Clinical utility of pharmacogenetic testing in children and adolescents with severe mental disorders

This is a retrospective cohort study of 20 children and adolescents to evaluate the clinical utility of a pharmacogenetic decision support tool. Twenty children and adolescents underwent pharmacogenetic testing between June 2014 and May 2017. All children and adolescents were evaluated at Puerta de Hierro University Hospital-Majadahonda (Madrid, Spain). We report the proportion of patients achieving clinical improvement, amelioration of side effects, and changes in number of drugs. Data normality was assessed with the Shapiro–Wilk test, and changes of pre- and post-pharmacogenetic testing were analyzed with the Wilcoxon test for paired samples. A two-sided p value threshold of 0.05 was considered for significance. Pharmacogenetic testing helped to improve the clinical outcome as measured by the Clinical Global Impressions (CGI) Scale in virtually all children (95%; 19 out of 20 children). The CGI improvement (CGI-I) was 2 (0.79) (range 1–4), 2.1 (0.56) (range 1–3), and 1.9 (0.99) (range 1–4) in foster and non-foster care children, respectively. Pharmacogenetic testing also helped to reduce the number of children using polypharmacy (from 65 to 45%), the mean number of drugs per children (from 3.3 to 2.4 drugs, p = 0.017), and self-reported relevant side effects (p = 0.006). Pharmacogenetic testing helped to improve the clinical outcome, and to reduce polypharmacy and the number of drugs used in children and adolescents with severe mental disorders. More evidence using robust (i.e., clinical trials) independent studies is required to properly determine the clinical utility and cost-effectiveness of pharmacogenetic testing tools in children and adolescents with mental disorders

Lack of educational impact of video game addiction in children and adolescents diagnosed with ADHD: A cross-sectional study

IntroductionThe use of video games has become widespread worldwide. Excessive use of video games is increasingly becoming a matter of concern, particularly in patients diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Currently, internet gaming disorder (IGD) is not included within the DSM-5-chapter Disorders related to substances and addictive disorders.MethodsThis is a post-hoc descriptive naturalistic study comparing children and adolescents diagnosed with ADHD with and without IGD. We used the 85% cut-off point of the test ADITEC-V for video game addiction to split our sample of ADHD patients into those with IGD (>=85%) and those without IGD (<85%).Results13 (25%) out of the 51 children and adolescents with ADHD included in our study had an IGD. Patients with IGD had a first contact with internet, smartphones, and videogames at a very early age (5.67 ± 3.31, 6.33 ± 4.60, and 7.50 ± 2.61, respectively). However, only age at first contact with the internet was statistically significantly different when comparing ADHD patients with and without IGD (8.68 ± 2.71 vs. 5.67 ± 3.31, t = 3.166, df = 47, p = 0.01). Different neurodevelopmental, clinical, and neuropsychological measures converging in impulsivity is a risk factor for IGD. Unexpectedly, we found no association between IGD and poor academic achievement.DiscussionFuture studies may include randomized controlled trials for treating IGD, the study of social adjustment as a protective factor against developing an IGD, and the role of serious and non-serious video games in the development of an IGD, among others. Additional research is clearly needed on IGD

Lower Gastrointestinal Bleeding and Paroxetine Use: Two Case Reports

Paroxetine is a selective serotonin reuptake inhibitor (SSRI), and an effective long-term treatment for social anxiety and major depression. SSRIs in general, and paroxetine in particular, were described as associated with depletion of serotonin in platelets. Serotonin is involved in platelet aggregation, and the association of bleeding and SSRI use was suggested two decades ago. In the last few years, some reviews have confirmed that initial fear. In contrast with aspirin, SSRIs seem to be related to non-ulcer, non-variceal gastrointestinal bleeds. SSRIs are usually associated with upper gastrointestinal bleeding but there is surprisingly little literature on lower gastrointestinal bleeding (LGIB) associated with SSRI use. The annual incidence of LGIB is approximately 20–30 cases per 100,000 inhabitants in Western countries; the incidence increases with age. We present two young males with no medical problems besides their psychiatric diagnoses presenting with LGIB after paroxetine use

Predicting Suicidal Behavior: Are We Really that Far Along? Comment on “Discovery and Validation of Blood Biomarkers for Suicidality”

A recent publication focused on biomarkers of future suicidal behaviors identifies several genes expressed in high-risk states among four samples. We discuss the implications of this study as well as the current state of research regarding biomarkers of suicidal behavior

Are we studying the right populations to understand suicide?

