Unmet needs in paediatric psychopharmacology: Present scenario and future perspectives

Persico, Antonio M.; Arango, Celso; Buitelaar, Jan K.; Correll, Christoph U.; Glennon, Jeffrey; Hoekstra, Pieter J.; Moreno, Carmen; Vitiello, Benedetto; Vorstman, Jacob; Zuddas, Alessandro

doi:10.1016/j.euroneuro.2015.06.009

Cited by 57 publications

(33 citation statements)

References 147 publications

(148 reference statements)

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“…For those drugs where efficacy has been demonstrated in RCTs of limited duration, there is a pressing need for longer lasting observational and discontinuation studies to determine the risks and benefits of long-term use [62–64]. Close monitoring of use of psychopharmacological agents over time and across countries may sensitize to national discrepancies in mental health care, differences in use of psychopharmacological treatment and populations with special needs or risks.…”

Section: Discussionmentioning

confidence: 99%

A multi-national comparison of antipsychotic drug use in children and adolescents, 2005–2012

Kalverdijk

Bachmann

Aagaard³

et al. 2017

Child Adolesc Psychiatry Ment Health

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Over the last decades, an increase in antipsychotic (AP) prescribing and a shift from first-generation antipsychotics (FGA) to second-generation antipsychotics (SGA) among youth have been reported. However, most AP prescriptions for youth are off-label, and there are worrying long-term safety data in youth. The objective of this study was to assess multinational trends in AP use among children and adolescents. A repeated cross-sectional design was applied to cohorts from varied sources from Denmark, Germany, the Netherlands, the United Kingdom (UK) and the United States (US) for calendar years 2005/2006–2012. The annual prevalence of AP use was assessed, stratified by age group, sex and subclass (FGA/SGA). The prevalence of AP use increased from 0.78 to 1.03% in the Netherlands’ data, from 0.26 to 0.48% in the Danish cohort, from 0.23 to 0.32% in the German cohort, and from 0.1 to 0.14% in the UK cohort. In the US cohort, AP use decreased from 0.94 to 0.79%. In the US cohort, nearly all ATP dispensings were for SGA, while among the European cohorts the proportion of SGA dispensings grew to nearly 75% of all AP dispensings. With the exception of the Netherlands, AP use prevalence was highest in 15–19 year-olds. So, from 2005/6 to 2012, AP use prevalence increased in all youth cohorts from European countries and decreased in the US cohort. SGA were favoured in all countries’ cohorts.

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Section: Discussionmentioning

confidence: 99%

A multi-national comparison of antipsychotic drug use in children and adolescents, 2005–2012

Kalverdijk

Bachmann

Aagaard³

et al. 2017

Child Adolesc Psychiatry Ment Health

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“…An essential part of the psychiatric care for pediatric disruptive/impulsive/CDs includes pharmacotherapy, despite the lack of Food and Drug Administration (FDA)-approved medications. In fact, there is considerable evidence from off-label prescriptions suggesting a role for several antipsychotic drugs, including risperidone [6][7][8][9][10]. Risperidone obtained FDA-approval for the treatment of irritability in children and adolescents with autism spectrum disorders.…”

Section: Introductionmentioning

confidence: 99%

Plasma Risperidone-related Measures in Children and Adolescents with Oppositional Defiant/Conduct Disorders

