搜索结果：Journal of child and adolescent psychopharmacology

Risperidone is an atypical antipsychotic commonly used in pediatric psychiatry that may be associated with metabolic and endocrine adverse effects. Prospective data on drug-naive children and adolescents are limited. To prospectively evaluate anthropometric, metabolic, endocrine, cardiovascular, and clinical changes during the first 6 months of risperidone treatment in drug-naive children and adolescents. This single-center, prospective observational study included 90 drug-naive patients aged 3-18 years who received risperidone treatment between September 2021 and September 2023. Participants were included if they were aged 3-18 years, planned to start risperidone, accepted treatment, and provided informed consent from parents with verbal or written assent from children. Exclusion criteria included chronic medical or neurological diseases requiring treatment, overweight or obesity, prior child psychiatry referrals, use of psychotropic medications, receipt of chronic medical treatment, and having illiterate parents. Assessments at baseline and visits at three and 6 months included height, weight, body mass index (BMI) percentile, waist circumference, fasting glucose, lipid profile, serum prolactin, blood pressure, pulse, and Clinical Global Impression-Severity (CGI-S) scores. Nonparametric tests were used to compare repeated measures, and correlations between risperidone dose and metabolic/endocrine variables were analyzed. The median age was 10.0 years, and 70% of the participants were male. The participant flow throughout the study is presented in Figures 1 and 2. The mean risperidone dose was 1.62 &#xb1; 1.00 mg/day at 3 months and 1.99 &#xb1; 1.12 mg/day at 6 months. Significant increases were observed in height, weight, BMI percentile (p = 0.000, p = 0.000, p = 0.044, respectively), and waist circumference (p = 0.014). Serum prolactin levels increased (p = 0.006), and high-density lipoprotein (HDL) cholesterol levels decreased (p = 0.018), whereas other metabolic and cardiovascular parameters showed no significant change. CGI-S scores improved (p < 0.001). A strong positive correlation between risperidone dose and waist circumference was observed at 3 months (r = 0.715, p = 0.000) and 6 months (r = 0.803, p = 0.000). Forty-eight participants did not attend the 3-month evaluation, and 17 did not attend the 6-month evaluation, which was addressed with sensitivity analyses. Within 6 months of initiation, risperidone use in drug-naive pediatric patients was associated with increased weight and abdominal adiposity, early prolactin elevation, HDL reduction, and clinical improvement. Waist circumference showed a strong dose-dependent association and should be routinely monitored along with metabolic and endocrine parameters.

Clozapine is the treatment of choice for treatment-resistant schizophrenia (TRS), yet it remains underutilized in child and adolescent psychiatry. This study aimed to assess knowledge, clinical skills, attitudes, and perceived barriers related to clozapine use among child and adolescent psychiatry professionals in T&#xfc;rkiye. A cross-sectional online survey was distributed to child and adolescent psychiatry residents, specialists, and academics across T&#xfc;rkiye via professional email lists and messaging groups. The questionnaire assessed sociodemographic characteristics, clozapine prescribing experience, perceived barriers, self-rated competence, training exposure, and attitudes toward clozapine. Group comparisons were performed using chi-square tests. A total of 517 professionals participated (180 residents, 212 specialists, and 125 academics). Only 30.0% had prescribed clozapine in the past 12 months, and 28.6% had received specific clozapine training. Barriers were common across all groups, with concerns about medication adherence (43.2%-58.0%), blood test compliance (56.8%-65.6%), and side effects being most frequently endorsed. A clear experience-related gradient emerged: residents reported significantly more barriers, lower self-rated competence, and greater reluctance to prescribe than specialists and academics. Clinicians without inpatient access reported more barriers and lower confidence and were less likely to have gained meaningful clozapine experience during residency (35.2% vs. 66.0%, p < 0.001) or to have observed clozapine's superiority firsthand (57.7% vs. 79.7%, p < 0.001). Despite these barriers, 92.3% of respondents acknowledged clozapine's superior efficacy compared with other antipsychotics. This nationwide survey, the largest to examine clozapine-related attitudes among child and adolescent psychiatry professionals globally, reveals substantial gaps in training, confidence, and service infrastructure in T&#xfc;rkiye. While efficacy is widely recognized, safety concerns and monitoring-related barriers, particularly among less experienced clinicians and those without inpatient access, limit appropriate prescribing. Findings underscore the unmet need for structured residency training programs, national clinical guidelines, and expanded service infrastructure to ensure equitable access to clozapine for youth with TRS.

