Fifteen million children in the U.S. have diagnosable psychiatric or learning disorders, yet nearly 70% don’t receive the help they need.

If your teenager shows signs of having an eating disorder, you may hope that, with the right mix of love, encouragement, and parental authority, he or she will just "snap out of it." If only it were that simple. To make matters worse, certain treatments assume you've somehow contributed to the problem and prohibit you from taking an active role. But as you watch your own teen struggle with a life-threatening illness, every fiber of your being tells you there must be some part you can play in restoring your child's health. In Help Your Teenager Beat an Eating Disorder, James Lock and Daniel Le Grange--two of the nation's top experts on the treatment of eating disorders--present compelling evidence that your involvement as a parent is critical. In fact, it may be the key to conquering your child's illness. Help Your Teenager Beat an Eating Disorder provides the tools you need to build a united family front that attacks the illness to ensure that your child develops nourishing eating habits and life-sustaining attitudes, day by day, meal by meal. Full recovery takes time, and relapse is common. But whether your child has already entered treatment or you're beginning to suspect there is a problem, the time to act is now. This book shows how.

Posttraumatic Stress Disorders in Children and Adolescents is an expert guide to the most salient issues pertaining to PTSD, stress, trauma, and the concurrent conditions that affect children and adolescents. The rich mix of clinical experience and research constitutes a thorough introduction for practitioners.

Over the last decade, the literature on therapy addressing trauma in children has expanded considerably, as has the literature on dissociation. Unfortunately, very little of this literature has addressed the issue of dissociation in children. At the same time, therapists working with children and adolescents have become increasingly aware of the occurrence of trauma and dissociation in their clients.

Dissociation in Traumatized Children and Adolescents is a groundbreaking text for the study of dissociation in young people. In eight unique and compelling case studies, the authors lay out detailed narratives that illustrate both therapy progression as well as the therapist’s reactions and thought process during case development. These case studies present many aspects of working with traumatized children who dissociate—trauma processing, attachment work, work with the family, interactions with the community—and give frank analysis of the difficulties clinicians encounter in various therapeutic situations and how and why they arrived at particular therapeutic decisions. While the book includes intensive analysis of each author’s theoretical framework as well as that of dissociation in general, it also shows clinicians, in the most practical terms, how to translate the theories of dissociation into action. No clinician interested in trauma and dissociation in children will want to be without this text.

Play-Based Interventions for Children and Adolescents with Autism Spectrum Disorders explores the most recognized, researched, and practical methods for using play therapy with the increasing number of children diagnosed with Autism Spectrum Disorders (ASDs), and shows clincians how to integrate these methods into their practices. Using a diverse array of play-based approaches, the book brings together the voices of researchers and practicing clinicians who are successfully utilizing play and play-based interventions with children and adolescents on the autism spectrum. It also examines the neurobiological underpinnings of play in children on the autism spectrum and the overall effect of play on neuro-typical and neuro-atypical development. Finally, through careful integration of theory with real-world clinical case application, each chapter also shows clinicians how to incorporate a particular treatment approach and make it a viable and effective part of their work with this challenging clinical population.

Aimed at advanced practice nurses and graduate students in nursing, this book is divided into 4 sections addressing assessment, treatment, special populations, and special issues. Within these sections, each chapter includes state-of-the-art, evidence-based information about the most common issues faced by psychiatric and primary care practitioners alike. Chapters focused on disorders review clinical manifestation, etiology, nursing interventions, integration with primary care, and implications for practice, research, and education. Chapters focused on issues describe the linkages between the behavioral/psychiatric profile of the child and associated risk and management strategies.

Written/reviewed by over 70 nurse experts, Child and Adolescent Behavioral Health: A Resource for Advanced Practice Psychiatric and Primary Care Practitioners in Nursing is a must-have reference for all practitioners caring for children and adolescents.

