Efficacy and tolerability of lithium in treating acute mania in youth with bipolar disorder: protocol for a systematic review The use of divalproex in alcohol relapse prevention: a pilot study. Integrating Children with Psychiatric Disorders in the Classroom: A Systematic Review Magnesium sulphate for pre‐eclampsia and eclampsia: the evidence so far Yoga on Our Minds: A Systematic Review of Yoga for Neuropsychiatric Disorders Patterns of pharmacological maintenance treatment in a community mental health services bipolar disorder cohort study (SIN-DEPRES). Five-fold increase in national prevalence rates of attention-deficit/hyperactivity disorder medications for children and adolescents with autism spectrum disorder, attention-deficit/hyperactivity disorder, and other psychiatric disorders: a Danish register-based study. Pharmacological management of chronic neuropathic pain - consensus statement and guidelines from the Canadian Pain Society. Evidence-based decisions about herbal products for treating mental disorders. The clinical effectiveness of different parenting programmes for children with conduct problems: a systematic review of randomised controlled trials Does lithium protect against dementia? Power Therapies and possible threats to the science of psychology and psychiatry. Divalproex treatment for youth with explosive temper and mood lability: a double-blind, placebo-controlled crossover design. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society Do Stimulants Protect Against Psychiatric Disorders in Youth With ADHD? A 10-Year Follow-up Study Depressed adolescents grown up. Risperidone for children and adolescents with autism spectrum disorder: a systematic review Traumatic brain injury in children and adolescents: psychiatric disorders at two years. Muscle Strengthening in Children and Adolescents With Spastic Cerebral Palsy: Considerations for Future Resistance Training Protocols Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status. Pilot study of community-based cognitive behavioral group therapy for adolescents with social phobia. Suicide in a large population of former psychiatric inpatients. Frequency, comorbidity, and psychosocial impairment of anxiety disorders in German adolescents.
Background Epidemiological , clinical , and high-risk studies have provided evidence that the peak period for onset of diagnosable episodes of mania and hypomania starts in mid-to-late adolescence . Moreover , clinical ly significant manic symptoms may occur even earlier , especially in children at familial risk . Lithium is the gold st and ard treatment for acute mania in adults , yet to our knowledge , there is no published systematic review assessing lithium treatment of mania in children or adolescents . This is a major gap in knowledge needed to inform clinical practice . Aim As a working group within the ISBD Task Force on Lithium Treatment ( http://www.isbd.org/active-task-forces ) , our aim is to complete a systematic review of the efficacy , tolerability , and acceptability of lithium compared with placebo and other active drugs in treating mania in children and adolescents diagnosed with bipolar disorder . Methods We will include double- or single-blind r and omized controlled trials in patients aged less than 18 years . No restrictions will be made by study publication date or language . Several electronic data bases will be search ed along with secondary sources such as bibliographies and trial registry websites for published and unpublished studies . Response rates to lithium compared with placebo or other active drugs will be the primary efficacy outcome . Primary tolerability and acceptability outcomes will be rates of serious adverse events and dropouts , respectively . Secondary outcomes will include rates of remission , severity of manic symptoms at different time points , and incidence of specific adverse events . Discussion Findings from this systematic review are critically needed to inform clinical practice . We should not generalize findings from adult studies , as children and adolescents are undergoing accelerated physiological and brain development . Therefore , efficacy , tolerability , and acceptability of lithium treatment of acute mania in children compared to adults may be very different . This systematic review has been registered in PROSPERO ( CRD42017055675 ) Anticonvulsant agents show promise in the treatment of the acute symptoms of alcohol withdrawal and may also treat some symptoms associated with the protracted abstinence syndrome . Impulsivity , hostility and irritability are common characteristics of alcohol-dependent individuals , and there is some evidence that anticonvulsant agents decrease these traits in individuals with a number of different psychiatric disorders . This pilot study is a 12-week , double-blind , placebo-controlled trial of an anticonvulsant agent , divalproex ( DVPX ) , in alcohol-dependent individuals .  