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The genetics of African populations reveals an otherwise "missing layer" of human variation that arose between 100,000 and 5 million years ago. Both the vast number of these ancient variants and the selective pressures they survived yield insights into genes responsible for complex traits in all populations.
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Evolução Biológica , População Negra/genética , África , Animais , Interação Gene-Ambiente , Variação Genética , Genética Médica , Hominidae/genética , Humanos , Esquizofrenia/epidemiologia , Esquizofrenia/genéticaRESUMO
Genes disrupted in schizophrenia may be revealed by de novo mutations in affected persons from otherwise healthy families. Furthermore, during normal brain development, genes are expressed in patterns specific to developmental stage and neuroanatomical structure. We identified de novo mutations in persons with schizophrenia and then mapped the responsible genes onto transcriptome profiles of normal human brain tissues from age 13 weeks gestation to adulthood. In the dorsolateral and ventrolateral prefrontal cortex during fetal development, genes harboring damaging de novo mutations in schizophrenia formed a network significantly enriched for transcriptional coexpression and protein interaction. The 50 genes in the network function in neuronal migration, synaptic transmission, signaling, transcriptional regulation, and transport. These results suggest that disruptions of fetal prefrontal cortical neurogenesis are critical to the pathophysiology of schizophrenia. These results also support the feasibility of integrating genomic and transcriptome analyses to map critical neurodevelopmental processes in time and space in the brain.
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Redes Reguladoras de Genes , Mutação , Córtex Pré-Frontal/embriologia , Mapas de Interação de Proteínas , Esquizofrenia/genética , Esquizofrenia/metabolismo , Encéfalo/embriologia , Encéfalo/crescimento & desenvolvimento , Encéfalo/metabolismo , Análise Mutacional de DNA , Bases de Dados Genéticas , Feminino , Humanos , Masculino , Neurogênese , Córtex Pré-Frontal/crescimento & desenvolvimento , Córtex Pré-Frontal/metabolismo , Esquizofrenia/fisiopatologia , Transcrição Gênica , TranscriptomaRESUMO
RING1 is an E3-ubiquitin ligase that is involved in epigenetic control of transcription during development. It is a component of the polycomb repressive complex 1, and its role in that complex is to ubiquitylate histone H2A. In a 13-year-old girl with syndromic neurodevelopmental disabilities, we identified a de novo mutation, RING1 p.R95Q, which alters a conserved arginine residue in the catalytic RING domain. In vitro assays demonstrated that the mutant RING1 retains capacity to catalyze ubiquitin chain formation, but is defective in its ability to ubiquitylate histone H2A in nucleosomes. Consistent with this in vitro effect, cells of the patient showed decreased monoubiquitylation of histone H2A. We modeled the mutant RING1 in Caenorhabditis elegans by editing the comparable amino acid change into spat-3, the suggested RING1 ortholog. Animals with either the missense mutation or complete knockout of spat-3 were defective in monoubiquitylation of histone H2A and had defects in neuronal migration and axon guidance. Relevant to our patient, animals heterozygous for either the missense or knockout allele also showed neuronal defects. Our results support three conclusions: mutation of RING1 is the likely cause of a human neurodevelopmental syndrome, mutation of RING1 can disrupt histone H2A ubiquitylation without disrupting RING1 catalytic activity, and the comparable mutation in C. elegans spat-3 both recapitulates the effects on histone H2A ubiquitylation and leads to neurodevelopmental abnormalities. This role for RING1 adds to our understanding of the importance of aberrant epigenetic effects as causes of human neurodevelopmental disorders.
