INSTITUTE 1

ADVANCES IN TREATMENT: IMPLICATIONS FOR CLINICAL PRACTICE

Karen Dineen Wagner, M.D., Ph.D., University of Texas Medical Branch at Galveston, Dept. of Psych. & Behavioral Sciences, 301 University Blvd., Galveston, TX, 77555-0188

Objectives: There is increased attention to the use of psychotropic medication for the treatment of children and adolescents. This institute will present the latest finding about efficacy and safety of medications for the treatment of BD, MDD, AD, ADHD, ASD, schizophrenia and SUD. Medico-legal issues related to the use of psychotropic medications for children and adolescents will be discussed.  

Methods: Findings from treatment studies are reviewed. Medico-legal issues related to psychotropic medications are discussed.  

Results: N/A

Conclusions: New findings from treatment studies inform clinical practice for attendees.

1.1 ADVANCES AND CHALLENGES IN THE TREATMENT OF DEPRESSION IN CHILDREN AND ADOLESCENTS

Karen Dineen Wagner, M.D., Ph.D., University of Texas Medical Branch at Galveston, Dept. of Psych. & Behavioral Sciences, 301 University Blvd., Galveston, TX, 77555-0188

Objectives: To discuss the evidence base for the treatment of MDD in children and adolescents.

Methods: Data available from controlled antidepressant treatment studies for children and adolescents with MDD including the Treatment of Adolescent Depression Study (TADS) and the Treatment of Selective Serotonin Reuptake Inhibitor-Resistant Depression in Adolescents (TORDIA) study will be reviewed. Clinical applications based on study findings will be discussed.

Results: Response rates to initial antidepressants are approximately 50-60% and about 50% of children and adolescents who fail to respond to an initial antidepressant will respond to an alternative antidepressant. CBT in combination with medication treatment increases response rates and decreases relapse rates. Limited, controlled data are available regarding combination medication strategies in children and adolescents.  

Conclusions: The evidence base regarding monotherapy treatment for children and adolescents with MDD has increased, but the evidence base for combination pharmacotherapy remains extremely limited, despite it’s common use in clinical practice. Other treatments for depression in children and adolescents are needed.

1.5 PHARMACOTHERAPY FOR YOUTH WITH BIPOLAR DISORDER

Kiki D. Chang, M.D., Psychiatry, Stanford University School of Medicine, 862 Clark Way, Palo Alto, CA, 94304

Objectives: To review the current state of pharmacotherapy in children and adolescents with BD (bipolar disorder).

Methods: This presentation will review the incidence, presentation and pharmacologic treatment of BD in children and adolescents with BD.

Results: BD is common in children and adolescents. Atypical antipsychotics have evidence for efficacy in mania, while open data support the use lithium and some anticonvulsants. Comorbidities can be successfully treated.

Conclusion: Further large-scale placebo-controlled trials are needed to clarify the safest and most effective pharmacotherapy for maintenance, combination treatment, and bipolar depression in children and adolescents.

1.6 SCHIZOPHRENIA AND PSYCHOTIC DISORDERS IN CHILDREN AND ADOLESCENTS

Robert L. Findling, M.D., Psychiatry, University Hospitals Case Medical Center, 10524 Euclid Ave., Suite 1155A, Cleveland, OH, 44106

Objectives: This presentation will provide a general overview of what is known about the pharmacological treatment of schizophrenia and its related conditions in children and adolescents.

Methods: Data from published medication treatment studies for schizophrenia and psychotic disorders, as well as presentations from relevant scientific meetings will be reviewed.  

Results: There is evidence that antipsychotics are being prescribed to children and adolescents at increasing rates and that most of the antipsychotics that are prescribed to young people are atypical antipsychotics. Data from clinical trials of varying methodological rigor have described the efficacy and tolerability of both the typical and atypical antipsychotics in children and adolescents suffering from psychotic illnesses. Several atypical antipsychotics are newly approved for use in adult patients with schizophrenia, but their efficacy has not yet been established in pediatric patients.  

Conclusions: Based on the available data, longer-term studies of the efficacy and safety of atypical antipsychotic treatment are warranted for the vulnerable patient group. Pivotal studies of newer agents, as well as trials comparing different atypical agents and neuroleptics are also recommended. Clinicians may incorporate these scientific data into an evidence-based medication treatment plan for young patients with schizophrenia and its related conditions.

1.7 PHARMACOTHERAPEUTIC INTERVENTIONS IN ADOLESCENT SUBSTANCE ABUSE

Catherine Martin, M.D., University of Kentucky College of Medicine, University of Kentucky Dept. Psychiatry, 3470 Blazer Parkway; Lexington, KY, 40509-1200

Objective: This presentation will review evidence based studies investigating pharmacological strategies used in treating substance abuse.

Methods: A review of the current literature regarding pharmacological interventions for substance abuse (alcohol, tobacco and other drugs of abuse) including agonists, antagonists, or medications that primarily address symptom management will be presented. In addition, issues regarding treatment of psychiatric comorbidity will be reviewed.

Results: By and large there is a paucity of evidenced-based knowledge that can guide the clinician who is treating substance abuse in adolescents. However, a review of current pharmacological treatments of substance use and their underlying pharmacological mechanisms can provide a starting point when deciding on pharmacological strategies. In addition, careful consideration of pharmacologic treatment of comorbid psychiatric disorders will be reviewed.  

Conclusions: The clinician should be guided by evidence-based knowledge including knowledge of the basic principles behind pharmacological therapeutic interventions when treating substance abuse in adolescents. In addition, special consideration of unique issues related to comorbid psychiatric and SUDs shape pharmacological interventions.