VIQ-PIQ Discrepancies are unrelated to mental health indicators in a child psychiatric sample

In a sample of children aged 8-16 years (N = 151) in a child psychiatric setting, the relationship between VIQ-PIQ discrepancies and both Quality of Life (QoL) and psychosocial problems was explored. It was hypothesized that compared to children without a VIQ-PIQ discrepancy children with a discrepancy would have lower QoL and show more psychosocial problems. Using the WISC-III to measure IQ discrepancies, QoL and the severity of psychosocial problems (measured with the Child Behavior Checklist) were found not to differ between the two groups of children. Neither were there any significant correlations between VIQ-PIQ discrepancies and these mental health indicators. Moreover, the proportion of children showing a VIQ-PIQ discrepancy was found not to deviate from the value in the normal population. The conclusion is that in children with psychiatric problems, VIQ-PIQ differences and core mental health indicators are unrelated and that therefore in diagnostic practice psychologists should be hesitant in assuming such a relationship

The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study):a study protocol for a randomized controlled trial

Background: Although clinical guidelines prioritize the treatment of depression and anxiety in young persons, there is accumulating evidence that the presence of symptoms of borderline personality disorder (BPD) is associated with the limited effectiveness of these standard treatments. These findings stress the need for interventions addressing early-stage BPD in young people with presenting symptoms of anxiety and depressive disorders. The aim of this study is to investigate the (cost-)effectiveness of an early intervention programme for BPD (MBT-early) compared to first-choice psychological treatment for depression and anxiety according to Dutch treatment guidelines (CBT), in adolescents with either depression, anxiety, or both, in combination with early-stage BPD. Methods: This study is a multi-centre randomized controlled trial. A total of 132 adolescents, presenting with either depression, anxiety, or both and significant BPD features will be randomized to either MBT-early or CBT. The severity of BPD, symptoms of depression and anxiety, personality, social and academic functioning, and quality of life will be assessed at baseline, end of treatment, and at 12-, 18-, and 24-month follow-up, along with medical costs and costs of productivity losses for cost-effectiveness analyses.Discussion: This study will provide an empirical evaluation of the potential surplus value of early intervention in young people for whom treatment oriented at common mental disorders like anxiety and depression may be insufficient given their underlying personality problems. Trial registration: Netherlands Trial registration: Netherlands trial register, NL9569. Registered on June 15, 2021<br/

Towards precision dosing of aripiprazole in children and adolescents with autism spectrum disorder:Linking blood levels to weight gain and effectiveness

Aims: Aripiprazole is one of the most commonly prescribed antipsychotic drugs to children and adolescents worldwide, but it is associated with serious side-effects, including weight gain. This study assessed the population pharmacokinetics of aripiprazole and its active metabolite and investigated the relationship between pharmacokinetic parameters and body mass index (BMI) in children and adolescents with autism spectrum disorder (ASD) and behavioural problems. Secondary outcomes were metabolic, endocrine, extrapyramidal and cardiac side-effects and drug effectiveness. Methods: Twenty-four children and adolescents (15 males, 9 females) aged 6–18 years were included in a 24-week prospective observational trial. Drug plasma concentrations, side-effects and drug effectiveness were measured at several time points during follow-up. Relevant pharmacokinetic covariates, including CYP2D6, CYP3A4, CYP3A5 and P-glycoprotein (ABCB1) genotypes, were determined. Nonlinear mixed-effects modelling (NONMEM®) was used for a population pharmacokinetic analysis with 92 aripiprazole and 91 dehydro-aripiprazole concentrations. Subsequently, model-based trough concentrations, maximum concentrations and 24-h area under the curves (AUCs) were analysed to predict outcomes using generalized and linear mixed-effects models. Results: For both aripiprazole and dehydro-aripiprazole, one-compartment models best described the measured concentrations, with albumin and BMI as significant covariates. Of all the pharmacokinetic parameters, higher sum (aripiprazole plus dehydro-aripiprazole) trough concentrations best predicted higher BMI z-scores (P &lt;.001) and higher Hb1Ac levels (P =.03) during follow-up. No significant association was found between sum concentrations and effectiveness. Conclusions: Our results indicate a threshold with regard to safety, which suggests that therapeutic drug monitoring of aripiprazole could potentially increase safety in children and adolescents with ASD and behavioural problems.</p

Risperidone plasma concentrations are associated with side effects and effectiveness in children and adolescents with autism spectrum disorder