d-Amphetamine transdermal system (d-ATS) is FDA-approved for treating attention-deficit/hyperactivity disorder (ADHD) in adults and pediatric patients &#x2265;6 years. In a pivotal study, d-ATS met its primary (SKAMP total score) and secondary endpoints. This analysis further evaluated d-ATS efficacy using SKAMP subscale scores and total score by subgroup. The pivotal study comprised a 5-week, open-label dose-optimization period (DOP) followed by a 2-week, randomized, cross-over double-blind treatment period (DBP). All eligible patients received d-ATS 5 mg/9 h, with weekly evaluation for dose increase and the optimal dose maintained during the DBP. Preplanned subgroup analyses of mean SKAMP total score in the DBP by optimized dose, sex, age group, ADHD type, and baseline ADHD severity were conducted. Efficacy was assessed by difference (d-ATS vs. placebo) in least-squares (LS) mean SKAMP total and subscale scores (Attention, Deportment, and Quality of Work) from a mixed-model repeated-measures (MMRM) analysis and is reported throughout as LS mean (95% confidence interval [CI]). Model-based effect sizes were calculated post hoc. In total, 110 patients were enrolled in the DOP; 106 were randomized in the DBP. The LS mean difference in SKAMP total score of d-ATS versus placebo was -5.9 (-6.8, -5.0), with differences in subscale scores (Attention, Deportment, and Quality of Work) of -1.4 (-1.7, -1.1), -1.9 (-2.2, -1.5), and -1.3 (-1.5, -1.0), respectively. Model-based effect sizes were 0.57, 0.42, 0.43, and 0.47, respectively. Patients receiving d-ATS demonstrated improvements versus placebo in LS mean SKAMP total score at each optimized dose in both male and female patients and children and adolescents and regardless of ADHD subtype or baseline ADHD severity. Consistent efficacy of d-ATS across subgroups and all SKAMP subscale scores suggests broad utility of d-ATS in all patients, regardless of age, sex, ADHD type, or baseline ADHD severity, and broad applicability of these results to patients with varying clinical presentations of functional impairment by ADHD.

Neurodevelopmental disorders (NDDs), including Autism Spectrum Disorder (ASD), Fragile X syndrome (FXS), and Rett Syndrome (RTT), share impairments in cognitive and behavioral functioning and may involve an altered excitatory/inhibitory balance modulated by the endocannabinoid system. This systematic review evaluated the safety and efficacy of cannabinoid-based products (CBPs) in these pediatric NDDs. We conducted a systematic review according to Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) 2020, including randomized and nonrandomized studies of patients under 18 years treated with cannabidiol (CBD), cannabidivarin (CBDV), tetrahydrocannabinol (THC), or their combinations. Outcomes were adverse events (AEs) and treatment discontinuation, seizure reduction, and behavioral and cognitive changes. Study quality and certainty of evidence were assessed using design-specific risk-of-bias tools and the GRADE approach. Seventeen studies (two randomized controlled trials, observational studies, and case series) met the inclusion criteria. Across diagnoses, CBPs were generally associated with mild-to-moderate AEs and low discontinuation rates. Descriptive pooled proportions suggested behavioral improvements in ASD and FXS and seizure reduction in RTT, with exploratory analyses indicating differential effects of CBD versus CBD + THC on behavioral and cognitive outcomes in ASD. CBPs may offer potential benefits for selected behavioral symptoms and comorbid epilepsy in pediatric NDDs, but current evidence is insufficient to support routine clinical use. High-quality randomized controlled trials with standardized outcome measures and long-term follow-up are needed to clarify efficacy, safety, and syndrome-specific effects.