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Caenorhabditis elegans/crescimento & desenvolvimento , Epigênese Genética , Regulação da Expressão Gênica no Desenvolvimento , Mutação , Transtornos do Neurodesenvolvimento/genética , Complexo Repressor Polycomb 1/genética , Sequência de Aminoácidos , Animais , Caenorhabditis elegans/genética , Estudos de Casos e Controles , Histonas/genética , Histonas/metabolismo , Humanos , Transtornos do Neurodesenvolvimento/patologia , Nucleossomos/metabolismo , Ubiquitina/metabolismo , Ubiquitina-Proteína Ligases/metabolismo , UbiquitinaçãoRESUMO
Chimeric genes can be caused by structural genomic rearrangements that fuse together portions of two different genes to create a novel gene. We hypothesize that brain-expressed chimeras may contribute to schizophrenia. Individuals with schizophrenia and control individuals were screened genome wide for copy-number variants (CNVs) that disrupted two genes on the same DNA strand. Candidate events were filtered for predicted brain expression and for frequency < 0.001 in an independent series of 20,000 controls. Four of 124 affected individuals and zero of 290 control individuals harbored such events (p = 0.002); a 47 kb duplication disrupted MATK and ZFR2, a 58 kb duplication disrupted PLEKHD1 and SLC39A9, a 121 kb duplication disrupted DNAJA2 and NETO2, and a 150 kb deletion disrupted MAP3K3 and DDX42. Each fusion produced a stable protein when exogenously expressed in cultured cells. We examined whether these chimeras differed from their parent genes in localization, regulation, or function. Subcellular localizations of DNAJA2-NETO2 and MAP3K3-DDX42 differed from their parent genes. On the basis of the expression profile of the MATK promoter, MATK-ZFR2 is likely to be far more highly expressed in the brain during development than the ZFR2 parent gene. MATK-ZFR2 includes a ZFR2-derived isoform that we demonstrate localizes preferentially to neuronal dendritic branch sites. These results suggest that the formation of chimeric genes is a mechanism by which CNVs contribute to schizophrenia and that, by interfering with parent gene function, chimeras may disrupt critical brain processes, including neurogenesis, neuronal differentiation, and dendritic arborization.
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Variações do Número de Cópias de DNA , Genoma Humano , Proteínas Mutantes Quiméricas/genética , Esquizofrenia/genética , Adolescente , Adulto , Encéfalo/embriologia , Encéfalo/metabolismo , Encéfalo/fisiologia , Estudos de Casos e Controles , Linhagem Celular , Criança , Deleção de Genes , Genes Duplicados , Predisposição Genética para Doença , Células HEK293 , Humanos , RNA Mensageiro/genética , Adulto JovemRESUMO
The forces of evolution-mutation, selection, migration, and genetic drift-shape the genetic architecture of human traits, including the genetic architecture of complex neuropsychiatric illnesses. Studying these illnesses in populations that are diverse in genetic ancestry, historical demography, and cultural history can reveal how evolutionary forces have guided adaptation over time and place. A fundamental truth of shared human biology is that an allele responsible for a disease in anyone, anywhere, reveals a gene critical to the normal biology underlying that condition in everyone, everywhere. Understanding the genetic causes of neuropsychiatric disease in the widest possible range of human populations thus yields the greatest possible range of insight into genes critical to human brain development. In this perspective, we explore some of the relationships between genes, adaptation, and history that can be illuminated by an evolutionary perspective on studies of complex neuropsychiatric disease in diverse populations.
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Transtornos Mentais , Mutação , Humanos , Transtornos Mentais/genéticaAssuntos
Síndrome de Capgras , Adolescente , Encéfalo , Delusões , Humanos , Imageamento por Ressonância Magnética , NeuroanatomiaRESUMO
OBJECTIVE: The accepted primary outcome measure for evaluating psychotic symptoms is decades old, long, and initially designed for adults. Surprisingly, the psychometric properties of primary outcome measures have never been reported for a pediatric sample using modern methods. The present study's aim is to use a pediatric sample to evaluate the psychometrics of the most used primary outcome measure in pediatric schizophrenia trials, the Positive and Negative Syndrome Scale (PANSS). METHOD: To evaluate the factor structure, item characteristics, and treatment sensitivity of the PANSS in a pediatric sample, secondary analyses of PANSS data at baseline and weekly throughout an 8-week randomized double-blind study of 3 antipsychotic agents (registered and previously published) were conducted. Subjects were 118 youths receiving outpatient psychiatric treatment for schizophrenia spectrum disorders (mean age = 14.26 years, SD = 2.41 years). RESULTS: A 10-item short form, keeping 2 strongest items for each factor, had r = 0.89 with the full-length scale. Each of the five 2-item subscales has alphas ranging from 0.66 to 0.84. Item Response Theory (IRT) found that the 10-item scale and 2-item subscores had high reliability across the severity range typical of those for clinical trials. Criterion validity was high, with equal sensitivity to clinical changes over time. CONCLUSION: A 10-item PANSS version eliminates weaker items in the pediatric population while preserving coverage of 5 factors and similar sensitivity to clinical changes over time. It thus may be more appropriate for subsequent pediatric trials, and for clinical use when time and efficiency are paramount.