Paperback: 592 pages
Company: Wiley-Blackwell (2012-04-03)
ISBN: 0813807867
List Price: $79.99
Amazon Price: $73.43

Int J Cancer. 2012 Feb 5;
Niemelä M, Paananen R, Hakko H, Merikukka M, Gissler M, Räsänen S

The studies reporting population-based estimates of the proportion of children with a parent suffering from cancer are very few. These children have been shown to suffer from psychological symptoms, but it is not known whether their use of psychiatric services is increased. This study examined the prevalence of children affected by parental cancer at national level and whether these children use specialised psychiatric services more than their peers. The study is a retrospective population-based registry study. All 60,069 children born in Finland in 1987 were followed up with various health and social registers from 1987 to 2008. The associations of parental cancer treatments with children's psychiatric service use were analysed with logistic regressions. During the 21-year follow-up 3,909 (6.6%) of the children had a parent suffering from cancer. The children of the cancer patients used more specialised psychiatric care than their peers and the service use depended on parent's gender, as well as cohort members' gender and the age at occurrence. The combination of parental cancer and psychiatric disorder, whether the ill parent or spouse, increased the children's psychiatric service use even more. Children affected by parental cancer comprise a substantial part of the population in society using increased level of psychiatric services. Parental cancer is clearly an illness which has to be taken into account in planning child- and parentingfocused prevention and promotion actions in adult health care. © 2012 Wiley-Liss, Inc.

Compr Psychiatry. 2012 Jan 31;
Sharp C, Ha C, Michonski J, Venta A, Carbone C

Empirical evidence is increasing in support of the validity of the construct of borderline personality disorder (BPD) in adolescence. There is growing consensus that the early identification and treatment of emerging borderline traits may be an important focus. However, few diagnostic (questionnaire- or interview-based) measures specifically developed or adapted for adolescents and children exist. The Childhood Interview for DSM-IV Borderline Personality Disorder (CI-BPD) [Zanarini, 2003] is a promising interview-based measure of adolescent BPD. Currently, no studies have explicitly been designed to examine the psychometric properties of the CI-BPD. The aim of the current study was to examine various psychometric properties of the CI-BPD in an inpatient sample of adolescents (n = 245). A confirmatory factor analytic approach was used to examine the internal factor structure of the 9 CI-BPD items. In addition, internal consistency, interrater reliability, convergent validity (with clinician diagnosis and 2 questionnaire-based measures of BPD), and concurrent validity (with Axis I psychopathology and deliberate self-harm) were examined. Similar to several adult studies, the confirmatory factor analytic results supported a unidimensional factor structure for the CI-BPD, indicating that the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria on which the CI-BPD is based constitute a coherent combination of traits and symptoms even in adolescents. In addition, other validity criteria were excellent. Taken together, the current study provides strong evidence for the validity of the CI-BPD for use in adolescents.

J Can Acad Child Adolesc Psychiatry. 2012 Feb; 21(1): 59-62
St-André M, Stikarovska I, Gascon S

Contraception-induced mood changes have been identified since the 1960s. To our knowledge, there has been no reported case about self-mutilation associated to any form of contraception. We report the case of a 17-year-old adolescent girl who presented with de novo self-mutilation and depressive symptoms three and a half weeks after the administration of 150 mg of Depot-Medroxyprogesterone Acetate (DMPA).Clinical case report and literature review. Possible confounding factors are reviewed.The patient had no personal psychiatric history and no significant family psychiatric history. A DSM-IV diagnosis of "mood disorder due to DMPA with depressive features" was formulated. There was no evidence of abnormal personality functioning. The mental status exam and collateral information validated the severity of her condition.DMPA is a birth control method especially useful for adolescent girls and possible secondary mood symptoms should not limit its access. However, since depressive symptoms substantially interfere with daily functioning and may have unfortunate consequences like self-mutilation and suicidal ideation, it is important to remain vigilant regarding the onset of mood symptoms following contraceptive use in adolescent girls. This vigilance should be more specific regarding adolescent girls with a history of mood disorders, anxiety disorders, self-mutilation or family diathesis of these conditions.

