological agents and frequent attendance to S&PC.

Topiramate, zonisamide and weight loss in children and adolescents prescribed psychiatric medications: A medical record review.

Childhood obesity is a growing epidemic that is contributed to by the use of psychopharmacological agents, such as antipsychotics. This study represents a preliminary investigation into the effectiveness of two anticonvulsants that were hypothesized to reduce weight in a pediatric sample seeking treatment at a psychiatric clinic. The electronic medical records of a university-based child and adolescent psychiatric clinic were reviewed for patients who were first prescribed either topiramate or zonisamide between 1 July 2011 and 30 June 2013. Based on inclusionary criteria, the review identified 47 children or adolescents. Multilevel modeling was utilized for study analyses. Including the full sample and controlling for confounders, anticonvulsant dosage was uniquely associated with an average reduction in body mass index of 1.3 (dosages above 200 mg) to 4.1 (dosages below 50 mg) every six months of treatment. Exlucing patients whose baseline body mass index was below 25.0 and controlling for confounders, anticonvulsant dosage was uniquely associated with an average reduction in body mass index of 3.2 (dosages above 200 mg) to 6.1 (dosages below 50 mg) every six months of treatment. Weight reduction was not statistically different between topiramate or zonisamide. Anticonvulsants were associated with an increase in body mass index, yet the benefits of the two anticonvulsants on weight loss remained despite the counteractive effects of antipsychotics. Results provide preliminary evidence that topiramate and zonisamide may be utilized for weight loss in a pediatric psychopharmacological treatment seeking sample, even if antipsychotics are also prescribed. A randomized controlled trial investigating the impact of topiramate and zonisamide on weight reduction is warranted.

Elevated neurotrophin-3 and neurotrophin 4/5 levels in unmedicated bipolar depression and the effects of lithium.

Bipolar disorder (BD) has been associated with diverse abnormalities in neural plasticity and cellular resilience. Neurotrophin-3 (NT-3) and neurotrophin-4/5 (NT-4/5) support synaptic neuronal survival and differentiation. NT-3 and NT-4/5 levels were found to be altered in BD, potentially representing a physiological response against cellular stress. However, the use of psychopharmacological agents and heterogeneous mood states may constitute important biases in such studies. Thus, we aimed to assess NT-3 and NT-4/5 levels in medication-free BD type I or II individuals in a current depressive episode, before and after 6 weeks of lithium monotherapy and matched with healthy controls. Twenty-three patients with BD type I or II during a depressive episode and 28 healthy controls were studied. Patients were required to have a 21-item Hamilton Depression Rating Scale score ≥18 and had not undergone any psychopharmacological treatment for at least 6 weeks prior to study entry. Patients were treated with lithium for 6 weeks and plasma NT-3 and NT-4/5 levels were determined at baseline and endpoint using ELISA method. Baseline plasma levels of both NT-3 and NT-4/5 were significantly increased in acutely depressed BD subjects in comparison to healthy controls (p=0.040 and 0.039, respectively). The NT-3 and NT-4/5 levels did not significantly change after lithium treatment. NT-3 and NT-4/5 levels were positively correlated to illness duration in BD (p=0.032 and 0.034, respectively). Our findings suggest that NT-3 and NT-4/5 levels are increased in the depressive phase of BD, which seems directly associated with illness duration. The increased levels of NT-3 and NT-4/5 may underlie a biological response to cellular stress associated with the course of BD.

Cognitive differences between patients who have psychogenic nonepileptic seizures (PNESs) and posttraumatic stress disorder (PTSD) and patients who have PNESs without PTSD

