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Role of depression in first-episode psychosis clarified
Patients with postpsychotic depression may experience a longer period of untreated psychosis and feel greater shame, less control, and a greater sense of loss related to their illness, a study showed.
Depression during acute psychosis is associated most with prodromal depression, malevolence in voices, safety behaviors, and feelings of entrapment, the researchers reported.
To better understand depression with psychosis, Dr. Rachel Upthegrove of the University of Birmingham (England) and her associates assessed 92 patients, average age 22, presenting at the Birmingham Early Intervention Service with first-episode psychosis (FEP) and no history of treated psychosis. Of the participants 75% were male, and 70% met diagnostic criteria for schizophrenia, with a mean Positive and Negative Syndrome Scale (PANSS) positive score of 18.84. All but 10 were assessed at a 12-month follow-up.
Among the information gathered at baseline was lifetime diagnosis; the severity of current psychotic symptoms based on the PANSS; the duration of untreated psychosis; depression symptoms in the 6 months before FEP; acute depression symptoms based on the Calgary Depression Scale for Schizophrenia (CDSS); and feedback from the Personal Beliefs About Illness Questionnaire (PBIQ-R).
Additional information gathered involved beliefs about auditory hallucinations (malevolence, benevolence, and omnipotence); the perceived power of voices; characteristics of the experienced threat; and safety behaviors.
In the 6 months leading up to FEP, 56% of the participants had had a depressive episode, and during acute psychosis, 59% had a moderate or severe depression, 63% of whom had prodromal depression. At the 12-month follow-up, participants again were assessed with instruments including the CDSS, PANSS, and PBIQ-R. All but four (excluded) patients were in postpsychosis, and 37% had postpsychotic depression (Psychiatry Res. 2014 April 14 [doi:10.1016/j.psychres.2014.03.023]).
Overall, 22% of participants were depressed before, during, and after psychosis; 17% were depressed only during prodromal and acute phases; 20% had acute phase depression but not prodromal depression; 20% never experienced depression; and 5% had only postpsychotic depression.
During acute psychosis, PANSS scores among depressed and nondepressed patients were similar, but those with depression who heard voices perceived greater malevolence and less benevolence in the voices, and had greater engagement with the voices than did those who weren’t depressed but heard voices. Depressed patients also used more safety behaviors and "reported more powerful persecutors ... and were more distressed by the threat from persecutors than those who were not depressed," he said. Although overall insight scores were similar among depressed and nondepressed participants, depressed patients had greater awareness of their illness and greater negative illness appraisals.
Patients with postpsychotic depression had a longer duration of untreated psychosis, higher current low-level PANSS positive scores, and higher control, shame, and loss subscale scores on the PBIQ-R, compared with nondepressed patients post psychosis.
Dr. Upthegrove cited several limitations of the study. For example, data on the participants’ use of antidepressants were not recorded and might have affected the prevalence of depression. Also, the researchers who administered the semistructured interviews "were not blinded to baseline results, and thus there is ... a potential bias here." However, most key measures were self-reported, and this would minimize that potential effect, they wrote.
No outside funding source was noted, and the authors reported no disclosures.
Patients with postpsychotic depression may experience a longer period of untreated psychosis and feel greater shame, less control, and a greater sense of loss related to their illness, a study showed.
Depression during acute psychosis is associated most with prodromal depression, malevolence in voices, safety behaviors, and feelings of entrapment, the researchers reported.
To better understand depression with psychosis, Dr. Rachel Upthegrove of the University of Birmingham (England) and her associates assessed 92 patients, average age 22, presenting at the Birmingham Early Intervention Service with first-episode psychosis (FEP) and no history of treated psychosis. Of the participants 75% were male, and 70% met diagnostic criteria for schizophrenia, with a mean Positive and Negative Syndrome Scale (PANSS) positive score of 18.84. All but 10 were assessed at a 12-month follow-up.
Among the information gathered at baseline was lifetime diagnosis; the severity of current psychotic symptoms based on the PANSS; the duration of untreated psychosis; depression symptoms in the 6 months before FEP; acute depression symptoms based on the Calgary Depression Scale for Schizophrenia (CDSS); and feedback from the Personal Beliefs About Illness Questionnaire (PBIQ-R).
Additional information gathered involved beliefs about auditory hallucinations (malevolence, benevolence, and omnipotence); the perceived power of voices; characteristics of the experienced threat; and safety behaviors.
In the 6 months leading up to FEP, 56% of the participants had had a depressive episode, and during acute psychosis, 59% had a moderate or severe depression, 63% of whom had prodromal depression. At the 12-month follow-up, participants again were assessed with instruments including the CDSS, PANSS, and PBIQ-R. All but four (excluded) patients were in postpsychosis, and 37% had postpsychotic depression (Psychiatry Res. 2014 April 14 [doi:10.1016/j.psychres.2014.03.023]).
Overall, 22% of participants were depressed before, during, and after psychosis; 17% were depressed only during prodromal and acute phases; 20% had acute phase depression but not prodromal depression; 20% never experienced depression; and 5% had only postpsychotic depression.
During acute psychosis, PANSS scores among depressed and nondepressed patients were similar, but those with depression who heard voices perceived greater malevolence and less benevolence in the voices, and had greater engagement with the voices than did those who weren’t depressed but heard voices. Depressed patients also used more safety behaviors and "reported more powerful persecutors ... and were more distressed by the threat from persecutors than those who were not depressed," he said. Although overall insight scores were similar among depressed and nondepressed participants, depressed patients had greater awareness of their illness and greater negative illness appraisals.
Patients with postpsychotic depression had a longer duration of untreated psychosis, higher current low-level PANSS positive scores, and higher control, shame, and loss subscale scores on the PBIQ-R, compared with nondepressed patients post psychosis.
Dr. Upthegrove cited several limitations of the study. For example, data on the participants’ use of antidepressants were not recorded and might have affected the prevalence of depression. Also, the researchers who administered the semistructured interviews "were not blinded to baseline results, and thus there is ... a potential bias here." However, most key measures were self-reported, and this would minimize that potential effect, they wrote.
No outside funding source was noted, and the authors reported no disclosures.
Patients with postpsychotic depression may experience a longer period of untreated psychosis and feel greater shame, less control, and a greater sense of loss related to their illness, a study showed.
Depression during acute psychosis is associated most with prodromal depression, malevolence in voices, safety behaviors, and feelings of entrapment, the researchers reported.
To better understand depression with psychosis, Dr. Rachel Upthegrove of the University of Birmingham (England) and her associates assessed 92 patients, average age 22, presenting at the Birmingham Early Intervention Service with first-episode psychosis (FEP) and no history of treated psychosis. Of the participants 75% were male, and 70% met diagnostic criteria for schizophrenia, with a mean Positive and Negative Syndrome Scale (PANSS) positive score of 18.84. All but 10 were assessed at a 12-month follow-up.
Among the information gathered at baseline was lifetime diagnosis; the severity of current psychotic symptoms based on the PANSS; the duration of untreated psychosis; depression symptoms in the 6 months before FEP; acute depression symptoms based on the Calgary Depression Scale for Schizophrenia (CDSS); and feedback from the Personal Beliefs About Illness Questionnaire (PBIQ-R).
Additional information gathered involved beliefs about auditory hallucinations (malevolence, benevolence, and omnipotence); the perceived power of voices; characteristics of the experienced threat; and safety behaviors.
In the 6 months leading up to FEP, 56% of the participants had had a depressive episode, and during acute psychosis, 59% had a moderate or severe depression, 63% of whom had prodromal depression. At the 12-month follow-up, participants again were assessed with instruments including the CDSS, PANSS, and PBIQ-R. All but four (excluded) patients were in postpsychosis, and 37% had postpsychotic depression (Psychiatry Res. 2014 April 14 [doi:10.1016/j.psychres.2014.03.023]).
Overall, 22% of participants were depressed before, during, and after psychosis; 17% were depressed only during prodromal and acute phases; 20% had acute phase depression but not prodromal depression; 20% never experienced depression; and 5% had only postpsychotic depression.
During acute psychosis, PANSS scores among depressed and nondepressed patients were similar, but those with depression who heard voices perceived greater malevolence and less benevolence in the voices, and had greater engagement with the voices than did those who weren’t depressed but heard voices. Depressed patients also used more safety behaviors and "reported more powerful persecutors ... and were more distressed by the threat from persecutors than those who were not depressed," he said. Although overall insight scores were similar among depressed and nondepressed participants, depressed patients had greater awareness of their illness and greater negative illness appraisals.
