- Email: [email protected]
27.0 Using the Newest Antidepressants: A Conversation for Child and Adolescent Psychiatrists
SYMPOSIA 26.4 — 27.1
Denver. The presenters discuss how child and adolescent psychiatrists are integrated into a comprehensive medical clinic to provide mental health services, including medication management, mother-child dyadic work, and individual therapy to teenage youth, who otherwise would not receive services. Mental health outcomes from this particular school-based clinic will be reviewed. Results: Unique strategies and culturally sensitive approaches to engaging atrisk youth in the school and primary care clinical settings will be examined. The student population of Florence Crittenton is 82 percent Hispanic, 11.7 percent African American, 1.7 percent Native American, and 2.2 percent Caucasian. This population poses a need for culturally versed approaches, as many are leery of psychiatric services because of cultural beliefs, miseducation, and concerns that social services may get involved with their child. Through these novel approaches in new settings, patients from underserved areas of Denver are not only able access mental health services but are able to promote mother–child attachment and healthy families, making this psychiatric approach truly a public health intervention. Conclusions: School-based clinics represent a novel way to provide psychiatric services to children and adolescents. Continuing to expand on improving access to youth by working with pregnant or mother teenagers provides not only a novel way to address an adolescent population with care but also their young child with mental health services, making the greatest public health impact for two generations.
ADOL, ATTACH, SC http://dx.doi.org/10.1016/j.jaac.2017.07.732
26.4 INCREASING MENTAL HEALTH AWARENESS AND INTERVENTIONS IN RURAL SCHOOLS Erika Ryst, MD, University of Nevada - Reno, eryst@medicine. nevada.edu Objectives: After the Newton, Connecticut school shooting in 2012, President Obama released his “Now is the Time” presidential plan. Through this initiative, $15 million was allocated for Youth Mental Health First Aid (YMHFA) training. As part of this initiative, SAMHSA also awarded $40 million for the development of school district demonstration projects. Nevada was one of 20 states that was awarded the Project AWARE (Advancing Wellness and Resilience Education) grant to increase mental health awareness, early identification, and intervention for youth mental disorders in three rural school districts. The current presentation will review the first three years of Nevada Project AWARE. Methods: To initiate AWARE, the Nevada State Department of Education partnered with a tri-county Frontier Community Coalition (FCC), three county school districts, and the University of Nevada, Reno. AWARE activities include hiring school-based mental health professionals, providing mental health awareness trainings, developing a triage and referral system for student referrals, and initiating school-based mental health services. Results: From October 2015 through September 2016, 130 adults were trained in YMHFA. Of 5,137 students, 308 students (6%) were referred for Project AWARE services. A survey of 231 teachers, school district administrators, mental health providers, and community members indicated that 40.97 percent had completed YMHFA training, 31.74 percent had referred a youth to school-based mental health, 30.67 percent had referred a youth to community-based mental health, and 49.55 percent felt that AWARE had improved access. Ongoing challenges included the high volume of student referrals, difficulties in coordination between community and school mental health, and uncertainty regarding long-term sustainability. Results from the second implementation year (2016–2017) will also be presented to highlight the impact of efforts to address these challenges. Conclusions: Nevada Project AWARE has made progress in establishing systems for connecting at-risk students with mental health support. Such pilot programs represent an important step in designing new models of schoolbased mental health delivery and also provide innovative venues for child and adolescent psychiatrists to impact public health.
