ISSN:1044-5463    

DOI:10.1089/cap.1995.5.1

年代:1995

数据来源: MAL

ISSN:1044-5463    

DOI:10.1089/cap.1995.5.5

年代:1995

数据来源: MAL

ISSN:1044-5463    

DOI:10.1089/cap.1995.5.9

年代:1995

数据来源: MAL

摘要:

ABSTRACTObjective:To evaluate the therapeutic and adverse effects of sertraline in children and adolescents with major depressive disorder (MDD). Method: Retrospective chart reviews were conducted on 33 youths (ages 8–18 years) treated for MDD with sertraline and no other psychotropic medication. Focusing on the interval from 2 to 10 weeks of treatment (when therapeutic changes were anticipated), clinical changes were assessed utilizing the Clinical Global Impression (CGI) subscales for severity of illness (modified to reflect severity of depressive illness) in 21 patients and for global improvement in 17 patients. Adverse effects were assessed in all 33 patients. Results: By the tenth week of treatment, the mean scores for severity of depressive illness changed significantly from 5.8 to 3.4 (6 = severely ill, 3 = mildly ill) and global improvement scores indicated that 11 of 17 patients (65%) improved much or very much. Older children improved to a greater degree. Mean dose was 1.6 mg/kg or 100 mg (range 25–200 mg) daily. No data were collected on which symptoms may have responded. Adverse effects were experienced by 16 of 33 patients, and 8 discontinued sertraline due to adverse effects. Seven patients (21%), including 4 of the 8 discontinuers, experienced behavioral side effects, whose onset clustered within the first 2 weeks and at 3 months of treatment. Two patients developed mania during sertraline treatment (one at 3 days, other at 94 days), and five developed other types of behavioral activation. No patient showed a worsening of depressive symptoms or an onset of suicidality or violence. Fatigue and sedation appeared to resolve spontaneously. Conclusion: These preliminary and uncontrolled clinical findings suggest that some children and adolescents with MDD may respond to sertraline, but adverse behavioral effects may be com

ISSN:1044-5463    

DOI:10.1089/cap.1995.5.13

年代:1995

数据来源: MAL

摘要:

ABSTRACTThe cardiovascular responses to methylphenidate (MPH) were investigated in anxious and nonanxious children with attention-deficit hyperactivity disorder (ADHD). A randomized, double-blind, placebo-controlled crossover design was used to evaluate the acute effects of three doses (0.3, 0.6, and 0.9 mg/kg) of MPH on cardiovascular function in 63 children (34 nonanxious, 29 anxious), aged 6 to 12 years, with ADHD. Resting heart rate as well as systolic and diastolic blood pressure readings were taken prior to 1 hr after, and 2 hrs after administration of medication. Results indicated that baseline cardiovascular measures were similar for the two diagnostic groups. MPH produced the expected dose-dependent and time-dependent increases in heart rate and both systolic and diastolic blood pressure in all children. However, MPH produced significantly greater increases in diastolic blood pressure in the anxious ADHD group, particularly 1 hr after its administration, than in the nonanxious ADHD children. Although these stimulant-induced changes were generally of little clinical concern, the exaggerated response of the ADHD/ANX children to MPH challenge supports the hypothesis of increased sensitivity to augmented noradrenergic function in this group. The presence of high levels of trait anxiety in some ADHD children alters the cardiovascular response to MPH, suggesting that highly anxious children with ADHD may constitute a distinct subgroup of children with ADHD. In this study, anxiety was defined by the child's self-report, so the findings attest to the importance of obtaining children's self-report of internalizing symptomatology. The presence of self-reported anxiety in ADHD children should alert clinicians to the possibility of a differential response to psychostimulants in anxious ADHD children.

ISSN:1044-5463    

DOI:10.1089/cap.1995.5.29

年代:1995

数据来源: MAL

摘要:

ABSTRACTThe knowledge and attitudes of a patient toward medication treatment may be crucial factors in modifying compliance with a prescribed regimen. The knowledge and attitudes regarding psychiatric medications, both of hospitalized adolescents and their parents, were compared with patients' medication compliance following hospitalization. Thirty adolescent inpatients (ages 13–18) and their parents underwent intensive medication education programs. Their attitudes and knowledge regarding the treatments were evaluated during the hospitalization, and patient compliance was assessed 2 months after discharge. Neither the parents' knowledge nor attitudes correlated with the adolescents' compliance. Also, the patients' medication-related knowledge (accurate information) gained during hospitalization about their treatment did not correlate with their posthospital behavior, although they learned substantially about their treatments. However, the patients' attitudes toward their pharmacotherapy correlated highly with their postdischarge compliance (R = 0.58, p<0.001). Even after receiving routine verbal information from the physician and giving informed consent for treatment, parents' attitudes toward medication treatment were quite mixed, suggesting that only a minimal level of parental comfort was achieved at start of treatment. To enhance compliance, educational efforts may better be focused more on the adolescents' attitudes instead of predominantly on their knowledge of their pharmacotherapy. Speculatively, modification of an adolescent's feelings and ideas related to pharmacotherapy may enhance their treatment adherenc