Piacentino

Kotzalidis

Schoretsanitis

et al. 2020

Clin Psychopharmacol Neurosci

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Objective: Therapeutic drug monitoring helps clinicians in choosing the right drug and adjust its dose in specific patients. To this end, we aimed to assess time patterns of risperidone and its metabolite, 9-hydroxyrisperidone, in children and adolescents with oppositional defiant and/or conduct disorder. Methods: We measured plasma concentrations of risperidone and 9-hydroxyrisperidone, their sum (active moiety, AM) and ratio, as well as plasma concentrations corrected for daily dose (C/D), from 140 children/adolescents with the above-mentioned disorders. We used Student's t test to compare females versus males, patients under versus over 16-year-old, patients with lower versus higher than the median body weight, and patients with lower versus higher than the median body mass index (BMI). Two mixed-effects logistic regression models were fitted for risperidone/9hydroxyrisperidone ratio and AM, respectively, by considering risperidone daily dose and patients' demographic characteristics. Results: Females had higher 9-hydroxyrisperidone and AM plasma concentrations than males (p = 0.004 and p = 0.034). Younger patients had lower risperidone plasma concentration and risperidone/9-hydroxyrisperidone ratio (p = 0.02 and p = 0.021), but higher C/D 9-hydroxyrisperidone and AM than older patients (p = 0.013 and p = 0.043). Lower-weight patients had lower plasma risperidone and risperidone/9-hydroxyrisperidone ratio (p = 0.014 and p = 0.019), but higher C/D 9-hydroxyrisperidone concentration than heavier patients (p = 0.03). All these results could be accounted for by daily dose. Patients with lower and higher BMI did not differ significantly. Regression analyses showed that only risperidone daily dose predicted risperidone/9-hydroxyrisperidone ratio, whereas risperidone daily dose, sex, and age predicted AM. Conclusion: Clinicians prescribing risperidone need to consider sex, age, and weight, but not BMI when adjusting daily doses.

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“…Current limitations in development of novel treatments are certainly represented by the hazy ASD pathophysiology, as well as the paucity of clear diagnostic biomarkers and outcome measures for clinical trials (3,4). Nonetheless, the prevalence of ASD dramatically raised over the last four decades (5).…”

Section: Introductionmentioning

confidence: 99%

Omega-3 PUFAs and vitamin D co-supplementation as a safe-effective therapeutic approach for core symptoms of autism spectrum disorder: case report and literature review

Infante

Sears

Rizzo

et al. 2018

Nutritional Neuroscience

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Introduction: Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders characterized by abnormal development of cognitive, social, and communicative skills. Although ASD aetiology and pathophysiology are still unclear, various nutritional factors have been investigated as potential risk factors for ASD development, including omega-3 polyunsaturated fatty acids (PUFAs) and vitamin D deficiency. In fact, both omega-3 PUFAs and vitamin D are important for brain development and function. Case report: Herein, we report the case of a 23-year-old young adult male with autism who was referred to our Unit due to a 12 months history of cyclic episodes of restlessness, agitation, irritability, oppositional and self-injurious behaviours. Laboratory tests documented a markedly altered omega-6/omega-3 balance, along with a vitamin D deficiency, as assessed by serum levels of 25-hydroxyvitamin D. Omega-3 and vitamin D co-supplementation was therefore started, with remarkable improvements in ASD symptoms throughout a 24 months follow-up period. A brief review of the literature for interventional studies evaluating the efficacy of omega-3 or vitamin D supplementation for the treatment of ASD-related symptoms is also provided. Conclusion: To our knowledge, this is the first case reporting remarkable beneficial effects on ASD symptoms deriving from omega-3 and vitamin D combination therapy. This case report suggests omega-3 and vitamin D co-supplementation as a potential safe-effective therapeutic strategy to treat core symptoms of ASD. However, larger studies are needed to evaluate the real effectiveness of such therapeutic approach in a broader sample of ASD patients.

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Unmet needs in paediatric psychopharmacology: Present scenario and future perspectives

Cited by 57 publications

References 147 publications

A multi-national comparison of antipsychotic drug use in children and adolescents, 2005–2012

A multi-national comparison of antipsychotic drug use in children and adolescents, 2005–2012

Plasma Risperidone-related Measures in Children and Adolescents with Oppositional Defiant/Conduct Disorders

Omega-3 PUFAs and vitamin D co-supplementation as a safe-effective therapeutic approach for core symptoms of autism spectrum disorder: case report and literature review

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