Child and adolescent obsessive-compulsive disorder treated with citalopram: Findings from an open trial of 23 cases
ABSTRACT The adverse effects and potential clinical value of citalopram, a highly selective serotonin reuptake inhibitor, were examined in 23 children and adolescent (9-18 years old, 11 boys) with obsessive-compulsive disorder (OCD) in an open-label trial of citalopram 10-40 mg (modal 40 mg) daily. After 10 weeks of citalopram treatment, statistically significant improvements were reflected in OCD symptom ratings (mean Total Y-BOCS/CY-BOCS scores, 30 +/- 4 vs. 21 +/- 4, p < 0.001) and global assessment scores (mean CGAS, 59 +/- 11 vs. 71 +/- 11, p < 0.001). Over 75% of these youth showed a marked improvement (4 patients had more than 50% reduction in CY-BOCS scores) or moderate improvement (14 patients had 20%-50% reduction) in OCD symptoms. No patient was found to have worsened during citalopram treatment. Adverse effects appeared minor and transient. None of the 23 patients dropped out of the study or had the medication discontinued because of side effects. These open trials of citalopram do not allow for any firm conclusions regarding its effectiveness in the treatment of childhood and adolescent OCD, but these preliminary findings suggest that citalopram might be particularly well-tolerated in children and adolescents with OCD at doses up to 40 mg daily.
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- "In a chart review, citalopram was found to be effective and safe in reducing depressive symptoms in children and adolescents (Baumgartner, Emslie & Crismon, 2002). An open-label study of adolescent OCD suggests that citalopram may also be effective and safe in treating adolescents (Thomsen, 1997). In addition, citalopram was found to reduce adolescent impulsive aggression (mean dose of 27mg/day) and have a low incidence of adverse events (Armenteros & Lewis, 2002). "
Article: Adolescent Problem Gambling[Show abstract] [Hide abstract]
ABSTRACT: Despite the high prevalence rates of pathological gambling in adolescents, research on this disorder is still in its infancy. Our understanding of neurodevelopmental changes that occur during adolescence, and their influence on adolescent behaviors, is still at an early stage. Longitudinal studies involving neuro-imaging, genetics, and behavioral assessments should help advance our understanding of adolescents, and with this understanding should come advances in prevention and treatment strategies for problems frequently experienced by adolescents, including risk behaviors such as pathological gambling. Available data on pathological gambling in adults suggest several possible pharmacological interventions. At present, the best evidence suggests the use of SRIs, mood stabilizers, and naltrexone in treating pathological gambling in adults (Grant, Kim & Potenza, 2003). However, no data currently exist directly evaluating the efficacy of pharmacological treatments for pathological gambling in adolescents. Pharmacological treatment of other disorders in adolescents suggests that certain medications-SRIs, mood stabilizers, naltrexoneùappear safe and effective at certain doses and for certain indications. Although the data suggest potentially promising pharmacological treatments for adolescent pathological gambling, definitive treatment recommendations await completion of controlled treatment studies in this population. As the combination of behavioral and drug therapies has been demonstrated in other addictive disorders to be superior to either treatment alone (Carroll, 1997), future investigations in the treatment of pathological gambling in adolescents and adults should consider empirically validating such combined treatment approaches (Potenza, 2002; Petry, 2003). Such studies offer substantial promise and should contribute to optimizing treatment strategies for pathological gambling.
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ABSTRACT: Nous proposons dans cette article de faire une revue des traitements psychotropes du trouble obsessionnel compulsif chez l’enfant et l’adolescent et de discuter leur place, leur indication à côté des autres abords thérapeutiques. On dispose de données solides aujourd’hui pour affirmer que les inhibiteurs de la recapture de la sérotonine réduisent au plan clinique la sévérité des symptômes obsessionnels compulsifs chez la plupart des enfants ou adolescents atteints du trouble. Néanmoins, l’amélioration n’est souvent que partielle, peu de sujets deviennent asymptomatiques, et un traitement prolongé est souvent nécessaire. Les psychothérapies cognitivo-comportementales, basées sur une exposition graduée aux stimuli anxiogènes (obsessions) et une prévention de la réponse comportementale (compulsions), semblent avoir des effets plus durables, et sont de ce fait le traitement de première intention dans les formes modérées sans comorbidité du trouble. Comme le TOC survient dans un contexte de difficultés adaptatives et psychopathologiques diverses, un abord psychothérapique individuel ou familial, une association de psychotropes ou un abord éducatif pourront aussi être proposés. The present report review available literature on psychopharmacological treatment of obsessive compulsive disorder (OCD) in children and adolescents. There is now clear evidence that drugs that are potent serotonin reuptake inhibitors (clomipramine and SSRIs) induce a clinically substantial reduction of OC symptoms for most children and adolescents with the disorder. However, improvement is often incomplete, few patients become asymptomatic, and long-term maintenance treatment may be required. Cognitive behavioural treatment, based on graded exposure with response prevention, might have more durable benefits, and is considered as the first line treatment in mild non comorbid OCD. Because OCD frequently occurs in the context of other psychopathology and adaptative difficulties, additional individual and family psychotherapy, pharmacological associations and educational interventions are often necessary.PSN 03/2003; 1(2):27-34. DOI:10.1007/BF03006795 · 0.07 Impact Factor
Article: The new antidepressants[Show abstract] [Hide abstract]
ABSTRACT: The acute pharmacology of currently marketed antidepressants is increasingly being understood, although the actions that are responsible for antidepressant efficacy remain poorly understood. All antidepressants marketed to date interact with brain monoamine systems and their ability to increase serotonin and/or noradrenaline neurotransmission in the longer term (as opposed to acute effects) is believed to contribute to antidepressant efficacy. Common adverse effects of antidepressants relate closely to their acute pharmacology and liability to cause drug interactions primarily because of their ability to inhibit hepatic cytochrome P-450 enzymes. This paper reviews current pharmacodynamic, pharmacokinetic and clinical aspects of antidepressant drug treatment and describes the pharmacology of new antidepressants that have been licensed in the last 10 years. These are the selective serotonin reuptake inhibitors (citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline), venlafaxine, reboxetine, nefazodone, mirtazapine and moclobemide.Current Anaesthesia and Critical Care 01/1983; 10(1-10):32-39. DOI:10.1016/S0953-7112(99)90028-5