Deprescribing, a structured, planned, and supervised approach to medication discontinuation, is increasingly recognized as an imperative rather than an elective component of rational psychopharmacological practice. Deprescribing is particularly compelling in child and adolescent psychiatry, where, despite accumulating evidence for pharmacotherapy, uncertainties regarding long-term risks and benefits persist. This makes deprescribing an important and often complex clinical consideration. Despite growing international attention, deprescribing remains challenging to implement in routine clinical care and is relatively understudied, especially in low- and middle-income countries. This study examined clinicians' perspectives on perceived barriers and facilitators to deprescribing psychotropics in tertiary Child and Adolescent Mental Health Services in India. The Reflexive Thematic Analysis framework, proposed by Braun and Clarke, was followed. Fourteen child mental health practitioners were recruited through purposive sampling to ensure diverse representation of clinical experience and practice settings. The sample included six consultants, seven specialty trainees, and one general psychiatry resident. Data were collected through in-depth interviews. Data collection and analysis were conducted iteratively. Five interrelated themes were identified: Evolving clinical philosophy; Illness Trajectory, Clinical Risk, and the Timing of Deprescribing; Shared and Shifting Roles in Deprescribing Decision-Making; Health System Constraints and (lack of) Care Continuity; and Cultural and Socioeconomic Context Shaping Deprescribing processes. Together, these themes showed that deprescribing was viewed as a negotiated process influenced by clinician confidence, illness severity, caregiver readiness, adolescent agency, service limitations, and sociocultural pressures. Deprescribing in child and adolescent psychiatry is an evolving clinical competency influenced by clinician, family, health-system, and cultural factors. Structured training, context-specific guidelines, active involvement of children and families, and improved service coordination can support safe deprescribing practices.

Borderline intellectual functioning (BIF), defined by intelligence quotient (IQ) scores between 71 and 84, is associated with increased psychiatric vulnerability but remains poorly characterized in terms of clinical severity and treatment complexity. This study aimed to compare psychopathological burden, adaptive functioning, suicidality, and psychopharmacological treatment patterns among hospitalized adolescents with BIF, average intellectual functioning, and intellectual disability. A retrospective chart review was conducted on adolescents aged 12-18 years admitted to a tertiary child and adolescent neuropsychiatry inpatient unit. Participants were classified into three groups based on full-scale IQ. Standardized assessments of cognitive functioning, psychiatric diagnoses, symptom severity, adaptive behavior, global functioning, and suicidality were integrated with clinical indicators derived from medical records, including emergency service utilization and psychotropic medication at discharge. Group differences were examined using nonparametric statistical analyses. The sample included 194 adolescents. Adolescents with BIF showed significantly poorer adaptive functioning across conceptual and practical domains compared with peers with average intellectual functioning, despite comparable global functioning. Overall psychiatric symptom severity at admission and discharge did not differ across groups; however, the BIF group displayed a mixed clinical profile with both internalizing and externalizing symptoms and persistent behavioral dysregulation. Compared with adolescents with average intellectual functioning, those with BIF demonstrated more frequent emergency psychiatric admissions and a higher likelihood of antipsychotic prescription at discharge. Suicidality differed qualitatively across cognitive groups: adolescents with cognitive impairment showed lower rates of suicide attempts, characterized by precipitation (i.e., falling from height) or defenestration (i.e., jumping from a window) as the only suicidal modality observed in this group. BIF in adolescence is associated with a distinct pattern of functional impairment and clinical complexity, characterized by adaptive difficulties and increased reliance on psychopharmacological treatment. These findings highlight the importance of considering cognitive functioning when planning treatment strategies in inpatient child and adolescent psychiatry.

Recurrent psychiatric hospitalizations in youth are costly and burdensome to patients and families. While postdischarge planning rarely stratifies patients based on their risk of readmission, predictive modeling could identify at-risk youth to facilitate targeted intervention strategies. This study developed and validated machine learning models to predict psychiatric readmission in children and adolescents. This retrospective cohort study included 11,225 patients (20,339 psychiatric admissions) &#x2264; 18 years old with at least one psychiatric admission and an anxiety or depressive disorder diagnosis at any time during the study period from two tertiary-care academic medical centers. Machine learning models were developed to predict psychiatric readmission versus no readmission within 30, 90, and 180 days of discharge using electronic health record data from one institution. These models were internally validated at the development site and externally validated at the second institution. Model development and internal validation using random forest models predicted 30-, 90-, and 180-day readmission with area under the receiver operating characteristic curves (AUROC) equal to 0.739, 0.742, and 0.746, respectively. The most important features identified across follow-up periods included previous psychiatric admissions, length of stay, age, and antipsychotic prescriptions. Models trained using a reduced set of 18 features obtained similar performance, with AUROCs ranging from 0.741 to 0.745. External validation of the models retrained using 12 features available at both institutions yielded AUROCs of 0.598, 0.634, and 0.657 for 30-, 90-, and 180-day readmission, respectively. The findings of this study suggest that machine learning models can identify children and adolescents at risk of psychiatric readmission.