International audienc

Horror Vacui: Emptiness Might Distinguish between Major Suicide Repeaters and Nonmajor Suicide Repeaters: A Pilot Study

This Letter to the Editor is brought to you for free and open access by the Psychiatry at UKnowledge. It has been accepted for inclusion in Psychiatr

The addictive model of self-harming (non-suicidal and suicidal) behavior

Introduction: Behavioral addictions such as gambling, sun-tanning, shopping, Internet use, work, exercise, or even love and sex are frequent, and share many characteristics and common neurobiological and genetic underpinnings with substance addictions (i.e., tolerance, withdrawal, and relapse). Recent literature suggests that both non-suicidal self-injury (NSSI) and suicidal behavior (SB) can also be conceptualized as addictions. The major aim of this mini review is to review the literature and explore the neurobiological and psychological mechanisms underlying the addiction to self-harming behaviors. Method: This is a narrative review. The authors performed literature searches in PubMed and Google for suicidal behavior, self-harming, addiction, and "major repeaters." Given the scarce literature on the topic, a subset of the most closely related studies was selected. The authors also focused on three empirical studies testing the hypothesis that major repeaters (individuals with ≥5 lifetime suicide attempts) represent a distinctive suicidal phenotype and are the individuals at risk of developing an addiction to SB. Results: The authors reviewed the concept of behavioral addictions and major repeaters, current empirical evidence testing concerning whether or not NSSI and SB can be understood as "addictions," and the putative mechanisms underlying them. Conclusion: Our review suggests that both NSSI and SB can be conceptualized as addictions. This is relevant because if some individual's self-harming behaviors are better conceptualized as an addiction, treatment approaches could be tailored to this addiction

Coprophagia in a patient with borderline personality disorder

Background and Objectives: Human coprophagia is a rare phenomenon with severe medical and social consequences. So far, coprophagia has mainly been associated with severe mental retardation, schizophrenia, dementia, and depression. We report a case of coprophagia in a 30-year-old woman with Borderline Personality Disorder (DSM-IV). This case report illustrates the severity of symptoms and maladaptive social consequences of severe personality disorders, comparable to those of patients with schizophrenia. Pharmacological interventions and, particularly intensive psychotherapy might be effective for patients diagnosed with borderline personality disorder displaying severe behavior disorders. The treatment of choice for coprophagia is aversive behavioral interventionThis study was funded in part by the National Alliance for Research on Schizophrenia and Affective Disorders (NARSAD), Fondo de Investigación Sanitaria (FIS) [grant number PI060092]; Fondo de Investigación Sanitaria FIS [grant number RD06/0011/0016]; ETES [grant number PI07/90207]; the Conchita Rabago Foundation, the Harriet and Esteban Vicente Foundation, the Spanish Ministry of Health, Instituto de Salud Carlos III, CIBERSAM (Intramural Project, P91B; Rio Hortega CM08/00170 –Dr. Hilario Blasco-Fontecilla), the Alicia Koplowitz foundation, and the National Institutes of Health, USA [grant number K24MH072712

Can the Holmes-Rahe Social Readjustment Rating Scale (SRRS) Be Used as a Suicide Risk Scale? An Exploratory Study

The objective of this research was to examine whether the Holmes-Rahe Social Readjustment Rating Scale, a life event scale, can be used to identify suicide attempters. The Holmes-Rahe Social Readjustment Rating Scale\u27s ability to identify suicide attempters was tested in 1183 subjects (478 suicide attempters, 197 psychiatric inpatients, and 508 healthy controls) using the Fisher Linear Discriminant Analysis and traditional psychometric methods. The Fisher Linear Discriminant Analysis outperformed traditional psychometric approaches (area under the curve: 0.85 vs. 0.78; p \u3c 0.05) and indicated that this scale may be used to identify suicide attempters. The life events that better characterized suicide attempters were change in frequency of arguments, marital separation, and personal injury. The Holmes-Rahe Social Readjustment Rating Scale may help identify suicide attempters