Alcohol use ( Timeline Follow Back ) , impulsivity ( Barratt Impulsivity Scale ) , irritability and aggression ( Buss-Durkee Hostility Index ; and Anger , Irritability , Aggression Scale ) were measured at baseline and throughout the 12-week treatment period . Drinking decreased significantly in both the placebo and the DVPX-treated groups . In the DVPX group , a significantly smaller percentage of individuals relapsed to heavy drinking , but there were no significant differences in other alcohol-related outcomes . There were significantly greater decreases in irritability in the DVPX-treated group and a trend towards greater decreases on measures of lability and verbal assault . There were no significant between-group differences on measures of impulsivity . While DVPX did not have a robust effect on alcohol-related outcomes , it did have modest impact on a measure of irritability . This is consistent with the findings of other investigators exploring the use of DVPX in schizophrenia , personality disorder and a number of other psychiatric disorders Background : The school setting may be the optimal context for early screening of and intervention on child mental health problems , because of its large reach and intertwinement with various participants ( child , teacher , parent , other community services ) . But this setting also exposes children to the risk of stigma , peer rejection and social exclusion . This systematic literature review investigates the efficacy of mental health interventions addressed to children and adolescents in school setting s , and it evaluates which programs explicitly take into account social inclusion indicators . Method : Only r and omized controlled trials conducted on clinical population s of students and carried out in school setting s were selected : 27 studies overall . Most studies applied group Cognitive Behavioural Therapy or Interpersonal Psychotherapy . Results : Findings were suggestive of the effectiveness of  school-based intervention programs  in reducing symptoms of most mental disorders . Some evidence was found about the idea that effective studies on clinical population s may promote the social inclusion of children with an ongoing mental disorder and avoid the risk of being highly stigmatized . Conclusion : School programs are still needed that implement st and ardized models with verifiable and evidence -based practice s involving the whole school community Eclampsia remains a rare , but serious , complication of pregnancy , estimated to complicate around 1 in 2000 deliveries in Europe and other developed countries ( Douglas & Redman 1992 ) , and from 1 in 100 to 1700 deliveries in developing countries ( Crowther 1985 ; WHO lnternational Collaborative Study of Hypertensive Disorders of Pregnancy 1988 ) ; eclampsia is associated with 10 % of maternal deaths and approximately 50000 women die each year having had an eclamptic convulsion ( Duley 1992 ) . Much of the recent debate about management of women with eclampsia has focused on control of convulsions .  Anticonvulsants are given to prevent the first fit in women who have fulminating pre-eclampsia and to prevent further convulsions in women who already have had an eclamptic fit . Although these indications are related , women who have pre-eclampsia are likely to be less sick than those with eclampsia . The potential for benefit or for harm will , therefore , be different , and the effectiveness of anticonvulsants should be evaluated separately for these two situations . For well over half a century , magnesium sulphate has been advocated for the care of women with pre-eclampsia and eclampsia , yet its use remains controversial ( Donaldson 1992 ) . In the past , the lack of a sound hypothesis for the mechanism by which magnesium sulphate might act as an anticonvulsant has contributed to this . Recent plausible suggestions are that it may act by vasodilatation and subsequent reduction of cerebral ischaemia ( Belfort & Moise 1992 ) ; an alternative is by blocking some of the neuronal damage associated with cerebral ischaemia ( Goldman & Finkbeiner 1988 ) . Reflecting ongoing uncertainty about its role , use of magnesium sulphate continues to vary enormously . In the United States , for example , magnesium sulphate is the anticonvulsant of choice for women with either eclampsia or pre-eclampsia ( Consensus Report 1990 ) , while in the United Kingdom it is used by only 2 % of obstetricians ( Hutton et al. 1992 ) . What is the evidence that magnesium sulphate given to women with either pre-eclampsia or eclampsia does more good than harm ? The popularity of . magnesium sulphate in North America ( and elsewhere ) is largely based on reports of a few hundred women with eclampsia who were treated with magnesium sulphate  ( Pritchard et al. 1984 ) . Whilst sometimes impressive in the number of women included , none of these reports included any form of comparison or control group . Without comparison , it is impossible to know whether the good or bad outcome for the women was due to magnesium sulphate or to a combination of other factors , such as the severity of disease , health status of the women , or to additional interventions . The effectiveness of an intervention , such as magnesium sulphate , is best evaluated by systematic review of all relevant r and omised trials . In the perinatal field , a system for preparing and maintaining review s of the effects of health care already exists ( Cochrane Pregnancy and Childbirth Data base 1993 ) . The evidence presented here is derived from review s published on this data base Background : The dem and for clinical ly efficacious , safe , patient acceptable , and cost-effective forms of treatment for mental illness is growing . Several studies have demonstrated benefit from yoga in specific psychiatric symptoms and a general sense of well-being . Objective : To systematic ally examine the evidence for efficacy of yoga in the treatment of selected major psychiatric disorders . Methods : Electronic search es of The Cochrane Central Register of Controlled Trials and the st and ard bibliographic data bases , MEDLINE , EMBASE , and PsycINFO , were performed through April 2011 and an up date d in June 2011 using the keywords yoga AND psychiatry OR depression OR anxiety OR schizophrenia OR cognition OR memory OR attention AND r and omized controlled trial ( RCT ) . Studies with yoga as the independent variable and one of the above mentioned terms as the dependent variable were included and exclusion criteria were applied . Results : The search yielded a total of 124 trials , of which 16 met rigorous criteria for the final