Pain Med. 2012 Feb 1;
Hart-Johnson T, Green CR

Objectives.  Physical and sexual abuses commonly co-occur with chronic pain. We hypothesized that: 1) abuse history questions would form distinct factors that relate differently to pain perceptions and pain outcomes; 2) abuse history consequences on physical and mental health differ by gender; and 3) different abuse types and age of occurrence (childhood vs adolescent/adulthood) predict different negative outcomes. Methods.  Chronic pain patients at a tertiary care pain center provided data (64% women, 50% black) through a confidential survey. Factors were formed for abuse type and age. Linear regression, controlling for socio-demographic information, was used to examine the relationship between abuse and abuse by sex interactions with pain-related outcomes. Results.  Six 3-item abuse factors (α = 0.77-0.91)-sexual molestation, sexual penetration, and physical abuse-were identified in both childhood and adulthood. Lifetime prevalence of abuse was 70% for men and 65% for women. Women experienced lower physical abuse (P = 0.01) in childhood, and higher penetration (P = 0.02) in adulthood. Decreased general health was associated with all abuse types (P 

Prim Care Companion CNS Disord. 2011; 13(5):
Carballo JJ, Muñoz-Lorenzo L, Blasco-Fontecilla H, Lopez-Castroman J, García-Nieto R, Dervic K, Oquendo MA, Baca-García E

Objective: To determine and compare rates of homotypic continuity of childhood- and adolescent-onset depression into adulthood.Method: This was a naturalistic, prospective cohort study of children and adolescents receiving psychiatric care at all community mental health centers in Madrid, Spain, from January 1986 to December 2007. Data were obtained from a regional registry wherein all psychiatric visits to public mental health centers are recorded. Patients received their first diagnosis of an ICD-10 F32 or F33 depressive disorder between 6 and 17 years of age and were at least 20 years old at the time of their last visit. Subjects whose first diagnosis was in childhood (aged 6-12 years: depressed-child group) and subjects whose first diagnosis was in adolescence (aged 13-17 years: depressed-adolescent group) were compared in terms of demographic characteristics, psychiatric comorbidity, and rates of homotypic continuity in adulthood.Results: Five hundred twenty-eight patients with depressive disorders met inclusion criteria. The depressed-adolescent group had a higher proportion of girls (60.3%) compared to the depressed-child group, but did not differ on other demographic or clinical variables. Most subjects who later received treatment in adult mental health facilities (n = 243; 57.2%; 95% CI, 50.9-57.2) continued to be diagnosed with a depressive disorder. High rates of anxiety disorders, bipolar disorder, personality disorders, and psychotic disorders in adulthood were observed among subjects from both groups. The absence of psychiatric comorbidity prior to age 18 years was associated with homotypic continuity of depressive disorder into adulthood.Conclusions: Subjects with adolescent-onset depression and subjects without comorbid psychiatric disorders in youth appear to have a higher level of homotypic continuity into adulthood. Both children and adolescents with depressive disorders are at risk for other psychiatric disorders in adulthood.

Int J Family Med. 2011; 2011: 801203
Meltzer H, Ford T, Goodman R, Vostanis P

Introduction. There is a paucity of evidence from epidemiological studies on the burden of children's emotional and conduct disorders on their parents. The main purpose of this study is to describe the problems experienced by parents of children with conduct and emotional disorders using data from a large national study on the mental health of children and young people in Great Britain. Materials and Methods. The Development and Well-Being Assessment and sections of the Child and Adolescent Burden Assessment were included in a nationally representative survey of the mental health of 10,438 children, aged 5-15, in Great Britain. Results and Discussion. Approximately half the parents of children with conduct disorder reported that they felt restricted in doing things socially with or without their children, embarrassed about their child's problems, and that these also made the relationship with their partner more strained. Conclusions. There is a growing need for research on the consequences of children mental disorders on families to increase the awareness of frontline workers on the burden to parents. Because parents feel embarrassed and stigmatized, they may hide their own feelings which may further exacerbate the situation.

Int J Family Med. 2011; 2011: 601979
Mockett M, Khan J, Theodosiou L

Background. User feedback is now an integral part of both clinical governance and service development, and it also provides a key route to engaging parents and children. Autistic spectrum disorders (ASDs) can impact on all members of a family, and close working between parents and professionals is essential. Aim. To explore parental satisfaction rates and identify areas in need of improvement. Method. A postal survey was completed by parents whose children had been diagnosed with an ASD in the past 18 months in a Manchester Child and Adolescent Mental Health Service. The National Autism Plan for Children was used as a gold standard. Results. Parents were particularly satisfied with the way team members dealt with them and their children during appointments. However, the standard of written information provided about the condition, diagnosis, and support available could be improved. The findings show the benefits of receiving a diagnosis in the recommended timeframe. Discussion. We discuss ways of effectively using scarce resources.