Patients with postpsychotic depression had a longer duration of untreated psychosis, higher current low-level PANSS positive scores, and higher control, shame, and loss subscale scores on the PBIQ-R, compared with nondepressed patients post psychosis.
Dr. Upthegrove cited several limitations of the study. For example, data on the participants’ use of antidepressants were not recorded and might have affected the prevalence of depression. Also, the researchers who administered the semistructured interviews "were not blinded to baseline results, and thus there is ... a potential bias here." However, most key measures were self-reported, and this would minimize that potential effect, they wrote.
No outside funding source was noted, and the authors reported no disclosures.
FROM PSYCHIATRY RESEARCH
Key clinical point: Patients with acute, early phases of psychosis have a significant risk of suicide. Cognitive therapies can help these patients.
Major finding: The most significant variables associated with depression during acute psychosis were prodromal depression, voice malevolence, safety behaviors, and entrapment feelings; the most significant variables associated with postpsychotic depression were the duration of untreated psychosis and feelings of loss.
Data source: Interviews and questionnaires with 92 treatment-naive patients with first-episode psychosis.
Disclosures: No outside funding source was noted, and the authors reported no disclosures.
Impaired imitation ability may help explain social deficits in schizophrenia
One contribution to the characteristic social impairment in schizophrenia might be an impaired ability to imitate the actions of others, a recent study suggests.
Using functional magnetic resonance imaging (fMRI) comparisons between healthy and schizophrenia participants’ brains, Katharine N. Thakkar, Ph.D., and her associates at Vanderbilt University in Nashville, Tenn., identified reduced activity among the schizophrenia patients in the parts of the brain involved with the "mirror neuron" network, which is partly responsible for imitation activities.
"Our results indicate abnormal neural activity during action imitation and observation in patients with schizophrenia," Dr. Thakkar and her coauthors reported (Am. J. Psychiatry 2014;171:539-548).
In earlier primate studies, researchers previously identified a network of mirror neurons in the human brain that receive information from the posterior superior temporal sulcus and operate in the temporoparietal and frontal regions. The researchers therefore compared the fMRI brain images of 16 medicated schizophrenia patients to the brain images of 16 healthy comparison controls, matched in age, sex, IQ, and handedness.
During the experiment, the subjects were expected to press one of three buttons based on each of three different visual cues: a video with a hand pressing a button (imitation), a still image with a pointing hand (nonimitative action), and a diagram (nonimitative action). The subjects also observed these visual cues without pressing the buttons to provide brain activity data during biological motion perception.
The results showed reduced activity in the posterior superior temporal sulcus during both imitation and action observation in the schizophrenia patients, compared with the healthy controls. Meanwhile, during nonimitative action, the schizophrenia patients showed greater activity than the healthy controls in the posterior superior temporal sulcus and in the inferior parietal lobe. Patients with a lower score on the Brief Psychiatric Rating Scale showed greater activity in the right posterior superior temporal sulcus during action imitation, and those with a lower Scale for the Assessment of Negative Symptoms score showed greater activity in the right inferior parietal lobe during nonimitative action.
Dr. Thakkar and her associates cited several limitations of their study. For example, the patients with schizophrenia were medicated, and the effects of antipsychotic medication on imitation are unknown. However, the investigators did find that "brain activation in patients with higher medication dosages looked more like that of healthy subjects."
Together, the findings point to cognitive deficits in the ability to observe and imitate others in those with schizophrenia. Action imitation is regarded as a "building block of social cognition," at the root of "the ability to interpret the minds of others," the authors wrote.
The study was supported by the National Institute of Mental Health, a Netherlands Organization for Scientific Research Rubicon grant, and the National Center for Research Resources. The authors reported no disclosures.
"These findings are similar to reports over the past two decades in studies of neurocognitive functioning using much more complex procedures. There too, the findings suggested underactivation of important regions defined by the brain functioning of healthy individuals during task performance and overactivation of regions that appear less relevant to the task immediately at hand.
"As people with schizophrenia commonly have major social problems, understanding their origin, both neurobiological and behavioral, is critically important. Many higher-level social skills are learned through observation and imitation. From the beginning, infants learn many skills through imitation, starting with basic motor skills learned in the preverbal period.
"This paper presents critical data suggesting that the basic neurobiological processes of observation and imitation of others may be deficient in people with schizophrenia, with many higher levels impacted in a bottom-to-top manner. As a result, these findings have the potential to have identified the first step in the cascade of poor social functioning in schizophrenia: the inability to learn through basic observational and imitative processes."
Philip D. Harvey, Ph.D., is professor of psychiatry and behavioral sciences at the University of Miami. These comments were adapted from his editorial in the May issue of the American Journal of Psychiatry.
"These findings are similar to reports over the past two decades in studies of neurocognitive functioning using much more complex procedures. There too, the findings suggested underactivation of important regions defined by the brain functioning of healthy individuals during task performance and overactivation of regions that appear less relevant to the task immediately at hand.
"As people with schizophrenia commonly have major social problems, understanding their origin, both neurobiological and behavioral, is critically important. Many higher-level social skills are learned through observation and imitation. From the beginning, infants learn many skills through imitation, starting with basic motor skills learned in the preverbal period.
"This paper presents critical data suggesting that the basic neurobiological processes of observation and imitation of others may be deficient in people with schizophrenia, with many higher levels impacted in a bottom-to-top manner. As a result, these findings have the potential to have identified the first step in the cascade of poor social functioning in schizophrenia: the inability to learn through basic observational and imitative processes."
Philip D. Harvey, Ph.D., is professor of psychiatry and behavioral sciences at the University of Miami. These comments were adapted from his editorial in the May issue of the American Journal of Psychiatry.
"These findings are similar to reports over the past two decades in studies of neurocognitive functioning using much more complex procedures. There too, the findings suggested underactivation of important regions defined by the brain functioning of healthy individuals during task performance and overactivation of regions that appear less relevant to the task immediately at hand.
"As people with schizophrenia commonly have major social problems, understanding their origin, both neurobiological and behavioral, is critically important. Many higher-level social skills are learned through observation and imitation. From the beginning, infants learn many skills through imitation, starting with basic motor skills learned in the preverbal period.
"This paper presents critical data suggesting that the basic neurobiological processes of observation and imitation of others may be deficient in people with schizophrenia, with many higher levels impacted in a bottom-to-top manner. As a result, these findings have the potential to have identified the first step in the cascade of poor social functioning in schizophrenia: the inability to learn through basic observational and imitative processes."
Philip D. Harvey, Ph.D., is professor of psychiatry and behavioral sciences at the University of Miami. These comments were adapted from his editorial in the May issue of the American Journal of Psychiatry.
One contribution to the characteristic social impairment in schizophrenia might be an impaired ability to imitate the actions of others, a recent study suggests.
Using functional magnetic resonance imaging (fMRI) comparisons between healthy and schizophrenia participants’ brains, Katharine N. Thakkar, Ph.D., and her associates at Vanderbilt University in Nashville, Tenn., identified reduced activity among the schizophrenia patients in the parts of the brain involved with the "mirror neuron" network, which is partly responsible for imitation activities.
"Our results indicate abnormal neural activity during action imitation and observation in patients with schizophrenia," Dr. Thakkar and her coauthors reported (Am. J. Psychiatry 2014;171:539-548).
In earlier primate studies, researchers previously identified a network of mirror neurons in the human brain that receive information from the posterior superior temporal sulcus and operate in the temporoparietal and frontal regions. The researchers therefore compared the fMRI brain images of 16 medicated schizophrenia patients to the brain images of 16 healthy comparison controls, matched in age, sex, IQ, and handedness.
During the experiment, the subjects were expected to press one of three buttons based on each of three different visual cues: a video with a hand pressing a button (imitation), a still image with a pointing hand (nonimitative action), and a diagram (nonimitative action). The subjects also observed these visual cues without pressing the buttons to provide brain activity data during biological motion perception.
The results showed reduced activity in the posterior superior temporal sulcus during both imitation and action observation in the schizophrenia patients, compared with the healthy controls. Meanwhile, during nonimitative action, the schizophrenia patients showed greater activity than the healthy controls in the posterior superior temporal sulcus and in the inferior parietal lobe. Patients with a lower score on the Brief Psychiatric Rating Scale showed greater activity in the right posterior superior temporal sulcus during action imitation, and those with a lower Scale for the Assessment of Negative Symptoms score showed greater activity in the right inferior parietal lobe during nonimitative action.
Dr. Thakkar and her associates cited several limitations of their study. For example, the patients with schizophrenia were medicated, and the effects of antipsychotic medication on imitation are unknown. However, the investigators did find that "brain activation in patients with higher medication dosages looked more like that of healthy subjects."
