ABSTRACT
Objective: Compared to the general population, the risk of suicide is three times higher in patients with epilepsy and remains doubled for these patients even after adjusting for sociodemographic correlates of suicide in the absence of mental health comorbidities. Following the United States (US) Food and Drug Administration (FDA) alert prompting a black box warning regarding the association between suicidality and antiepileptic drugs (AEDs), several studies were conducted, the results of which have been ambiguous, with some demonstrating a positive association between suicidality and AEDs, while others did not. This systematic review of literature sought to study the relationship between suicidality and AEDs when used exclusively for treatment of epilepsy. Methods: A comprehensive literature search was conducted on PubMed without time limits using a predefined search language. The search results were then subjected to a systematic screening process. Eight out of a total of 443 articles satisfying predefined inclusion and exclusion criteria were included in the review for final data extraction. Results: Three studies found a significant association between suicide-related behavior and levetiracetam use in the treatment of epilepsy. One study reported a positive association of pregabalin use in patients with epilepsy under 40 years of age and high AED load with suicidality, independent of depression. The remaining four studies reported a significant association between positive family and personal history of psychiatric comorbidities and suicidality in epilepsy. Conclusion: Although there were several methodological limitations, this review found an association between levetiracetam use and mental health comorbidities and the occurrence of suicidality in epilepsy. Larger prospective, randomized studies that overcome the limitations of current studies are required to provide definitive evidence on the occurrence of suicidality in patients with epilepsy and AED use.
ABSTRACT
Attention deficit/hyperactivity disorder (ADHD), one of the most common neurodevelopmental disorders, affected 3.3 million adolescents in the United States (US) in 2016. Ten to 30 percent of these patients do not respond to standard pharmacotherapy and, as a result, suffer adverse physical/mental health and socioeconomic consequences. Despite being approved by the US Food and Drug Administration (FDA) for treatment of adult depression, with evidence suggesting positive outcomes in children and adults in treatment of ADHD and good safety and tolerability records, there is no existent literature reviewing the efficacy, safety, and feasibility of use of transcranial magnetic stimulation (TMS) in the treatment of adolescent ADHD. Thus, We have conducted this review for which a thorough literature search was conducted on PubMed and PsycInfo databases using a combination of MeSH terms that yielded 32 articles, five of which satisfied the inclusion criteria. We observed objective improvements in ADHD treatment outcomes in adolescent patients who participated in a randomized, sham-controlled, crossover pilot study that assessed the safety and efficacy of TMS. The study participants did not suffer any major adverse events, which was also supported by findings from other studies. However, since only one study out of five included in the review is an interventional study with limited number of study participants, there is a need to conduct large-scale clinical trials that recruit a greater number of study participants to explore the clinical efficacy and safety of TMS in the treatment of adolescent ADHD patients who do not respond to or tolerate standard pharmacotherapy based on the preliminary data extracted to this end.
ABSTRACT
Social media use by minors has significantly increased and has been linked to depression and suicidality. Simultaneously, age-adjusted suicide rates have steadily increased over the past decade in the United States with suicide being the second most common cause of death in youth. Hence, the increase in suicide rate parallels the simultaneous increase in social media use. In addition, the rate of nonsuicidal self-injury ranges between 14% and 21% among young people. Evidence suggests that self-harming youth is more active on online social networks than youth who do not engage in self-harm behavior. The role of online social networking on deliberates self-harm and suicidality in adolescents with a focus on negative influence was assessed by conducting a systematized literature review. A literature search on "PubMed" and "Ovid Medline" using a combination of MeSH terms yielded nine articles for data extraction satisfying predefined inclusion/exclusion criteria. It was found that social networking websites are utilized by suicidal and self-harming youth as a medium to communicate with and to seek social support from other users. Online social networking also leads to increased exposure to and engagement in self-harm behavior due to users receiving negative messages promoting self-harm, emulating self-injurious behavior of others, and adopting self-harm practices from shared videos. Greater time spent on social networking websites led to higher psychological distress, an unmet need for mental health support, poor self-rated mental health, and increased suicidal ideation. In conclusion, greater time spent on online social networking promotes self-harm behavior and suicidal ideation in vulnerable adolescents.