EDUC, PUP, SC Supported by SAMHSA http://dx.doi.org/10.1016/j.jaac.2017.07.733
S344
www.jaacap.org
SYMPOSIUM 27 USING THE NEWEST ANTIDEPRESSANTS: A CONVERSATION FOR CHILD AND ADOLESCENT PSYCHIATRISTS Robert Findling, MD, MBA, Kennedy Krieger Institute and Johns Hopkins University, [email protected]; Renee Saenger, MD, Weill Cornell Medical College, rcs7001@ med.cornell.edu; Janki M. Avari, MD, Weill Cornell Medical College, [email protected]; Jeffrey R. Strawn, MD, University of Cincinnati, [email protected]; Kathryn R. Cullen, MD, University of Minnesota Medical School, [email protected]; Graham J. Emslie, MD, University of Texas Southwestern Medical Center, graham.emslie@ UTsouthwestern.edu; Daniel S. Pine, MD, National Institute of Mental Health, [email protected] Objectives: The goals of this presentation are to provide a forum for child and adolescent psychiatrists to engage in a discussion of the newest antidepressants (vortioxetine, levomilnacipran, vilazodone, and ketamine), including the latest research developments and recommendations for clinical usage specific to the pediatric population and to highlight those clinicians who have valuable personal and research experience in prescribing these medications to youth. Methods: PubMed and Google Scholar literature searches were carried out for each of the four medications (vortioxetine, levomilnacipran, vilazodone, and ketamine) to identify primary investigators involved in academic research surrounding the use of these medications in youth. Once researchers were identified, they were contacted about their research and personal clinical experience using these novel medications. Those who responded were asked to present to AACAP meeting attendees. Results: Jeff Strawn, MD, is involved in an ongoing randomized, double-blind, fixed-dose study of vortioxetine in adolescents with major depressive disorder. Kathryn Cullen, MD, is currently concluding a small pilot study using six doses of intravenous ketamine (0.5 mg/kg) over two weeks to target treatment-resistant depression in adolescents. Graham Emslie, MD, draws on his vast experience treating major depression in youth and is currently involved in research studies of vilazodone. Robert Findling, MD, is involved in ongoing investigations of the newer antidepressants and can provide a unique perspective on the currently limited role of levomilnacipran for children and adolescents. Conclusions: Only a handful of academic child and adolescent psychiatrists are investigating the newest antidepressants (vortioxetine, levomilnacipran, vilazodone, and ketamine) in youth populations. Almost no literature exists on this topic. Four physician-investigators were identified (Jeff Strawn, MD, Kathryn Cullen, MD, Graham Emslie, MD, and Robert Findling, MD) who are uniquely positioned to share their research and clinical knowledge on a topic with which most child and adolescent psychiatrists remain unfamiliar.
ADP, PPC http://dx.doi.org/10.1016/j.jaac.2017.07.735
27.1 LEVOMILNACIPRAN: A REVIEW OF ITS BIODISPOSITION AND EFFICACY IN MAJOR DEPRESSIVE DISORDER Robert Findling, MD, MBA, Kennedy Krieger Institute and Johns Hopkins University, [email protected] Objectives: The goal of this talk is to review what is known about the biodisposition, mechanism of action, and efficacy of levomilnacipran [LMN (Fetzimaâ)] in MDD. Methods: Several literature searches were performed. In addition, websites and presentations from relevant scientific meetings were examined. Results: LMN is a serotonin and norepinephrine transport inhibitor. LMN is metabolized by desethylation and hydroxylation. The pharmacokinetics of LMN have been described in adults. At present, according to the US Food
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
Denver. The presenters discuss how child and adolescent psychiatrists are integrated into a comprehensive medical clinic to provide mental health services, including medication management, mother-child dyadic work, and individual therapy to teenage youth, who otherwise would not receive services. Mental health outcomes from this particular school-based clinic will be reviewed. Results: Unique strategies and culturally sensitive approaches to engaging atrisk youth in the school and primary care clinical settings will be examined. The student population of Florence Crittenton is 82 percent Hispanic, 11.7 percent African American, 1.7 percent Native American, and 2.2 percent Caucasian. This population poses a need for culturally versed approaches, as many are leery of psychiatric services because of cultural beliefs, miseducation, and concerns that social services may get involved with their child. Through these novel approaches in new settings, patients from underserved areas of Denver are not only able access mental health services but are able to promote mother–child attachment and healthy families, making this psychiatric approach truly a public health intervention. Conclusions: School-based clinics represent a novel way to provide psychiatric services to children and adolescents. Continuing to expand on improving access to youth by working with pregnant or mother teenagers provides not only a novel way to address an adolescent population with care but also their young child with mental health services, making the greatest public health impact for two generations.
ADOL, ATTACH, SC http://dx.doi.org/10.1016/j.jaac.2017.07.732
26.4 INCREASING MENTAL HEALTH AWARENESS AND INTERVENTIONS IN RURAL SCHOOLS Erika Ryst, MD, University of Nevada - Reno, eryst@medicine. nevada.edu Objectives: After the Newton, Connecticut school shooting in 2012, President Obama released his “Now is the Time” presidential plan. Through this initiative, $15 million was allocated for Youth Mental Health First Aid (YMHFA) training. As part of this initiative, SAMHSA also awarded $40 million for the development of school district demonstration projects. Nevada was one of 20 states that was awarded the Project AWARE (Advancing Wellness and Resilience Education) grant to increase mental health awareness, early identification, and intervention for youth mental disorders in three rural school districts. The current presentation will review the first three years of Nevada Project AWARE. Methods: To initiate AWARE, the Nevada State Department of Education partnered with a tri-county Frontier Community Coalition (FCC), three county school districts, and the University of Nevada, Reno. AWARE activities include hiring school-based mental health professionals, providing mental health awareness trainings, developing a triage and referral system for student referrals, and initiating school-based mental health services. Results: From October 2015 through September 2016, 130 adults were trained in YMHFA. Of 5,137 students, 308 students (6%) were referred for Project AWARE services. A survey of 231 teachers, school district administrators, mental health providers, and community members indicated that 40.97 percent had completed YMHFA training, 31.74 percent had referred a youth to school-based mental health, 30.67 percent had referred a youth to community-based mental health, and 49.55 percent felt that AWARE had improved access. Ongoing challenges included the high volume of student referrals, difficulties in coordination between community and school mental health, and uncertainty regarding long-term sustainability. Results from the second implementation year (2016–2017) will also be presented to highlight the impact of efforts to address these challenges. Conclusions: Nevada Project AWARE has made progress in establishing systems for connecting at-risk students with mental health support. Such pilot programs represent an important step in designing new models of schoolbased mental health delivery and also provide innovative venues for child and adolescent psychiatrists to impact public health.
