ISSN:1044-5463    

DOI:10.1089/cap.1998.8.1

年代:1998

数据来源: MAL

ISSN:1044-5463    

DOI:10.1089/cap.1998.8.3

年代:1998

数据来源: MAL

ISSN:1044-5463    

DOI:10.1089/cap.1998.8.5

年代:1998

数据来源: MAL

摘要:

ABSTRACTPreschool children with attention-deficit/hyperactivity disorder (ADHD) (27 boys, 5 girls, mean age 4 years 10 months) participated in a double-blind placebo-controlled crossover drug study to assess the side effects of methyphenidate. Children received twice daily, for at least 1 week each, placebo, 0.3 mg/kg methylphenidate, and 0.5 mg/kg methylphenidate. Side effects were monitored by a parent rating scale designed for medication studies. In general, methylphenidate was tolerated relatively well, with no children withdrawing because of adverse effects. Of 17 childhood behaviors usually associated with side effects, 8 behaviors showed significant changes, generally at the higher dose of methylphenidate. Interestingly, 3 of the side effects were associated with improved behavior. The number of side effects appeared higher than what is usually reported in a population of school-age children, but few parents reported them as being severe. Severe side effects were reported in less than 10% of the sample, with approximately as many reports of severe effects on placebo as on low and high doses of the medication. The results indicate that methylphenidate has a relatively low toxicity in preschool children (over the first 7–10 days), that some behavioral changes that might be viewed as side effects of methylphenidate are actually normal behaviors or ADHD behaviors in preschool children (e.g., sociability), that these "side-effect" behaviors are more common in preschool than school-age children, that some "side effects" of methylphenidate are associated with improvements in behavior, and that preschool and school-age children may have different side effects of methylphenidate (e.g., mood changes and anxiety

ISSN:1044-5463    

DOI:10.1089/cap.1998.8.13

年代:1998

数据来源: MAL

摘要:

ABSTRACTThe prevalence and patterns of use of psychiatric and anticonvulsant medications were studied in 83 seriously emotionally disturbed children and adolescents at the time of their admission to a residential treatment facility. Youths (aged 5–19, mean = 13.6 years), consecutively admitted over 17 months, were assessed for the prevalence and patterns of use of psychotropic and anticonvulsant treatments. At admission, 76% of the youths were receiving psychiatric pharmacotherapy, 40% with more than one psychiatric agent, and 15% with a combination of psychotropic and anticonvulsant medications. Frequently prescribed medications were neuroleptics (35% of the medicated youths), sedative-hypnotics (26%), and anticonvulsants (15%). Psychostimulants (16%) and antidepressants (22%) were under-prescribed relative to their diagnostic indications. Over 50 different medication combinations were used. The neuroleptic + lithium combination was most common (25% of the polypharmacological treatments). Neuroleptics were the most commonly prescribed medication and mostly used for nonpsychotic, nontic, and nonbipolar indications (55% of neuroleptic trials). Neuroleptics were used primarily for aggression regardless of diagnosis. Neuroleptics were used more in symptomatic treatments than in treatments for indicated diagnoses. The high prevalence of psychiatric and antiepileptic medication use in children and adolescents admitted to a residential treatment facility, and especially the pattern of their use, raises questions about prescribing practices for youths entering residential treatment and about pediatric psychopharmacotherapy in genera

ISSN:1044-5463    

DOI:10.1089/cap.1998.8.27

年代:1998

数据来源: MAL

摘要:

ABSTRACTThis pilot study was designed to assess the short-term effectiveness and side effects of methylphenidate in treating symptoms of attention deficit hyperactivity disorder (ADHD) in Native American children (5 to 12 years old) with documented fetal alcohol syndrome (FAS) or partial fetal alcohol syndrome. Using strict criteria for the diagnosis of FAS and ADHD, a randomized double-blind cross-over study of two placebos and a fixed dose of methylphenidate was completed in 4 Native American children in a residential school. Each treatment condition lasted 5 days, and daily observational outcome measures, the Conners Parent Rating Scale (CPRS-48), and the Conners Teacher Rating Scale (CTRS-39), were employed. Methylphenidate significantly improved scores of the Hyperactivity Index Scale on the CPRS-48 and the CTRS-39 but not the Daydreaming–Attention score on the CTRS-39. Side effects were similar to those traditionally found in other populations. The promising preliminary results suggest that a more definitive study of methylphenidate in Native and non-Native children with FAS and ADHD is warrante

ISSN:1044-5463    

DOI:10.1089/cap.1998.8.39

年代:1998

数据来源: MAL

摘要:

ABSTRACTOpen clinical treatment with risperidone was administered to a clinically heterogeneous group of 11 children and adolescents (age range 5.5–16 years, mean 9.8 years) with concurrent presentation of affective symptoms (mostly suggestive of bipolar disorder), aggressive and violent behavior, and marked management problems. These patients had responded inadequately to several mood-stabilizing medications. In this outpatient sample, 8 of 11 children (73%) appeared to have therapeutic responses to risperidone. Risperidone doses were low (0.75–2.5 mg daily) and clinical responses were observed at times within days of receiving the medication. Improvement was clinically judged to be moderate to marked in 7 of 8 children. In addition, the treatment of 2 children was stopped because of drowsiness; one also experienced a weight gain of 6 kg (13 lbs). An additional child with autism and aggressive behavior who lacked affective symptoms did not respond to risperidone. None of the children showed behavioral deterioration. Seven of the 8 responders were taking concurrent medications; including 4 on mood-stabilizing medications (either lithium, carbamazepine, or valproic acid) in subtherapeutic doses. Even in combination with other medications, side effects at these doses were minimal and limited to mild sedation and, at times, troubling weight gain. Pending controlled studies, these preliminary findings suggest that risperidone—alone or in combination with mood stabilizers—may be of value in treating children and adolescents with mood disorders (especially subthreshold bipolar disorder) and aggressive b

ISSN:1044-5463    

DOI:10.1089/cap.1998.8.49

年代:1998

数据来源: MAL

摘要:

ABSTRACTMedication management of obsessive-compulsive disorder (OCD) has consisted of monotherapy with either clomipramine (CMI) or selective serotonin reuptake inhibitors (SSRIs) such as fluvoxamine, paroxetine, or sertraline. Frequently, OCD patients receiving monotherapy experience low treatment response rates and problematic side effects that may result in discontinuation or noncompliance. This open-label case series presents 7 patients (6 male, 1 female) ages 9 to 23 years with OCD who were effectively treated with combination of CMI plus an SSRI. Treatment effects persisted through 5 to 22 months of follow-up from onset of combination therapy. The drug combination was effective in the 2 patients with OCD and no mood/anxiety comorbidity. Side effects appeared in 5 of 7 patients; cardiovascular side effects were the most common adverse effects. Two patients had prolongation of QTc intervals and 2 developed tachycardia while taking CMI and SSRI combinations. Other risks might include serotonin syndrome, manic switch, insomnia, and possibly headaches, EPS, and sexual dysfunction. Recommendations are made to monitor electrocardiograms, CMI blood concentrations, and vital signs in all cases because SSRIs can increase the blood levels of CMI and/or its active metabolite, desmethylclomipramine (DCMI). CMI could also potentially increase SSRI absorption and/or protein binding. The use of CMI and SSRI combination therapy was found to be more effective compared with their monotherapy in all 7 cases.

ISSN:1044-5463    

DOI:10.1089/cap.1998.8.61

年代:1998

数据来源: MAL

摘要:

ABSTRACTThe authors present a case report involving an adolescent with trichotillomania who was treated with paroxetine. A significant reduction in symptoms was apparent after two weeks of treatment. Dose was gradually increased to 30 mg of paroxetine per day, which was well tolerated without any significant adverse events. The authors discuss potential treatment implications of this case.

ISSN:1044-5463    

DOI:10.1089/cap.1998.8.69

年代:1998

数据来源: MAL

摘要:

ABSTRACTIn a sample of 40 youths (ages 11–17) with obsessive-compulsive disorder (OCD) and mood disorders who were treated with behavior therapy, 20 patients received serotonin reuptake inhibitors (SRIs) and 20 did not. In open-label clinical treatment, 30% of the patients (6/20) treated with SRIs developed manic or hypomanic symptoms (5/15 on fluoxetine, 1/1 on sertraline). Symptoms included impulsivity, grandiosity, pressured speech, and disinhibition and did not resemble akathisia or "behavioral activation." These behaviors emerged despite gradual dose elevation (2–5 mg/wk), conservative dosing (maximum 40 mg daily), and careful weekly outpatient monitoring of each patient. Fluoxetine-induced mania occurred at doses as low as 10 mg daily. It is unclear whether mania/hypomania would appear in OCD children without comorbid mood disorders or, alternatively, whether OCD is a stronger risk factor than mood disorder for manic switch in SRI-treated youths. Clinicians are advised to be aware of the risk and to be vigilant in monitoring manic and hypomanic behaviors when using SRIs to treat OCD in youth, even with low doses and gradual dose elevat

ISSN:1044-5463    

DOI:10.1089/cap.1998.8.73

年代:1998

数据来源: MAL