Congenital malformations with psychopharmacologic agents

Psychopharmacological agents are frequently used and often for a long time because of the chronicity of mental illness. Ayd reports that about 250 million people have taken these drugs.³ This number probably includes a considerable number of pregnant women. The safety of psychotropic drugs for the fetus has not been established with certainty, even though none except thalidomide is incriminated. The conclusive evidence can only be obtained by monitoring of fetal effects. In this paper, the fetal effects, particularly teratogenesis, of the psychopharmacologic agents are reviewed.     

Changes in autonomic regulation with age: implications for psychopharmacologic treatments in children and adolescents

Developmental changes in the cardiovascular system could have an impact on risks associated with psychopharmacological interventions. Children may be more vulnerable to adverse cardiac events due to immaturity in autonomic control of the heart. These changes are incompletely understood and are characterized in this study. A consecutive series of 70 boys, aged 6-14 years, was recruited. Developmental variation in the autonomic nervous system was evaluated by assessing heart period variability (HPV), pulse, and blood pressure in response to orthostasis. Increased age correlated significantly with greater heart rate and diastolic blood pressure response to orthostasis. HPV at rest and in response to tilt did not significantly correlate with age. Boys with family histories of hypertension had a significantly greater blood pressure response to orthostasis. These findings suggest that developmental age-related changes in the sympathetic nervous system, as reflected by changes of pulse and blood pressure response to tilt, occur across this age range. Parasympathetic changes, as reflected by HPV, do not. In light of these findings, more research is needed on children's and adolescents' relative cardiac risk with psychotropic medications as opposed to adults'.     

The effectiveness of generic agents in psychopharmacologic treatment

In order to win FDA approval, generic drugs must demonstrate bioequivalence, namely the ability to achieve blood levels similar to those of the innovator ones on which they are based. They must have the same active ingredients, be identical in strength, dosage form, and route of administration, and be manufactured under strict FDA standards. Because basic efficacy and safety studies are not required, their cost is significantly lower. However, there can be important differences between the innovator drugs and generics, as well as among the generics themselves. More research needs to be done to establish true comparability.     

The effect of atypical antipsychotic agents on prolactin levels in children and adolescents

This report is a review of the available literature on the effect of atypical antipsychotic agents on prolactin in children and adolescents. Fourteen reports are reviewed. Most reports (79%) have included adolescents. Three reports (21%) consisted of children only, while 7 reports (50%) included only adolescents. A total of 4 reports (29%) included both children and adolescents. The total number of subjects listed in all the reports is 276, while only 49 of the individuals on atypical neuroleptics had prolactin elevations clearly identified as outside of the normal range. The details of the reports are provided by individual atypical antipsychotic agent. Clinical implications, such as the potential impact of hyperprolactinemia on bone density, osteoporosis, gynecomastia, galactorrhea, and weight gain, are presented. Discussion of pertinent medical differential and treatment options are also reported.     

Psychological symptoms in patients with hearing and equilibrium disorders and possibilities of treatment with psychopharmacologic agents

The aim of the investigation was to find out in a group of 130 hospitalized men and women, suffering from impaired hearing and equilibrium, the prevalence of psychic symptoms and psychopathological syndromes and symptoms suitable for psychopharmacological intervention. The method of interview and questionnaire SCL-90 was used which makes it possible to extract from quantifiable answers to 90 questions 10 symptoms constructions (dimensions) which roughly correspond with psychopathological syndromes. Psychopathological syndromes which are associated with the basic disease and are suitable for psychopharmacological intervention are in both sexes the following: somatization, depression, anxiety, phobic anxiety, impaired sleep and appetite. The assessed symptoms corresponding to a varying extent to the items of the questionnaire in both sexes are within the mentioned dimensions. In the subsequent stage the authors differentiate psychopathological syndromes and symptoms in acute and chronic ENT disease of the investigated groups. The authors maintain that psychopharmacological drugs influence in a favourable way not only the present mental symptoms in the framework of secondary psychopathology but also the psychosomatic component of the basic disease and thus have a favourable effect on its course. The author recommend some antidepressants, anxiolytics and neuroleptics to be used in small doses.     

