Assessment and treatment of anxiety disorders in children and adolescents.

Recent advances in the developmental epidemiology, neurobiology, and treatment of pediatric anxiety disorders have increased our understanding of these conditions and herald improved outcomes for affected children and adolescents. This article reviews the current epidemiology, longitudinal trajectory, and neurobiology of anxiety disorders in youth. Additionally, we summarize the current evidence for both psychotherapeutic and psychopharmacologic treatments of fear-based anxiety disorders (e.g., generalized, social, and separation anxiety disorders) in children and adolescents. Current data suggest that these disorders begin in childhood and adolescence, exhibit homotypic continuity, and increase the risk of secondary anxiety and mood disorders. Psychopharmacologic trials involving selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SSNRIs) are effective in pediatric patients with anxiety disorders and have generally demonstrated moderate effect sizes. Additionally, current data support cognitive behavioral therapy (CBT) for the treatment of these conditions in youth and suggest that the combination of psychotherapy + an SSRI may be associated with greater improvement than would be expected with either treatment as monotherapy.

Heterogeneous association between engrailed-2 and autism in the CPEA network.

Autism is a neurodevelopmental disorder characterized by an early onset of abnormal social, communicative, and repetitive behavior. Engrailed-2 (EN2) was identified as an autism candidate gene because its influence on cerebellar development in mice parallels neurodevelopmental abnormalities seen in individuals with autism. Studies investigating association between markers at EN2 (chr7q36), a location associated with language disorders, and autism reveal mixed findings. Two positive reports revealed association with two intronic SNPs. Since the associated SNPs were in high linkage disequilibrium and shared similar minor allele frequencies, we chose to test whether one of the SNPs (rs1861972) was associated with autism in three recruiting sites from the NIH Collaborative Programs of Excellence in Autism (CPEA) network. A recessive model revealed significant association with broad autism spectrum disorder. Site specific analyses indicated differential allele transmission by site, despite similar ethnicity, and parental genotypes, suggesting the SNP may contribute to various risk haplotypes. No significant association with autism was found under an additive model for either a broad (autism spectrum disorder) or a narrow (autistic disorder) diagnostic group. Although our findings were not as robust as the previous studies, they suggest that rs1861972 may influence the risk for autism spectrum disorders. Future studies investigating EN2 should consider how the association of variants in this gene with autism could be influenced by differences in phenotype and possible interactions with genotypes at other autism candidate genes.

Mitogen-activated protein kinases and retinal ischemia.

PURPOSE: Mitogen-activated protein kinases (MAPKs), consisting of three major enzymes-extracellular signal-regulated kinase (ERK), p38, and c-jun N-terminal kinase (JNK)-couple cell-surface receptors to critical regulatory targets and gene transcription. We hypothesized that MAPKs are differentially expressed and have distinct functions after retinal ischemia. METHODS: Rats were subjected to retinal ischemia by elevation of intraocular pressure. Changes in MAPK expression were examined by Western blot of whole retinal homogenates and by immunohistochemistry of retinal cryosections. Phosphorylated (activated) ERK, p38, and JNK proteins were localized by fluorescent double labeling. The functional significance of activated MAPKs was assessed using pharmacological antagonists. Specific MAPK blockade was documented by kinase assay and immunohistochemistry for phosphorylated target proteins. The outcome after ischemia was examined with electroretinography (ERG), by measuring retinal cell layer thickness in paraffin-embedded sections, and by TUNEL staining on retinal cryosections. Data were analyzed using ANOVA and post hoc t-test, with P < 0.05 considered significant. RESULTS: Expression of phosphorylated JNK and p38 increased significantly after ischemia and followed a specific time course, beginning at 1 hour, and persisting up to 1 week later. JNK and p38 were expressed in the nuclei of ganglion and amacrine cells, the outer plexiform layer, the nerve fiber layer, and the axonal terminals of bipolar cells. Phosphorylated ERK was expressed in Müller cells, peaking at 1 to 6 hours after ischemia. Blocking activation of p38 or ERK significantly improved recovery of the ERG b-wave after ischemia, dramatically decreased thinning of the inner nuclear layers, and decreased the percentage of TUNEL-positive cells. CONCLUSIONS: The MAPKs each demonstrate a specific cellular distribution after ischemia, and ERK and p38 are linked to apoptosis. Blockade of p38 or ERK provides significant protection from ischemic damage, suggesting a novel therapeutic role for MAPK inhibition in neuroprotection.