review . Grade B evidence supporting a potential acute benefit for yoga exists in depression ( four RCTs ) , as an adjunct to pharmacotherapy in schizophrenia ( three RCTs ) , in children with ADHD ( two RCTs ) , and Grade C evidence in sleep complaints ( three RCTs ) . RCTs in cognitive disorders and eating disorders yielded conflicting results . No studies looked at primary prevention , relapse prevention , or comparative effectiveness versus pharmacotherapy . Conclusion : There is emerging evidence from r and omized trials to support popular beliefs about yoga for depression , sleep disorders , and as an augmentation therapy . Limitations of literature include inability to do double-blind studies , multiplicity of comparisons within small studies , and lack of replication . Biomarker and neuroimaging studies , those comparing yoga with st and ard pharmaco- and psychotherapies , and studies of long-term efficacy are needed to fully translate the promise of yoga for enhancing mental health Maintenance therapy in bipolar disorder ( BD ) is usually required to prevent relapses and improve residual symptoms . Therefore , in this study , we describe patterns of pharmacological maintenance treatment and identify associated clinical features . This prospect i ve multicentre epidemiological study recruited a cohort of 739 consecutive out- patients with clinical ly stable BD . Clinical stability was assessed at baseline with the Clinical Global Impression scale for BD and depressive symptoms with the Hamilton Depression Rating Scale .  Psychotropic medications were classified and analysed according to their mechanism as well as use . Logistic regression models were used to examine the associations between pharmacological strategies and clinical features . Longer time since last episode [ odds ratio ( OR ) 1.002 , p < 0.0001 ] and family history of psychiatric disorders ( OR 1.911 , p = 0.028 ) were associated with lithium in monotherapy ;  manic polarity of the most recent episode ( OR 3.300 , p = 0.006 ) and longer duration of clinical stability ( OR 1.009 , p = 0.034 ) with antipsychotic in monotherapy ;  depressive polarity of the most recent episode ( OR 2.567 , p = 0.003 ) and bipolar II disorder diagnosis ( OR 2.278 , p = 0.008 ) with antidepressant combination ;  no ongoing psychiatric co-morbidity ( OR 0.230 , p = 0.004 ) with lithium and anticonvulsant ;  manic polarity of the most recent episode ( OR 3.774 , p < 0.0001 ) with lithium and antipsychotic ;  manic polarity of the most recent episode ( OR 2.907 , p = 0.028 ) with lithium , anticonvulsant and antipsychotic . The pharmacological patterns followed published recommendations , except for the excessive use of antidepressants . This study reveals clinical factors closely related to prescription patterns OBJECTIVE The purpose of this study was to estimate the prevalence and time trends in prescriptions of methylpheni date , dexamphetamine , and atomoxetine in children and adolescents , within three diagnostic groups : 1 ) autism spectrum disorder ( ASD ) , 2 ) attention-deficit/hyperactivity disorder ( ADHD ) , and 3 ) other psychiatric disorders . METHODS Data from six different national registers were used and merged to identify a cohort of all children and adolescents born in Denmark between 1990 and 2001 ( n=852,711 ) . Sociodemographic covariates on cohort members and their parents and lifetime prescriptions of methylpheni date , dexamphetamine , and atomoxetine were extracted from the registers . Prescriptions were also stratified by duration ( < 6 months . vs.≥ 6 months ) . RESULTS Sixteen percent of 9698 children and adolescents with ASD ( n=1577 ) , 61 % of 11,553 children and adolescents with ADHD ( n=7021 ) and 3 % of 48,468 children and adolescents with other psychiatric disorders ( n=1537 ) were treated with one or more ADHD medications . There was a significant increase in prescription rates of these medications for all three groups . From 2003 to 2010 , youth 6 - 13 years of age with ASD , ADHD , and other psychiatric disorders had 4.7-fold ( 4.4 - 4.9 ) , 6.3-fold ( 6.0 - 6.4 ) , and 5.5-fold ( 5.0 - 5.9 ) increases , respectively , in prescription rates of ADHD medications . CONCLUSION This is the largest study to date assessing stimulant treatment in children and adolescents with ASD , and is the first prospect i ve study quantifying the change over time in the prevalence of treatment with ADHD medications in a population -based national cohort of children and adolescents with ASD . The prevalence of stimulant treatment in youth with ASD of 16 % is consistent with earlier studies . The past decade has witnessed a clear and progressive increase in the prescription rates of medications typically used to treat ADHD in children and adolescents in Denmark . This increase is not limited to only those with ADHD , but includes others with neuropsychiatric disorders , including ASD . The risks and benefits of this practice await further study Neuropathic pain ( NeP ) , generated by disorders of the peripheral and central nervous system , can be particularly severe and disabling . Prevalence estimates indicate that 2 % to 3 % of the population in the developed world suffer from NeP , which suggests that up to one million Canadians have this disabling condition . Evidence -based guidelines for the pharmacological management of NeP are therefore urgently needed . R and omized , controlled trials , systematic review s and existing guidelines focusing on the pharmacological management of NeP were evaluated at a consensus meeting . Medications are recommended in the guidelines if their analgesic efficacy was supported by at least one method ologically sound , r and omized , controlled trial showing significant benefit relative to placebo or another relevant control group . Recommendations for treatment are based on degree of evidence of analgesic efficacy , safety , ease of use and cost-effectiveness .  