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2012 American Psychiatric Association Annual Meeting

New research was presented at the American Psychiatric Association’s 165th Annual Meeting from May 5-9, 2012 in Philadelphia. The features below highlight just some of the studies that emerged from the conference. Treating Sleep Disorders Benefits Psychiatric Patients The Particulars: Research has shown that disturbances in quality and quantity of sleep can exacerbate underlying psychiatric illness. It has been hypothesized that treatment of sleep disorders might improve symptoms of psychiatric illness. Data Breakdown: Investigators reviewed the charts of patients with and without psychiatric disorders at a sleep disorders clinic. They recorded outcomes at 6, 12, and 24 months in those with comorbid psychiatric disorders. Compliance with sleep disorder treatment was compared between those with and without comorbid psychiatric illness. When compared with baseline, psychiatric status progressively improved significantly, with no differences in treatment compliance observed between the groups. Take Home Pearls: Treatment of comorbid sleep disorders in patients with comorbid psychiatric illness appears to significantly improve psychiatric disorder symptoms. Compliance with sleep disorder treatment does not appear to be affected by the presence of a psychiatric disorder. Improving Metabolic Monitoring of Patients on Antipsychotics The Particulars: Antipsychotic medications, particularly second generation antipsychotics (SGAs), have been linked to various metabolic changes that are associated with cardiovascular disease. Despite recommendations from the American Psychiatric Association and American Diabetes Association that patients on SGAs be monitored for metabolic changes, it is unknown how well these individuals are systematically monitored. Data Breakdown: At a primary care network, multiple departments monitored metabolic syndrome in patients placed on SGAs more closely. All members of these departments were educated on the morbidity associated with SGA use...

New Guidelines for Pediatric ADHD

Contributing author: Mark L. Wolraich, MD. In 2000, the American Academy of Pediatrics (AAP) released its first clinical recommendations for the diagnosis and evaluation of ADHD in children and followed that a year later with treatment recommendations. In 2011, the AAP updated these guidelines due to new evidence that has emerged in the management of children with ADHD. Important Changes to the Guidelines The AAP’s 2011 guideline update recommends that primary care physicians (PCPs) evaluate children for ADHD from age 4 through 18. The earlier version of the guidelines covered children ages 6 to 12. This change was made because of an accumulation of evidence in recent years in a broader pediatric population. Enough evidence has emerged that we now feel comfortable about the criteria being appropriate for preschoolers and adolescents. Previously, the AAP had one guideline for diagnosis and evaluation and another for treatment. Now, the academy has included diagnosis, evaluation, and treatment in a single document. The revised guideline also includes recommendations for managing pediatric patients who exhibit some signs and symptoms of ADHD but don’t meet current diagnostic criteria for the condition. This information is particularly applicable to PCPs. Furthermore, a new process-of-care algorithm has been developed to provide physicians with step-by-step guidance on implementing the recommendations, and the AAP’s ADHD toolkit has been revised based on this algorithm. Key Action Statements for Pediatric ADHD The 2011 AAP guideline includes a summary of several key action statements: PCPs should initiate an ADHD evaluation for any child aged 4 to 18 who has school or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity. Symptoms and behavior must...
4 Genes May Guide ADHD Treatment

4 Genes May Guide ADHD Treatment

Researchers found four gene variants that may be involved in vital brain signaling pathways in a subset of kids with ADHD. This discovery may aid in the development of drugs that target those pathways. It’s estimated that a half million children in this country have ADHD and these gene variants, which belong to the glutamate receptor (GMR) gene family. While the disorder tends to occur in families, scientists are still uncertain of the exact cause. Drugs prescribed for the condition may not always work, especially when symptoms are severe. In a recent study published in Nature, 1,000 children with ADHD from a database at the Children’s Hospital of Philadelphia were found to have a considerably greater number of copy number variations (CNVs) on four GMR genes, compared with 4,100 kids in the control group who did not have ADHD. The one with the strongest result was gene GMR5. Carefully selected GRM agonists could be used in human studies to determine whether they might have potential as therapies for ADHD patients with particular...

Comorbidities in ADHD

Clinical management of ADHD should address multiple comorbid conditions and manage a range of adverse functional outcomes, according to findings from a UCLA research team. Investigators found that children with ADHD were more likely to have other mental health and neurodevelopmental conditions. Parents reported that 46% of children with ADHD had a learning disability vs 5% without ADHD; 27% vs 2% had a conduct disorder; 18% vs 2% anxiety;14% vs 1% depression; and 12% vs 3% speech problems. Most children with ADHD had at least one comorbid disorder, and 18% had three or more. The study recommended that therapeutic approaches be responsive to each...
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