ObjectivesThe objective of this study was to examine cognitive and clinical differences among three groups of patients diagnosed with psychogenic nonepileptic seizures (PNESs): those with posttraumatic stress disorder (PTSD), those with a history of trauma but no PTSD, and those without a history of trauma. MethodsSeventeen patients who were confirmed to have PTSD based on the Trauma Symptom Inventory-2 (TSI-2) and clinical interview were compared with 29 patients without PTSD who had experienced trauma and 17 patients who denied experiencing trauma. We analyzed demographic data, psychiatric information, trauma characteristics, and neuropsychological variables in these groups. ResultsOur study revealed that patients with PNESs with comorbid PTSD performed significantly worse on episodic verbal memory (narrative memory); had greater self-reported Total, Verbal, and Visual Memory impairments; and had higher substance abuse history and use of psychopharmacological agents compared with patients without PTSD regardless of a history of trauma. ConclusionThe present study showed that patients with PNESs diagnosed with PTSD exhibited memory functions that were significantly different from those in patients with PNESs who do not carry a diagnosis of PTSD (regardless of history of trauma). Furthermore, these specific cognitive findings in narrative memory are consistent with those reported in patients with PTSD alone. The present findings contribute to further identifying discrete intragroup differences within PNESs. Identifying a specific psychopathological subgroup such as PTSD will allow clinicians to accurately select treatment.

Nonpharmacologic Management of Behavioral Disturbances in Long Term Care

Behavioral disturbances represent some of the most common and challenging psychiatric problems associated with dementia. They are seen in both outpatient and long-term care settings, and require not only application of pharmacologic and nonpharmcologic treatment modalities, but also coordination of caregivers and staff to enhance or modify the care environment. There is growing controversy over the use of pharmacologic agents. On the one hand, there is a body of literature supporting the efficacy and relative safety of a variety of psychotropic medications. On the other hand, the efficacy data is limited and the safety issues have been eclipsed by concerns about side effects from antipsychotic medications, in particular. This concern has even taken on national political significance, with Congressional hearings about the safety and potential overuse of antipsychotics in dementia patients and a resulting mandate from the Centers for Medicare and Medicaid Services authorizing reductions in antipsychotic use in long-term care settings. The use of nonpharmacologic treatment modalities is always cited as a safer alternative to the use of psychopharmacologic agents. But do these approaches actually work? This symposium will provide an overview and critical analysis of nonpharmacologic treatments, ranging from the assessment and modification of care needs and environmental stressors to the use of soothing and stimulating therapies such as music and pet therapy to the introduction of an applied behavioral analytic approach. Research and meta-analyses will be presented and discussed.

Features of psycho - emotional sphere of patients with stress – associated arterial hypertension

The aim of this study is to examine the association between symptoms of stress-tension, depression and anxiety and hypertension status. In the studu were used next questionnaires Determination of nervous and mental strain ( by T. Nemchin, 1988), the scale of PSM-25 ( by Lemyr-Tessier-Fillion-, 1983), Method for determining stress-tndurance and social adaptation (by Holmes and Rage, 1995) Boston stres -endurance test, and evaluation of stress (by Kouhen, 1995), Beck depression scale (BDI) , self-test hypochondria (by Wilson test ), exhaustion of vitality ( by Appels ) and scales of anxiety ( by Spielberger ) . The study of changes in the level of psycho-emotional men with hypertension proven correlation with the degree of hypertension severity of mental disorders . This result proves, that successful treatment of hypertension impossible without psychotherapy and / or use of psychopharmacological agents.

P.4.a.004 The use of psychopharmacological agents in a sample of patients with obsessive-compulsive disorder and their relationship to symptoms

P.4.a.004 The use of psychopharmacological agents in a sample of patients with obsessive-compulsive disorder and their relationship to symptoms

Pharmacological Attenuation of Electroconvulsive Therapy-Induced Cognitive Deficits

Electroconvulsive therapy (ECT) is an effective treatment for depression and other psychiatric disorders. However, the practice of ECT is limited by memory and nonmemory cognitive adverse effects. Technical strategies such as a preference for unilateralover bilateral ECT and low-dose over high-dose stimulation reduce these cognitive adverse effects but may also be associated with lesser treatment efficacy or slower treatment response. This article therefore reviews the use of psychopharmacological agents in the attenuation of ECT-induced cognitive deficits with 2 objectives: the identification of implicated mechanisms and the identification of putative efficacy in both animal and human studies. Drugs examined include N-methyl-d-aspartate receptor antagonists, cyclooxygenase inhibitors, calcium channel blockers, cholinesterase inhibitors, glucocorticoid receptor antagonists, thyroid hormones, opioid antagonists, NO donors, nootropic agents, and other medications. Although the clinical data at present are sparse and inconsistent, many recently opened lines of research improve our understanding of the mechanisms involved as well as suggest possible avenues for the testing of new treatments with the potential to attenuate the cognitive adverse effects of ECT.

