- Email: [email protected]
5.58 Serotonin Norepinephrine Reuptake Inhibitors (SNRI), Selective Serotonin Reuptake Inhibitors (SSRI), Breastfeeding, and Concerns for Infant Safety
NEW RESEARCH POSTERS 5.57 — 5.59
Conclusions: These results suggest that DEHP exposure at age two years plays a more significant role in children’s intelligence than exposure after age four years and that boys are more vulnerable to phthalate exposure than girls.
LONG, COG, NEURODEV Supported by the Environmental Health Center, funded by the Korean Ministry of Environment and the Ministry of Food and Safety Grant 15162MFDS046 http://dx.doi.org/10.1016/j.jaac.2017.09.339
5.57 MATERNAL DEPRESSION TRAJECTORIES IN ADOLESCENT MOTHERS LIVING IN A POOR URBAN AREA AND THEIR ASSOCIATION WITH PARENTAL STRESS, INFANT BEHAVIORAL PROBLEMS, AND PSYCHOLOGICAL VIOLENCE Daniel Fatori, PhD, University of Sao Paulo Medical School, [email protected]; Guilherme V. Polanczyk, MD, PhD, Universidade de S~ ao Paulo, [email protected]; Euripedes Miguel, MD, PhD, University of Sao Paulo Medical School, [email protected]; Alicia Matijasevich, MD, PhD, University of Sao Paulo Medical School, alicia.matijasevich@ usp.br Objectives: The goals of this study are to identify maternal depression trajectories (MDT) during the antenatal and postnatal period and to evaluate whether distinct MDTs predict parental stress, home environment characteristics, and infants’ behavior and developmental problems. Methods: We conducted a pilot randomized controlled clinical trial to test the feasibility of a nurse home visitation program for poor pregnant youth. The intervention consisted of home visits focused on health/social care, environmental health, life course goals, and parenting skills. Pregnant youth (N ¼ 80) were included in the study. Participants were randomized to intervention (n ¼ 40) and control group (usual care, n ¼ 40). Maternal depression was assessed during gestation (16th and 30th weeks) and after child birth (infant age of 3, 6, and 12 months) using the Beck Depression Inventory. Outcomes were measured at 12 months of infant age and consisted of the following instruments: Parental Stress Index, Home Observation for Measurement of the Environment, Ages and Stages Questionnaire, and Parent-Child Conflict Tactics Scale. A group-based trajectory modelling approach was used to determine latent MDTs. To identify associations between MDTs and outcomes we conducted ANOVAs with pairwise comparisons. Intervention/control group status was inserted as a covariate in all models. Results: We identified four MDTs across five time points: 1) low stable (n ¼ 42); 2) moderate antenatal and low postnatal (n ¼ 21); 3) moderate chronic (n ¼ 13); and 4) high antenatal and decreasing postnatal (n ¼ 4). MDTs were associated with parental stress (p ¼ 0.004), infant behavior problems (p ¼ 0.019), and infant psychological violence (p ¼ 0.013). Mean scores increased significantly from the low stable group to the high antenatal and decreasing postnatal group. Infant development and the home environment were not associated with MDTs. Conclusions: Our study showed that MDTs have different manifestations and are associated with parental stress, infant behavior problems, and infant psychological violence. Given the potential long-term effects of maternal depression, early identification, appropriate treatment and follow-up of depressed adolescents must be a key priority for primary health care services.
LONG, STRESS, DEV Supported by Saving Brains, Bill & Melinda Gates Foundation, and Companhia Brasileira de Metalurgia e Minerac¸ ~ao. http://dx.doi.org/10.1016/j.jaac.2017.09.340
5.58 SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRI), SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI), BREASTFEEDING, AND CONCERNS FOR INFANT SAFETY Tapan Parikh, MD, MPH, Cooper University Hospital, [email protected]; Dharmendra Goyal, MD, Augusta
S274
www.jaacap.org
University, [email protected]; Ramkrishna Makani, MD, MPH, Cooper University Hospital, [email protected]; Consuelo C. Cagande, MD, Cooper University Hospital, cagande-consuelo@ cooperhealth.edu Objectives: Antidepressants secreted into mothers’ breastmilk may have potential side effects in infants. Mental health of mother is crucial for maternal infant bonding, and mothers may need medications. Clinicians may not have the information on potential effects of medications on infants readily available. This abstract describes literature review of SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs). These are commonly used for MDD, postpartum depression, OCD, and anxiety. Methods: A thorough literature search using the PubMed and TOXNET was conducted. From 196 informative articles on various SSRIs and SNRIs published until May 2017, after excluding irrelevant articles, the search was narrowed to 98 articles. Results: It is known that there are very little to no side effects to infants if the relative infant dose (RID) is <10 percent. No side effects were reported in a number of infants (within parentheses) who were administered the following drugs: fluvoxamine (N ¼ 8), paroxetine (N ¼ 119), sertraline (N ¼ 151), duloxetine (N ¼ 2), and desvenlafaxine (N ¼ 11). Medications with reported infant side effects include the following: citalopram (uneasy sleep, n ¼ 1 of 68); escitalopram (necrotizing enterocolitis, n ¼ 1 of 16); fluoxetine (colic, n ¼ 3 of 72; seizure-like episode, n ¼ 1 of 72; mother also on carbamazepine and buspirone; lower weight gain, n ¼ 1 of 72), and venlafaxine (low weight gain or failure to thrive, n ¼ 5 of 35). No side effects were reported in statistically analyzable number, and data suggest that, overall, no SSRI or SNRI has consistent adverse effects in infants. Conclusions: Fluvoxamine, paroxetine, sertraline, and venlafaxine are considered to be the safest. Some suggest sertraline to be the safest SSRI. Citalopram, escitalopram, and fluoxetine have mixed reviews, and caution is suggested. Limited data are available for duloxetine and desvenlafaxine. The clinical risks versus benefits have to be justified. Clinical caution and monitoring should include the basic infant safety questions. Clinical studies should follow FDA guidance on lactation studies, and those who publish case reports based on the clinical encounters should include detailed history and developmental data, preferably longitudinal, and the longitudinal studies are long due and warranted.