Analgesic agents recommended for first-line treatments are certain antidepressants ( tricyclics ) and anticonvulsants ( gabapentin and pregabalin ) . Second-line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine . Tramadol and controlled-release opioid analgesics are recommended as third-line treatments for moderate to severe pain . Recommended fourth-line treatments include cannabinoids , methadone and anticonvulsants with lesser evidence of efficacy , such as lamotrigine , topiramate and valproic acid . Treatment must be individualized for each patient based on efficacy , side-effect profile and drug accessibility , including cost . Further studies are required to examine head-to-head comparisons among analgesics , combinations of analgesics , long-term outcomes , and treatment of pediatric and central Herbal products are becoming increasingly mainstream . This is not simply a comment on their popularity , but on the level and rigor of scientific research and acceptance by clinical investigators , as well as the attention being paid to these therapeutic options by government bodies . A recent trial published in the Journal of the American Medical Association ( JAMA ) evaluating St. John 's wort for depression demonstrates this shift.1 Several features of this trial are noteworthy . Not only was the trial of rigorous design and published in a highly reputed journal , but it was completed by a group of high profile and experienced US psychiatric research ers who are generally associated with research ing pharmaceuticals . In the past , the quality of trials involving herbal products and other alternative treatment options for psychiatric and other disorders has been criticized.2 Criticisms have included failing to account for biases and confounders , using nonst and ardized products and poor study design . However , in the last 5 years , MEDLINE ( www.ncbi.nlm.nih.gov/ PubMed ) has indexed over 50 r and omized controlled trials ( RCTs ) investigating complementary medicines for treating mental disorders , suggesting that an increasing number of alternative approaches are being tested using what is approaching gold st and ard methods . This number is likely an underestimate because MEDLINE search strategies , even those devised by experts , can fail to locate a significant number of relevant trials.3 It is also well recognized that MEDLINE does not index all relevant journals in the area of complementary medicines.4 The Cochrane Controlled Trials Register of the Cochrane Library ( www.cochranelibrary.com ) , which lists clinical trials that have been identified through regular search ers of MEDLINE , EMBASE and h and search es of clinical journals , is considered an authoritative source of RCTs .5 For illustrative purpose s only , a selection of RCTs from the Cochrane Library of herbal products used for psychiatric indications is listed in Table 1.1,6,7,8,9,10,11,12,13 Table 1 Considering that the amount of good- quality research regarding herbals in psychiatric disorders appears to be exp and ing steadily , treatment review s , unless up date d regularly , quickly become out date d and serve a limited purpose . Such review s are also not particularly useful for making individual patient treatment decisions ; they tend not to address specific clinical questions adequately , but rather , provide the reader with a general awareness of the topic . As such , this paper is not intended to comprehensively review the benefits and risks of herbal products commonly used for psychiatric disorders . Recent examples of such review s can be found elsewhere.14,15,16,17 Instead , the purpose of this review is to present the steps involved in taking an evidence -based approach to clinical decision making regarding the use of herbal products in psychiatry . The reader will be oriented to the evidence -based process using examples of herbal product use for mental disorders . Methods and tools that facilitate rapid access to the best clinical research about herbal products will be presented . In addition , special issues concerning herbal therapies that differ from the evaluation of pharmaceutical products will be introduced and discussed Background Conduct problems are common , disabling and costly . The prognosis for children with conduct problems is poor , with outcomes in adulthood including criminal behaviour , alcoholism , drug abuse , domestic violence , child abuse and a range of psychiatric disorders . There has been a rapid expansion of group based parent-training programmes for the treatment of children with conduct problems  in a number of countries over the past 10 years . Existing review s of parent training have method ological limitations such as inclusion of non-r and omised studies , the absence of investigation for heterogeneity prior to meta- analysis or failure to report confidence intervals . The objective of the current study was to systematic ally review r and omised controlled trials of parenting programmes for the treatment of children with conduct problems .  