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Antipsicóticos , Transtornos Psicóticos , Esquizofrenia , Adulto , Adolescente , Humanos , Criança , Reprodutibilidade dos Testes , Esquizofrenia/diagnóstico , Esquizofrenia/tratamento farmacológico , Esquizofrenia/epidemiologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/psicologia , Antipsicóticos/uso terapêutico , Psicometria , Escalas de Graduação PsiquiátricaRESUMO
OBJECTIVE: Impairing emotional outbursts, defined by extreme anger or distress in response to relatively ordinary frustrations and disappointments, impact all mental health care systems, emergency departments, schools, and juvenile justice programs. However, the prevalence, outcome, and impact of outbursts are difficult to quantify because they are transdiagnostic and not explicitly defined by current diagnostic nosology. Research variably addresses outbursts under the rubrics of tantrums, anger, irritability, aggression, rage attacks, or emotional and behavioral dysregulation. Consistent methods for identifying and assessing impairing emotional outbursts across development or systems of care are lacking. METHOD: The American Academy of Child and Adolescent Psychiatry Presidential Task Force (2019-2021) conducted a narrative review addressing impairing emotional outbursts within the limitations of the existing literature and independent of diagnosis. RESULTS: Extrapolating from the existing literature, best estimates suggest that outbursts occur in 4%-10% of community children (preschoolers through adolescents). Impairing emotional outbursts may respond to successful treatment of the primary disorder, especially for some children with attention-deficit/hyperactivity disorder whose medications have been optimized. However, outbursts are generally multi-determined and often represent maladaptive or deficient coping strategies and responses. CONCLUSION: Evidence-based strategies are necessary to address factors that trigger, reinforce, or excuse the behaviors and to enhance problem-solving skills. Currently available interventions yield only modest effect sizes for treatment effect. More specific definitions and measures are needed to track and quantify outbursts and to design and assess the effectiveness of interventions. Better treatments are clearly needed.
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Transtorno do Deficit de Atenção com Hiperatividade , Transtornos do Humor , Criança , Adolescente , Humanos , Transtornos do Humor/epidemiologia , Ira , Agressão/psicologia , Humor IrritávelRESUMO
Severe neuropsychiatric disorders are so genetically heterogeneous that virtually every unrelated patient harbors different clinically significant alleles. By studying schizophrenia in the Ashkenazi Jewish founder population, Lencz and co-authors identified rare severe alleles each shared by a few patients. Experimental evaluation of an implicated protocadherin allele revealed failure to form homophilic cellular aggregates as a possible mechanism for defective development of neural circuits.
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Esquizofrenia , Alelos , Caderinas , Frequência do Gene , Humanos , Judeus , Esquizofrenia/genéticaRESUMO
OBJECTIVE: Large-scale studies have revolutionized biomedical research, and neurocognitive tests can help elucidate the biological basis of neuropsychiatric diseases. However, studies have predominantly been conducted in Western settings. We describe the development and validation of a computerized battery (PennCNB) with the Xhosa population of South Africa. METHOD: Individuals with schizophrenia (n = 525) and a normative comparison group (n = 744) were balanced on age, sex, education, and region. Participants provided blood samples, were assessed psychiatrically, and were administered a PennCNB translation to isiXhosa, including measures of executive functions, episodic memory, complex cognition, social cognition, and sensorimotor speed. Feasibility was examined with test completion rates and input from administrators, and psychometric structural validity and associations with clinical and demographic characteristics were examined. RESULTS: Tests were well tolerated by participants, as >87% had one (or fewer) test missing. Results suggested a similar factor structure to prior PennCNB studies in Western contexts, and expected age and sex effects were apparent. Furthermore, a