ADP, PPC, INF http://dx.doi.org/10.1016/j.jaac.2017.09.341
5.59 CHARACTERISTICS OF FAMILIES PARTICIPATING IN MULTIFAMILY GROUP THERAPY FOR CHILDREN IN A LONG-TERM PSYCHIATRIC INPATIENT PROGRAM Nayla M. Khoury, MD, University of Washington, Nayla. [email protected]; L. Lee Carlisle, MD, Child Study and Treatment Center, [email protected]; Fran Lexcen, PhD, Child Study and Treatment Center, Fran. [email protected] Objectives: Multifamily group therapy (MFGT) has been used in a variety of inpatient and outpatient settings to facilitate parental skill development with children who have emotional, social, or behavioral problems. This study looked for similarities and differences among parents of children receiving inpatient psychiatric treatment in a long-term placement program. Methods: The study was completed at Child Study Treatment Center, a staterun psychiatric hospital for children and adolescents with severe mental illnesses with average stays lasting from nine to 16 months. Caregivers of the patients were given the opportunity to attend MFGT sessions and choose whether or not to participate in the study. A series of measurements, including the Child-Parent Relationship Scale, the Strengths and Difficulties Questionnaire, and the Hope Scale, were conducted. Seventeen families participated in up to 14 sessions of MFGT. Measures were collected at intake and at six months.
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
Conclusions: These results suggest that DEHP exposure at age two years plays a more significant role in children’s intelligence than exposure after age four years and that boys are more vulnerable to phthalate exposure than girls.
LONG, COG, NEURODEV Supported by the Environmental Health Center, funded by the Korean Ministry of Environment and the Ministry of Food and Safety Grant 15162MFDS046 http://dx.doi.org/10.1016/j.jaac.2017.09.339
5.57 MATERNAL DEPRESSION TRAJECTORIES IN ADOLESCENT MOTHERS LIVING IN A POOR URBAN AREA AND THEIR ASSOCIATION WITH PARENTAL STRESS, INFANT BEHAVIORAL PROBLEMS, AND PSYCHOLOGICAL VIOLENCE Daniel Fatori, PhD, University of Sao Paulo Medical School, [email protected]; Guilherme V. Polanczyk, MD, PhD, Universidade de S~ ao Paulo, [email protected]; Euripedes Miguel, MD, PhD, University of Sao Paulo Medical School, [email protected]; Alicia Matijasevich, MD, PhD, University of Sao Paulo Medical School, alicia.matijasevich@ usp.br Objectives: The goals of this study are to identify maternal depression trajectories (MDT) during the antenatal and postnatal period and to evaluate whether distinct MDTs predict parental stress, home environment characteristics, and infants’ behavior and developmental problems. Methods: We conducted a pilot randomized controlled clinical trial to test the feasibility of a nurse home visitation program for poor pregnant youth. The intervention consisted of home visits focused on health/social care, environmental health, life course goals, and parenting skills. Pregnant youth (N ¼ 80) were included in the study. Participants were randomized to intervention (n ¼ 40) and control group (usual care, n ¼ 40). Maternal depression was assessed during gestation (16th and 30th weeks) and after child birth (infant age of 3, 6, and 12 months) using the Beck Depression Inventory. Outcomes were measured at 12 months of infant age and consisted of the following instruments: Parental Stress Index, Home Observation for Measurement of the Environment, Ages and Stages Questionnaire, and Parent-Child Conflict Tactics Scale. A group-based trajectory modelling approach was used to determine latent MDTs. To identify associations between MDTs and outcomes we conducted ANOVAs with pairwise comparisons. Intervention/control group status was inserted as a covariate in all models. Results: We identified four MDTs across five time points: 1) low stable (n ¼ 42); 2) moderate antenatal and low postnatal (n ¼ 21); 3) moderate chronic (n ¼ 13); and 4) high antenatal and decreasing postnatal (n ¼ 4). MDTs were associated with parental stress (p ¼ 0.004), infant behavior problems (p ¼ 0.019), and infant psychological violence (p ¼ 0.013). Mean scores increased significantly from the low stable group to the high antenatal and decreasing postnatal group. Infant development and the home environment were not associated with MDTs. Conclusions: Our study showed that MDTs have different manifestations and are associated with parental stress, infant behavior problems, and infant psychological violence. Given the potential long-term effects of maternal depression, early identification, appropriate treatment and follow-up of depressed adolescents must be a key priority for primary health care services.