Methods St and ard systematic review methods were followed including duplicate inclusion decisions , data extraction and quality assessment . Twenty electronic data bases from the fields of medicine , psychology , social science and education were comprehensively search ed for RCTs and systematic review s to February 2006 . Inclusion criteria were : r and omised controlled trial ; of structured , repeatable parenting programmes ; for parents/carers of children up to the age of 18 with a conduct problem ; and at least one measure of child behaviour . Meta- analysis and qualitative synthesis were used to summarise included studies . Results 57 RCTs were included . Studies were small with an average group size of 21 . Meta-analyses using both parent ( SMD -0.67 ; 95 % CI : -0.91 , -0.42 ) and independent ( SMD -0.44 ; 95 % CI : -0.66 , -0.23 ) reports of outcome showed significant differences favouring the intervention group . There was insufficient evidence to determine the relative effectiveness of different approaches to delivering parenting programmes . Conclusion Parenting programmes are an effective treatment for children with conduct problems . The relative effectiveness of different parenting programmes requires further research OBJECTIVE To investigate whether treatment with lithium in patients with mania or bipolar disorder is associated with a decreased rate of subsequent dementia . METHODS Linkage of register data on prescribed lithium in all patients discharged from psychiatric health care service with a diagnosis of mania or bipolar disorder and subsequent diagnoses of dementia in Denmark during a period from 1995 to 2005 . RESULTS A total of 4,856 patients with a diagnosis of a manic or mixed episode or bipolar disorder at their first psychiatric contact were included in the study . Among these patients , 2,449 were exposed to lithium ( 50.4 % ) , 1,781 to anticonvulsants ( 36.7 % ) , 4,280 to antidepressants ( 88.1 % ) , and 3,901 to antipsychotics ( 80.3 % ) during the study period . A total of 216 patients received a diagnosis of dementia during follow-up ( 103.6/10,000 person-years ) . During the period following the second prescription of lithium , the rate of dementia was decreased compared to the period following the first prescription . In contrast , the rates of dementia during multiple prescription periods with anticonvulsants , antidepressants , or antipsychotics , respectively , were not significantly decreased compared to the rate of dementia during the period with one prescription of these drugs . CONCLUSIONS Continued treatment with lithium was associated with a reduced rate of dementia in patients with bipolar disorder in contrast to continued treatment with anticonvulsants , antidepressants , or antipsychotics . Method ological reasons for these findings can not be excluded due to the nonr and omized nature of the data OBJECTIVE Advocates of new therapies frequently make bold cl aims regarding therapeutic effectiveness , particularly in response to disorders which have been traditionally treatment-refractory . This paper review s a collection of new therapies collectively self-termed " The Power Therapies " , outlining their proposed procedures and the evidence for and against their use . These therapies are then put to the test for pseudoscientific practice . METHOD Therapies were included which self-describe themselves as " Power Therapies " . Published work search es were conducted on each therapy using Medline and PsychInfo data bases for r and omized controlled trials assessing their efficacy , except for the case of Eye Movement Desensitization and Reprocessing ( EMDR ) . Eye Movement Desensitization and Reprocessing has more r and omized controlled studies conducted on its efficacy than any other treatment for trauma and thus , previous meta-analyses were evaluated . RESULTS AND CONCLUSIONS It is concluded that these new therapies have offered no new scientifically valid theories of action , show only non-specific efficacy , show no evidence that they offer substantive improvements to extant psychiatric care , yet display many characteristics consistent with pseudoscience OBJECTIVE The authors sought to replicate open-label findings showing that specific criteria for explosive temper and mood lability identify disruptive youth who improve while receiving the anticonvulsant divalproex sodium . METHOD Twenty outpatient children and adolescents ( ages 10 - 18 ) with a disruptive behavior disorder ( oppositional defiant disorder or conduct disorder ) met the specific criteria for explosive temper and mood lability . They received 6 weeks of divalproex treatment and 6 weeks of placebo by r and om assignment . Independent evaluators blind to group assignment assessed response at the end of each phase . RESULTS At the end of phase 1 , eight of 10 subjects had responded to divalproex ; zero of 10 had responded to placebo . Of the 15 subjects who completed both phases , 12 has superior response taking divalproex . CONCLUSIONS This preliminary study replicates open-label findings showing that divalproex is an efficacious treatment for explosive temper and mood lability in disruptive children and adolescents CONTEXT : The optimal pharmacologic treatment for early convulsive status epilepticus is unclear . OBJECTIVE : To analyze efficacy , tolerability and safety data for anticonvulsant treatment of children and adults with convulsive status epilepticus and use this analysis to develop an evidence -based treatment algorithm . DATA SOURCES : Structured literature review using MEDLINE , Embase , Current Contents , and Cochrane library supplemented with article reference lists . STUDY SELECTION : R and omized controlled trials of anticonvulsant treatment for seizures lasting longer than 5 minutes . DATA EXTRACTION : Individual studies were rated using predefined criteria and these results were used to form recommendations , conclusions , and an evidence -based treatment algorithm . RESULTS : A total of 38 r and omized controlled trials were identified , rated and contributed to the assessment . Only four trials were considered to have class I evidence of efficacy . Two studies were rated as class II and the remaining 32 were judged to have class III evidence . In adults with convulsive status epilepticus , intramuscular midazolam , intravenous lorazepam , intravenous diazepam and intravenous