Guidelines Advise MH Treatment for Very Young Children

Back to table of contents Previous article Next article Professional NewsFull AccessGuidelines Advise MH Treatment for Very Young ChildrenJun YanJun YanSearch for more papers by this authorPublished Online:18 Jan 2008https://doi.org/10.1176/pn.43.2.0006Attempting to bridge the chasm between the lack of research data and the need to treat severely disturbed young children, a group of experts in early childhood psychiatry, psychopharmacology, clinical psychology, general and behavioral pediatrics, and neurological development have published pharmacological treatment guidelines for psychiatric disorders in very young children in the December 2007 Journal of the American Academy of Child and Adolescent Psychiatry.The experts formed the Preschool Psychopharmacology Working Group (PPWG) and mapped out nine algorithms for the management of attention-deficit/hyperactivity disorder (ADHD), disruptive behavior disorders, major depressive disorder, bipolar disorder, anxiety disorders, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, pervasive developmental disorders, and primary sleep disorders in preschool-aged children. The algorithms provide step-by-step guidance—from diagnosis to treatment—for physicians and note the level of available evidence-based research for each step and treatment option.“These are the first comprehensive guidelines, as far as we know, on treating very young children that involve the expertise across multiple disciplines and areas in child mental health,” Mary Gleason, M.D., the lead author and a clinical assistant professor of psychiatry at Brown University's medical school, told Psychiatric News. She practices child psychiatry at the Bradley Hasbro Children's Research Center in Rhode Island.“We had three main goals in compiling this document,” she said.“ The first was to review and present the current state of evidence for treatment for preschoolers and provide some resource for physicians.”The second goal, she said, was to formulate evidence-based guidelines for both mental health providers and children and families in terms of pharmacologic options and present rational algorithms for treatment.Finally, this document is intended to be used as “a springboard and advocacy for more independently funded research in this area.” Gleason stressed that the child psychiatric community urgently needs the resources for more studies, more specialized training, and more financial support, such as reimbursement for psychotherapy, for the diagnosis and treatment of psychiatric problems in preschool-aged children.Because it is risky and difficult to conduct medical research on very young children, safety and efficacy data on medication use in this population are woefully inadequate, and regulatory approval nearly nonexistent. In addition to the limited literature on these children, the PPWG reviewed the scientific evidence in older children, which is more abundant, and obtained consensus from practicing clinicians, through a survey; their recommendations were also based on the expertise among the PPWG members. The initiative was funded by the American Academy of Child and Adolescent Psychiatry.The work group highlighted the need to perform a thorough assessment of very young patients—and their home environment—before forming treatment strategies. “It is very important to get a family-focused, developmentally appropriate diagnosis,” said Gleason. “The clinician should gather information from multiple appointments and multiple sources.” She recommended using various methods, including observation, interviews, structured examinations, and informal assessments, to form a clear and complete impression of the patient. “That is the critical first step.” The guidelines ask clinicians to pay attention to each child's particular developmental, family, and community context of the symptoms during evaluation.The group recommended that “evidence-supported psychosocial treatments” be applied as a first-line treatment for preschool-aged children and continued even if medications are prescribed. In addition, they suggested that family caregivers should be involved in psychotherapy as much as possible. For example, the group recommended parent-management training or other behavioral techniques as first-line interventions for ADHD in preschoolers.“It is important to work with the family and together identify realistic treatment goals, discuss side effects, and plan for the time when medications may be discontinued,” Gleason said. “Then reassess the child often.” Also, “help the family understand the risks and benefits of the medications prescribed through informed consent,” she recommended.The guidelines encourage physicians to anticipate and try discontinuation of medications over time, depending on patient's response and development.“ [The guidelines are] not intended to promote the use of medications,” the PPWG pointed out. Rather, they “anticipate that application of these algorithms will result in a reduction in the use of psychopharmacological agents for young children.”An abstract of “Psychopharmacological Treatment for Very Young Children: Contexts and Guidelines” can be accessed at<www.jaacap.com/pt/re/jaacap/home> by clicking on “Archive” and the December 2007 issue.▪ ISSUES NewArchived

