Treatment of Psychiatric Disorders in Children and Adolescents with HIV/AIDS
Department of Psychiatry, The University of Pennsylvania School of Medicine/The Children's Hospital of Philadelphia, The Behavioral Health Center, Suite 400, 3440 Market Street, Philadelphia, PA 19104, USA. Current Psychiatry Reports
(Impact Factor: 3.24).
04/2010; 12(2):104-10. DOI: 10.1007/s11920-010-0092-z
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.
Available from: Anusha Lachman
- "Mirtazapine has been helpful for sleep and in promoting weight gain although controlled trial data is still lacking. Similar to other groups with depression, careful monitoring of the emergence of suicidal ideation is warranted (Benton, 2010). The prevalence of bipolar disorders in HIV-positive youth has not been systematically studied and recommendations for treatment are based on current pediatric and adult treatment guidelines. "
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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, PhotoSensitive
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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.
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ABSTRACT: The non-OCD (obsessive-compulsive disorder) anxiety disorders in the pediatric population- separation anxiety disorder, generalized anxiety disorder, and social phobia and others- are arguably the most common psychiatric disorders in this age group. Anxiety disorders, in addition to being common, also significantly impair the affected child at home, school, and with peers. A small developing evidence base suggests the selective serotonin reuptake inhibitors (SSRIs) are the pharmacological treatment of choice for pediatric non-OCD anxiety disorders. In clinical trials, SSRIs are often very effective in reducing symptoms and improving functioning and generally well tolerated. The U.S. Food and Drug Administration's (FDA) review of the safety of antidepressants in the pediatric population suggest a small, but significant, increased relative risk for suicidality adverse events on antidepressant versus placebo. Despite the apparent increased risk, the larger magnitude of benefit of the SSRIs for pediatric non-OCD anxiety disorders compared to depression suggests the benefit/risk ratio for anxiety disorders is more favorable than that for depression. This paper will review available studies on the treatment of non-OCD childhood anxiety disorders with antidepressants, including the SSRIs, and discuss pertinent safety issues.
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