phenobarbital are established as efficacious as initial therapy ( Level A ) . Intramuscular midazolam has superior effectiveness compared to intravenous lorazepam in adults with convulsive status epilepticus without established intravenous access ( Level A ) . In children , intravenous lorazepam and intravenous diazepam are established as efficacious at stopping seizures lasting at least 5 minutes ( Level A ) while rectal diazepam , intramuscular midazolam , intranasal midazolam , and buccal midazolam are probably effective ( Level B ) . No significant difference in effectiveness has been demonstrated between intravenous lorazepam and intravenous diazepam in adults or children with convulsive status epilepticus ( Level A ) . Respiratory and cardiac symptoms are the most commonly encountered treatment-emergent adverse events associated with intravenous anticonvulsant drug administration in adults with convulsive status epilepticus ( Level A ) . The rate of respiratory depression in patients with convulsive status epilepticus treated with benzodiazepines is lower than in patients with convulsive status epilepticus treated with placebo indicating that respiratory problems are an important consequence of untreated convulsive status epilepticus ( Level A ) . When both are available , fosphenytoin is preferred over phenytoin based on tolerability but phenytoin is an acceptable alternative ( Level A ) . In adults , compared to the first therapy , the second therapy is less effective while the third therapy is substantially less effective ( Level A ) . In children , the second therapy appears less effective and there are no data about third therapy efficacy ( Level C ) . The evidence was synthesized into a treatment algorithm . CONCLUSIONS : Despite the paucity of well- design ed r and omized controlled trials , practical conclusions and an integrated treatment algorithm for the treatment of convulsive status epilepticus across the age spectrum ( infants through adults ) can be constructed . Multicenter , multinational efforts are needed to design , conduct and analyze additional r and omized controlled trials that can answer the many outst and ing clinical ly relevant questions identified in this guideline OBJECTIVE : Little is known about the effect of stimulant treatment in youth with attention-deficit/hyperactivity disorder ( ADHD ) on the subsequent development of comorbid psychiatric disorders . We tested the association between stimulant treatment and the subsequent development of psychiatric comorbidity in a longitudinal sample of patients with ADHD . METHODS : We conducted a case-control , 10-year prospect i ve follow-up study into young-adult years of youth with ADHD . At baseline , we assessed consecutively referred white male children with ( n = 140 ) and without ( n = 120 ) ADHD , aged 6 to 18 years . At the 10-year follow-up , 112 ( 80 % ) and 105 ( 88 % ) of the children in the ADHD and control groups , respectively , were reassessed ( mean age : 22 years ) . We examined the association between stimulant treatment in childhood and adolescence and subsequent comorbid disorders and grade retention by using proportional hazards survival models . RESULTS : Of the 112 participants with ADHD , 82 ( 73 % ) were previously treated with stimulants .  Participants with ADHD who were treated with stimulants were significantly less likely to subsequently develop depressive and anxiety disorders and disruptive behavior and less likely to repeat a grade compared with participants with ADHD who were not treated . CONCLUSIONS : We found evidence that stimulant treatment decreases the risk for subsequent comorbid psychiatric disorders and academic failure in youth with ADHD CONTEXT Major depressive disorder ( MDD ) that arises in adolescence impairs functioning and is associated with suicide risk , but little is known about its continuity into adulthood . OBJECTIVE To describe the clinical course of adolescent-onset MDD into adulthood . DESIGN AND PARTICIPANTS Prospect i ve case-control study . Seventy-three subjects had onset of MDD based on systematic clinical assessment during adolescence ( Tanner stage III-V ) and 37 controls had no evidence of past or current psychiatric disorders , and also were assessed in adolescence ( assessment years : 1977 - 1985 ) . Follow-up was conducted 10 to 15 years after the initial assessment by an independent team without knowledge of initial diagnosis ( follow-up years : 1992 - 1996 ) . SETTING Cases were identified at Columbia Presbyterian Hospital , New York City , NY ; controls were recruited from the community . MAIN OUTCOME MEASURES Suicide and suicide attempts , psychiatric diagnoses , treatment utilization , and social functioning . RESULTS Clinical outcomes of adolescent-onset MDD into adulthood compared with control subjects without psychiatric illness include a high rate of suicide ( 7.7 % ) ; a 5-fold increased risk for first suicide attempt ; a 2-fold increased risk of MDD , but not other psychiatric disorders ; an increased occurrence of psychiatric and medical hospitalization ; and impaired functioning in work , social , and family life . Thirty-seven percent of those with adolescent MDD survived without an episode of MDD in adulthood vs 69 % of the control participants ( relative risk , 2.2 [ 95 % confidence interval , 1.0 - 4.7 ; P<.05 ] ) . CONCLUSION There is substantial continuity , specificity , morbidity , and potential mortality from suicide into adulthood in adolescent-onset MDD patients . Now that empirically based guides to their treatment are becoming available , early identification and treatment seems warranted Background Various clinical trials suggested that risperidone was beneficial in the treatment of autism spectrum disorder ( ASD ) in children and