161 research outputs found
Starting ADHD medications during the Covid-19 pandemic. Recommendations from the European ADHD Guidelines Group (EAGG)
No full text
Putative mechanisms of action and clinical use of lithium in children and adolescents : A critical review
No full textBACKGROUND:
Lithium is a first-line treatment for bipolar disorder in adults, but its mechanism of action is still far from clear. Furthermore, evidences of its use in pediatric populations are sparse, not only for bipolar disorders, but also for other possible indications.
OBJECTIVES:
To provide a synthesis of published data on the possible mechanisms of action of lithium, as well as on its use in pediatric samples, including pharmacokinetics, efficacy, and safety data.
METHODS:
Clinical trials in pediatric samples with at least one standardized measure of efficacy/effectiveness were included in this review. We considered: i) randomized and open label trials, ii) combination studies iii) augmentation studies iv) case series including at least 5 patients.
RESULTS:
Different and non-alternative mechanisms of action can explain the clinical efficacy of lithium. Clinical studies in pediatric samples suggest that lithium is effective in managing manic symptoms/episodes of bipolar disorder, both in the acute phase and as maintenance strategy. Efficacy on depressive symptoms/phases of bipolar disorder is much less clear, while studies do not support its use in unipolar depression and severe mood dysregulation. Conversely, it may be effective on aggression in the context of conduct disorder. Other possible indications, with limited published evidence, are the acute attacks in Kleine-Levin syndrome, behavioral symptoms of X-fragile syndrome, and the management of clozapine- or chemotherapy- induced neutropenia. Generally, lithium resulted relatively safe.
CONCLUSIONS:
Lithium seems an effective and well-tolerated medication on pediatric bipolar disorder and aggression, while further evidences are needed for other clinical indications.
Behavioural aspects of Gaucher's disease – An explorative study
No full textMolecular Genetics and Metabolism Volume 102, Issue 2, February 2011, Pages S28–S29 Cover image Behavioural aspects of Gaucher's disease – An explorative study Lauren McPartlana, Ruksana Ahmeda, Ashok Vellodia, b, Paramala Santosha a Great Ormond Street Hospital, London, Greater London, U.K. b Institute of Child Health, U.K. Available online 15 January 2011 Show less http://dx.doi.org/10.1016/j.ymgme.2010.11.096 Get rights and content Introduction: The management of Gaucher Disease has been revolutionized by enzyme replacement therapy. Consequently, life expectancy has increased. As a result, other features of GD are being ‘uncovered’ and attention is now turning to the neurobehavioural problems. This study aimed to assess the behavioural symptoms displayed by children with GD3. Description/cases/results: The study was a postal and internet-based survey of a group of 7 children with GD3. The subjects were recruited from the Metabolic Clinic at Great Ormond Street Hospital. The parents of the participants completed the Profile of Neuropsychiatric Symptoms questionnaire (PONS) and the parental stress index (PSI).The GD3 patients PONS data showed that compared to the general child population, 71.4% of the patients had difficulties with learning and clumsiness, 42.9% had difficulties arising from sensory symptoms, low mood, manic episodes and oppositional and defiant behaviour and 28.6% had difficulties due to hyperactivity, impulsivity, aggression, poor language, circumscribed interests, self-injury, poor empathy, obsessions & compulsions, depressive thoughts, worries, fears and poor memory.The PSI highlighted that 50% of GD3 parent's show levels of distress that warrant professional attention. Conclusion/Discussion: These preliminary findings indicate that patients with GD3 do present with behavioural and emotional difficulties. The clinical implications for social functioning, and, crucially, for education, are profound. Larger cohorts need to be studied both in order to corroborate these findings as well as to develop a more detailed behavioural phenotype of GD subtypes. Through a more comprehensive understanding of patients’ psychosocial and psychopharmacological needs, appropriate interventions can be designed
Affective disorders : current status and controversies
