2 results
6 - Pharmacology for attention-deficit hyperactivity disorder, Tourette syndrome and autism spectrum disorder
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- By David Coghill, Reader in Child and Adolescent Psychiatry, Division of Neuroscience, Medical Research Institute, University of Dundee, UK, Eugenia Sinita, Head of Research and Development & Consultant in Adult Psychiatry, Department of Research and Development, National Centre of Mental Health, Clinical Psychiatric Hospital, Chisinau, Republic of Moldova
- Edited by Sarah Huline-Dickens
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- Book:
- Clinical Topics in Child and Adolescent Psychiatry
- Published online:
- 02 January 2018
- Print publication:
- 01 March 2014, pp 74-93
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- Chapter
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Summary
Historically, paediatric pharmacology in general and paediatric psychopharmacology in particular have received much less research interest and funding than their adult counterparts. As a consequence, relatively few drugs are licensed for use in child and adolescent populations.
One of the greatest obstacles to evidence-based clinical practice is the time taken to translate research findings into treatment recommendations that are effective and usable in a general out-patient setting. Unfortunately, there are also several clear examples of changes in clinical practice outstripping the available evidence. In this chapter and the next, we describe some of the recent advances and current controversies in child and adolescent psychopharmacology. With the exception of attentiondeficit hyperactivity disorder (ADHD) in this chapter, they are organised by disorder rather than drug class. The section on ADHD is organised by class of drug as this best reflects the ways in which clinical decisions are made about individual patients.
Attention-deficit hyperactivity disorder
There has been more research into the use of medication for the treatment of ADHD than any other area of child and adolescent psychopharmacology, and most clinicians are now comfortable with the idea of using medications as a part of their treatment of ADHD. There have, however, been key advances in knowledge and several new treatment options introduced over the past few years. In addition, more basic science studies have helped clarify the relationship between the pharmacokinetics and misuse potential of stimulant medications (Volkow et al, 1995) and raised interesting questions about the relationship between core ADHD symptoms and cognition (Coghill et al, 2007). Clinical studies have started to address the similarities and differences between different medications as well as their effect on non-core aspects of functioning and quality of life (Coghill, 2010). In view of the quantity of trial data and the fact that most clinicians are used to working with these drugs, we focus here on newer medications and current controversies.
Evidence-based treatment and the MTA study
The end of 1999 saw the publication of the primary findings from the Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) multisite study, which was funded by the US National Institute of Mental Health. These findings, and the ensuing commentaries and criticisms of the study, marked a milestone in child and adolescent psychiatry research.
7 - Pharmacology for anxiety and obsessive–compulsive disorders, affective disorders and schizophrenia
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- By Eugenia Sinita, Head of Research and Development & Consultant in Adult Psychiatry, Department of Research and Development, National Centre of Mental Health, Clinical Psychiatric Hospital, Chisinau, Republic of Moldova, David Coghill, Reader in Child and Adolescent Psychiatry, Division of Neuroscience, Medical Research Institute, University of Dundee, UK
- Edited by Sarah Huline-Dickens
-
- Book:
- Clinical Topics in Child and Adolescent Psychiatry
- Published online:
- 02 January 2018
- Print publication:
- 01 March 2014, pp 94-111
-
- Chapter
- Export citation
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Summary
This chapter has been written as a companion to Chapter 6. Here we focus on current pharmacological approaches to the treatment of anxiety disorders, obsessive–compulsive disorder, affective disorders and schizophrenia in children and adolescents.
Anxiety disorders
Despite being the most common psychiatric illness in childhood and adolescence, affecting somewhere between 5 and 18% of young people, early-onset anxiety disorders remain poorly understood. They can, however, cause serious disruption to children's lives and are often persistent over time, leading to increased risks of continued anxiety disorders in adulthood as well as major depression, substance misuse and educational underachievement. The use of medication to manage child and adolescent anxiety disorders remains contentious, with many clinicians arguing that these disorders are always most appropriately treated with psychosocial interventions. However, as success rates for cognitive and behavioural interventions fall in the range of 70–80%, significant numbers of children require further treatments.
Benzodiazepines and tricyclic antidepressants
The first drugs to be studied in the treatment of child and adolescent anxiety were benzodiazepines and tricyclic antidepressants. Benzodiazepines should be considered only when other pharmacological approaches have failed, and they should be prescribed for weeks rather than months. Dose adjustments should be made gradually, both when starting and when tapering off treatment (Velosa & Riddle, 2000). There have been several randomised controlled trials (RCTs) of tricyclic antidepressants in the treatment of paediatric anxiety. Unfortunately, the positive results from initial studies have not been sustained (Velosa & Riddle, 2000) and tricyclics should not be considered as first-line treatments for anxiety disorders in this age group. Several open-label studies have shown buspirone, a non-benzodiazepine anxiolytic reported effective in adults, to be comparable in efficacy to the benzodiazepines, with fewer adverse events, in childhood anxiety disorders. However, no controlled data are available for either safety or efficacy.
Selective serotonin reuptake inhibitors
The selective serotonin reuptake inhibitors (SSRIs) are now the first-choice pharmacological treatment for child and adolescent anxiety disorders. As in depression (see below), their use increased before firm data on their efficacy were available. However, there are now RCT data for fluvoxamine, fluoxetine, sertraline, paroxetine and venlafaxine.
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