Together, the findings point to cognitive deficits in the ability to observe and imitate others in those with schizophrenia. Action imitation is regarded as a "building block of social cognition," at the root of "the ability to interpret the minds of others," the authors wrote.
The study was supported by the National Institute of Mental Health, a Netherlands Organization for Scientific Research Rubicon grant, and the National Center for Research Resources. The authors reported no disclosures.
One contribution to the characteristic social impairment in schizophrenia might be an impaired ability to imitate the actions of others, a recent study suggests.
Using functional magnetic resonance imaging (fMRI) comparisons between healthy and schizophrenia participants’ brains, Katharine N. Thakkar, Ph.D., and her associates at Vanderbilt University in Nashville, Tenn., identified reduced activity among the schizophrenia patients in the parts of the brain involved with the "mirror neuron" network, which is partly responsible for imitation activities.
"Our results indicate abnormal neural activity during action imitation and observation in patients with schizophrenia," Dr. Thakkar and her coauthors reported (Am. J. Psychiatry 2014;171:539-548).
In earlier primate studies, researchers previously identified a network of mirror neurons in the human brain that receive information from the posterior superior temporal sulcus and operate in the temporoparietal and frontal regions. The researchers therefore compared the fMRI brain images of 16 medicated schizophrenia patients to the brain images of 16 healthy comparison controls, matched in age, sex, IQ, and handedness.
During the experiment, the subjects were expected to press one of three buttons based on each of three different visual cues: a video with a hand pressing a button (imitation), a still image with a pointing hand (nonimitative action), and a diagram (nonimitative action). The subjects also observed these visual cues without pressing the buttons to provide brain activity data during biological motion perception.
The results showed reduced activity in the posterior superior temporal sulcus during both imitation and action observation in the schizophrenia patients, compared with the healthy controls. Meanwhile, during nonimitative action, the schizophrenia patients showed greater activity than the healthy controls in the posterior superior temporal sulcus and in the inferior parietal lobe. Patients with a lower score on the Brief Psychiatric Rating Scale showed greater activity in the right posterior superior temporal sulcus during action imitation, and those with a lower Scale for the Assessment of Negative Symptoms score showed greater activity in the right inferior parietal lobe during nonimitative action.
Dr. Thakkar and her associates cited several limitations of their study. For example, the patients with schizophrenia were medicated, and the effects of antipsychotic medication on imitation are unknown. However, the investigators did find that "brain activation in patients with higher medication dosages looked more like that of healthy subjects."
Together, the findings point to cognitive deficits in the ability to observe and imitate others in those with schizophrenia. Action imitation is regarded as a "building block of social cognition," at the root of "the ability to interpret the minds of others," the authors wrote.
The study was supported by the National Institute of Mental Health, a Netherlands Organization for Scientific Research Rubicon grant, and the National Center for Research Resources. The authors reported no disclosures.
FROM THE AMERICAN JOURNAL OF PSYCHIATRY
Key clinical point: The nature of social dysfunction within schizophrenia can be understood by looking at activity within two regions of the brain: the posterior superior temporal sulcus and the inferior parietal lobe.
Major finding: Compared with healthy controls, schizophrenia patients showed poorer activation of the mirror neuron network, responsible for the ability to imitate others; the activation correlated with symptom severity and social functioning.
Data source: The findings are based on an analysis of functional magnetic resonance imaging in 16 healthy subjects and in 16 medicated schizophrenia subjects from a Nashville, Tenn., psychiatric facility.
Disclosures: The study was supported by the National Institute of Mental Health, a Netherlands Organization for Scientific Research Rubicon grant, and the National Center for Research Resources. The authors reported no disclosures.
Hippocampal activity may be biomarker for schizophrenia
Tracking activity in the hippocampus might provide a way to measure the effectiveness of therapeutic agents in patients with schizophrenia, a new study suggests.
"Intrinsic hyperactivity may contribute to the inability of the [hippocampal] region to be recruited during cognitive tasks in which it is thought to be required, such as image encoding and verbal encoding," wrote Jason R. Tregellas, Ph.D., and his associates. "The observed hyperactivity both supports models of hippocampal dysfunction and schizophrenia and increases the appeal of this measure as a potential biomarker," they reported (Am. J. Psychiatry 2014;171:549-56).
The researchers compared functional magnetic resonance imaging (fMRI) scans of the brains of 28 patients with schizophrenia, all taking antipsychotics, to the scans of 28 healthy controls, matched by age, while at rest. The schizophrenia patients also were assessed for negative symptoms, and all participants underwent cognitive function assessment with the MCCB (MATRICS Consensus Cognitive Battery), reported Dr. Tregellas of the psychiatry department at the University of Colorado at Denver, Aurora, and the Denver Veterans Affairs Medical Center Research Service, and his associates.
Although the schizophrenia patients scored within 1 standard deviation of the healthy controls’ scores in the verbal learning, working memory, visual learning, and reasoning/problem-solving domains on the MCCB, the schizophrenia patients’ scores were at least 1 standard deviation lower than the controls’ for processing speed, attention/vigilance, social cognition, and overall composite score.
The fMRI scans showed considerably greater intrinsic activity in the right hippocampus of the schizophrenia patients, compared with the controls’ hippocampal activity. The right hippocampal activity in the schizophrenia patients also was negatively correlated with their MCCB composite score (R = –0.53; P = .004), primarily because of the negative correlation with vigilance, working memory, and visual learning domains.
The right hippocampal activity in schizophrenia patients was positively correlated with their total SANS (Scale for the Assessment of Negative Symptoms) scores (R = 0.42; P = .028), but no correlation was seen with scores from the Brief Psychiatric Rating Scale. Total SANS scores were meanwhile negatively correlated with the MCCB working memory scores (R = –0.45; P = .016) and verbal learning scores (R = –0.45; P = .017).
Several limitations of the study were cited. For example, the investigators said it is unclear whether the association between hippocampal hyperactivity and cognitive function is specific to schizophrenia. "Studies examining MCCB performance and hippocampal activity in healthy subjects and other populations (e.g., patients with bipolar disorder) are needed to examine this possibility," the authors wrote.
The study was supported by the National Institute of Mental Health, the VA Biomedical Laboratory and Clinical Science Research and Development Service, the Brain and Behavior Research Foundation, and the Blowitz-Ridgeway Foundation. The authors reported that they had no financial relationships with commercial interests.
Tracking activity in the hippocampus might provide a way to measure the effectiveness of therapeutic agents in patients with schizophrenia, a new study suggests.
"Intrinsic hyperactivity may contribute to the inability of the [hippocampal] region to be recruited during cognitive tasks in which it is thought to be required, such as image encoding and verbal encoding," wrote Jason R. Tregellas, Ph.D., and his associates. "The observed hyperactivity both supports models of hippocampal dysfunction and schizophrenia and increases the appeal of this measure as a potential biomarker," they reported (Am. J. Psychiatry 2014;171:549-56).
The researchers compared functional magnetic resonance imaging (fMRI) scans of the brains of 28 patients with schizophrenia, all taking antipsychotics, to the scans of 28 healthy controls, matched by age, while at rest. The schizophrenia patients also were assessed for negative symptoms, and all participants underwent cognitive function assessment with the MCCB (MATRICS Consensus Cognitive Battery), reported Dr. Tregellas of the psychiatry department at the University of Colorado at Denver, Aurora, and the Denver Veterans Affairs Medical Center Research Service, and his associates.
Although the schizophrenia patients scored within 1 standard deviation of the healthy controls’ scores in the verbal learning, working memory, visual learning, and reasoning/problem-solving domains on the MCCB, the schizophrenia patients’ scores were at least 1 standard deviation lower than the controls’ for processing speed, attention/vigilance, social cognition, and overall composite score.
The fMRI scans showed considerably greater intrinsic activity in the right hippocampus of the schizophrenia patients, compared with the controls’ hippocampal activity. The right hippocampal activity in the schizophrenia patients also was negatively correlated with their MCCB composite score (R = –0.53; P = .004), primarily because of the negative correlation with vigilance, working memory, and visual learning domains.
The right hippocampal activity in schizophrenia patients was positively correlated with their total SANS (Scale for the Assessment of Negative Symptoms) scores (R = 0.42; P = .028), but no correlation was seen with scores from the Brief Psychiatric Rating Scale. Total SANS scores were meanwhile negatively correlated with the MCCB working memory scores (R = –0.45; P = .016) and verbal learning scores (R = –0.45; P = .017).