PLoS One. 2012; 7(1): e29404
Zheng Y, Fan F, Liu X, Mo L

To examine the relationship between negative life events, coping styles, and symptoms of post-traumatic stress disorder (PTSD) among adolescent survivors exposed to 2008 Wenchuan Earthquake, China.A survey was conducted in a sample of 2250 adolescent students from two schools in Dujiangyan District, a seriously damaged area, 20 kilometers away from the epicenter, 6 months after the earthquake. Participants completed a self-administered questionnaire including demographics, negative life events, coping styles, and PTSD symptoms.Academic pressure was the strongest predictor of adolescents' PTSD symptoms among all negative life events. Main effects of negative life events, positive coping and negative coping on PTSD symptoms were significant in both younger adolescents and older adolescents, while the moderator effects of two coping styles were found significant only within older adolescents.Coping may play a role to moderate the relationship between post-earthquake negative life events and PTSD symptom, but the function seems to depend on the age of participants. Psychosocial coping skills training may be important in the prevention and intervention of mental health problems in adolescent survivors of traumatic earthquake.

World Psychiatry. 2012 Feb; 11(1): 11-5
Mikulincer M, Shaver PR

In recent years, attachment theory, which was originally formulated to describe and explain infant-parent emotional bonding, has been applied to the study of adolescent and adult romantic relationships and then to the study of psychological processes, such as interpersonal functioning, emotion regulation, coping with stress, and mental health. In this paper, we offer a brief overview of the attachment perspective on psychopathology. Following a brief account of attachment theory, we go on to explain how the study of individual differences in adult attachment intersects with the study of psychopathology. Specifically, we review research findings showing that attachment insecurity is a major contributor to mental disorders, and that the enhancement of attachment security can facilitate amelioration of psychopathology.

Community Ment Health J. 2012 Feb 1;
Golubchik P, Sever J, Finzi-Dottan R, Kosov I, Weizman A

Indications and criteria for psychiatric hospitalization (PH) continue to be questioned and assessed. We investigated the major clinical criteria affecting child psychiatrists' decision to recommend hospitalization. Records of 80 children (aged 7-13 years) treated at the Geha Mental Health Center's (GMHC's) outpatient clinic were reviewed. The patients' files were divided into three groups: admitted to PH (n = 20), candidates for PH who, ultimately, were not hospitalized (n = 20) and 40 patients for whom PH was not a consideration. Three groups of criteria were chosen to evaluate the decision for PH (type and severity of the psychiatric disorders, family's level of distress and parental capacity to contain the child). These criteria were rated quantitatively by using CGI-S. Highly significant inverse association was found between the level of parental capacity to contain the child and the decision to hospitalize in a psychiatric pediatric institution. The correlations between severity of the psychiatric disorders and family's level of distress was also found significant, but to a lesser extent. Parental capacity to contain the child, with its various components, is a major factor in the decision making process, when referring children to PH. This is the first study, demonstrating a strong association between parental-capacity components and the rate of hospitalization.

BMC Psychiatry. 2012 Jan 30; 12(1): 7
Pedrini L, Colasurdo G, Costa S, Fabiani M, Ferraresi L, Franzoni E, Masina F, Moschen R, Neviani V, Palazzi S, Parisi R, Parmeggiani A, Preti A, Ricciutello C, Rocchi MB, Sisti D, Squarcia A, Trebbi S, Turchetti D, Visconti P, Tullini A, de Girolamo G