similar profile of schizophrenia was observed, with neurocognitive deficits most pronounced for executive functions, especially attention, as well as memory, social cognition, and motor speed relative to complex cognition and sensorimotor speed. CONCLUSIONS: Results support the feasibility of implementing a culturally adapted computerized neurocognitive battery in sub-Saharan African settings and provide evidence supporting the concurrent validity of the translated instrument. Thus, the PennCNB is implementable on a large scale in non-Western contexts, shows expected factor structure, and can detect cognitive deficits associated with neuropsychiatric disorders. Obtaining valid measures of cognition by nonspecialized proctors is especially suitable in resource-limited settings, where traditional testing is prohibitive. Future work should establish normative standards, test-retest reliability, and sensitivity to treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Cognição , Função Executiva , Humanos , Testes Neuropsicológicos , Reprodutibilidade dos Testes , África do SulRESUMO
BACKGROUND: In adolescents and adults, bipolar disorder (BD) is associated with significant morbidity, mortality, and impairment in psychosocial and occupational functioning. IPSRT is an empirically supported adjunctive psychotherapy for adults with bipolar disorder, which has been shown to help delay relapse, speed recovery from a bipolar depressive episode, and increase occupational and psychosocial functioning in adults with BD. This study is designed to describe the adolescent-specific developmental adaptations made to IPSRT (i.e., IPSRT-A) and to report the results from an open trial of IPSRT-A with 12 adolescents with a bipolar spectrum disorder. METHOD: Interpersonal and Social Rhythm Therapy was adapted to be developmentally relevant to adolescents with bipolar disorder. Twelve adolescents (mean age 16.5+/-1.3 years) diagnosed with a bipolar spectrum disorder participated in 16-18 sessions of adjunctive IPSRT-A over 20 weeks. Manic, depressive, and general symptoms and global functioning were measured at baseline, monthly during treatment, and at post-treatment. Adolescent satisfaction with treatment was also measured. RESULTS: Feasibility and acceptability of IPSRT-A were high; 11/12 participants completed treatment, 97% of sessions were attended, and adolescent-rated satisfaction scores were high. IPSRT-A participants experienced significant decreases in manic, depressive, and general psychiatric symptoms over the 20 weeks of treatment. Participants' global functioning increased significantly as well. Effect sizes ranged from medium-large to large. CONCLUSIONS: IPSRT-A appears to be a promising adjunctive treatment for adolescents with bipolar disorder. A current randomized controlled trial is underway to examine effects of adjunctive IPSRT-A on psychiatric symptoms and psychosocial functioning.
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Transtorno Bipolar/terapia , Relações Interpessoais , Psicoterapia/métodos , Adaptação Psicológica , Adolescente , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Satisfação do Paciente , PsicologiaRESUMO
BACKGROUND: There is a paucity of research investigating psychosocial treatments for youth receiving long-term residential care. OBJECTIVE: This study describes the implementation and impact of dialectical behavioural therapy (DBT) in a long-term psychiatric hospital located in the United States of America. METHOD: Changes in overall functioning, number of psychotropic medications prescribed, non-suicidal self-injurious behaviour (NSIB), and locked seclusions were investigated in 106 consecutive unique adolescent patients who received DBT. In addition, a comparison group of historical controls was used to examine the effect of DBT in youth with the highest rates of NSIB. RESULTS: A statistically significant increase in overall functioning, as well as a decrease in number of psychotropic medications and non-suicidal self-injurious behaviour (NSIB) was observed within the DBT group. A decrease in locked seclusions was not observed. Accounting for the effects of age, gender, length of stay, and time, youth who received DBT were less likely to engage in NSIB relative to historical controls. CONCLUSIONS: These preliminary data suggest that DBT is beneficial for youth with NSIB in long term inpatient psychiatric care.
