- Email: [email protected]
1.6 Treatment Strategies for Youth With and At-Risk for Bipolar Disorder
INSTITUTES 1.4 – 2.0
1.4 PSYCHOPHARMACOLOGIC TREATMENT OF PEDIATRIC ANXIETY DISORDERS Jeffrey R. Strawn, MD, Psychiatry, University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue j Mail Location 3014, Cincinnati, OH 45229 Objectives: The goals of this session are to summarize, integrate, and apply the current evidence for psychopharmacologic interventions in youth with non–OCD anxiety disorders. Methods: A literature review was conducted to identify pharmacologic treatments for youth with generalized anxiety disorder (GAD), social phobia/ social anxiety disorder, separation anxiety disorder (SAD), and PTSD. Results: SSRIs and SNRIs have been evaluated in pediatric GAD, social anxiety disorder, and SAD and are effective in the treatment of these disorders. Long-term efficacy data suggest that acute response to SSRIs and lower baseline anxiety predict remission. Furthermore, a meta-analysis of randomized, placebo-controlled trials, involving a total of 1,612 children and adolescents with GAD, social anxiety disorder, and SAD, suggests that moderate effect sizes for reduction in anxiety symptom severity reveal no significant differences in efficacy or treatment-emergent suicidality among these medications. Conclusions: SSRIs and SNRIs are effective in the treatment of pediatric anxiety disorders, whereas long-term data suggest that nearly one-half of youth will experience remission after treatment with an SSRI.
ANX PTSD PPC http://dx.doi.org/10.1016/j.jaac.2016.07.008
1.5 ADVANCES IN THE TREATMENT OF DEPRESSIVE DISORDERS IN CHILDREN AND ADOLESCENTS Karen Dineen Wagner, MD, PhD, University of Texas Medical Branch, Dept. of Psychiatry & Behavioral Sciences, 301 University Blvd, Galveston, TX 77555-5302 Objectives: The goal of this session is to discuss the evidence base for the treatment of depressive disorders in children and adolescents. Methods: Data available from controlled antidepressant treatment studies for children and adolescents with major depression will be reviewed. A clinical treatment algorithm for major depression based on study findings will be discussed. Treatments for DMDD will be reviewed. Results: Response rates to initial antidepressants are approximately 50 to 60 percent, and approximately 50 percent of youths who fail to respond to an initial antidepressant will respond to an alternative antidepressant. CBT, in combination with medication treatment, increases response rates and decreases relapse rates. There are no controlled data available on the treatment of DMDD in youth. Conclusions: The evidence base regarding monotherapy treatment for youth with major depression has increased, but the evidence base for combination pharmacotherapy remains extremely limited, despite its common use in clinical practice. Controlled treatment trials for DMDD in youth are warranted.
Methods: We will review findings from recent controlled studies of treatments for youth with or at risk for developing BD. We will review evidencebased strategies that address the common side effects of these treatments. Results: There are an increasing number of studies examining interventions for mania and depression in youth with BD. Specifically, these studies suggest that second-generation antipsychotic (SGA) drugs are more effective and less tolerable than lithium and antiepileptic agents for mania. Weight gain and obesity are common side effects to SGA drugs. However, there are several evidence-based strategies to mitigate these adverse effects. Caution should be used when using antidepressants to treat depression and anxiety in children and adolescents with or at risk for developing BD. Early interventions may reduce prodromal symptoms of incipient BD. Conclusions: Data supporting the use of pharmacological agents for the treatment of children and adolescents with BD are rapidly expanding. Understanding the risks and benefits of these interventions, as well as early interventions for prodromal manifestations of adolescent BD, is essential to establish safe and effective treatment strategies for this population.