Several limitations of the study were cited. For example, the investigators said it is unclear whether the association between hippocampal hyperactivity and cognitive function is specific to schizophrenia. "Studies examining MCCB performance and hippocampal activity in healthy subjects and other populations (e.g., patients with bipolar disorder) are needed to examine this possibility," the authors wrote.
The study was supported by the National Institute of Mental Health, the VA Biomedical Laboratory and Clinical Science Research and Development Service, the Brain and Behavior Research Foundation, and the Blowitz-Ridgeway Foundation. The authors reported that they had no financial relationships with commercial interests.
Tracking activity in the hippocampus might provide a way to measure the effectiveness of therapeutic agents in patients with schizophrenia, a new study suggests.
"Intrinsic hyperactivity may contribute to the inability of the [hippocampal] region to be recruited during cognitive tasks in which it is thought to be required, such as image encoding and verbal encoding," wrote Jason R. Tregellas, Ph.D., and his associates. "The observed hyperactivity both supports models of hippocampal dysfunction and schizophrenia and increases the appeal of this measure as a potential biomarker," they reported (Am. J. Psychiatry 2014;171:549-56).
The researchers compared functional magnetic resonance imaging (fMRI) scans of the brains of 28 patients with schizophrenia, all taking antipsychotics, to the scans of 28 healthy controls, matched by age, while at rest. The schizophrenia patients also were assessed for negative symptoms, and all participants underwent cognitive function assessment with the MCCB (MATRICS Consensus Cognitive Battery), reported Dr. Tregellas of the psychiatry department at the University of Colorado at Denver, Aurora, and the Denver Veterans Affairs Medical Center Research Service, and his associates.
Although the schizophrenia patients scored within 1 standard deviation of the healthy controls’ scores in the verbal learning, working memory, visual learning, and reasoning/problem-solving domains on the MCCB, the schizophrenia patients’ scores were at least 1 standard deviation lower than the controls’ for processing speed, attention/vigilance, social cognition, and overall composite score.
The fMRI scans showed considerably greater intrinsic activity in the right hippocampus of the schizophrenia patients, compared with the controls’ hippocampal activity. The right hippocampal activity in the schizophrenia patients also was negatively correlated with their MCCB composite score (R = –0.53; P = .004), primarily because of the negative correlation with vigilance, working memory, and visual learning domains.
The right hippocampal activity in schizophrenia patients was positively correlated with their total SANS (Scale for the Assessment of Negative Symptoms) scores (R = 0.42; P = .028), but no correlation was seen with scores from the Brief Psychiatric Rating Scale. Total SANS scores were meanwhile negatively correlated with the MCCB working memory scores (R = –0.45; P = .016) and verbal learning scores (R = –0.45; P = .017).
Several limitations of the study were cited. For example, the investigators said it is unclear whether the association between hippocampal hyperactivity and cognitive function is specific to schizophrenia. "Studies examining MCCB performance and hippocampal activity in healthy subjects and other populations (e.g., patients with bipolar disorder) are needed to examine this possibility," the authors wrote.
The study was supported by the National Institute of Mental Health, the VA Biomedical Laboratory and Clinical Science Research and Development Service, the Brain and Behavior Research Foundation, and the Blowitz-Ridgeway Foundation. The authors reported that they had no financial relationships with commercial interests.
FROM THE AMERICAN JOURNAL OF PSYCHIATRY
Key clinical point: A therapeutic treatment that lowers "intrinsic hippocampal activity may improve cognition in schizophrenia."
Major finding: Greater activity was seen in the right hippocampus of schizophrenia patients, relative to healthy controls. In addition, the greater activity was negatively correlated with cognitive function (R = –0.53; P = .004) and positively correlated with negative symptoms (R = 0.42; P = .028).
Data source: A comparison of fMRI brain scans between 28 schizophrenia patients taking antipsychotics and 28 age-matched healthy controls.
Disclosures: The study was supported by the National Institute of Mental Health, the VA Biomedical Laboratory and Clinical Science Research and Development Service, the Brain and Behavior Research Foundation, and the Blowitz-Ridgeway Foundation. The authors reported no disclosures.
USPSTF recommends fluoride tooth varnish for young children
Oral fluoride supplementation for children in areas with inadequately fluoridated water and the application of fluoride varnish to all children’s teeth can help prevent dental caries in children aged 5 and under, according to updated recommendations from the U.S. Preventive Services Task Force.
The moderate benefits of both fluoride treatments were determined to outweigh the potential harms of fluorosis, Dr. Virginia A. Moyer reported on behalf of the USPSTF (Pediatrics 2014 [doi:10.15425/peds.2014-0483]).
Meanwhile, the task force found no studies that addressed improved clinical outcomes or possible harms of oral screenings by children’s primary care doctors and therefore issued no recommendation regarding routine oral screening exams.
The new statement updates the previous recommendations issued in 2004, when only the oral fluoride supplementation was recommended for children in areas with fluoride levels below 0.6 ppm in the local drinking water. That recommendation remains, with the fluoride varnish recommendation added based on new research. Both interventions received B recommendations and therefore are required by the Affordable Care Act to be covered by insurers without out of pocket costs to the patient, as with all preventive care services that receive an A or B recommendation.
Approximately 42% of children aged 2-11 years old have dental caries in their primary teeth, according to the 1999-2004 National Health and Nutrition Examination Survey, making dental caries the most common chronic disease among U.S. children. Risk factors for increased dental caries include frequent snacking or sugar consumption, inappropriate bottle feeding, low socioeconomic status, being an ethnic minority, poor dental care access, failure to use fluoride toothpaste, a history of previous caries in the child or family, dry mouth, and developmental defects of the tooth enamel.
The task force did not recommend limiting fluoride varnish application only to children at higher risk for dental caries because no validated tools exist for assessing which children are at highest risk, and "a risk-based approach to fluoride varnish application will miss opportunities to provide an effective dental caries preventive intervention to children who could benefit from it," Dr. Moyer, USPSTF chairwoman, wrote.
The oral fluoride supplementation recommendation is based on the same six trials assessed for the 2004 recommendations. Those trials showed a 32%- 72% reduction of decayed, missing and filled teeth and a 38%- 81% reduction of decayed, missing, or filled tooth surfaces, compared with no supplementation or placebo.
The fluoride varnish recommendation relies on three recent studies that found a decreased risk for dental caries (from 1 to 2.4 fewer caries) after 2 years among children receiving a fluoride varnish every 6 months, compared with children not receiving the varnish. It’s unclear, however, how often the varnish should be applied: three other studies found no clinical differences with application multiple times in 2 weeks, once every 6 months or once a year.
The task force also considered the use of xylitol to reduce caries but found insufficient evidence to make a recommendation. The Community Preventive Services Task Force already recommended in April 2013 both community water fluoridation and school-based dental sealant delivery programs to prevent caries in children.
The Agency for Healthcare Research and Quality supports the independent, voluntary U.S. Preventive Services Task Force, as mandated by Congress. The authors reported no conflicts of interest.
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Dental caries are a burdensome and common problem in young children. In my practice, I regularly care for young children with severe and painful dental caries. Many require sedation for adequate treatment, further increasing the risk to their health.
I am very happy to see USPSTF recommend that primary care providers apply fluoride varnish to the primary teeth of all children under the age of 5, starting with tooth eruption. There are a few important considerations to ensure successful implementation that these recommendations will help support.
First is a strong partnership between the pediatric primary care providers and pediatric dentists in a community to ensure smooth coordination, excellent care and quality assurance. Second is a strong and robust system of training and support for primary care practices as they incorporate this procedure into clinic work flow and processes. Last is to ensure the primary care provider will be paid for the time and skill required to apply fluoride varnish.
For many states, this will require advocacy to enable pediatric primary care providers to use the relevant dental codes. Pediatric primary care providers are taking on increasing responsibilities for their patients through the medical home and need appropriate supports and compensation for the work they are doing.
Dr. Lee Savio Beers is with the department of pediatrics at Children’s National Medical Center and the George Washington University Medical Center in Washington, D.C.
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Dental caries are a burdensome and common problem in young children. In my practice, I regularly care for young children with severe and painful dental caries. Many require sedation for adequate treatment, further increasing the risk to their health.
I am very happy to see USPSTF recommend that primary care providers apply fluoride varnish to the primary teeth of all children under the age of 5, starting with tooth eruption. There are a few important considerations to ensure successful implementation that these recommendations will help support.