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AIM: The primary aim of this study was to examine the effect of recent tobacco, alcohol and cannabis use on treatment outcomes among participants experiencing first episode psychosis (FEP). METHODS: Secondary data analyses were conducted on 404 participants enrolled in the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study. RAISE-ETP investigated the effectiveness of a coordinated specialty care (CSC) intervention for FEP in community mental health agencies in the United States. Generalized estimating equations were used to examine whether recent tobacco smoking, alcohol, and cannabis use at baseline were associated with illness severity, number of antipsychotic pills missed, psychiatric symptoms and quality of life during the 24-month treatment period, after controlling for duration of untreated psychosis and treatment group. RESULTS: At baseline, roughly 50% (n = 209) of participants reported recent tobacco, 28% (n = 113) alcohol and 24% (n = 95) cannabis use. Tobacco smokers had higher levels of illness severity (ß = .24; P < .005), a higher number of missed pills (ß = 2.89; P < .05), higher psychiatric symptoms and lower quality of life during treatment relative to non-smokers. Alcohol users had a higher number of missed pills (ß = 3.16; P < .05) during treatment and cannabis users had higher levels of illness severity (ß = .18; P < .05) and positive symptoms (ß = 1.56; P < .05) relative to non-users. CONCLUSIONS: Tobacco, alcohol and cannabis use are common in youth seeking treatment for FEP. Tobacco smoking was associated with more negative clinical outcomes. These findings have implications for including interventions targeting these areas of substance use within current CSC models.
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Consumo de Bebidas Alcoólicas/psicologia , Fumar Maconha/psicologia , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/psicologia , Uso de Tabaco/psicologia , Adolescente , Adulto , Intervenção Médica Precoce/métodos , Feminino , Humanos , Masculino , Qualidade de Vida , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
Early-onset schizophrenia-spectrum (EOSS) disorders (onset of psychotic symptoms before 18 years of age) represent a severe variant associated with significant chronic functional impairment and poor response to antipsychotic treatment. All drugs with proven antipsychotic effects block dopamine D(2) receptors to some degree. The ongoing development of the dopamine and other neurotransmitter receptor systems during childhood and adolescence may affect clinical response and susceptibility to side effects in youth. A literature search was conducted of clinical trials of antipsychotics in children and adolescents with EOSS disorders between 1980 and 2007 from the Medline database, reference lists, and conference proceedings. Trials were limited to double-blind studies of duration of 4 or more weeks that included 15 or more patients. Ten clinical trials were identified. Antipsychotic medications were consistently found to reduce the severity of psychotic symptoms in children and adolescents when compared with placebo. The superiority of clozapine has been now demonstrated relative to haloperidol, standard-dose olanzapine, and "high-dose" olanzapine for EOSS disorders. However, limited comparative data are available regarding whether there are differences among the remaining second-generation antipsychotics (SGAs) in clinical effectiveness. The available data from short-term studies suggest that youth might be more sensitive than adults to developing antipsychotic-related adverse side effects (eg, extrapyramidal side effects, sedation, prolactin elevation, weight gain). In addition, preliminary data suggest that SGA use can lead to the development of diabetes in some youth, a disease which itself carries with it significant morbidity and mortality. Such a substantial risk points to the urgent need to develop therapeutic strategies to prevent and/or mitigate weight gain and diabetes early in the course of treatment in this population.
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Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Clozapina/efeitos adversos , Haloperidol/efeitos adversos , Esquizofrenia Infantil/tratamento farmacológico , Antipsicóticos/uso terapêutico , Doenças dos Gânglios da Base/induzido quimicamente , Doenças dos Gânglios da Base/epidemiologia , Benzodiazepinas/uso terapêutico , Clozapina/uso terapêutico , Distúrbios do Sono por Sonolência Excessiva/induzido quimicamente , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Haloperidol/uso terapêutico , Humanos , Olanzapina , Prolactina/biossíntese , Prolactina/sangue , Resultado do Tratamento , Aumento de Peso/efeitos dos fármacosRESUMO
This Viewpoint discusses the important role pediatricians play in assessment, prevention, and early intervention for children who display impairing emotional outbursts.