adolescents . Objective The aim of this systematic review was to determine the efficacy , acceptability and tolerability of risperidone in the treatment of children and adolescents with ASD . Data sources The data bases of Scopus , PubMed , CINAHL and Cochrane Controlled Trials Register were search ed in February 2017 . Study eligibility criteria , participants and interventions Eligible RCTs of risperidone in the treatment of child and adolescent patients with ASD . Language s were not restricted . Study appraisal and synthesis methods The full-text versions of relevant studies were thoroughly assessed and extracted . The primary efficacy of outcome was the pooled response rate and the pooled mean changed scores of the st and ardized rating scales for ASD . Results A total of 372 r and omized subjects from seven RCTs were included in this review . In acute treatment , the pooled mean change score of the Aberrant Behavior Checklist for irritability subscale ( ABC-I ) and response rate for the risperidone-treated group had a greater significance than that of the placebo-treated group . In the long-term treatment , the pooled mean change score of the CARS in the risperidone-treated group was significantly greater than that in the placebo-treated group . According to the discontinuation phase , the overall pooled relapse rate of the risperidone-treated group was significantly less than that of the placebo-treated group . The rates of pooled overall discontinuation and discontinuation due to adverse events rates were not different between the two groups in acute and long-term treatments . Limitations A small study was included in the current review . Conclusion In relation to the current systematic review , risperidone is efficacious in the treatment of symptoms in children and adolescents with ASD . Although its acceptability is comparable to placebo , treatment with risperidone is well tolerated in children and adolescents with ASD OBJECTIVE To extend findings regarding predictive factors of psychiatric outcome from the first to the second year after traumatic brain injury ( TBI ) in children and adolescents . METHOD Subjects were children aged 6 to 14 years at the time they were hospitalized after TBI . The study used a prospect i ve follow-up design . Assessment s of preinjury psychiatric , behavioral , adaptive functioning , family functioning and family psychiatric history status were conducted . Severity of injury was assessed by st and ard clinical scales and neuroimaging was analyzed . The outcome measure was the presence of a psychiatric disorder , not present before the injury ( " novel " ) , during the second year after TBI . RESULTS Fifty subjects enrolled , and the analyses focused on 42 subjects followed at 24 months . Severity of injury , preinjury family function , and preinjury lifetime psychiatric history predicted the development of a " novel " psychiatric disorder present in the second year . CONCLUSION These data suggest that there are children , identifiable through clinical assessment , at increased risk for " novel " psychiatric disorders in the second year after TBI Resistance training of the lower limbs is now commonly used in clinical practice in children and adolescents with spastic cerebral palsy ( CP ) . However , the effectiveness of this type of training is still disputed . The most recently published systematic review with meta- analysis included interventions such as electrical stimulation and resistance training and found insufficient evidence to support or refute the efficacy of these exercises in children with CP . Thus , the aim of this article is to evaluate the extent to which training protocol s from the most recent r and omized controlled trials are in keeping with the evidence for effective resistance  training in children who are developing typically , as reflected in the training guidelines of the National Strength and Conditioning Association . Recommendations for resistance training protocol s , based on this evidence and appropriate to children with CP , are provided to help guide both future research and clinical practice for resistance training in children with CP OBJECTIVE The paucity of data concerning the long-term natural history of attention-deficit hyperactivity disorder ( ADHD ) , a common childhood psychiatric disorder , prompted a longitudinal study to investigate the adult sequelae of the childhood disorder . DESIGN Prospect i ve study , follow-up intervals ranging from 13 to 19 years ( mean , 16 years ) , with blind systematic clinical assessment s. SUBJECTS Ninety-one white males ( mean age , 26 years ) , representing 88 % of a cohort systematic ally diagnosed as hyperactive in childhood , and 95 ( 95 % ) of comparison cases of similar race , gender , age , whose teachers had voiced no complaints about their school behavior in childhood . RESULTS Prob and s had significantly higher rates than comparisons of ADHD symptoms ( 11 % vs 1 % ) , antisocial personality disorders ( 18 % vs 2 % ) , and drug abuse disorders ( 16 % vs 4 % ) . Significant comorbidity occurred between antisocial and drug disorders . Educational and occupational achievements were significantly compromised in the prob and s. These disadvantages were independent of psychiatric status . We did not find increased rates of affective or anxiety disorders in the prob and s. CONCLUSIONS Childhood ADHD predicts specific adult psychiatric disorders , namely antisocial and drug abuse disorders . In the adolescent outcome of this cohort , we found that these disturbances were dependent on the continuation of ADHD symptoms . In contrast , in adulthood , antisocial and drug disorders appeared , in part , independent of sustained ADHD . In addition , regardless of psychiatric status , ADHD placed children at