Delirium in the setting of critical illness occurs in 15%-60% of pediatric patients and is associated with increased duration of hospital admission. Strategies for symptom management include minimizing exposure to deliriogenic medications, optimizing day-night cycles, and in some cases prescribing antipsychotic medications. Symptom management occurs while simultaneously identifying and treating the underlying etiology. Over a 5-year period, our pediatric intensive care units implemented several unit-based initiatives to prevent and minimize the severity of delirium in critically ill children. The objective of this study is to retrospectively characterize antipsychotic prescribing practices over the study period. Over a 5-year timeframe in our children's hospital, we extracted dispensing data for risperidone, olanzapine, quetiapine, and haloperidol. We used descriptive statistics to characterize patients initiated on an antipsychotic in an ICU area, dosing information, and quantitative change in annual orders over the study period. During the study period, 533 antipsychotic orders were placed for 165 patients. Most of the identified patients were male (60.6%) and Black (44.2%). Ninety (16.9%) of the medication orders remained active after patient transfer to a general care floor. Risperidone was the most prescribed antipsychotic (54%), with a 413% increase observed between 2016 and 2018, followed by a decline of 89% between 2018 and 2021. Use of other antipsychotics was less than risperidone but consistent during the study period. Risperidone was more commonly prescribed for younger children, and prescribing patterns suggest a preference for nighttime administration. Implementation of unit-based initiatives to promote delirium screening and awareness led to an initial increase in antipsychotic medication prescribing for critically ill children with delirium. This was followed by a significant decline in antipsychotic prescribing with the inclusion of the child and adolescent psychiatry team in our delirium management and prevention algorithm. This study highlights the importance of collaboration with the child and adolescent psychiatry team in the management of pediatric delirium across the hospital system. Additional research on antipsychotic prescribing practices and the associated impact of nonpharmacologic interventions and multidisciplinary collaboration for delirium treatment is warranted.

Post-traumatic stress disorder and trauma-related presentations in children and adolescents frequently co-occur with attention deficit hyperactivity disorder (ADHD), compounding functional impairment. Because evidence-based pediatric treatment options for trauma-related presentations remain limited and symptoms can overlap with ADHD, optimizing the choice of ADHD medications is of clinical importance. This review aimed to map and synthesize the available evidence for the utility of different ADHD medications in children and adolescents with trauma-related presentations. A systematic scoping review was undertaken following the Joanna Briggs Institute methodology and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Medline, Embase, PsycINFO, and gray literature sources were searched for studies published between January 1985 and November 2025. Findings were synthesized narratively and organized by medication class. From 3,626 identified records, 19 were included in the final analysis (15 primary studies and 4 systematic reviews). These consisted of case reports (N = 8), open-label trials (N = 4), retrospective chart reviews (N = 2), and one large-scale electronic health record study. Alpha-2 agonists (guanfacine and clonidine) were associated with the most consistently reported improvements for trauma-related symptoms. Although stimulants and atomoxetine did not show consistent improvement in trauma-related symptoms across available studies, real-world data revealed that stimulant use was associated with reduced hospitalization, emergency department visits, and secondary antipsychotic or mood stabilizer prescribing in comorbid youth. No studies evaluating viloxazine were identified. Stimulants have been shown to benefit wider long-term psychiatric outcomes, although smaller studies demonstrated a more consistent improvement in specific trauma-related symptoms with alpha-2 agonists. Rather than following a rigid medication sequence, clinicians should adopt a trauma-informed approach that prioritizes or combines treatments based on whether ADHD or trauma is the primary driver of functional impairment. However, because the current evidence is predominantly low quality and lacks controlled trials, these findings must be interpreted with caution.

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition in children and adolescents, yet randomized controlled trial evidence supporting pharmacological treatment in Chinese populations remains limited. This study evaluated the efficacy and safety of clonidine hydrochloride extended-release tablets (CLON-XR) as monotherapies for ADHD among Chinese children and adolescents. In this 6-week, multicenter, randomized, double-blind, placebo-controlled phase 3 trial, 75 patients aged 6-17 years with ADHD were assigned (2:1) to receive once-daily CLON-XR (target dosage 0.2 mg/day) or placebo. The primary endpoint was the change from baseline to week 5 in the Swanson, Nolan, and Pelham Version-IV (SNAP-IV) total score. Secondary endpoints included SNAP-IV subscales, Clinical Global Impression-Severity (CGI-S) and Improvement (CGI-I) scores, and safety assessments. Compared with placebo, CLON-XR significantly improved the primary endpoint (least squares mean change in the SNAP-IV total score: -17.5 vs. -10.3; p = 0.0039). Significant improvements were also observed in the SNAP-IV inattention and hyperactivity/impulsivity subscales, CGI-S, and CGI-I (all p < 0.05). The incidence of treatment-emergent adverse events (TEAEs) in the CLON-XR group was comparable with that in the placebo group; the TEAEs were mild, and the dropout rate was low (5.3%). No serious adverse events or clinically significant vital sign abnormalities were reported. CLON-XR was efficacious and well tolerated in Chinese children and adolescents with ADHD, supporting its potential as a nonstimulant treatment option in this population. These findings provide evidence for ADHD management in China and suggest that further investigations in longer-term and real-world settings are needed.