First is a strong partnership between the pediatric primary care providers and pediatric dentists in a community to ensure smooth coordination, excellent care and quality assurance. Second is a strong and robust system of training and support for primary care practices as they incorporate this procedure into clinic work flow and processes. Last is to ensure the primary care provider will be paid for the time and skill required to apply fluoride varnish.
For many states, this will require advocacy to enable pediatric primary care providers to use the relevant dental codes. Pediatric primary care providers are taking on increasing responsibilities for their patients through the medical home and need appropriate supports and compensation for the work they are doing.
Dr. Lee Savio Beers is with the department of pediatrics at Children’s National Medical Center and the George Washington University Medical Center in Washington, D.C.
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Dental caries are a burdensome and common problem in young children. In my practice, I regularly care for young children with severe and painful dental caries. Many require sedation for adequate treatment, further increasing the risk to their health.
I am very happy to see USPSTF recommend that primary care providers apply fluoride varnish to the primary teeth of all children under the age of 5, starting with tooth eruption. There are a few important considerations to ensure successful implementation that these recommendations will help support.
First is a strong partnership between the pediatric primary care providers and pediatric dentists in a community to ensure smooth coordination, excellent care and quality assurance. Second is a strong and robust system of training and support for primary care practices as they incorporate this procedure into clinic work flow and processes. Last is to ensure the primary care provider will be paid for the time and skill required to apply fluoride varnish.
For many states, this will require advocacy to enable pediatric primary care providers to use the relevant dental codes. Pediatric primary care providers are taking on increasing responsibilities for their patients through the medical home and need appropriate supports and compensation for the work they are doing.
Dr. Lee Savio Beers is with the department of pediatrics at Children’s National Medical Center and the George Washington University Medical Center in Washington, D.C.
Oral fluoride supplementation for children in areas with inadequately fluoridated water and the application of fluoride varnish to all children’s teeth can help prevent dental caries in children aged 5 and under, according to updated recommendations from the U.S. Preventive Services Task Force.
The moderate benefits of both fluoride treatments were determined to outweigh the potential harms of fluorosis, Dr. Virginia A. Moyer reported on behalf of the USPSTF (Pediatrics 2014 [doi:10.15425/peds.2014-0483]).
Meanwhile, the task force found no studies that addressed improved clinical outcomes or possible harms of oral screenings by children’s primary care doctors and therefore issued no recommendation regarding routine oral screening exams.
The new statement updates the previous recommendations issued in 2004, when only the oral fluoride supplementation was recommended for children in areas with fluoride levels below 0.6 ppm in the local drinking water. That recommendation remains, with the fluoride varnish recommendation added based on new research. Both interventions received B recommendations and therefore are required by the Affordable Care Act to be covered by insurers without out of pocket costs to the patient, as with all preventive care services that receive an A or B recommendation.
Approximately 42% of children aged 2-11 years old have dental caries in their primary teeth, according to the 1999-2004 National Health and Nutrition Examination Survey, making dental caries the most common chronic disease among U.S. children. Risk factors for increased dental caries include frequent snacking or sugar consumption, inappropriate bottle feeding, low socioeconomic status, being an ethnic minority, poor dental care access, failure to use fluoride toothpaste, a history of previous caries in the child or family, dry mouth, and developmental defects of the tooth enamel.
The task force did not recommend limiting fluoride varnish application only to children at higher risk for dental caries because no validated tools exist for assessing which children are at highest risk, and "a risk-based approach to fluoride varnish application will miss opportunities to provide an effective dental caries preventive intervention to children who could benefit from it," Dr. Moyer, USPSTF chairwoman, wrote.
The oral fluoride supplementation recommendation is based on the same six trials assessed for the 2004 recommendations. Those trials showed a 32%- 72% reduction of decayed, missing and filled teeth and a 38%- 81% reduction of decayed, missing, or filled tooth surfaces, compared with no supplementation or placebo.
The fluoride varnish recommendation relies on three recent studies that found a decreased risk for dental caries (from 1 to 2.4 fewer caries) after 2 years among children receiving a fluoride varnish every 6 months, compared with children not receiving the varnish. It’s unclear, however, how often the varnish should be applied: three other studies found no clinical differences with application multiple times in 2 weeks, once every 6 months or once a year.
The task force also considered the use of xylitol to reduce caries but found insufficient evidence to make a recommendation. The Community Preventive Services Task Force already recommended in April 2013 both community water fluoridation and school-based dental sealant delivery programs to prevent caries in children.
The Agency for Healthcare Research and Quality supports the independent, voluntary U.S. Preventive Services Task Force, as mandated by Congress. The authors reported no conflicts of interest.
Oral fluoride supplementation for children in areas with inadequately fluoridated water and the application of fluoride varnish to all children’s teeth can help prevent dental caries in children aged 5 and under, according to updated recommendations from the U.S. Preventive Services Task Force.
The moderate benefits of both fluoride treatments were determined to outweigh the potential harms of fluorosis, Dr. Virginia A. Moyer reported on behalf of the USPSTF (Pediatrics 2014 [doi:10.15425/peds.2014-0483]).
Meanwhile, the task force found no studies that addressed improved clinical outcomes or possible harms of oral screenings by children’s primary care doctors and therefore issued no recommendation regarding routine oral screening exams.
The new statement updates the previous recommendations issued in 2004, when only the oral fluoride supplementation was recommended for children in areas with fluoride levels below 0.6 ppm in the local drinking water. That recommendation remains, with the fluoride varnish recommendation added based on new research. Both interventions received B recommendations and therefore are required by the Affordable Care Act to be covered by insurers without out of pocket costs to the patient, as with all preventive care services that receive an A or B recommendation.
Approximately 42% of children aged 2-11 years old have dental caries in their primary teeth, according to the 1999-2004 National Health and Nutrition Examination Survey, making dental caries the most common chronic disease among U.S. children. Risk factors for increased dental caries include frequent snacking or sugar consumption, inappropriate bottle feeding, low socioeconomic status, being an ethnic minority, poor dental care access, failure to use fluoride toothpaste, a history of previous caries in the child or family, dry mouth, and developmental defects of the tooth enamel.
The task force did not recommend limiting fluoride varnish application only to children at higher risk for dental caries because no validated tools exist for assessing which children are at highest risk, and "a risk-based approach to fluoride varnish application will miss opportunities to provide an effective dental caries preventive intervention to children who could benefit from it," Dr. Moyer, USPSTF chairwoman, wrote.
The oral fluoride supplementation recommendation is based on the same six trials assessed for the 2004 recommendations. Those trials showed a 32%- 72% reduction of decayed, missing and filled teeth and a 38%- 81% reduction of decayed, missing, or filled tooth surfaces, compared with no supplementation or placebo.
The fluoride varnish recommendation relies on three recent studies that found a decreased risk for dental caries (from 1 to 2.4 fewer caries) after 2 years among children receiving a fluoride varnish every 6 months, compared with children not receiving the varnish. It’s unclear, however, how often the varnish should be applied: three other studies found no clinical differences with application multiple times in 2 weeks, once every 6 months or once a year.
The task force also considered the use of xylitol to reduce caries but found insufficient evidence to make a recommendation. The Community Preventive Services Task Force already recommended in April 2013 both community water fluoridation and school-based dental sealant delivery programs to prevent caries in children.
The Agency for Healthcare Research and Quality supports the independent, voluntary U.S. Preventive Services Task Force, as mandated by Congress. The authors reported no conflicts of interest.
FROM PEDIATRICS
Poorer quality of life found in children with at least two anxiety disorders and ADHD
Children with attention-deficit/hyperactivity disorder and at least two anxiety disorders have poorer functioning and quality of life than peers with ADHD and no anxiety, a study showed.
"Systematically assessing and treating anxiety in children with ADHD has the potential to improve functioning for these children," wrote Dr. Emma Sciberras of Murdoch Children’s Research Institute in Parkville, Australia, and her colleagues (Pediatrics 2014;133:801-8)
The researchers analyzed parent-reported quality of life, behavior and peer problems, daily functioning, and school attendance, as well as teacher-reported behavior and peer problems, in 392 children with ADHD, aged 5-13 years, from 21 pediatric practices across Victoria, Australia. Eighty-five percent of the children were taking medication for ADHD. Nearly two in five had at least two anxiety disorders (143 children, 39%), while 95 children (26%) had one anxiety disorder, and 132 (36%) had no anxiety disorders.
The most common anxiety disorder was social phobia in 177 children (48%), followed by generalized anxiety in 125 children (34%), and separation anxiety in 119 children (32%). In addition, 8% had obsessive-compulsive disorder, 6% had posttraumatic stress disorder, and 2% had panic disorder.