LONG, STRESS, DEV Supported by Saving Brains, Bill & Melinda Gates Foundation, and Companhia Brasileira de Metalurgia e Minerac¸ ~ao. http://dx.doi.org/10.1016/j.jaac.2017.09.340
5.58 SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRI), SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI), BREASTFEEDING, AND CONCERNS FOR INFANT SAFETY Tapan Parikh, MD, MPH, Cooper University Hospital, [email protected]; Dharmendra Goyal, MD, Augusta
S274
www.jaacap.org
University, [email protected]; Ramkrishna Makani, MD, MPH, Cooper University Hospital, [email protected]; Consuelo C. Cagande, MD, Cooper University Hospital, cagande-consuelo@ cooperhealth.edu Objectives: Antidepressants secreted into mothers’ breastmilk may have potential side effects in infants. Mental health of mother is crucial for maternal infant bonding, and mothers may need medications. Clinicians may not have the information on potential effects of medications on infants readily available. This abstract describes literature review of SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs). These are commonly used for MDD, postpartum depression, OCD, and anxiety. Methods: A thorough literature search using the PubMed and TOXNET was conducted. From 196 informative articles on various SSRIs and SNRIs published until May 2017, after excluding irrelevant articles, the search was narrowed to 98 articles. Results: It is known that there are very little to no side effects to infants if the relative infant dose (RID) is <10 percent. No side effects were reported in a number of infants (within parentheses) who were administered the following drugs: fluvoxamine (N ¼ 8), paroxetine (N ¼ 119), sertraline (N ¼ 151), duloxetine (N ¼ 2), and desvenlafaxine (N ¼ 11). Medications with reported infant side effects include the following: citalopram (uneasy sleep, n ¼ 1 of 68); escitalopram (necrotizing enterocolitis, n ¼ 1 of 16); fluoxetine (colic, n ¼ 3 of 72; seizure-like episode, n ¼ 1 of 72; mother also on carbamazepine and buspirone; lower weight gain, n ¼ 1 of 72), and venlafaxine (low weight gain or failure to thrive, n ¼ 5 of 35). No side effects were reported in statistically analyzable number, and data suggest that, overall, no SSRI or SNRI has consistent adverse effects in infants. Conclusions: Fluvoxamine, paroxetine, sertraline, and venlafaxine are considered to be the safest. Some suggest sertraline to be the safest SSRI. Citalopram, escitalopram, and fluoxetine have mixed reviews, and caution is suggested. Limited data are available for duloxetine and desvenlafaxine. The clinical risks versus benefits have to be justified. Clinical caution and monitoring should include the basic infant safety questions. Clinical studies should follow FDA guidance on lactation studies, and those who publish case reports based on the clinical encounters should include detailed history and developmental data, preferably longitudinal, and the longitudinal studies are long due and warranted.
ADP, PPC, INF http://dx.doi.org/10.1016/j.jaac.2017.09.341
5.59 CHARACTERISTICS OF FAMILIES PARTICIPATING IN MULTIFAMILY GROUP THERAPY FOR CHILDREN IN A LONG-TERM PSYCHIATRIC INPATIENT PROGRAM Nayla M. Khoury, MD, University of Washington, Nayla. [email protected]; L. Lee Carlisle, MD, Child Study and Treatment Center, [email protected]; Fran Lexcen, PhD, Child Study and Treatment Center, Fran. [email protected] Objectives: Multifamily group therapy (MFGT) has been used in a variety of inpatient and outpatient settings to facilitate parental skill development with children who have emotional, social, or behavioral problems. This study looked for similarities and differences among parents of children receiving inpatient psychiatric treatment in a long-term placement program. Methods: The study was completed at Child Study Treatment Center, a staterun psychiatric hospital for children and adolescents with severe mental illnesses with average stays lasting from nine to 16 months. Caregivers of the patients were given the opportunity to attend MFGT sessions and choose whether or not to participate in the study. A series of measurements, including the Child-Parent Relationship Scale, the Strengths and Difficulties Questionnaire, and the Hope Scale, were conducted. Seventeen families participated in up to 14 sessions of MFGT. Measures were collected at intake and at six months.
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017