CAD MSS Other http://dx.doi.org/10.1016/j.jaac.2016.07.010
1.7 PHARMACOTHERAPY FOR ADOLESCENT SUBSTANCE USE DISORDERS Kevin M. Gray, MD, Medical University of South Carolina, Medical University of South Carolina, 125 Doughty Street, Suite 190, Charleston, SC 29425-0001 Objectives: Adolescents are more prone to substance initiation than adults, and those who use regularly are more prone than adults to experiencing significant substance-related adverse consequences, including the development of SUD. Prevention and intervention efforts are critical to minimizing the potentially lasting adverse impact of substance use during this important developmental stage. For adolescents that develop SUD, evidence-based psychosocial treatments convey generally small to modest effects, and recent efforts have focused on developing pharmacotherapies to augment psychosocial treatment. Methods: Trends in the prevalence of use of various substances and rates of SUD in adolescents will be reviewed, and a brief overview of evidence-based psychosocial treatments will be provided. Findings from randomized controlled trials of medications targeting SUD in adolescents will be presented in detail, and guidance will be provided for practitioners wishing to implement these treatments in psychiatric practice. Results: In the context of evidence-based psychosocial treatment for adolescent SUD, emerging evidence suggests that select medications may be safely and effectively used to enhance treatment outcomes. Conclusions: With adequate understanding of adolescent SUD and the evidence base for treatment, attendees will be equipped to provide appropriate pharmacological management when indicated.
ADOL SUD TREAT Supported by NIDA Grants U01DA031779, R01DA038700, UG1DA013727, and P50DA16511. http://dx.doi.org/10.1016/j.jaac.2016.07.011
DDD PSC PSP http://dx.doi.org/10.1016/j.jaac.2016.07.009
1.6 TREATMENT STRATEGIES FOR YOUTH WITH AND AT-RISK FOR BIPOLAR DISORDER Melissa P. DelBello, MD, MS, Cincinnati Children’s Hospital Medical Center, 260 Stetson St Ste 3200, Ml 559, Cincinnati, OH 45219-2472 Objectives: The goals of this session are to examine the efficacy and tolerability of evidenced-based pharmacological treatments for children and adolescents with BD; identify effective strategies to mitigate the adverse effects of these agents; and explore the risks and benefits of early interventions for youth with a high risk for developing BD.
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
INSTITUTE 2 RESEARCH INSTITUTE: EPIGENETICS IN CHILD AND ADOLESCENT PSYCHIATRY Jean A. Frazier, MD, University of Massachusetts, 55 Lake Avenue North, Worcester, MA, MA 01655; Jeremy M. VeenstraVanderWeele, MD, Columbia University, 1051 Riverside Drive, Unit 78, New York, NY 10032 Objectives: We will provide an overview of epigenetic mechanisms and the integration of epigenetics into child psychiatry research. Epigenetic factors, defined as all that resides “above genetics,” make a major contribution to
www.jaacap.org
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1.4 PSYCHOPHARMACOLOGIC TREATMENT OF PEDIATRIC ANXIETY DISORDERS Jeffrey R. Strawn, MD, Psychiatry, University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue j Mail Location 3014, Cincinnati, OH 45229 Objectives: The goals of this session are to summarize, integrate, and apply the current evidence for psychopharmacologic interventions in youth with non–OCD anxiety disorders. Methods: A literature review was conducted to identify pharmacologic treatments for youth with generalized anxiety disorder (GAD), social phobia/ social anxiety disorder, separation anxiety disorder (SAD), and PTSD. Results: SSRIs and SNRIs have been evaluated in pediatric GAD, social anxiety disorder, and SAD and are effective in the treatment of these disorders. Long-term efficacy data suggest that acute response to SSRIs and lower baseline anxiety predict remission. Furthermore, a meta-analysis of randomized, placebo-controlled trials, involving a total of 1,612 children and adolescents with GAD, social anxiety disorder, and SAD, suggests that moderate effect sizes for reduction in anxiety symptom severity reveal no significant differences in efficacy or treatment-emergent suicidality among these medications. Conclusions: SSRIs and SNRIs are effective in the treatment of pediatric anxiety disorders, whereas long-term data suggest that nearly one-half of youth will experience remission after treatment with an SSRI.
ANX PTSD PPC http://dx.doi.org/10.1016/j.jaac.2016.07.008
1.5 ADVANCES IN THE TREATMENT OF DEPRESSIVE DISORDERS IN CHILDREN AND ADOLESCENTS Karen Dineen Wagner, MD, PhD, University of Texas Medical Branch, Dept. of Psychiatry & Behavioral Sciences, 301 University Blvd, Galveston, TX 77555-5302 Objectives: The goal of this session is to discuss the evidence base for the treatment of depressive disorders in children and adolescents. Methods: Data available from controlled antidepressant treatment studies for children and adolescents with major depression will be reviewed. A clinical treatment algorithm for major depression based on study findings will be discussed. Treatments for DMDD will be reviewed. Results: Response rates to initial antidepressants are approximately 50 to 60 percent, and approximately 50 percent of youths who fail to respond to an initial antidepressant will respond to an alternative antidepressant. CBT, in combination with medication treatment, increases response rates and decreases relapse rates. There are no controlled data available on the treatment of DMDD in youth. Conclusions: The evidence base regarding monotherapy treatment for youth with major depression has increased, but the evidence base for combination pharmacotherapy remains extremely limited, despite its common use in clinical practice. Controlled treatment trials for DMDD in youth are warranted.