No full textAffective disorders are common during childhood and adolescence and often pose a challenge in clinical settings. The clinical presentation of affective disorders varies with the developmental age of the child and the classical symptoms increase with age and severity. From a developmental perspective, the disruptive mood dysregulation disorder as a new diagnostic category in DSM 5 addresses this concern as well as the unparalleled increase in pediatric bipolar diagnoses. Use of developmentally appropriate assessments has helped address some of the controversies centred around diagnosis of depression in the young. However, there is sparse evidence of effectiveness of pharmacological and psychological means of treatment and controversies continues to exist regarding effective management of affective disorders in children and adolescents in bringing about a more favourable outcome. This chapter focuses on the current status and particularly controversies related to diagnosis of preschool depression, disruptive mood dysregulation disorder, pediatric bipolar and the differences in pattern of comorbidities across western and Indian literature; current insights into the course and outcome of affective disorders and controversies regarding management of affective disorders
The efficacy of real versus sham external Trigeminal Nerve Stimulation (eTNS) in youth with Attention-Deficit/Hyperactivity Disorder (ADHD) over 4 weeks: a protocol for a multi-centre, double-blind, randomized, parallel-group, phase IIb study (ATTENS)
No full textBackground: attention Deficit/Hyperactivity Disorder (ADHD), if severe, is usually treated with stimulant or non-stimulant medication. However, users prefer non-drug treatments due to side effects. Alternative non-medication treatments have so far only shown modest effects. External trigeminal nerve stimulation (eTNS) is a minimal risk, non-invasive neuromodulation device, targeting the trigeminal system. It was approved for ADHD in 2019 by the USA Food and Drug administration (FDA) based on a small proof of concept randomised controlled trial (RCT) in 62 children with ADHD showing improvement of ADHD symptoms after 4 weeks of nightly real versus sham eTNS with minimal side effects. We present here the protocol of a larger confirmatory phase IIb study testing efficacy, longer-term persistency of effects and underlying mechanisms of action.Methods: a confirmatory, sham-controlled, double-blind, parallel-arm, multi-centre phase IIb RCT of 4 weeks of eTNS in 150 youth with ADHD, recruited in London, Portsmouth, and Southampton, UK. Youth with ADHD will be randomized to either real or sham eTNS, applied nightly for 4 weeks. Primary outcome is the change in the investigator-administered parent rated ADHD rating scale. Secondary outcomes are other clinical and cognitive measures, objective hyperactivity and pupillometry measures, side effects, and maintenance of effects over 6 months. The mechanisms of action will be tested in a subgroup of 56 participants using magnetic resonance imaging (MRI) before and after the 4-week treatment.Discussion: this multi-centre phase IIb RCT will confirm whether eTNS is effective in a larger age range of children and adolescents with ADHD, whether it improves cognition and other clinical measures, whether efficacy persists at 6 months and it will test underlying brain mechanisms. The results will establish whether eTNS is effective and safe as a novel non-pharmacological treatment for ADHD.Trial registration: ISRCTN82129325 on 02/08/2021, https://doi.org/10.1186/ISRCTN82129325
Putative mechanisms of action and clinical use of lithium in children and adolescents: a critical review
No full textLithium is a first-line treatment for bipolar disorder in adults, but its mechanism of action is still far from clear. Furthermore, evidences of its use in pediatric populations are sparse, not only for bipolar disorders, but also for other possible indications
Key issues in Rett syndrome: emotional, behavioural and autonomic dysregulation (EBAD) - a target for clinical trials
Get PDFAbstract Complex neurodevelopmental disorders need multi-disciplinary treatment approaches for optimal care. The clinical effectiveness of treatments is limited in patients with rare genetic syndromes with multisystem morbidity. Emotional and behavioural dysregulation is common across many neurodevelopmental disorders. It can manifest in children across multiple diagnostic groups, including those on the autism spectrum and in rare genetic syndromes such as Rett Syndrome (RTT). There is, however a remarkable scarcity in the literature on the impact of the autonomic component on emotional and behavioural regulation in these disorders, and on the longer-term outcomes on disorder burden. RTT is a debilitating and often life-threatening disorder involving multiple overlapping