EDUC, PUP, SC Supported by SAMHSA http://dx.doi.org/10.1016/j.jaac.2017.07.733
S344
www.jaacap.org
SYMPOSIUM 27 USING THE NEWEST ANTIDEPRESSANTS: A CONVERSATION FOR CHILD AND ADOLESCENT PSYCHIATRISTS Robert Findling, MD, MBA, Kennedy Krieger Institute and Johns Hopkins University, [email protected]; Renee Saenger, MD, Weill Cornell Medical College, rcs7001@ med.cornell.edu; Janki M. Avari, MD, Weill Cornell Medical College, [email protected]; Jeffrey R. Strawn, MD, University of Cincinnati, [email protected]; Kathryn R. Cullen, MD, University of Minnesota Medical School, [email protected]; Graham J. Emslie, MD, University of Texas Southwestern Medical Center, graham.emslie@ UTsouthwestern.edu; Daniel S. Pine, MD, National Institute of Mental Health, [email protected] Objectives: The goals of this presentation are to provide a forum for child and adolescent psychiatrists to engage in a discussion of the newest antidepressants (vortioxetine, levomilnacipran, vilazodone, and ketamine), including the latest research developments and recommendations for clinical usage specific to the pediatric population and to highlight those clinicians who have valuable personal and research experience in prescribing these medications to youth. Methods: PubMed and Google Scholar literature searches were carried out for each of the four medications (vortioxetine, levomilnacipran, vilazodone, and ketamine) to identify primary investigators involved in academic research surrounding the use of these medications in youth. Once researchers were identified, they were contacted about their research and personal clinical experience using these novel medications. Those who responded were asked to present to AACAP meeting attendees. Results: Jeff Strawn, MD, is involved in an ongoing randomized, double-blind, fixed-dose study of vortioxetine in adolescents with major depressive disorder. Kathryn Cullen, MD, is currently concluding a small pilot study using six doses of intravenous ketamine (0.5 mg/kg) over two weeks to target treatment-resistant depression in adolescents. Graham Emslie, MD, draws on his vast experience treating major depression in youth and is currently involved in research studies of vilazodone. Robert Findling, MD, is involved in ongoing investigations of the newer antidepressants and can provide a unique perspective on the currently limited role of levomilnacipran for children and adolescents. Conclusions: Only a handful of academic child and adolescent psychiatrists are investigating the newest antidepressants (vortioxetine, levomilnacipran, vilazodone, and ketamine) in youth populations. Almost no literature exists on this topic. Four physician-investigators were identified (Jeff Strawn, MD, Kathryn Cullen, MD, Graham Emslie, MD, and Robert Findling, MD) who are uniquely positioned to share their research and clinical knowledge on a topic with which most child and adolescent psychiatrists remain unfamiliar.
ADP, PPC http://dx.doi.org/10.1016/j.jaac.2017.07.735
27.1 LEVOMILNACIPRAN: A REVIEW OF ITS BIODISPOSITION AND EFFICACY IN MAJOR DEPRESSIVE DISORDER Robert Findling, MD, MBA, Kennedy Krieger Institute and Johns Hopkins University, [email protected] Objectives: The goal of this talk is to review what is known about the biodisposition, mechanism of action, and efficacy of levomilnacipran [LMN (Fetzimaâ)] in MDD. Methods: Several literature searches were performed. In addition, websites and presentations from relevant scientific meetings were examined. Results: LMN is a serotonin and norepinephrine transport inhibitor. LMN is metabolized by desethylation and hydroxylation. The pharmacokinetics of LMN have been described in adults. At present, according to the US Food
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017