ABSTRACT: BACKGROUND: To date, no studies have assessed in detail the characteristics, organisation, and functioning of Child and Adolescent Mental Health Services (CAMHS). This information gap represents a major limitation for researchers and clinicians because most mental disorders have their onset in childhood or adolescence, and effective interventions can therefore represent a major factor in avoiding chronicity. Interventions and mental health care are delivered by and through services, and not by individual, private clinicians, and drawbacks or limitations of services generally translate in inappropriateness and ineffectiveness of treatments and interventions: therefore information about services is essential to improve the quality of care and ultimately the course and outcome of mental disorders in childhood and adolescence. The present paper reports the results of the first study aimed at providing detailed, updated and comprehensive data on CAMHS of a densely populated Italian region (over 4 million inhabitants) with a target population of 633,725 subjects aged 0-17 years. METHODS: Unit Chiefs of all the CAMHS filled in a structured 'Facility Form', with activity data referring to 2008 (data for inpatient facilities referred to 2009), which were then analysed in detail. RESULTS: Eleven CAMHS were operative, including 110 outpatient units, with a ratio of approximately 20 child psychiatrists and 23 psychologists per 100,000 inhabitants aged 0-17 years. All outpatient units were well equipped and organized and all granted free service access. In 2008, approximately 6% of the target population was in contact with outpatient CAMHS, showing substantial homogeneity across the eleven areas thereby. Most patients in contact in 2008 received a language disorder- or learning disability diagnosis (41%). First-ever contacts accounted for 30% of annual visits across all units. Hospital bed availability was 5 per 100,000 inhabitants aged 0-17 years. CONCLUSION: The percentage of young people in contact with CAMHS for mental disorders is in line with those observed in previous epidemiological studies. The overall number of child psychiatrists per 100,000 inhabitants is one of the highest in Europe and it is comparable with the most well equipped areas in the US. This comparison should be interpreted with caution, however, because in Italy, child psychiatrists also treat neurological disorders. Critical areas requiring improvement are: the uneven utilisation of standardised assessment procedures and the limited availability of dedicated emergency services during non-office hours (e.g., nights and holidays). KEYWORDS: Child and Adolescent Mental Health Services (CAMHS); Process of care; Adolescence; Child Psychiatry.

J Child Psychol Psychiatry. 2012 Jan 31;
Coghill D, Sonuga-Barke EJ

The question of whether child and adolescent mental disorders are best classified using dimensional or categorical approaches is a contentious one that has equally profound implications for clinical practice and scientific enquiry. Here, we explore this issue in the context of the forth coming publication of the DSM-5 and ICD-11 approaches to classification and diagnosis and in the light of recent empirical studies. First, we provide an overview of current category-based systems and dimensional alternatives. Second, we distinguish the various strands of meaning and levels of analysis implied when we talk about categories and dimensions of mental disorder - distinguishing practical clinical necessity, formal diagnostic systems, meta-theoretical beliefs and empirical reality. Third, we introduce the different statistical techniques developed to identify disorder dimensions and categories in childhood populations and to test between categorical and dimensional models. Fourth, we summarise the empirical evidence from recent taxometric studies in favour of the 'taxonomic hypothesis' that mental disorder categories reflect discrete entities with putative specific causes. Finally, we explore the implications of these findings for clinical practice and science.

Neuro Endocrinol Lett. 2012 Jan 9; 32(6): 748-750
Kocourkova J, Soltysova M, Mohaplova M, Hrdlicka M

Eating disorders represent significant psychopathological spectrum, particularly in adolescent girls. One of the risk factors associated with eating disorders is a strong emphasis of western visual-oriented culture on physical appearance and slimness. However, sensory handicap leading to disability to see one's own body and bodies of others does not mean that eating disorder cannot develop in blind people. The authors believe that body image is a mental construct that is not dependent on sensory perception only. They present the case of an adolescent patient, blind from early childhood, who shows symptoms of mental anorexia, depression, suicidal behavior and self-harming.

J Marital Fam Ther. 2012 Jan; 38(1): 3-29
Sprenkle DH

This article serves as an introduction to this third version of research reviews of couple and family therapy (CFT) that have appeared in this journal beginning in 1995. It also presents a methodological and substantive overview of research in couple and family therapy from about 2001/2002 to 2010/2011 (the period covered in this issue), while also making connections with previous research. The article introduces quantitative research reviews of family-based intervention research that appear in this issue on 10 substantive areas including conduct disorder/delinquency, drug abuse, childhood and adolescent disorders (not including the aforementioned), family psycho-education for major mental illness, alcoholism, couple distress, relationship education, affective disorders, interpersonal violence, and chronic illness. The paper also introduces the first qualitative research paper in this series, as well as a paper that highlights current methodologies in meta-analysis. The first part of this article rates the 10 content areas on 12 dimensions of methodological strength for quantitative research and makes generalizations about the state of quantitative methodology in CFT. The latter part of the papers summarizes and makes comments on the substantive findings in the 12 papers in this issue, as well as on the field as a whole.