physiological systems. Autonomic dysregulation otherwise known as dysautonomia is a cardinal feature of RTT characterised by an imbalance between the sympathetic and parasympathetic arms of the autonomic nervous system. Unlocking the autonomic component of emotional and behavioural dysregulation would be central in reducing the impairment seen in patients with RTT. In this vein, Emotional, Behavioural and Autonomic Dysregulation (EBAD) would be a useful construct to target for treatment which could mitigate burden and improve the quality of life of patients. RTT can be considered as a congenital dysautonomia and because EBAD can give rise to impairments occurring in multiple overlapping physiological systems, understanding these physiological responses arising out of EBAD would be a critical part to consider when planning treatment strategies and improving clinical outcomes in these patients. Biometric guided pharmacological and bio-feedback therapy for the behavioural and emotional aspects of the disorder offers an attracting perspective to manage EBAD in these patients. This can also allow for the stratification of patients into clinical trials and could ultimately help streamline the patient care pathway for optimal outcomes. The objectives of this review are to emphasise the key issues relating to the management of EBAD in patients with RTT, appraise clinical trials done in RTT from the perspective of autonomic physiology and to discuss the potential of EBAD as a target for clinical trials
The interface between child/adolescent and adult mental health services:results from a European 28-country survey
No full textTransition-related discontinuity of care is a major socioeconomic and societal challenge for the EU. The current service configuration, with distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS), is considered a weak link where the care pathway needs to be most robust. Our aim was to delineate transitional policies and care across Europe and to highlight current gaps in care provision at the service interface. An online mapping survey was conducted across all 28 European Countries using a bespoke instrument: The Standardized Assessment Tool for Mental Health Transition (SATMEHT). The survey was directed at expert(s) in each of the 28 EU countries. The response rate was 100%. Country experts commonly (12/28) reported that between 25 and 49% of CAMHS service users will need transitioning to AMHS. Estimates of the percentage of AMHS users aged under 30 years who had has previous contact with CAMHS were most commonly in the region 20–30% (33% on average).Written policies for managing the interface were available in only four countries and half (14/28) indicated that no transition support services were available. This is the first survey of CAMHS transitional policies and care carried out at a European level. Policymaking on transitional care clearly needs special attention and further elaboration. The Milestone Study on transition should provide much needed data on transition processes and outcomes that could form the basis for improving policy and practice in transitional care.</p
Molecular Insights into Neurological Regression with a Focus on Rett Syndrome—A Narrative Review
No full textRett syndrome (RTT) is a multisystem neurological disorder. Pathogenic changes in the MECP2 gene that codes for methyl-CpG-binding protein 2 (MeCP2) in RTT lead to a loss of previously established motor and cognitive skills. Unravelling the mechanisms of neurological regression in RTT is complex, due to multiple components of the neural epigenome being affected. Most evidence has primarily focused on deciphering the complexity of transcriptional machinery at the molecular level. Little attention has been paid to how epigenetic changes across the neural epigenome in RTT lead to neurological regression. In this narrative review, we examine how pathogenic changes in MECP2 can disrupt the balance of the RTT neural epigenome and lead to neurological regression. Environmental and genetic factors can disturb the balance of the neural epigenome in RTT, modifying the onset of neurological regression. Methylation changes across the RTT neural epigenome and the consequent genotoxic stress cause neurons to regress into a senescent state. These changes influence the brain as it matures and lead to the emergence of specific symptoms at different developmental periods. Future work could focus on epidrugs or epi-editing approaches that may theoretically help to restore the epigenetic imbalance and thereby minimise the impact of genotoxic stress on the RTT neural epigenome
- …