We aimed to explore the relationships between childhood adversity, as assessed by the Childhood Trauma Questionnaire (CTQ) and transcranial magnetic stimulation (TMS) neurophysiological measures of GABAergic and glutamatergic neurotransmission. We hypothesized that elevated CTQ scores would have associations with dysregulated GABAergic and glutamatergic neurotransmission. Adolescents (N&#xa0;=&#xa0;47) aged 12-18&#xa0;years diagnosed with Major Depressive Disorder (MDD) were assessed with the CTQ and TMS neurophysiology measures (n&#xa0;=&#xa0;40) including: Short-Interval Cortical Inhibition (SICI), Long-Interval Cortical Inhibition (LICI), the Cortical Silent Period (CSP), and Intracortical Facilitation (ICF). Spearman partial correlation coefficients, controlled for age, number of failed medical trials and depressive symptom severity were employed to examine potential associations among the CTQ and markers of GABAergic and glutamatergic neurotransmission. A significant positive correlation was observed between ICF-10 and physical abuse (&#x3c1;&#xa0;=&#xa0;0.36276, p&#xa0;=&#xa0;0.0297) suggesting an association with historical physical abuse and increased glutamatergic neurotransmission. Significant negative correlations also emerged between LICI-200 and emotional abuse (&#x3c1;&#xa0;=&#xa0;-0.36047, p&#xa0;=&#xa0;0.0308), emotional neglect (&#x3c1;&#xa0;=&#xa0;-0.42310, p&#xa0;=&#xa0;0.0101), physical neglect (&#x3c1;&#xa0;=&#xa0;-0.35610, p&#xa0;=&#xa0;0.0330), and overall adversity scores (&#x3c1;&#xa0;=&#xa0;-0.515, p&#xa0;=&#xa0;0.0013), suggesting that greater childhood adversity was associated with increased GABA-B mediated inhibitory neurotransmission. This study suggests that childhood adversity may be linked to distinct neurophysiological alterations in adolescents. These findings support the potential of TMS-derived measures as candidate biomarkers for adversity-related psychiatric disorders. Further studies should validate these findings in larger samples with a longitudinal design.

Increasing dispensing of sedative antipsychotics in children and adolescents has been reported in several countries, including the Netherlands, raising concerns about appropriate prescribing and safety. While previous studies have described antipsychotic use in Dutch youth, detailed information on dispensing patterns, dosages, treatment duration, and prescribers of sedative antipsychotics remains limited. This study therefore examined the dispensing patterns of quetiapine, olanzapine, and pipamperone and compared them with aripiprazole and risperidone, using data from the IADB.nl database. Data from the IADB.nl pharmacy dispensing database (120 Dutch community pharmacies) were analyzed to assess sedative antipsychotic dispensing patterns in children and adolescents, aged between 0 and 19 from 2017 to 2022. Dispensing rates, dosages, durations, sex differences, and prescriber types were analyzed using descriptive statistics, Kaplan-Meier survival analysis, Wilcoxon signed-rank tests, and Kolmogorov-Smirnov tests. Dispensing rates increased for quetiapine (0.33 to 0.63/1000) and olanzapine (0.16 to 0.23/1000) from 2017 to 2022, while pipamperone decreased (0.54 to 0.33/1000). Most quetiapine prescriptions (91.5%) were low-dose (<100 mg). Girls received significantly lower doses (43.37 mg) compared with boys (53.25 mg). Median use duration was shortest for quetiapine (3 months) and longest for pipamperone (10 months). General practitioners (GPs) initiated 26% of sedative antipsychotic prescriptions, with quetiapine being the most frequently prescribed, especially by GPs. Specialist-initiated prescriptions generally had longer durations than those initiated by GPs. Rising quetiapine and olanzapine prescriptions, especially low-dose quetiapine despite known adverse effects, raise safety and efficacy concerns. Increased olanzapine use may reflect broader indications; decreased pipamperone suggests shifting preferences. Sex differences in dosage and treatment duration underscore potential clinical or pharmacological differences. These findings call for safer use through individualized prescribing based on clinical indication, patient characteristics, and clear treatment goals, supported by specialist oversight and structured monitoring, alongside stricter guideline adherence and further research on the long-term impacts of sedative antipsychotics in youth.