relative risk for educational and vocational disadvantage . The results do not support a relationship between childhood ADHD and adult mood or anxiety disorders OBJECTIVE A pilot study to evaluate the efficacy of a cognitive-behavioral group therapy program for adolescents with social phobia , simplified both in terms of time and labor intensity from a previously studied program ( Social Effectiveness Therapy for Children and Adolescents ) to be more appropriate for a community outpatient psychiatric setting . METHOD Twelve adolescents with social phobia ( ages 13 - 18 ) , diagnosed by DSM-IV criteria and confirmed with Anxiety Disorders Interview Schedule for Children assessment , were r and omly assigned to treatment ( n=6 ) and waitlist ( n=6 ) groups . The waitlist group was subsequently treated , and results were included in the data analysis . Assessment s , including Anxiety Disorders Interview Schedule for Children interviews and self-report Social Phobia and Anxiety Inventory and Beck Depression Inventory II question naires , were performed at baseline and immediately after treatment or waitlist . RESULTS All subjects completed the treatment program . Compared with the waitlist group , treated subjects showed significantly greater improvement in both examiner-evaluated ( Anxiety Disorders Interview Schedule for Children ) and self-reported ( Social Phobia and Anxiety Inventory ) symptoms of social anxiety ( effect sizes [ d ] , 1.63 and 0.85 , respectively ) . No significant change was seen in Beck Depression Inventory II scores for treatment or waitlist groups . CONCLUSIONS This study provides support for the use of simplified cognitive-behavioral interventions for adolescents with social phobia that are practical for community psychiatric setting AIMS The aim of this study was to identify predictors of completed suicide in a wide sample of psychiatric in patients receiving retrospective and prospect i ve DSM-IV diagnoses . METHODS We followed up 4441 severe psychiatric patients who were hospitalized for some time during a 35-year period in a private hospital setting . We collected sociodemographic , clinical and temperamental data . RESULTS Ninety-six patients from the sample committed suicide .  There were no sex differences in suicide completion and no differences between major psychiatric disorders , but people who had been hospitalized for anxiety disorders did not commit suicide and people with bipolar disorders were more likely to commit suicide than people with unipolar major depression . Shorter-term treatment with lithium and anticonvulsants , longer-term treatment with antidepressants , history of suicide attempts , suicidal thinking , and single status positively predicted completed suicide . Suicide tended to occur after a mean period of about 14 years of duration of disease . Patients ' symptoms during the period preceding suicide were assessed through interviewing patients ' physicians or family members . Symptoms occurring in > 10 % of cases were , in decreasing order , inner tension , racing/crowded thoughts , aggressive behavior , guilt , psychomotor agitation , persecutory ideation , anxiety , and hallucinations . Surprisingly , cyclothymic temperament was less associated with completed suicide as compared to other temperaments . CONCLUSIONS Suicide is likely to occur in a milieu of agitation , mixed anxiety and depression , and psychosis . Longer-term mood stabilizer treatment may reduce the rate of completed suicide The frequency , comorbidity , and psychosocial impairment of anxiety disorders among German adolescents was estimated from a survey of 1,035 students aged 12 - 17 years . The adolescents were r and omly selected from 36 schools in the province of Bremen , Germany . Anxiety disorders and other psychiatric disorders were coded based on criteria from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders , using the computerized Munich version of the Composite International Diagnostic Interview . Anxiety disorders occurred frequently in our sample of adolescents , with a rate of 18.6 % . When considering the subtypes of anxiety disorders , phobia was the most common . Posttraumatic stress disorder and obsessive-compulsive disorder occurred less frequently with rates below 2 % . Panic disorder and generalized anxiety disorder were the least common , with rates well below 1 % . Anxiety disorders were significantly higher in girls than in boys , and that the rates increased with age . Comorbidity occurs quite frequently , both within the anxiety disorders and also with other psychiatric disorders . The most common pattern of comorbidity was that of anxiety and depressive disorders . Although a high number of anxiety cases were psychosocially impaired , at least during the worst episode of their disorders , only a few of them sought treatment for their problems . We conclude by discussing some research priorities in the area of anxiety disorders in children and adolescents
In several small , single-site RCTs , valproate and sulthiame were better than placebo for the management of recurrent aggression .
Conclusions : Currently available RCTs do not support the efficacy of anticonvulsants as mood stabilizers in children .
There is some preliminary evidence from small RCTs of the efficacy of some anticonvulsants in the control of aggression and behavioral dyscontrol in conduct disorder , autism , and intellectual disability
Aim : Anticonvulsant medications are frequently used in clinical practice to treat psychiatric disorders in children and adolescents , but the evidence for their efficacy is uncertain .
We conducted a systematic review of published r and omized controlled trials ( RCT ) that assessed the psychiatric benefit of anticonvulsants  in patients under 18 years of age .