Although children with one anxiety disorder did not function any more poorly than the children without anxiety, children with two or more anxiety disorders did experience poorer quality of life, more behavioral difficulties, and more daily functioning difficulty than those without anxiety after investigators adjusted for ADHD medication use and symptom severity; the existence of a mood disorder, externalizing disorder, or autism spectrum disorder; parent age and education; and the child’s age, sex, and neighborhood socioeconomic disadvantage.
Compared with those without anxiety, children with at least two anxiety disorders showed poorer quality of life measures with an effect size of –0.8. Children with two or more anxiety disorders also showed more behavioral difficulties (effect size, 0.4) and more problems with daily functioning (effect size, 0.3).
The research was supported by a Project Grant from the Australian National Health and Medical Research Council and partly by the Centre for Community Child Health at the Royal Children’s Hospital and the Murdoch Children’s Research Institute. The authors reported no relevant financial disclosures.
Children with attention-deficit/hyperactivity disorder and at least two anxiety disorders have poorer functioning and quality of life than peers with ADHD and no anxiety, a study showed.
"Systematically assessing and treating anxiety in children with ADHD has the potential to improve functioning for these children," wrote Dr. Emma Sciberras of Murdoch Children’s Research Institute in Parkville, Australia, and her colleagues (Pediatrics 2014;133:801-8)
The researchers analyzed parent-reported quality of life, behavior and peer problems, daily functioning, and school attendance, as well as teacher-reported behavior and peer problems, in 392 children with ADHD, aged 5-13 years, from 21 pediatric practices across Victoria, Australia. Eighty-five percent of the children were taking medication for ADHD. Nearly two in five had at least two anxiety disorders (143 children, 39%), while 95 children (26%) had one anxiety disorder, and 132 (36%) had no anxiety disorders.
The most common anxiety disorder was social phobia in 177 children (48%), followed by generalized anxiety in 125 children (34%), and separation anxiety in 119 children (32%). In addition, 8% had obsessive-compulsive disorder, 6% had posttraumatic stress disorder, and 2% had panic disorder.
Although children with one anxiety disorder did not function any more poorly than the children without anxiety, children with two or more anxiety disorders did experience poorer quality of life, more behavioral difficulties, and more daily functioning difficulty than those without anxiety after investigators adjusted for ADHD medication use and symptom severity; the existence of a mood disorder, externalizing disorder, or autism spectrum disorder; parent age and education; and the child’s age, sex, and neighborhood socioeconomic disadvantage.
Compared with those without anxiety, children with at least two anxiety disorders showed poorer quality of life measures with an effect size of –0.8. Children with two or more anxiety disorders also showed more behavioral difficulties (effect size, 0.4) and more problems with daily functioning (effect size, 0.3).
The research was supported by a Project Grant from the Australian National Health and Medical Research Council and partly by the Centre for Community Child Health at the Royal Children’s Hospital and the Murdoch Children’s Research Institute. The authors reported no relevant financial disclosures.
Children with attention-deficit/hyperactivity disorder and at least two anxiety disorders have poorer functioning and quality of life than peers with ADHD and no anxiety, a study showed.
"Systematically assessing and treating anxiety in children with ADHD has the potential to improve functioning for these children," wrote Dr. Emma Sciberras of Murdoch Children’s Research Institute in Parkville, Australia, and her colleagues (Pediatrics 2014;133:801-8)
The researchers analyzed parent-reported quality of life, behavior and peer problems, daily functioning, and school attendance, as well as teacher-reported behavior and peer problems, in 392 children with ADHD, aged 5-13 years, from 21 pediatric practices across Victoria, Australia. Eighty-five percent of the children were taking medication for ADHD. Nearly two in five had at least two anxiety disorders (143 children, 39%), while 95 children (26%) had one anxiety disorder, and 132 (36%) had no anxiety disorders.
The most common anxiety disorder was social phobia in 177 children (48%), followed by generalized anxiety in 125 children (34%), and separation anxiety in 119 children (32%). In addition, 8% had obsessive-compulsive disorder, 6% had posttraumatic stress disorder, and 2% had panic disorder.
Although children with one anxiety disorder did not function any more poorly than the children without anxiety, children with two or more anxiety disorders did experience poorer quality of life, more behavioral difficulties, and more daily functioning difficulty than those without anxiety after investigators adjusted for ADHD medication use and symptom severity; the existence of a mood disorder, externalizing disorder, or autism spectrum disorder; parent age and education; and the child’s age, sex, and neighborhood socioeconomic disadvantage.
Compared with those without anxiety, children with at least two anxiety disorders showed poorer quality of life measures with an effect size of –0.8. Children with two or more anxiety disorders also showed more behavioral difficulties (effect size, 0.4) and more problems with daily functioning (effect size, 0.3).
The research was supported by a Project Grant from the Australian National Health and Medical Research Council and partly by the Centre for Community Child Health at the Royal Children’s Hospital and the Murdoch Children’s Research Institute. The authors reported no relevant financial disclosures.
FROM PEDIATRICS
Major finding: Among 392 Australian children with ADHD, the 39% with two or more anxiety disorders had a poorer quality of life, more behavioral difficulties, and more daily functioning difficulty than the 36% without anxiety; no effect was seen for the 26% with one anxiety disorder.
Data source: An analysis of parent-reported quality of life, behavior and peer problems, daily functioning and school attendance, plus teacher-reported behavior and peer problems, for 392 children.
Disclosures: The research was supported by a Project Grant from the Australian National Health and Medical Research Council and partly by the Centre for Community Child Health at the Royal Children’s Hospital, and the Murdoch Children’s Research Institute. The authors reported no relevant financial disclosures.
Children with ADHD at increased risk for language problems
Children with attention-deficit/hyperactivity disorder are more likely to have language problems and consequently poorer academic performance, according to a recent study.
In addition, only a quarter of those with attention-deficit/hyperactivity disorder (ADHD) and language problems were seeing a speech pathologist.
"There was strong evidence that language problems in children with ADHD were associated with markedly poorer academic functioning," reported Dr. Emma Sciberras of Murdoch Childrens Research Institute in Parkville, Australia, and her colleagues. "In contrast, there was little evidence that language problems adversely affected social functioning in children with ADHD" (Pediatrics 2014 April 16;133:793-800).
The researchers assessed oral language skills of 179 children with ADHD and 212 controls, aged 6-8 years, from 43 schools in Melbourne. The children’s academic functioning also was assessed based on an achievement test and teacher report, and social functioning was assessed via parent and teacher report.
Language problems occurred among 40% of the children with ADHD, compared with 17% of the controls. Similar proportions of children with ADHD and language problems (38%) and ADHD alone (42%) were taking medication.
Children with ADHD had 2.8 times greater odds of having language problems than did the controls after the researchers adjusted for child and parent demographics, ADHD severity, and behavioral/developmental comorbidities.
Among those with ADHD and language problems, 42% had accessed speech pathology services and 24% were seeing a speech pathologist at the time of the study.
Further, the children with ADHD and language problems scored more poorly in word reading, math computation, and overall academic competence than did children with ADHD alone.
The research was supported by a project grant from the Australian National Health and Medical Research Council, the Collier Foundation, the Murdoch Childrens Research Institute, and the Victorian Government. The authors reported no relevant financial disclosures.
Children with attention-deficit/hyperactivity disorder are more likely to have language problems and consequently poorer academic performance, according to a recent study.
In addition, only a quarter of those with attention-deficit/hyperactivity disorder (ADHD) and language problems were seeing a speech pathologist.
"There was strong evidence that language problems in children with ADHD were associated with markedly poorer academic functioning," reported Dr. Emma Sciberras of Murdoch Childrens Research Institute in Parkville, Australia, and her colleagues. "In contrast, there was little evidence that language problems adversely affected social functioning in children with ADHD" (Pediatrics 2014 April 16;133:793-800).
The researchers assessed oral language skills of 179 children with ADHD and 212 controls, aged 6-8 years, from 43 schools in Melbourne. The children’s academic functioning also was assessed based on an achievement test and teacher report, and social functioning was assessed via parent and teacher report.
Language problems occurred among 40% of the children with ADHD, compared with 17% of the controls. Similar proportions of children with ADHD and language problems (38%) and ADHD alone (42%) were taking medication.
Children with ADHD had 2.8 times greater odds of having language problems than did the controls after the researchers adjusted for child and parent demographics, ADHD severity, and behavioral/developmental comorbidities.
Among those with ADHD and language problems, 42% had accessed speech pathology services and 24% were seeing a speech pathologist at the time of the study.