CTx-1301 is the first trimodal dexmethylphenidate formulation developed for the treatment of attention-deficit/hyperactivity disorder (ADHD). In this 5-week, phase 3, fixed-dose study, patients with ADHD aged 6-17 years were randomized to once-daily treatment with CTx-1301 (18.75, 25.0, or 37.5 mg) or placebo. CTx-1301 was initiated at 12.5 mg and uptitrated weekly to reach the assigned fixed dose. The primary endpoint was the change from baseline to week 5 in the ADHD Rating Scale, Version 5 (ADHD-RS-5). Secondary efficacy endpoints included Clinical Global Impression-Severity (CGI-S) and -Improvement (CGI-I). Statistical comparisons were evaluated at a Bonferroni-adjusted significance level of 0.017. The mean age (&#xb1;standard deviation) of the study population (N = 103) was 11.3 &#xb1; 3.3 years, and the majority of subjects (60.2%) were male. Treatment with CTx-1301 25.0 or 37.5 mg significantly improved ADHD-RS-5 score from baseline compared with placebo (p &#x2264; 0.011). Exploratory post hoc analyses revealed effect sizes for the comparison of CTx-1301 and placebo ranging from 0.732 (18.75-mg dose) to 1.185 (37.5-mg dose). Improvement in CGI-S was statistically significant for CTx-1301 37.5 mg versus placebo (p < 0.001). More than 60% of subjects who received CTx-1301 were much to very much improved on CGI-I compared with 18% for placebo. All adverse events were mild or moderate in severity, no new safety signals were identified, and the safety profile was consistent with the known effects of dexmethylphenidate. CTx-1301 demonstrated dose-related improvements in signs and symptoms of ADHD, although statistical significance is not consistent across all dose groups. The treatment was well tolerated over 5 weeks in children and adolescents with ADHD. Given the limited sample size and reduced statistical power, these findings should be considered preliminary and require confirmation in larger, adequately powered studies.

Methylphenidate (MPH) is widely used to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. However, concerns persist about its potential to induce psychotic symptoms, including hallucinations. This study aimed to evaluate the association between MPH exposure and psychotic symptoms in children and adolescents using VigiBase&#xae;, the World Health Organization global pharmacovigilance database. We conducted a retrospective, observational study using disproportionality analysis on reports from children and adolescents (5-17 years) exposed to MPH and other ADHD drugs (amitriptyline, atomoxetine, clomipramine, clonidine, desipramine, guanfacine, and nortriptyline). Multivariate logistic regression was used to calculate adjusted reporting odds ratios (aRORs) of psychotic symptoms in MPH-exposed children and adolescents. Among 1,992 cases of psychotic symptoms, 1,232 were MPH-associated, with 51.7% classified as serious; significant disproportionalities were observed for the overall age range (aROR = 1.27; 95% confidence intervals [CI]: 1.15-1.40) and the 5-11 (children) age group (aROR = 1.35; 95%CI: 1.19-1.53). Of 1,250 hallucination cases, 809 were MPH-associated, with 59.2% serious; significant disproportionalities were found for the entire age range (aROR = 1.35; 95% CI: 1.19-1.52) and the children age group (aROR = 1.43; 95% CI: 1.23-1.67). The most common type of hallucination was visual (43.2%). MPH discontinuation or dose reduction led to a significantly higher rate of symptom abatement (88.6% of cases) compared to those without these measures (12.0%) (p < .001). These results suggest that MPH exposure in children is associated with an increased probability of serious psychotic symptoms, including hallucinations, which typically resolve with discontinuation or dose reduction. Further research is needed to better understand the MPH-induced psychotic symptoms.

