Treatment of psychiatric disorders in children and adolescents with HIV/AIDS.
ABSTRACT We could not have predicted that HIV/AIDS would become one of our greatest public health challenges worldwide when the first cases were identified in the 1980s. More than 22 million people have died from the disease, and HIV is now the seventh-leading cause of death in the United States among 15- to 24-year-olds. At the beginning of this pandemic, most HIV infections of youth were acquired congenitally. Prenatal screening of pregnant women, early detection, and antiretroviral therapies have reduced mother-to-child transmission. Children born with HIV infections are now young adults living with HIV, while other adolescents are acquiring HIV primarily through high-risk behaviors. Associations between psychiatric symptoms and poor health outcomes have been recognized among adults. Few studies have examined these factors among youth. We review what is known about psychiatric syndromes among HIV-positive youth, and their treatments.
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ABSTRACT: Lithium is a benchmark treatment for bipolar illness in adults. However, there has been relatively little methodologically stringent research regarding the use of lithium in youth suffering from bipolarity. Under the auspices of the Best Pharmaceuticals for Children Act (BPCA), a Written Request (WR) pertaining to the study of lithium in pediatric mania was issued by the United States Food and Drug Administration (FDA) to the National Institute of Child Health and Human Development (NICHD) in 2004. Accordingly, the NICHD issued a Request for Proposals (RFP) soliciting submissions to pursue this research. Subsequently, the NICHD awarded a contract to a group of investigators in order to conduct these studies. The Collaborative Lithium Trials (CoLT) investigators, the BPCA-Coordinating Center, and the NICHD developed protocols to provide data that will: (1) establish evidence-based dosing strategies for lithium; (2) characterize the pharmacokinetics and biodisposition of lithium; (3) examine the acute efficacy of lithium in pediatric bipolarity; (4) investigate the long-term effectiveness of lithium treatment; and (5) characterize the short- and long-term safety of lithium. By undertaking two multi-phase trials rather than multiple single-phase studies (as was described in the WR), the feasibility of the research to be undertaken was enhanced while ensuring all the data outlined in the WR would be obtained. The first study consists of: (1) an 8-week open-label, randomized, escalating dose Pharmacokinetic Phase; (2) a 16-week Long-Term Effectiveness Phase; (3) a 28-week double-blind Discontinuation Phase; and (4) an 8-week open-label Restabilization Phase. The second study consists of: (1) an 8-week, double-blind, parallel-group, placebo-controlled Efficacy Phase; (2) an open-label Long-Term Effectiveness lasting either 16 or 24 weeks (depending upon blinded treatment assignment during the Efficacy Phase); (3) a 28-week double-blind Discontinuation Phase; and (4) an 8-week open-label Restabilization Phase. In December of 2006, enrollment into the first of these studies began across seven sites. These innovative studies will not only provide data to inform the labeling of lithium in children and adolescents with bipolar disorder, but will also enhance clinical decision-making regarding the use of lithium treatment in pediatric bipolar illness. NCT00442039.Child and Adolescent Psychiatry and Mental Health 02/2008; 2(1):21.
Article: Predicting the outcome of treatment.[Show abstract] [Hide abstract]
ABSTRACT: The clinical question--"Which treatment(s) for which patients with what set of subgrouping characteristics working by what mechanism(s)?"--rests at the heart of differential therapeutics. Experimentally, this question reduces to a test of how well we can predict the outcome of treatment using the treatment conditions plus other moderating and mediating variables. Reflecting the discussions held at a recent National Institute of Mental Health (NIMH) conference on psychosocial treatments, and using pediatric anxiety disorders as a case in point, we discuss the problem of prediction in treatment outcome studies from the standpoint of definition of terms, using the general linear model of prediction. We also outline types of studies that may be useful in testing potential predictors, and put forward a possible matrix of predictor variables as currently implemented in an NIMH-funded treatment outcome study of pediatric obsessive-compulsive disorder (OCD). We conclude by making specific suggestions for implementing a broader approach to the study of predictors.Journal of Abnormal Child Psychology 03/1998; 26(1):39-51. · 3.09 Impact Factor
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ABSTRACT: This publication is intended for professionals training or practicing in mental health and not for the general public. The opinions expressed are those of the authors and do not necessarily represent the views of the Editor or IACAPAP. This publication seeks to describe the best treatments and practices based on the scientific evidence available at the time of writing as evaluated by the authors and may change as a result of new research. Readers need to apply this knowledge to patients in accordance with the guidelines and laws of their country of practice. Some medications may not be available in some countries and readers should consult the specific drug information since not all dosages and unwanted effects are mentioned. Organizations, publications and websites are cited or linked to illustrate issues or as a source of further information. This does not mean that authors, the Editor or IACAPAP endorse their content or recommendations, which should be critically assessed by the reader. Websites may also change or cease to exist. ©IACAPAP 2013. This is an open-access publication under the Creative Commons Attribution Non-commercial License. Use, distribution and reproduction in any medium are allowed without prior permission provided the original work is properly cited and the use is non-commercial. Send comments about this book or chapter to jmreyATbigpond.net.au Suggested citation: Benton TD, Lachman A, Seedat S. HIV/AIDS. Addressing the mental health needs of affected children and families.. In Rey JM (ed), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions 2013. Conflict of interest: research grants from the National Institutes of Health and from several pharmaceutical companies (Lundbeck, GlaxoSmithKline, and Astra-Zeneca), speaker honoraria from Pfizer, Servier, Dr Reddy's, Sanofi-Aventis, and Eli-Lilly. 'Amelia, 13, (right) and her sister Mamdiuana, 7, inside the door of their house near Mombane (Mozambique). The sisters now live alone, with the support of their community after both of their parents died of AIDS. Community support for HIV/AIDS orphans has become a priority for many communities. Leaders quickly realized that the effects of HIV related illness are felt by entire communities -not only those who are infected with the disease. As a result, community responses to the pandemic are necessary.' Image and text: Andy Clark, PhotoSensitiveIACAPAP e-TEXTBOOK OF CHILD & ADOLESCENT MENTAL HEALTH, Edited by JM REY, 01/2013: chapter Chapter I.3 HIV/AIDS ADDRESSING THE MENTAL HEALTH NEEDS OF AFFECTED CHILDREN AND FAMILIES: pages 1-26;