ISSN:1044-5463    

DOI:10.1089/cap.1995.5.39

年代:1995

数据来源: MAL

摘要:

ABSTRACTIn open clinical trials, 10 children and adolescents (7–17 years) refractory to previous treatments were administered the atypical antipsychotic risperidone (2–6 mg daily). The sample covered a wide range of diagnostic entities, including psychosis, schizophrenia, bipolar disorder, major depression with psychotic features, Tourette's disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Risperidone studies in adults have suggested a low incidence of adverse effects, particularly extrapyramidal symptoms. However, 6 of the 10 youths developed extrapyramidal symptoms, and four required the addition of anticholinergic medication. Also, four patients developed dysphoric mood, two of whom met criteria for major depression and required the addition of an antidepressant. Three patients had a significant weight increase. One (age 17) of the 3 adolescent girls developed galactorrhea. Only two patients were free of serious adverse effects. However, all 10 showed overall clinical improvement in their target symptoms during treatment with risperidone. These preliminary and uncontrolled findings do not permit firm inferences about the safety or efficacy of risperidone. However, the apparently high incidence of adverse effects underscores the risk of generalizing findings in adult studies to children and adolescents, and encourages caution in using newly developed pharmacological agents in the pediatric population. Special care is urged in using risperidone in youth until controlled data are availa

ISSN:1044-5463    

DOI:10.1089/cap.1995.5.49

年代:1995

数据来源: MAL

摘要:

ABSTRACTMany children and adolescents with a variety of chronic psychiatric disorders receive long-term therapy with antipsychotic medications. Clinical case reports are presented of seven such adolescents, aged 11–17 years, who were treated with risperidone. All but one patient had prior unsuccessful treatments with various psychotropic medications. The use of risperidone seemed effective in six of the seven adolescents in a dose range of 1–4 mg daily, with a significant therapeutic response appearing in 1 to 3 weeks. The length of risperidone treatment ranged from 3 to 15 months. Some sedation/drowsiness was observed in two patients at the maximum recommended adult dose (6 mg/day), but this was resolved by a reduction in the daily dosage. There were no other significant adverse effects, including extrapyramidal reactions. Two adolescents received concomitant medication, includingd-amphetamine and clomipramine. Risperidone appeared to be effective in relieving a variety of symptoms across a range of diagnoses, including schizophrenia, pervasive developmental disorder (PDD), and attention deficit disorder (ADD), but not obsessive compulsive disorder (OCD). Risperidone administration seemed most useful in treating paranoid ideation, aggressive and impulsive behavior, and mood swings. Controlled studies are needed to determine the efficacy and safety of risperidone in adolescents. If risperidone proves to be safe and effective over the long term, then clinicians may have a relatively nontoxic "antipsychotic" agent that could relieve disabling symptoms in nonpsychotic as well as psychotic children and adolesce

ISSN:1044-5463    

DOI:10.1089/cap.1995.5.69

年代:1995

数据来源: MAL

摘要:

ABSTRACTThough decreased intestinal motility and constipation are well recognized anticholinergic side effects of antipsychotic medications, frank intestinal obstruction is an unusual complication. To our knowledge, this is the first report of a neuroleptic unmasking a previously unrecognized intestinal anomaly. A 7-year-old girl, with an asymptomatic congenital intestinal anomaly, developed an obstruction while on perphenazine and benztropine mesylate. Presenting with increasing abdominal pain within a few days of starting perphenazine, she required surgical correction of a jejunal ileus. Antipsychotics, and other medications with antiperistaltic activity, should be prescribed with caution, even in patients with asymptomatic gastrointestinal narrowing.

ISSN:1044-5463    

DOI:10.1089/cap.1995.5.81

年代:1995

数据来源: MAL

ISSN:1044-5463    

DOI:10.1089/cap.1995.5.85

年代:1995

数据来源: MAL