Psychiatry Res. 2012 Jan 24;
Lázaro L, Bargalló N, Andrés S, Falcón C, Morer A, Junqué C, Castro-Fornieles J

Abnormalities in neurochemical compounds in obsessive-compulsive disorder (OCD) may help increase our knowledge of neurobiological abnormalities in the fronto-subcortical circuits. The aims of this exploratory study were to identify with in vivo magnetic resonance spectroscopy ((1)H-MRS) the possible alterations in neurometabolites in a group of drug naïve children and adolescents with OCD in comparison with a control group and to determine whether there was any effect of treatment on the metabolite levels. Eleven OCD children and adolescents (age range 9-17years; 6 male, 5 female) and twelve healthy subjects with similar age, sex and estimated intellectual quotient were studied. Proton magnetic resonance spectroscopy at 1.5T was used. We placed 3 voxels, one bilaterally located involving anterior cingulate-medial frontal regions, and one in each striatal region involving the caudate and putaminal regions. Concentrations of creatine (Cr), myo-inositol (mI), total Cho (glycerophosphocholine+phosphocholine), total NAA (N-acetyl aspartate+N-acetyl aspartylglutamate), and total Glx (glutamate+glutamine) were calculated. We found significantly lower concentrations of total Cho in left striatum in OCD patients compared with healthy subjects. The difference in Cho concentrations in left striatum between the two groups did not change over time and persisted at follow-up assessment. Like the control subjects, OCD patients undergoing pharmacological treatment and clinical recovery showed no significant changes in neurometabolic activity between the first and second evaluations.

Psychol Med. 2012 Jan 25; 1-14
Kessler RC, Avenevoli S, McLaughlin KA, Green JG, Lakoma MD, Petukhova M, Pine DS, Sampson NA, Zaslavsky AM, Merikangas KR

BACKGROUND: Research on the structure of co-morbidity among common mental disorders has largely focused on current prevalence rather than on the development of co-morbidity. This report presents preliminary results of the latter type of analysis based on the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A).MethodA national survey was carried out of adolescent mental disorders. DSM-IV diagnoses were based on the Composite International Diagnostic Interview (CIDI) administered to adolescents and questionnaires self-administered to parents. Factor analysis examined co-morbidity among 15 lifetime DSM-IV disorders. Discrete-time survival analysis was used to predict first onset of each disorder from information about prior history of the other 14 disorders. RESULTS: Factor analysis found four factors representing fear, distress, behavior and substance disorders. Associations of temporally primary disorders with the subsequent onset of other disorders, dated using retrospective age-of-onset (AOO) reports, were almost entirely positive. Within-class associations (e.g. distress disorders predicting subsequent onset of other distress disorders) were more consistently significant (63.2%) than between-class associations (33.0%). Strength of associations decreased as co-morbidity among disorders increased. The percentage of lifetime disorders explained (in a predictive rather than a causal sense) by temporally prior disorders was in the range 3.7-6.9% for earliest-onset disorders [specific phobia and attention deficit hyperactivity disorder (ADHD)] and much higher (23.1-64.3%) for later-onset disorders. Fear disorders were the strongest predictors of most other subsequent disorders. CONCLUSIONS: Adolescent mental disorders are highly co-morbid. The strong associations of temporally primary fear disorders with many other later-onset disorders suggest that fear disorders might be promising targets for early interventions.

Int J Aging Hum Dev. 2011; 73(3): 209-26
Patrick JH, Stahl ST, Sundaram M

The majority of our knowledge about eating disorders derives from adolescent and young adult samples; knowledge regarding disordered eating in middle and later adulthood is limited. We examined the associations among known predictors of eating disorders for younger adults in an age-diverse sample and within the context of psychological distress. Using data from 567 adults (ages 18 to 88 years), we tested a path model in which age, gender, eating-related cognitions, and satisfaction with appearance predicted eating disorders which, in turn, predicted psychological distress. The model fit the data well (chi2 (DF = 11, N = 567) = 30.58, p < .001; GFI = .987, NFI = .963; RMSEA = .056), explaining 20.1% of the variance in psychological distress.

