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Curr Psychiatry Rep ; 22(5): 26, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32377970


PURPOSE OF REVIEW: This paper aims to acquaint child and adolescent psychiatrists with the field of pharmacogenomics (PGX) and review the most up-to-date evidence-based practices to guide the application of this field in clinical care. RECENT FINDINGS: Despite much research being done in this area, the field of PGX continues to yield controversial findings. In the adult world, studies have focused on the impact of combinatorial gene panels that guide medication selection by providing reports that estimate the impact of multiple pharmacodynamic and pharmacokinetic genes, but to date, these have not been directly examined in younger patient populations. Pharmacokinetic genes, CYP2D6 and CYP2C19, and hypersensitivity genes, HLA-A and HLA-B, have the strongest evidence base for application to pharmacotherapy in children. Although the field is evolving, and the evidence is mixed, there may be a role for PGX testing in children to help guide dosing and monitoring strategies. However, evidence-based medicine, rather than PGX testing, continues to play the lead role in guiding medication selection in pediatric psychopharmacology.

Farmacogenética , Psiquiatria , Adolescente , Psiquiatria do Adolescente , Adulto , Criança , Citocromo P-450 CYP2D6/genética , Medicina Baseada em Evidências , Humanos
Semin Pediatr Neurol ; 23(3): 224-230, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27989330


Pediatric neurologists frequently encounter patients who present with significant musculoskeletal pain that cannot be attributed to a specific injury or illness, which can often be defined as pain amplification syndrome (PAS). PAS in children and adolescents is the result of a heightened pain sensitivity pathway, which is intensified by significant biological, psychological, and social contributors. Appropriate assessment and multimodal intervention of PAS are crucial to treatment success, including neurology and behavioral health collaborative treatment plans to restore patient function and reduce pain perception. Pediatric neurologists are imperative in the identification of patients with PAS, providing the family assurance in diagnosis and validation of pain, and directing patients to the appropriate multidisciplinary treatment pathway.

Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/terapia , Adolescente , Criança , Humanos , Dor Musculoesquelética/psicologia , Síndrome
Conn Med ; 69(9): 525-33, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16270789


This article summarizes clinical guidelines and reviews psychopharmacologic studies involving children and adolescents with Pervasive Developmental Disorders (PDDs). Strategies are drawn from basic principles of pediatric psychopharmacology, nonpharmacological approaches to the treatment of PDDs, and practical clinical experience in an attempt to provide the practitioner with an evidence-based approach to utilizing pharmacotherapy in children and adolescents with PDDs. Although early identification followed by intensive educational and behavioral interventions remains the essential treatment of PDDs, there is evidence to support the identification of target behaviors or symptom domains, for medication. Evidence-based medicine (EBM) is then used to guide pharmacotherapy with the overall goal of optimizing the benefits of multidisciplinary treatment interventions.

Transtornos Globais do Desenvolvimento Infantil/tratamento farmacológico , Transtornos Globais do Desenvolvimento Infantil/psicologia , Psicotrópicos/uso terapêutico , Adolescente , Criança , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Equipe de Assistência ao Paciente , Guias de Prática Clínica como Assunto
J Dev Behav Pediatr ; 24(2): 104-8, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12692455


This study assessed the effectiveness and tolerability of the selective serotonin reuptake inhibitor citalopram in the treatment of patients with pervasive developmental disorders (PDDs). The medical charts of 15 children and adolescents (aged 6-16 yr) with Asperger syndrome, autism, or PDD not otherwise specified treated with citalopram were retrospectively reviewed. The final dose of citalopram was 16.9 +/- 12.1 mg/day with a treatment duration of 218.8 +/- 167.2 days. Independent ratings of the Clinical Global Impression (CGI) Severity and Improvement scales allowed comparison between baseline and PDD symptoms at the last visit. Eleven adolescents (73%) exhibited significant improvement in PDD, anxiety, or mood CGI score (z = 2.95; p =.003). Anxiety symptoms associated with PDDs improved significantly in 66% of patients (z = 2.83, p =.005), and mood symptoms improved significantly in 47% of patients (z = 2.78, p =.005). Mild side effects were reported by five patients (33%). These data suggest citalopram may be effective, safe, and well tolerated as part of the treatment of PDDs.

Antidepressivos de Segunda Geração/uso terapêutico , Síndrome de Asperger/tratamento farmacológico , Transtorno Autístico/tratamento farmacológico , Transtornos Globais do Desenvolvimento Infantil/tratamento farmacológico , Citalopram/uso terapêutico , Inibidores de Captação de Serotonina/uso terapêutico , Adolescente , Antidepressivos de Segunda Geração/efeitos adversos , Síndrome de Asperger/diagnóstico , Síndrome de Asperger/psicologia , Transtorno Autístico/diagnóstico , Transtorno Autístico/psicologia , Criança , Transtornos Globais do Desenvolvimento Infantil/diagnóstico , Transtornos Globais do Desenvolvimento Infantil/psicologia , Citalopram/efeitos adversos , Quimioterapia Combinada , Feminino , Humanos , Masculino , Estudos Retrospectivos , Inibidores de Captação de Serotonina/efeitos adversos , Resultado do Tratamento