Brain disorders-encompassing neurological, mental, and substance use disorders-account for 10 of the top 25 causes of disability worldwide according to the Global Burden of Disease (GBD) 2021 study. Despite such an impact, they have not been centrally analyzed in prior GBD studies. This paper synthesizes the latest disability-focused GBD study to quantify the prevalence and disability burden of 35 conditions from 2010 to 2021, a period marking the first decline in global health outcomes in three decades. It further incorporates disability metrics from 2021 to 2023 to contextualize post-pandemic trends. The paper covers the prevalence and disability burden of neurological, mental, and substance use disorders along with COVID-19 using disability-adjusted life-years (DALYs) and years lived with disability (YLDs) metrics. From 2010-2021, Parkinson's, Alzheimer's, and migraine (in neurological disorders), major depressive, anxiety, and eating disorders (in mental disorders), and opioid and drug use disorders (in substance use disorders) showed the greatest increases in age-adjusted prevalence rates across both sexes. In 2021, neurological disorders were the largest contributor to DALYs among brain-disorder categories, while depressive and anxiety disorders ranked as the 2nd and 6th leading causes of global YLDs. Alzheimer's disease/dementias, Parkinson's disease, autism spectrum disorder (ASD), depressive and anxiety disorders, and opioid and drug use disorders showed the largest increases in burden within their respective categories between 2010 and 2021. In both 2021 and 2023, females had higher prevalence rates of overall neurological disorders, headache/migraine, multiple sclerosis, depressive/anxiety disorders, and anorexia nervosa, while males had higher rates of stroke, Parkinson's disease, ASD/ADHD, and substance use disorders. In DALY/YLD metrics, females showed higher rates for anorexia nervosa and multiple sclerosis, and males for ASD, certain neurological disorders, COVID-19, and substance use disorders. In the 2021-2023 extension analysis, disability data showed increases in prevalence and disability of several brain disorders, mostly anxiety disorders, while the COVID-19 disability burden declined markedly by 2023. Further sex-specific disability burden metrics, key insights from each disorder, and limitations/confounds are discussed.

To compare the short-term efficacy and tolerability of second-generation antipsychotics (SGAs) versus placebo for schizophrenia-spectrum disorders in children and adolescents using pairwise meta-analysis of randomized trials, and to summarize prospective long-term evidence. We pooled acute double-blind randomized controlled trials (RCTs) (&#x2264;12 weeks; participants &#x2264;19 years; Diagnostic and Statistical Manual of Mental Disorders [DSM]/International Classification of Diseases [ICD] schizophrenia-spectrum) with random-effects models. Efficacy was change in Positive and Negative Syndrome Scale (PANSS) or Brief Psychiatric Rating Scale [BPRS] total score, expressed as standardized mean difference (SMD) versus placebo. Short-term tolerability was defined as adverse event-related outcomes and expressed as risk ratios (RRs) for potentially drug-related treatment-emergent adverse events (TEAEs) versus placebo. Trials without a placebo arm and long-term prospective studies were synthesized narratively. Seventeen acute RCTs were identified; ten were placebo-controlled and entered pooling (agents: olanzapine [OLZ], risperidone [RSP], asenapine [ASP], aripiprazole [APZ], brexpiprazole [BRX], blonanserin [BNS], quetiapine [QTP], lurasidone [LUR], paliperidone [PAL], ziprasidone [ZPD]); seven head-to-head or open-label trials were not pooled. Placebo-referenced efficacy favored several agents: OLZ -1.12 [-1.44 to -0.81], RSP -0.93 [-1.22 to -0.63], BNS -0.50 [-0.89 to -0.11], ASP -0.41 [-0.65 to -0.17], APZ -0.37 [-0.61 to -0.13], BRX -0.34 [-0.61 to -0.07], QTP -0.33 [-0.61 to -0.06], LUR -0.31 [-0.54 to -0.08], PAL -0.25 [-0.57 to -0.07], and ZPD -0.06 [-0.31 to -0.19]. For tolerability, most drugs showed numerically higher TEAE risk versus placebo with wide confidence intervals (typical RR &#x2248; 2-3); APZ showed a statistically higher risk (RR 2.34 [1.42-3.86]), whereas the point estimate for LUR was below 1 (0.47 [0.18-1.17]). One randomized maintenance study and 12 open-label extensions were reviewed narratively and were not meta-analyzed. Several SGAs produce short-term symptom reductions versus placebo in children and adolescents with schizophrenia-spectrum disorders, with heterogeneity in TEAE risk across agents. Evidence for long-term maintenance and continuation remains limited, underscoring the need for adequately powered randomized continuation trials to guide sustained treatment in this population.

