Depressive Störungen im Kindes- und Jugendalter

Klinische Pharmakologie am Lehrstuhl mit Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg.
Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie (Impact Factor: 0.99). 03/2013; 41(2):109-19. DOI: 10.1024/1422-4917/a000218
Source: PubMed


Objective: The present analysis evaluates the prevalence and medication use in inpatients with depression during childhood and adolescence at the KinderAGATE hospitals in 2010. Also discussed are age and sex distribution. Method: Since 2009 the following information has been recorded anonymously twice a year from each patient at the participating hospitals of KinderAGATE: age, sex, leading diagnosis, prescribed medication and dosage. The data obtained provide an excellent epidemiological basis for the observation of the prescription practice in child and adolescent psychiatry. Results: In 2010, 8.4 % of the patients included were treated for a depressive disorder at the KinderAGATE hospitals. This is only a small portion compared to the rates found in adult psychiatry (25.8 % of patients). In our sample male patients diagnosed with depression (58 % DPat, mean age 13.8 years) were treated more often and earlier than female patients (42 % DPat, mean age 15.3 years). Fluoxetine and mirtazapine were the most frequently prescribed substances. Sertraline, escitalopram, and citalopram were also prescribed. Conclusion: A reserved medical treatment can be observed in child and adolescence psychiatry. Off-label use seems to be nearly unavoidable due to the lack of newly authorized medicine. Moreover, the numerous prescriptions for fluoxetine, the only SSRI currently approved for this age group in Germany, lead to the question of possible unauthorized alternatives.

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    ABSTRACT: Diagnosing childhood depression can pose a challenge, even for mental health specialists. Screening tools can aid clinicians within the initial step of the diagnostic process. For the first time, the Children׳s Depression Screener (ChilD-S) is validated in a mental health setting as a novel field of application beyond the previously examined pediatric setting. Based on a structured interview, DSM-IV-TR diagnoses of depression were made for 79 psychiatric patients aged 9-12, serving as the gold standard for validation. For assessing criterion validity, receiver operating characteristic (ROC) curves were calculated. Point prevalence of major depression and dysthymia was 28%. Diagnostic accuracy in terms of the area under the ROC curve was high (0.97). At the optimal cut-off point ≥12 according to the Youden׳s index, sensitivity was 0.91 and specificity was 0.81. The findings suggest that the ChilD-S is not only a valid screening instrument for childhood depression in pediatric care but also in mental health settings. As a brief tool it can easily be implemented into daily clinical practice of mental health professionals facilitating the diagnostic process, especially in case of comorbid depression.
    04/2014; 217(3). DOI:10.1016/j.psychres.2014.03.037
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    ABSTRACT: PurposeLongitudinal data on prescriptions of antidepressants (AD) in children and adolescents depression are scarce. This study aimed to examine AD prescription trends in children and adolescents in Germany.Methods Data of a large statutory health insurance company were analyzed for the period 2005–2012, and outpatients aged 0–19 years with AD prescriptions were identified. Prescriptions were evaluated with respect to age, sex, region of residence (East vs. West Germany) and substance class.ResultsOur study population comprised 1.4–1.6 million children and adolescents per year; between 4790 and 6849 of them received AD prescriptions. From 2005 to 2012, the prevalence of AD prescriptions rose from 0.32% to 0.48% (+49.2%), with a significant increase only in the age group 15–19 years (from 0.83% to 1.41%; +71.0%). The prevalence of AD prescriptions rose from 0.41% to 0.63% (+53.3%) for women and from 0.24% to 0.35% (+43.1%) for men. Regarding substance classes, serotonin reuptake inhibitors (SSRI) prescriptions increased from 37.7% to 54.4% of all AD prescriptions, whereas tricyclic antidepressants (TCA) significantly decreased (from 39.6% to 23.0%). In all years, fluoxetine was the substance most frequently prescribed (2005: 12.2% and 2012: 24.3% of all AD prescriptions).Conclusions During an 8-year period, prescriptions of AD to children and adolescents in Germany have markedly increased, but almost exclusively in adolescents. Fortunately, in accordance with guidelines, both fluoxetine and SSRI prescriptions have risen over recent years. Yet, there still remain a significant proportion of TCA prescriptions. Copyright © 2014 John Wiley & Sons, Ltd.
    Pharmacoepidemiology and Drug Safety 12/2014; 23(12). DOI:10.1002/pds.3649 · 2.94 Impact Factor

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