Aim: Risperidone is the most commonly prescribed antipsychotic drug to children and adolescents worldwide, but it is associated with serious side effects, including weight gain. This study assessed the relationship of risperidone and 9-hydroxyrisperidone trough concentrations, maximum concentrations and 24-hour area under the curves (AUCs) with body mass index (BMI) z-scores in children and adolescents with autism spectrum disorder (ASD) and behavioural problems. Secondary outcomes were metabolic, endocrine, extrapyramidal and cardiac side effects and effectiveness. Methods: Forty-two children and adolescents (32 males) aged 6-18 years were included in a 24-week prospective observational trial. Drug plasma concentrations, side effects and effectiveness were measured at several time points during follow-up. Relevant pharmacokinetic covariates, including medication adherence and CYP2D6, CYP3A4, CYP3A5 and P-glycoprotein (ABCB1) genotypes, were measured. Nonlinear mixed-effects modelling (NONMEM®) was used for a population pharmacokinetic analysis with 205 risperidone and 205 9-hydroxyrisperidone concentrations. Subsequently, model-based trough concentrations, maximum concentrations and 24-hour AUCs were analysed to predict outcomes using generalized and linear mixed-effects models. Results: A risperidone two-compartment model combined with a 9-hydroxyrisperidone one-compartment model best described the measured concentrations. Of all the pharmacokinetic parameters, higher risperidone sum trough concentrations best predicted higher BMI z-scores during follow-up (P <.001). Higher sum trough concentrations also predicted more sedation (P <.05), higher prolactin levels (P <.001) and more effectiveness measured with Aberrant Behavior Checklist irritability score (P <.01). Conclusion: Our results indicate a therapeutic window exists, which suggests that therapeutic drug monitoring of risperidone might increase safety and effectiveness in children and adolescents with ASD and behavioural problems

Enduring Effects of Neurofeedback in Children

This chapter demonstrates the benefits of neurofeedback as a treatment for children with developmental disorders. Neurofeedback has shown efficacy for a wide variety of developmental disorders such as autism, attention deficit hyperactivity disorder (ADHD), epilepsy, and dyslexia. Preliminary research suggests that neurofeedback is an effective therapy for reducing core symptoms in children with both autism and ADHD. Neuro- feedback is a therapy that teaches clients to regulate their brain activity to work in a new, more efficient way through the use of underlying operant conditioning paradigms. This treatment involves providing a subject with visual and/or auditory "feedback" for particular neural behaviors. Through conditioning, the subject is taught to inhibit EEG frequencies that are excessively generated and augment frequencies that are deficient. With continuous training and coaching, individuals are taught to maintain brainwave patterns concurrent with healthy neural functioning

VIQ-PIQ Discrepancies are Unrelated to Mental Health Indicators in a Child Psychiatric Sample

In a sample of children aged 8-16 years (N = 151) in a child psychiatric setting, the relationship between VIQ-PIQ discrepancies and both Quality of Life (QoL) and psychosocial problems was explored. It was hypothesized that compared to children without a VIQ-PIQ discrepancy children with a discrepancy would have lower QoL and show more psychosocial problems. Using the WISC-III to measure IQ discrepancies, QoL and the severity of psychosocial problems (measured with the Child Behavior Checklist) were found not to differ between the two groups of children. Neither were there any significant correlations between VIQ-PIQ discrepancies and these mental health indicators. Moreover, the proportion of children showing a VIQ-PIQ discrepancy was found not to deviate from the value in the normal population. The conclusion is that in children with psychiatric problems, VIQ-PIQ differences and core mental health indicators are unrelated and that therefore in diagnostic practice psychologists should be hesitant in assuming such a relationship

Risk factors and pattern of weight gain in youths using antipsychotic drugs

Antipsychotic-induced weight gain is a major health concern in children and adolescents. The aim of this study was to identify risk factors for weight gain during short-, middle- and long-term treatment with antipsychotic drugs in this young population. We analysed a combined prospective and a retrospective observational cohort of Dutch children and adolescents, starting with risperidone, aripiprazole or pipamperone treatment. Linear mixed models were used to test whether sex, age, baseline body-mass-index (BMI) z score, type of antipsychotic, dose equivalent/kg, duration of use, previous antipsychotic use, ethnicity, physical exercise, IQ, concomitant medication, and psychiatric classification predicted the BMI z score for a follow-up of 52 weeks. A total of 144 patients were included with a median [interquartile range ([IQR)] age of 9 (4) years and median follow-up of 30 (73) weeks. During the complete follow-up, the median (IQR) weight gain was 0.37 (0.95) BMI z score points. Antipsychotic-induced weight gain was found to be most pronounced during the first 15 weeks of use (BMI z score increase per week β = 0.02, 95% CI 0.01–0.03, p = 0.002). A higher baseline BMI z score and the absence of stimulant use were associated with a higher BMI z score during the entire follow-up and after 15 weeks, respectively. Previous treatment with an antipsychotic drug was associated with less weight gain during the first 15 weeks of treatment. Our findings underscore the importance of close patient monitoring during the first weeks of antipsychotic treatment with a focus on patients with a high baseline BMI z score