Further, the children with ADHD and language problems scored more poorly in word reading, math computation, and overall academic competence than did children with ADHD alone.
The research was supported by a project grant from the Australian National Health and Medical Research Council, the Collier Foundation, the Murdoch Childrens Research Institute, and the Victorian Government. The authors reported no relevant financial disclosures.
Children with attention-deficit/hyperactivity disorder are more likely to have language problems and consequently poorer academic performance, according to a recent study.
In addition, only a quarter of those with attention-deficit/hyperactivity disorder (ADHD) and language problems were seeing a speech pathologist.
"There was strong evidence that language problems in children with ADHD were associated with markedly poorer academic functioning," reported Dr. Emma Sciberras of Murdoch Childrens Research Institute in Parkville, Australia, and her colleagues. "In contrast, there was little evidence that language problems adversely affected social functioning in children with ADHD" (Pediatrics 2014 April 16;133:793-800).
The researchers assessed oral language skills of 179 children with ADHD and 212 controls, aged 6-8 years, from 43 schools in Melbourne. The children’s academic functioning also was assessed based on an achievement test and teacher report, and social functioning was assessed via parent and teacher report.
Language problems occurred among 40% of the children with ADHD, compared with 17% of the controls. Similar proportions of children with ADHD and language problems (38%) and ADHD alone (42%) were taking medication.
Children with ADHD had 2.8 times greater odds of having language problems than did the controls after the researchers adjusted for child and parent demographics, ADHD severity, and behavioral/developmental comorbidities.
Among those with ADHD and language problems, 42% had accessed speech pathology services and 24% were seeing a speech pathologist at the time of the study.
Further, the children with ADHD and language problems scored more poorly in word reading, math computation, and overall academic competence than did children with ADHD alone.
The research was supported by a project grant from the Australian National Health and Medical Research Council, the Collier Foundation, the Murdoch Childrens Research Institute, and the Victorian Government. The authors reported no relevant financial disclosures.
FROM PEDIATRICS
Major finding: Children with attention-deficit/hyperactivity disorder had 2.8 greater odds of having language problems than controls, and those with language problems had poorer word reading, math computation, and academic performance.
Data source: The findings are based on oral language, academic functioning and social functioning assessments of 179 children with ADHD and 212 controls, all aged 6-8 years, from 43 schools in Melbourne.
Disclosures: The research was supported by a project grant from the Australian National Health and Medical Research Council, the Collier Foundation, the Murdoch Childrens Research Institute and the Victorian Government. The authors reported no disclosures.
Urine culture essential for UTI diagnosis in febrile neonates
All febrile infants under 1 month old should receive a urine culture because of the prevalence of urinary tract infections and the inadequacy of other clinical parameters in identifying urinary tract infection risk, according to results of a recent study.
Approximately one in six infants aged 30 days or younger experienced urinary tract infections (UTIs), and males were more than twice as likely as females to have one, reported Dr. William Bonadio and Dr. Gary Maida of Maimonides Medical Center in New York.
Infants with a UTI should receive renal ultrasound imaging because nearly half of those with UTIs had radiographic anatomic abnormalities, the authors reported (Pediatr. Infect. Dis. J. 2014;33:342-4).
Of 670 febrile infants evaluated for sepsis in the emergency department at Maimonides Medical Center between 2004 and 2013, a total of 15.4% of the 651 receiving a urine culture had a UTI. Of these, 73% were male, and 47% had anatomic abnormalities appearing on renal ultrasound imaging.
The patients with abnormalities included 19 with pelviectasis and 26 with hydronephrosis. In the 21 patients with hydronephrosis who received a voiding cystourethrogram, 5 had vesicoureteral reflux. None of the infants had bacterial meningitis, and four had urosepsis.
Meanwhile the sensitivity of clinical symptoms, including fever height, CBC total white blood cell count, and urine dipstick test, was insufficient to determine risk of UTI in infants. Among those with UTIs, only 40% had a CBC total white blood cell count of at least 15,000/mm3, and 39% had a fever of 102° F or greater; 79% tested positive for leukocyte esterase or nitrite with a urine dipstick test.
"Reliance on urine dipstick test results to determine whether to perform a urine culture would have resulted in missed diagnosis of 21% of UTI cases in our cohort," the authors wrote. "Similarly, microscopic urinalysis was relatively insensitive at identifying those with underlying UTI."
Escherichia coli was the most common uropathogen, identified in 71% of the patients with UTI, followed by Enterococcus (10%), and Klebsiella species (10%).
The researchers did not report external funding. The authors reported no disclosures.
Dr. Bonadio and Dr. Maida provide a consecutive study that is illuminating for a number of reasons. It’s been well known that a high percentage of febrile neonates have UTI. As many studies have either lumped together patients aged up to 90 days or evaluated those exclusively with the comorbidity of respiratory syncytial virus plus bronchiolitis, this paper dedicating attention to the neonatal period is useful. As the study notes, recent American Academy of Pediatrics guidelines intentionally excluded the 0- to 2-month period because of a paucity of data.
A frequent question is whether a febrile neonate needs a lumbar puncture after diagnosis of UTI. While the standard of care for infants aged less than 30 days is a complete febrile sepsis work-up, including lumbar puncture, this study adds to the body of literature suggesting that an infant older than 30 days, and certainly older than 60 days, does not always need an lumbar puncture once UTI is identified as the source of fever. Two other findings of note are the relatively low frequency of neonates with a WBC greater than 15,000/mm3 (39%) and the much higher than previously described incidence of renal system anomalies. Digging deeper, almost half of the 47% of renal anomalies were transient. Nonetheless, this may change management or make the recommendation for evaluation that much stronger after a single UTI.
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Dr. Bonadio has made numerous varied contributions to the field of pediatrics, with a keen eye to clinical utility. Both for the contribution of more cases of UTI without meningitis and the incidence of anomalies in males with UTIs, this study again helps practitioners practice good medicine.
Dr. Amy Baxter is director of emergency research for Pediatric Emergency Medicine Associates, Children’s Healthcare of Atlanta at Scottish Rite; CEO of MMJ Labs; and a clinical associate professor of emergency medicine at the Medical College of Georgia, Augusta. Dr. Baxter invented Buzzy Personal Pain Solution and is the owner and CEO of Buzzy4shots.com. She has no other disclosures.
Dr. Bonadio and Dr. Maida provide a consecutive study that is illuminating for a number of reasons. It’s been well known that a high percentage of febrile neonates have UTI. As many studies have either lumped together patients aged up to 90 days or evaluated those exclusively with the comorbidity of respiratory syncytial virus plus bronchiolitis, this paper dedicating attention to the neonatal period is useful. As the study notes, recent American Academy of Pediatrics guidelines intentionally excluded the 0- to 2-month period because of a paucity of data.
A frequent question is whether a febrile neonate needs a lumbar puncture after diagnosis of UTI. While the standard of care for infants aged less than 30 days is a complete febrile sepsis work-up, including lumbar puncture, this study adds to the body of literature suggesting that an infant older than 30 days, and certainly older than 60 days, does not always need an lumbar puncture once UTI is identified as the source of fever. Two other findings of note are the relatively low frequency of neonates with a WBC greater than 15,000/mm3 (39%) and the much higher than previously described incidence of renal system anomalies. Digging deeper, almost half of the 47% of renal anomalies were transient. Nonetheless, this may change management or make the recommendation for evaluation that much stronger after a single UTI.
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Dr. Bonadio has made numerous varied contributions to the field of pediatrics, with a keen eye to clinical utility. Both for the contribution of more cases of UTI without meningitis and the incidence of anomalies in males with UTIs, this study again helps practitioners practice good medicine.
Dr. Amy Baxter is director of emergency research for Pediatric Emergency Medicine Associates, Children’s Healthcare of Atlanta at Scottish Rite; CEO of MMJ Labs; and a clinical associate professor of emergency medicine at the Medical College of Georgia, Augusta. Dr. Baxter invented Buzzy Personal Pain Solution and is the owner and CEO of Buzzy4shots.com. She has no other disclosures.
Dr. Bonadio and Dr. Maida provide a consecutive study that is illuminating for a number of reasons. It’s been well known that a high percentage of febrile neonates have UTI. As many studies have either lumped together patients aged up to 90 days or evaluated those exclusively with the comorbidity of respiratory syncytial virus plus bronchiolitis, this paper dedicating attention to the neonatal period is useful. As the study notes, recent American Academy of Pediatrics guidelines intentionally excluded the 0- to 2-month period because of a paucity of data.