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Transtornos do Humor , HumanosRESUMO
OBJECTIVE: This study examined racial and ethnic differences in treatment outcomes among participants in a randomized controlled trial of an intervention for first-episode psychosis called NAVIGATE. METHODS: Secondary data analyses were conducted for participants randomly assigned to usual community care (N=181) and NAVIGATE (N=223). Generalized estimating equations assessed whether race and ethnicity were associated with psychiatric symptoms and service use (medication management, family psychoeducation, and individual therapy) over a 24-month treatment period, accounting for baseline symptoms, duration of untreated psychosis, and insurance status. RESULTS: Among persons in usual community care, non-Hispanic blacks scored significantly higher throughout treatment on measures of positive symptoms (ß=2.15, p=.010), disorganized thoughts (ß=1.15, p=.033), and uncontrolled hostility (ß=.74, p=.027), compared with non-Hispanic whites, and non-Hispanic blacks were less likely than non-Hispanic whites to receive individual therapy (OR=.45, p=.001). Families of Hispanic participants in usual community care were less likely than non-Hispanic white families to receive family psychoeducation (OR=.20, p=.01). For NAVIGATE participants, race and ethnicity were not associated with differences in psychiatric symptoms over time; families of non-Hispanic black participants were less likely than those of non-Hispanic white participants to receive family psychoeducation (OR=.53, p=.009). Hispanic participants in NAVIGATE were more likely than non-Hispanic white participants to receive medication management (OR=2.93, p=.001). CONCLUSIONS: In usual community care, non-Hispanic blacks scored higher on measures of psychiatric symptoms and were less likely to receive important services, compared with non-Hispanic whites. In NAVIGATE, racial and ethnic differences in psychiatric symptoms were not evident, although non-Hispanic blacks were less likely than non-Hispanic whites to receive family psychoeducation.
Assuntos
Negro ou Afro-Americano/etnologia , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Psicoterapia/estatística & dados numéricos , Transtornos Psicóticos/terapia , Esquizofrenia/etnologia , Esquizofrenia/terapia , Adulto , Informação de Saúde ao Consumidor/estatística & dados numéricos , Família , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Transtornos Psicóticos/etnologia , População Branca/etnologia , Adulto JovemRESUMO
The diagnosis of psychotic disorders in children and adolescents is often complex and challenging. The symptomatic overlap between different psychotic conditions and other emotional, behavioral, and developmental disorders has led to high rates of misdiagnosis, especially at time of onset. The clinical expression and progression of diagnosable disorders are affected by maturational processes. Thus, psychotic illnesses in pediatric patients may vary from adult presentations because of developmental factors. Establishing a specific diagnosis is difficult when the differential diagnosis comprises disorders that share common symptoms and are frequently comorbid. The clinical assessment depends as much on input from parents and teachers as from the patients themselves, and there may be conflict between these different perceptions. This article reviews recent research and current concepts relating to diagnostic challenges in pediatric psychiatry.
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Transtornos Psicóticos/diagnóstico , Adolescente , Fatores Etários , Criança , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/epidemiologia , Comorbidade , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Masculino , Inventário de Personalidade , Escalas de Graduação Psiquiátrica , Psicometria/instrumentação , Psicometria/métodos , Transtornos Psicóticos/classificação , Transtornos Psicóticos/epidemiologia , Índice de Gravidade de Doença , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
OBJECTIVE: To provide a list of evidence-based psychopharmacology and psychotherapy treatments for child psychiatry. METHOD: Published reviews and Medline searches were examined to generate a list of treatments supported by randomized controlled trials. RESULTS: For psychopharmacology, the best evidence to date supports the use of stimulant medications for attention-deficit/hyperactivity disorder and selective serotonin reuptake inhibitors (SSRIs) for obsessive-compulsive disorder. There is also reasonable evidence addressing SSRIs for anxiety disorders and moderate to severe major depressive disorder, and risperidone for autism. The psychosocial interventions best supported by well-designed studies are cognitive-behavioral and behavioral interventions, especially for mood, anxiety, and behavioral disorders. Family-based and systems of care interventions also have been found effective. CONCLUSIONS: Although the number of evidence-based treatments for child psychiatry is growing, much of clinical practice remains based on the adult literature and traditional models of care. Challenges toward adopting evidence-based practices are discussed.
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Psiquiatria do Adolescente , Psiquiatria Infantil , Medicina Baseada em Evidências , Psicoterapia/tendências , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Criança , Ensaios Clínicos como Assunto , Depressão/tratamento farmacológico , Humanos , Transtorno Obsessivo-Compulsivo/tratamento farmacológicoRESUMO
Psychosis in children and adolescents is a relatively rare entity, with a plethora of possible origins. Appropriate evaluation and treatment can stem only from a complete understanding of the differential diagnosis of psychotic presentations in children. Once the acute presentation is stabilized and the cause for the psychosis accurately identified, the child can be referred appropriately to ongoing psychiatric care or substance abuse treatment, or he or she can be handed over to another medical specialty to further treat the underlying cause when there is a medical cause for the psychosis.