A prospective study of hyperprolactinemia in children and adolescents treated with atypical antipsychotic agents

OBJECTIVE: Few studies have prospectively compared the change of prolactin levels in children and adolescents associated with the use of atypical antipsychotic agents. In our study, we present preliminary data of an ongoing study, which compares changes in prolactin levels in children and adolescents after treatment to risperidone versus olanzapine versus quetiapine. We hypothesized: (1) risperidone would be associated with hyperprolactinemia most frequently, and (2) postpubertal females may be at higher risk of prolactin elevation and associated adverse effects. METHODS: Prolactin levels were obtained at baseline and after a mean of 11.2 weeks (SD = 2.2; range, 4-15 weeks) from 40 subjects (mean age, 13.4 years; SD = 3.4; range, 5-18 years) who were started on risperidone (n = 21), olanzapine (n = 13), or quetiapine (n = 6). End-point prolactin levels were compared using a Kruskal-Wallis test. RESULTS: End-point prolactin levels were significantly higher with risperidone, compared to olanzapine (p = 0.027) or quetiapine (p = 0.008). With the Bonferroni correction, the latter remains significant. Twenty-five percent of our subjects experienced sexual side effects at end point, independent of prolactin levels and antipsychotic agents. CONCLUSION: Risperidone significantly increased prolactin levels in children and adolescents. The duration of this prolactin elevation, and its long-term effects in children and adolescents, are unknown.     

Off-label psychopharmacologic prescribing for children: History supports close clinical monitoring

The review presents pediatric adverse drug events from a historical perspective and focuses on selected safety issues associated with off-label use of medications for the psychiatric treatment of youth. Clinical monitoring procedures for major psychotropic drug classes are reviewed. Prior studies suggest that systematic treatment monitoring is warranted so as to both minimize risk of unexpected adverse events and exposures to ineffective treatments. Clinical trials to establish the efficacy and safety of drugs currently being used off-label in the pediatric population are needed. In the meantime, clinicians should consider the existing evidence-base for these drugs and institute close clinical monitoring.     

Serotonergic agents in the treatment of social phobia in children and adolescents: a case series.

Serotonergic agents have become the treatment of choice for adult patients with social phobia. However, there are few reports of the use of these agents in the treatment of children and adolescents with this disorder. The pharmacological treatment of social anxiety in children and adolescents is briefly reviewed, and a consecutive series of child and adolescent patients who were treated with a variety of serotonin acting agents is described. Seven patients, aged 7 to 18 years, with a Primary DSM-IV diagnosis of generalized social phobia were treated with paroxetine, sertraline, or nefazodone for up to 7 months. Response to treatment was evaluated by retrospective chart review by the treating clinicians. All of the patients appeared to have a very positive clinical response to the serotonergic agents. No adverse events were reported and side effects were well tolerated. Results suggest that serotonergic agents may be an effective and safe treatment for children and adolescents with social phobia.     

Hallucinations in children and adolescents

Clinicians need to consider a wide range of differential diagnoses when children and adolescents present with hallucinations. This includes considering whether it is a developmentally normal phenomenon or if there is a psychiatric, medical, or neurologic diagnosis. Nonpsychotic children with hallucinations can be differentiated from psychotic children. Nonpsychotic children who are at risk (or prodromal) for future psychosis can be differentiated from nonprodromal healthier children. We examine the epidemiology, prognosis, and neurobiological research. Lastly, we discuss treatment approaches, including medication and cognitive behavioral therapy.     

Depression in children and adolescents

Depression is a common problem in children and adolescents. The disorder may be overlooked because of the prominent irritability seen in children with depression and because of the perception that moodiness is a normal phase of childhood. Depression frequently is associated with other psychiatric problems and neurologic disorders. Therapy consists of psychotherapy and medication, with SSRIs the first choice for pharmacotherapy.     

Telemedicine in children and adolescents

Psychiatric care for children and adolescents is limited in remote and underserved areas because of the shortage of child and adolescent psychiatrists. Telepsychiatry has the potential to alleviate this problem. This article reviews the procedures used to develop telepsychiatry, equipment needed for videoconferencing in telepsychiatry, benefits and limitations of telepsychiatry, and confidentiality issues in telepsychiatry. Many questions regarding confidentiality, legality, reimbursement, cost-effectiveness, and technology still need to be resolved. However, telepsychiatry has the potential to be a useful treatment alternative.     

Antipsychotics in children and adolescents

OBJECTIVES: To present a critical overview of the available evidence for the efficacy and safety of antipsychotic agents in children and adolescents and to identify knowledge gaps and needs for further research. Data from adults that are relevant to children are discussed. METHOD: Mainly reports of double-blind, placebo-controlled studies were reviewed. RESULTS: In children and adolescents, antipsychotics are used to treat psychotic and a variety of nonpsychotic conditions. The amount of data based on well-designed, double-blind, placebo-controlled studies with satisfactory sample sizes in diagnostically homogeneous subjects is modest. CONCLUSIONS: Currently available standard antipsychotics have a definite role in the treatment of children and adolescents. The use of these agents is limited mainly by tardive and withdrawal dyskinesias and, in some patients, by excessive sedation. The atypical antipsychotics should be critically assessed and compared with psychosocial interventions; if effective, the combination of both types of treatments should be evaluated.