Cardiac biomarkers are recognized as potential indicators for brain function, emotion regulation, and psychiatric risk. While research in adults has suggested associations between cardiac variables of autonomic function and neural changes, little is known about these relationships in children and young adults with psychiatric conditions. This systematic review aimed to examine the evidence linking cardiac biomarkers with structural, functional, and connectivity-based brain changes in this population. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Multiple databases were searched for studies examining associations between any cardiac biomarker and neuroimaging findings in individuals under 21 years old with psychiatric diagnoses. After screening and full-text review, 11 eligible studies were included. The included studies investigating a range of psychiatric conditions and cardiac biomarkers were associated with brain changes across three domains: structure, connectivity, and neural responses. Associations were most consistent between higher vagal tone and structural and functional integrity of emotion-regulating regions such as the prefrontal cortex, amygdala, and insula. However, findings were heterogeneous and potentially moderated by symptom severity or environmental stressors. This review supports the potential of cardiac biomarkers, particularly high-frequency heart rate variability and root mean square of the successive differences, as proxies of brain changes in youth with psychiatric disorders. While promising, current evidence is too limited and variable for clinical applications. Future research should prioritize large-scale, longitudinal studies using harmonized protocols and wearable technologies to validate these indices as translational tools in child and adolescent psychiatry.

A variety of rating scales are currently being used to assess symptom severity and quantify symptoms change in attention-deficit/hyperactivity disorder (ADHD) research and clinical practice. This poses difficulties in interpreting scores from different scales in clinical practice and synthesizing data from studies using different scales. We aimed to develop algorithms for converting scores across the ADHD scales most often used in randomized controlled trials (RCTs) of ADHD medications in children/adolescents and adults, and to develop an online tool for implementing the algorithms. We analyzed individual participant data from RCTs of ADHD medications (32 RCTs in children/adolescents, 21 in adults), with data on at least two scales per participant at the same timepoint. We applied a series of competing models, that is, univariable and multivariable regression, random forests, and an equipercentile linkage approach, to link pairs of scales. To assess the error of the linking procedure and identify the optimal model, we calculated the median absolute error and R2 of all approaches by comparing the values predicted from the models to the observed ones. We subsequently developed a tool to implement the best algorithms. We linked six commonly used ADHD scales, such as the ADHD Rating Scale (ADHD-RS-IV; investigator-rated) and the Conners' Parent Rating Scale (CPRS-R:S). Spline models most frequently yielded the lowest prediction error, outperforming alternative conversion algorithms for absolute scores in 6 out of 12 univariable models and 8 out of 12 multivariable models. The tool for scores conversion is available at ADHD_Scale_Conversion_Tool. Our linkage algorithms enable the comparison and harmonization of findings across studies using different ADHD rating scales. Translating scores across scales improves the interpretability of research findings, facilitates future evidence synthesis across studies, and may support clinical practice. Our online tool supports the practical uptake of our results.

The prevalence of opioid use disorder (OUD) among adolescents has increased, yet few adolescents receive medication for OUD (MOUD), particularly buprenorphine. However, initiation can be challenging, as the medication, a high-affinity partial agonist at the mu opioid receptor, can precipitate withdrawal if administered inappropriately. Many adolescents lack access to appropriate levels of supervised care, making it increasingly important for physicians to feel equipped to initiate buprenorphine at home. This is a preliminary feasibility case series for a protocol used in a pediatric addiction clinic for home initiation of buprenorphine in patients 18 and younger. The primary objective is to outline the protocol used, and the secondary objective is to examine the rate of successful initiation. Patients aged 18 years old and younger, who entered treatment for OUD in a child and adolescent outpatient psychiatry clinic between 2022 and 2024 and who chose home buprenorphine initiation were consecutively included. Data from the intake appointment and planned follow-ups at the 1 and 3 month mark were collected. The data collected included characteristics of adolescents who entered treatment and the proportion who successfully initiated buprenorphine. Successful initiation was defined as those who self-reported initiation of buprenorphine at the first follow-up appointment. Out of 19 patients (mean age = 15.7), we found that 10 (53%) adolescents initiated buprenorphine at the first follow-up appointment, 3 (16%) were successful at subsequent follow-up appointments, and 6 (32%) adolescents dropped out of treatment. We also identified several individual and systemic barriers to successful initiation including insurance status, transportation and housing status, and relapse on fentanyl. This early descriptive study finds that a standard protocol for buprenorphine initiation in adolescents implemented by a trained health care professional in an outpatient setting is preliminarily feasible.