To compare the rates of physical, psychiatric, and suicide-related events in adolescents with MDD treated with fluoxetine alone (FLX), cognitive-behavioral therapy (CBT), combination treatment (COMB), or placebo (PBO).
Safety assessments included adverse events (AEs) collected by spontaneous report, as well as systematic measures for specific physical and psychiatric symptoms. Suicidal ideation and suicidal behavior were systematically assessed by self- and clinician reports. Suicidal events were also reanalyzed by the Columbia Group and expert raters using the Columbia-Classification Algorithm for Suicidal Assessment used in the U.S. Food and Drug Administration reclassification effort.
Depressed adolescents reported high rates of physical symptoms at baseline, which improved as depression improved. Sedation, insomnia, vomiting, and upper abdominal pain occurred in at least 2% of those treated with FLX and/or COMB and at twice the rate of placebo. The rate of psychiatric AEs was 11% in FLX, 5.6% in COMB, 4.5% in PBO, and 0.9% in CBT. Suicidal ideation improved overall, with greatest improvement in COMB. Twenty-four suicide-related events occurred during the 12-week period: 5 patients (4.7%) in COMB, 10 (9.2%) in FLX, 5 (4.5%) in CBT, and 3 (2.7%) in placebo. Statistically, only FLX had more suicide-related events than PBO (p =.0402, odds ratio (OR) = 3.7, 95% CI 1.00-63.7). Only five actual attempts occurred (2 COMB, 2 FLX, 1 CBT, 0 PBO). There were no suicide completions.
Different methods for eliciting AEs produce different results. In general, as depression improves, physical complaints and suicidal ideation decrease in proportion to treatment benefit. In this study, psychiatric AEs and suicide-related events are more common in FLX-treated patients. COMB treatment may offer a more favorable safety profile than medication alone in adolescent depression.
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"The natural history of many of these child psychiatric disorders (particularly depression, ADHD, and social phobia), can be altered dramatically with proper treatment (March et al., 2004, 2009; Kratochvil et al., 2009; Molina et al., 2009; Reinecke et al., 2009). With early intervention, the developmental impact of all of these disorders can be minimized (Birmaher et al., 1996; Graham et al., 2006). Thus, our data suggests that in many cases the self-reported screening strategies may be able to identify individuals with high likelihood of having child mental issues that are associated with school dropout and that children appear willing to endorse symptoms on self-report measures. "
[Show abstract][Hide abstract] ABSTRACT: School dropout has significant consequences for both individuals and societies. Only 21% of adults in Mexico achieve the equivalent of a high school education. We examined the relationship between school dropout and self-reported psychiatric symptoms in a middle school in a suburb of Mexico City. We used binomial logistic regression to examine the odds ratio (OR) of school dropout associated with students' self-reported psychopathology. Two-hundred thirty-seven students participated in the study. Psychosis [OR = 8.0 (95% confidence interval, CI: 1.7-37.2)], depression [OR = 4.7 (95% CI: 2.2-9.7)], tic disorders [OR = 3.7 (95% CI: 1.4-9.5)], ADHD [OR = 3.2 (95% CI: 1.5-6.4)], and social phobia [OR = 2.6 (95% CI: 1.2-5.8)] were associated with increased risk of school dropout after controlling for age and gender as covariates. Our study suggested that students' self-reported psychopathology is associated with increased school dropout in Mexico. ADHD and depression may be particularly useful childhood psychiatric disorders to target with public health interventions because they explain the greatest amount of the variance in school dropout of child psychiatric disorders.
Frontiers in Psychiatry 03/2012; 3:20. DOI:10.3389/fpsyt.2012.00020
"This is especially true following the US Food and Drug Administration issuing of a black box warning on these medications that focuses on potential for suicidality in October 2004. This black box warning now extends to all patients aged 25 years or younger (http://www.fda.gov/Drugs/Drug-Safety/InformationbyDrugClass/UCM096273).75 Current guidelines suggest that adequate parental and patient consent should be obtained from any patient potentially being prescribed serotonergic antidepressants. "
[Show abstract][Hide abstract] ABSTRACT: Anxiety disorders are the most prevalent mental health concern facing adolescents today, yet they are largely undertreated. This is especially concerning given that there are fairly good data to support an evidence-based approach to the diagnosis and treatment of anxiety, and also that untreated, these problems can continue into adulthood, growing in severity. Thus, knowing how to recognize and respond to anxiety in adolescents is of the utmost importance in primary care settings. To that end, this article provides an up-to-date review of the diagnosis and treatment of anxiety disorders geared towards professionals in primary care settings. Topics covered include subtypes, clinical presentation, the etiology and biology, effective screening instruments, evidence-based treatments (both medication and therapy), and the long-term prognosis for adolescents with anxiety. Importantly, we focus on the most common types of anxiety disorders, often known as phobias, which include generalized anxiety disorder, social anxiety/social phobia, separation anxiety disorder, panic disorder, and specific phobias. In summary, anxiety is a common psychiatric problem for adolescents, but armed with the right tools, primary care providers can make a major impact.
Adolescent Health, Medicine and Therapeutics 01/2012; 3:1-16. DOI:10.2147/AHMT.S7597
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[Show abstract][Hide abstract] ABSTRACT: This paper reviews literature regarding psychopharmacological treatment options for ADHD, depression and dual diagnosis, and explores perceptions of treatment and considerations for art therapy in conjunction with psychotropic medication. This review attempts to initiate discussion and propel further research in the expressive arts field regarding the growing need to conceptualize our understandings of the role art therapy plays in combined treatment with psychopharmacology.
The Arts in Psychotherapy 02/2011; 38(1):29-35. DOI:10.1016/j.aip.2010.10.003 · 0.58 Impact Factor