Psychiatrike. 2011 Oct-Dec; 22(4): 314-9
Pejovic-Milovancevic M, Miletic V, Popovic-Deusic S, Draganic-Gajic S, Lecic-Tosevski D, Marotic V

Medication can be an effective part of treatment for several psychiatric disorders of childhoodand adolescence but its use should be based on a comprehensive psychiatric evaluation andtreatment plan. The aim of this study was to evaluate psychotropic medication use for childrenand adolescents treated as inpatients and to compare it with principles of rational pharmacotherapy,thus identifying possible downsides of current practices and pointing a way towards saferand more efficient practices. This is a descriptive study of prescribing trends at the Clinical Department forChildren and Adolescents of the Institute of Mental Health in Belgrade, during the period from September2009 to September 2010. Analyzed demographic data (age, gender) and the number of hospitalizationswere obtained from medical histories, while diagnoses were obtained from discharge notes. Prescribedtherapy was copied from medication charts. Drug dosages were analyzed as average daily doses prescribedduring the hospitalization. Psychiatric diagnoses were classified according to The International Classificationof Diseases and Related Health Problems, 10th Revision (ICD-10). During the examined time period, 264 patients were hospitalized (61.4% males), with an average age of 11.4±5.1 years. We have found that 66.3% of admitted patients were treated with pharmacotherapy in addition to other treatment modalities. There was a highly significant correlation between the age of patients and the prescribed dosage (Spearman'srho=0.360, p

Atten Defic Hyperact Disord. 2012 Jan 21;
Wehmeier PM, Schacht A, Escobar R, Hervas A, Dickson R

Attention-deficit/hyperactivity disorder (ADHD) is associated with considerable impairment in health-related quality of life (HR-QoL). Atomoxetine has been found to improve HR-QoL in both children and adolescents. However, there is scarcity of data on gender differences in treatment responses to ADHD medications. This pooled analysis of five atomoxetine trials aimed to evaluate treatment differences with respect to HR-QoL and ADHD symptoms across genders. Data from 5 clinical atomoxetine trials (4 from Europe and 1 from Canada) with similar inclusion and exclusion criteria and similar durations (8- to 12-week follow-up) were included in the pooled analysis. All studies included the Child Health and Illness Profile-Child Edition (CHIP-CE) Parent Report Form. In addition, correlations between HR-QoL and ADHD core symptoms were compared between girls and boys. Data from 136 girls and 658 boys (mean age: 9.6 and 9.7 years, respectively) were pooled. Boys and girls were similarly impaired at baseline with minor differences in some of the subdomains. Treatment effect of atomoxetine was significant in both groups for the Risk Avoidance domain and its subdomains. No gender effect with both clinical and statistical significance was found for treatment outcome. Correlations between ADHD Rating Scale and CHIP-CE scores were similar in both genders and were generally low at baseline and moderate at endpoint and for the change from baseline to endpoint. Atomoxetine was effective in improving some aspects of HR-QoL in both genders without any significant differences across genders. Correlations between core symptoms of ADHD and HR-QoL were low to moderate in both boys and girls.

Eur Child Adolesc Psychiatry. 2012 Jan 22;
Ercan ES, Kandulu R, Akyol Ardic U

Obsessive-compulsive disorder (OCD) is an anxiety disorder which can substantially disable children's ability to function at home and school. Clinicians frequently rely on knowledge about symptoms that can be examined early in treatment to determine future treatment effectiveness. However, OCD in preschoolers has also received little attention in literature. To the best of our knowledge, there is only one retrospective chart review and one case report in the literature for preschool cases treated with SSRIs. Therefore, the effect of fluoxetine on preschool children was imprecisely understood. The aim of this case report was to examine the efficacy and safety of fluoxetine treatment for pediatric OCD. Four preschool children with OCD completed an 8-week fluoxetine (up to 20 mg) trial. We diagnosed OCD according to Diagnostic and statistical manual of mental disorders, 4th edition, text revision (DSM-IV-TR) criteria and symptoms of OCD were assessed with the Childrens' Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Initial and post-treatment symptom severity and improvement were assessed by using the severity (S) and improvement (I) scales of Clinical Global Impressions Scale (CGI). The CY-BOCS total, obsessions and compulsions subscale scores and CGI-S scores were significantly improved for all of the cases at the end of the eighth week. In this case report four preschool children, with severe OCD and resistant to the previous non-psychopharmacologic treatment responded well to fluoxetine monotherapy. On the other hand, the usage of SSRIs in preschool children remains highly controversial, due to the lack of data on safety and efficacy.