In clinical samples, juvenile bipolar disorder (JBPD) is frequently accompanied by co-morbid attention-deficit/hyperactivity disorder (ADHD). Clinical trials assessing combined psychopharmacological interventions in this population are scarce, and methylphenidate (MPH) may worsen manic symptoms. We conducted a randomized crossover trial with MPH and placebo (2 weeks each) combined with aripiprazole in children and adolescents (n = 16; 8-17 years old) with JBPD and ADHD who had a significant response in manic symptoms with aripiprazole but still presented clinically significant symptoms of ADHD. ADHD, manic, and depressive symptoms were assessed by means of standard scales. Fourteen out of the 16 subjects completed the trial. No significant differences between the effects of methylphenidate and placebo were detected in ADHD (F(1, 43.22) = 0.00; p = 0.97) or manic (F(1, 40.19) = 0.93; p = 0.34) symptoms. Significant improvement in depressive symptoms was observed in the MPH group (F(1,19.03) = 7.75; p = 0.01) according to a secondary self-reported outcome measure. One patient using aripiprazole and MPH discontinued the trial due to the onset of a severe mixed episode. No other significant adverse events were observed. Although MPH did not worsen manic symptoms, it was not more effective than placebo in improving ADHD symptoms in children and adolescents with JBPD co-morbid with ADHD stabilized with aripiprazole. Further investigations are warranted. This study is registered at www.clinicaltrials.gov under the identifier NCT00305370.

Attention-deficit/hyperactivity disorder (ADHD) seems to be associated with significant psychosocial adversity. However, few studies assessed the role of environmental, social and interpersonal factors specifically in ADHD, inattentive type (ADHD-I). Thus, this study aims to investigate whether family environment risk factors are associated with ADHD-I. In a case-control study, we assessed a non-referred sample of 100 children and adolescents with ADHD-I and 100 non-ADHD controls (6-18 years old). They were systematically evaluated through structured diagnostic interviews. The following family adversity measures were used: Rutter's family adversity index (marital discord, low social class, large family size, paternal criminality, maternal mental disorder), Family Environment Scale (FES) (subscores of cohesion, expressiveness and conflict) and Family Relationship Index (FRI) (based on the subscores above). After adjusting for confounding factors (social phobia and maternal history of ADHD), the odds ratio (OR) for ADHD-I increased as the number of Rutter's indicators increased. Families of children with lower FES cohesion subscores presented higher OR for ADHD-I (OR 1.24; 95% confidence interval 1.05-1.45). Lower levels of FRI, a general index of family relationship, were also related to higher risk of ADHD-I (OR 1.11; 95% confidence interval 1.03-1.21). Our findings suggest that family adversity (in general), low family cohesion and low FRI (in particular) are associated with an increase in the risk for ADHD-I. However, the cross-sectional nature of the study limits our ability to infer causality.

clinicaltrials.gov Identifier: NCT00116259.

Social anxiety disorder (SAD) is a highly prevalent and disabling disorder in children and adolescents. This study was designed to evaluate the efficacy and safety of a highly potent and selective serotonin reuptake inhibitor, escitalopram, in the treatment of SAD in children and adolescents. Twenty outpatients with a primary diagnosis of SAD were treated in a 12-week open trial with escitalopram. The primary outcome variable was the change from baseline to end point in Clinical Global Impression-Improvement scale (CGI-I). Secondary efficacy measures included the CGI-Severity scale (CGI-S), the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Screen for Child and Anxiety Related Emotional Disorders (SCARED)-Child and Parent version, and The Youth Quality of Life Instrument-Research Version (Y-QOL-R). On the CGI-I scale, 13 of 20 patients (65%) had a score < or =2, meaning response to treatment. All symptomatic and quality of life measures showed improvements from baseline to week 12, with large effect sizes ranging from 0.9 to 1.9 (all p < 0.001). Escitalopram was generally well-tolerated. These results suggest that escitalopram may be an effective and safe treatment for pediatric SAD. Future double-blind, placebo-controlled, randomized clinical trials are warranted.

No abstract

ResumoContexto: O termo tratamentos baseados em evidências refere-se a intervenções que possuem evidência de eficácia em pesquisas empíricas. Tratamentos psicológicos baseados em evidências têm sido identificados como um objetivo principal nos Estados Unidos, e, atualmente, há uma clara orientação em direção à sua indicação para os transtornos psiquiátricos mais prevalentes. Objetivo: Revisar a efetividade de intervenções psicossociais para as principais formas clínicas dos transtornos mentais na infância e adolescência, e os desafios para a pesquisa em tratamentos baseados em evidência. Métodos: Revisão bibliográfica do banco de dados Medline, de 1985 a 2005, e revisão de artigos encontrados em capítulos de livros e artigos de revisão. Resultados: Psicoterapias com suporte empírico em depressão, ansiedade, transtornos do comportamento disruptivo e transtorno de déficit de atenção/hiperatividade. Conclusão: Houve um progresso importante na pesquisa em psicoterapia na infância e adolescência, que se reflete na quantidade de estudos e na identificação de tratamentos baseados em evidências. O desafio atual engloba a generalização de tais achados para a prática clínica. Pheula, G.F.; Isolan, L.R. / Rev. Psiq. Clín. 34 (2); 74-83, 2007Palavras-chave: Eficácia, psicoterapia, ensaios clínicos controlados, pesquisa em terapia na infância e adolescência, terapias com suporte empírico. AbstractBackground: Evidence-based treatments refer to interventions that have empirical research on their behalf. Evidencebased psychological therapy have been identified as a national goal in United States, and there is now clear guidance regarding referral for major mental health conditions. Objective: Review the effectiveness of psychosocial interventions for all major forms of mental health problems in childhood and adolescence, and the challenges to research EvidenceBased treatments. Methods: Computerized search of Medline database from 1985 to 2005 and review bibliographies of book chapters and review articles. Results: We present empirically based psychological treatments for depression, anxiety, disruptive behavior disorder, attention deficit hyperactivity and autism. Conclusion: Considerable progress has been made in child and adolescent psychotherapy research, as reflected in the quantity of studies and the identification of evidence-based treatments. The actual challenge include generalization to clinical practice.

Risperidone was effective in reducing irritability in SMD youth. To the best of our knowledge, this is the first psychopharmacological trial in this group of patients with positive results. Further randomized, controlled studies are needed.

Aripiprazole was effective in improving mania and ADHD symptoms, but neither JBD nor ADHD symptom remission was observed in most of the cases. Randomized placebo-controlled trials for JBD and ADHD are needed.