Methods: We will review findings from recent controlled studies of treatments for youth with or at risk for developing BD. We will review evidencebased strategies that address the common side effects of these treatments. Results: There are an increasing number of studies examining interventions for mania and depression in youth with BD. Specifically, these studies suggest that second-generation antipsychotic (SGA) drugs are more effective and less tolerable than lithium and antiepileptic agents for mania. Weight gain and obesity are common side effects to SGA drugs. However, there are several evidence-based strategies to mitigate these adverse effects. Caution should be used when using antidepressants to treat depression and anxiety in children and adolescents with or at risk for developing BD. Early interventions may reduce prodromal symptoms of incipient BD. Conclusions: Data supporting the use of pharmacological agents for the treatment of children and adolescents with BD are rapidly expanding. Understanding the risks and benefits of these interventions, as well as early interventions for prodromal manifestations of adolescent BD, is essential to establish safe and effective treatment strategies for this population.
CAD MSS Other http://dx.doi.org/10.1016/j.jaac.2016.07.010
1.7 PHARMACOTHERAPY FOR ADOLESCENT SUBSTANCE USE DISORDERS Kevin M. Gray, MD, Medical University of South Carolina, Medical University of South Carolina, 125 Doughty Street, Suite 190, Charleston, SC 29425-0001 Objectives: Adolescents are more prone to substance initiation than adults, and those who use regularly are more prone than adults to experiencing significant substance-related adverse consequences, including the development of SUD. Prevention and intervention efforts are critical to minimizing the potentially lasting adverse impact of substance use during this important developmental stage. For adolescents that develop SUD, evidence-based psychosocial treatments convey generally small to modest effects, and recent efforts have focused on developing pharmacotherapies to augment psychosocial treatment. Methods: Trends in the prevalence of use of various substances and rates of SUD in adolescents will be reviewed, and a brief overview of evidence-based psychosocial treatments will be provided. Findings from randomized controlled trials of medications targeting SUD in adolescents will be presented in detail, and guidance will be provided for practitioners wishing to implement these treatments in psychiatric practice. Results: In the context of evidence-based psychosocial treatment for adolescent SUD, emerging evidence suggests that select medications may be safely and effectively used to enhance treatment outcomes. Conclusions: With adequate understanding of adolescent SUD and the evidence base for treatment, attendees will be equipped to provide appropriate pharmacological management when indicated.
ADOL SUD TREAT Supported by NIDA Grants U01DA031779, R01DA038700, UG1DA013727, and P50DA16511. http://dx.doi.org/10.1016/j.jaac.2016.07.011
DDD PSC PSP http://dx.doi.org/10.1016/j.jaac.2016.07.009
1.6 TREATMENT STRATEGIES FOR YOUTH WITH AND AT-RISK FOR BIPOLAR DISORDER Melissa P. DelBello, MD, MS, Cincinnati Children’s Hospital Medical Center, 260 Stetson St Ste 3200, Ml 559, Cincinnati, OH 45219-2472 Objectives: The goals of this session are to examine the efficacy and tolerability of evidenced-based pharmacological treatments for children and adolescents with BD; identify effective strategies to mitigate the adverse effects of these agents; and explore the risks and benefits of early interventions for youth with a high risk for developing BD.
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
INSTITUTE 2 RESEARCH INSTITUTE: EPIGENETICS IN CHILD AND ADOLESCENT PSYCHIATRY Jean A. Frazier, MD, University of Massachusetts, 55 Lake Avenue North, Worcester, MA, MA 01655; Jeremy M. VeenstraVanderWeele, MD, Columbia University, 1051 Riverside Drive, Unit 78, New York, NY 10032 Objectives: We will provide an overview of epigenetic mechanisms and the integration of epigenetics into child psychiatry research. Epigenetic factors, defined as all that resides “above genetics,” make a major contribution to
www.jaacap.org
S85