Primhe: Primary Care Mental Health &amp; Education

AbstractPsychotropic drug prescribing patterns among CAMHS clinicians and paediatriciansThere has been an increase in the use of psychopharmacological agents by Child and Adolescent Mental Health Services (CAMHS) clinicians and paediatricians in recent years. This audit of FP10 prescriptions issued by secondary care clinicians in child health looked at the prescribing patterns among CAMHS clinicians and paediatricians in a secondary care setting. Copyright © 2007 Wiley Interface Ltd

Female Hypoactive Sexual Desire Disorder: History and Current Status

Hypoactive sexual desire disorder (HSDD) is a common problem that is often treatment refractory. This refractoriness to treatment is reflective of our lack of knowledge concerning the determinants of sexual libido in women. To review the development and current status of information concerning the diagnosis and treatment of HSDD. Literature on HSDD published between 1950 and 2005 was reviewed. Historically, HSDD was considered to be a psychiatric disorder. Thus, the diagnostic criteria utilized in studies of interventions for this disorder are based on the Diagnostic and Statistical Manual of the American Psychiatric Association. This system was never designed to encompass organic causes of sexual dysfunction and has evolved by expert opinion. If the syndrome is poorly defined by these diagnostic criteria, this could limit progress in this field. Epidemiological studies have found that approximately 24-43% of women complain of low sexual desire in the preceding year. The percentage of the population meeting diagnostic criteria for HSDD is probably much lower. There has been considerable progress in the development of psychometrically sound instruments for the assessment of libido. The development of approaches to treatment was reviewed. Approaches to treatment have evolved in three major areas: psychological, hormonal, and use of psychopharmacological agents. There is some evidence of efficacy utilizing all three approaches. The major evidence of efficacy concerns the use of testosterone therapy. Long-term safety data concerning this treatment are absent. There is a rapidly expanding knowledge base concerning the diagnosis and treatment of HSDD. However, the contemporary clinician is faced with the absence of an approved treatment for this disorder and the lack of clear guidelines concerning the indications and safety of the use of non-approved agents.

Editorial

Editorial

Disordered gambling in adolescents : epidemiology, diagnosis, and treatment.

Rapid expansion of legalized gambling has been associated with increased rates of gambling disorders among adults and adolescents worldwide. Epidemiologic studies suggest that, in North America, up to 6% of adults and 20% of adolescents have a gambling problem. Despite increasing prevalence rates of gambling disorders, little research is available on how to treat such disorders in adolescents. Much of what is known about how to treat adolescent problem and pathological gambling comes from research on psychosocial and psychopharmacologic treatments for adult pathological gambling. Risk factors for adolescent gambling disorders include male gender, alcohol and drug use, deviant peers, family history of gambling, and impulsive behavior. While several risk factors characterize disordered gambling among adolescents, the extent to which these characteristics are related remains to be determined. In terms of screening for adolescent problem and pathological gambling, several instruments designed to reflect the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria for pathological gambling are available. Psychosocial approaches used to treat adult pathological gambling include Gamblers Anonymous, cognitive-behavioral therapy (CBT), and motivational enhancement therapy (MET). Among adolescents, CBT as well as an eclectic therapy have been helpful in reducing problematic gambling behavior. In terms of pharmacotherapy, three classes of psychotropic drugs have been used to treat adult pathological gambling - serotonin reuptake inhibitors, opioid antagonists, and mood stabilizers. While some of these pharmacotherapies have been efficacious in treating adult pathological gambling, additional double-blind, placebo-controlled studies are needed to determine the long-term effectiveness of these treatments. No known study has evaluated the use of psychopharmacologic agents in treating adolescent pathological gambling. Possible reasons for the lack of research on treatment for adolescent gambling disorders include lack of motivation to pursue treatment, feelings of self-control, and negative perception of therapy. Referrals from parents, teachers, and peers of adolescents, as well as community outreach programs, may be useful in successfully deriving a treatment population. Clinicians are advised to be sensitive to behavioral risk factors and to screen for disordered gambling in high risk adolescents. A combination of CBT and MET, as well as medication for any comorbid psychiatric condition, is recommended.