A frequent question is whether a febrile neonate needs a lumbar puncture after diagnosis of UTI. While the standard of care for infants aged less than 30 days is a complete febrile sepsis work-up, including lumbar puncture, this study adds to the body of literature suggesting that an infant older than 30 days, and certainly older than 60 days, does not always need an lumbar puncture once UTI is identified as the source of fever. Two other findings of note are the relatively low frequency of neonates with a WBC greater than 15,000/mm3 (39%) and the much higher than previously described incidence of renal system anomalies. Digging deeper, almost half of the 47% of renal anomalies were transient. Nonetheless, this may change management or make the recommendation for evaluation that much stronger after a single UTI.
|
|
Dr. Bonadio has made numerous varied contributions to the field of pediatrics, with a keen eye to clinical utility. Both for the contribution of more cases of UTI without meningitis and the incidence of anomalies in males with UTIs, this study again helps practitioners practice good medicine.
Dr. Amy Baxter is director of emergency research for Pediatric Emergency Medicine Associates, Children’s Healthcare of Atlanta at Scottish Rite; CEO of MMJ Labs; and a clinical associate professor of emergency medicine at the Medical College of Georgia, Augusta. Dr. Baxter invented Buzzy Personal Pain Solution and is the owner and CEO of Buzzy4shots.com. She has no other disclosures.
All febrile infants under 1 month old should receive a urine culture because of the prevalence of urinary tract infections and the inadequacy of other clinical parameters in identifying urinary tract infection risk, according to results of a recent study.
Approximately one in six infants aged 30 days or younger experienced urinary tract infections (UTIs), and males were more than twice as likely as females to have one, reported Dr. William Bonadio and Dr. Gary Maida of Maimonides Medical Center in New York.
Infants with a UTI should receive renal ultrasound imaging because nearly half of those with UTIs had radiographic anatomic abnormalities, the authors reported (Pediatr. Infect. Dis. J. 2014;33:342-4).
Of 670 febrile infants evaluated for sepsis in the emergency department at Maimonides Medical Center between 2004 and 2013, a total of 15.4% of the 651 receiving a urine culture had a UTI. Of these, 73% were male, and 47% had anatomic abnormalities appearing on renal ultrasound imaging.
The patients with abnormalities included 19 with pelviectasis and 26 with hydronephrosis. In the 21 patients with hydronephrosis who received a voiding cystourethrogram, 5 had vesicoureteral reflux. None of the infants had bacterial meningitis, and four had urosepsis.
Meanwhile the sensitivity of clinical symptoms, including fever height, CBC total white blood cell count, and urine dipstick test, was insufficient to determine risk of UTI in infants. Among those with UTIs, only 40% had a CBC total white blood cell count of at least 15,000/mm3, and 39% had a fever of 102° F or greater; 79% tested positive for leukocyte esterase or nitrite with a urine dipstick test.
"Reliance on urine dipstick test results to determine whether to perform a urine culture would have resulted in missed diagnosis of 21% of UTI cases in our cohort," the authors wrote. "Similarly, microscopic urinalysis was relatively insensitive at identifying those with underlying UTI."
Escherichia coli was the most common uropathogen, identified in 71% of the patients with UTI, followed by Enterococcus (10%), and Klebsiella species (10%).
The researchers did not report external funding. The authors reported no disclosures.
All febrile infants under 1 month old should receive a urine culture because of the prevalence of urinary tract infections and the inadequacy of other clinical parameters in identifying urinary tract infection risk, according to results of a recent study.
Approximately one in six infants aged 30 days or younger experienced urinary tract infections (UTIs), and males were more than twice as likely as females to have one, reported Dr. William Bonadio and Dr. Gary Maida of Maimonides Medical Center in New York.
Infants with a UTI should receive renal ultrasound imaging because nearly half of those with UTIs had radiographic anatomic abnormalities, the authors reported (Pediatr. Infect. Dis. J. 2014;33:342-4).
Of 670 febrile infants evaluated for sepsis in the emergency department at Maimonides Medical Center between 2004 and 2013, a total of 15.4% of the 651 receiving a urine culture had a UTI. Of these, 73% were male, and 47% had anatomic abnormalities appearing on renal ultrasound imaging.
The patients with abnormalities included 19 with pelviectasis and 26 with hydronephrosis. In the 21 patients with hydronephrosis who received a voiding cystourethrogram, 5 had vesicoureteral reflux. None of the infants had bacterial meningitis, and four had urosepsis.
Meanwhile the sensitivity of clinical symptoms, including fever height, CBC total white blood cell count, and urine dipstick test, was insufficient to determine risk of UTI in infants. Among those with UTIs, only 40% had a CBC total white blood cell count of at least 15,000/mm3, and 39% had a fever of 102° F or greater; 79% tested positive for leukocyte esterase or nitrite with a urine dipstick test.
"Reliance on urine dipstick test results to determine whether to perform a urine culture would have resulted in missed diagnosis of 21% of UTI cases in our cohort," the authors wrote. "Similarly, microscopic urinalysis was relatively insensitive at identifying those with underlying UTI."
Escherichia coli was the most common uropathogen, identified in 71% of the patients with UTI, followed by Enterococcus (10%), and Klebsiella species (10%).
The researchers did not report external funding. The authors reported no disclosures.
FROM THE PEDIATRIC INFECTIOUS DISEASE JOURNAL
Key clinical point: A urine culture is needed to diagnose a UTI in neonates with a fever.
Major finding: When a urine culture was taken in 651 febrile infants evaluated for sepsis, 15.4% had a UTI.
Data source: 670 febrile infants were evaluated for sepsis in the emergency department at Maimonides Medical Center between 2004 and 2013.
Disclosures: The researchers did not report external funding. The authors reported no disclosures.
ADHD link to obesity may involve stimulant use
The link between attention-deficit/hyperactivity disorder and later obesity may exist for both children with ADHD treated or not treated with stimulants, according to a study published online in Pediatrics March 17.
A longitudinal analysis of electronic health records for 163,820 Pennsylvania children, aged 3-18 years and 91% of whom were white, revealed variations in body mass index (BMI) trajectories for children with untreated ADHD, with ADHD and taking stimulant medications, and without ADHD, reported Dr. Brian Schwartz of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and his colleagues. Among the children, 8.4% were diagnosed with ADHD, 6.8% had been prescribed stimulants, and 9.5% had either an ADHD diagnosis or a stimulant prescription (Pediatrics 2014 [doi:10.1542/peds.2013-3427]).
Dr. Schwartz’s team analyzed modeled untransformed BMI values instead of BMI z scores because the former "yields estimates that are more interpretable, precise, and sensitive to factors that alter change," they wrote. The researchers identified a curvilinear average trajectory of BMI increasing with age, with girls having higher BMIs than boys at all ages and black children diverging by age 5 and continuing to widen with age.
Compared with children who neither had ADHD nor were taking stimulants, children with ADHD who were not taking stimulants showed more rapid BMI growth after age 10 years. Children prescribed stimulants but lacking an ADHD diagnosis had a lower average BMI trajectory than did the controls (neither ADHD nor stimulant use).
Meanwhile, those with ADHD and taking stimulants had slower BMI growth in early childhood but later "rebounded," ending with BMIs in late adolescence that exceeded those of controls – especially if they started taking stimulants at a younger age and took them for longer. "The earlier stimulants were ordered, the earlier and stronger that BMI growth ‘rebounded’ and eventually exceeded values in controls," the researchers wrote.
The findings suggest that stimulant use, rather than ADHD itself, is most strongly associated with growth trajectories in childhood, early BMI rebound, and later obesity," Dr. Schwartz’s team wrote. The researchers discussed possible ways that stimulants might affect usual growth patterns and noted that "behavioral therapy, specifically parent training, can be effective for ADHD management and has no known BMI rebound effect."
The study was funded by the National Institutes of Health. No disclosures were reported.
Dr. L. Eugene Arnold, Dr. Laurence L. Greenhill, and James M. Swanson, Ph.D., comment: This article provides a great example of the benefits of electronic health records, which provided access to a large sample size (approximately 15,000 with ADHD and about 11,000 treated with stimulants). It also addresses a very important question: Can a side effect of stimulants produce a secondary benefit by reducing obesity in ADHD individuals? And it provides a clear answer: No, the initial effect of stimulants is to reduce BMI in childhood, but the effect in adolescence is the opposite.
However, some technical issues also should be noted to put the basic findings into context. First, these effects on BMI do not represent a new pattern unique to ADHD; in the 1960s when these drugs were used often by non-ADHD adults for weight control, apparently initial weight loss later turned into weight gain.Next, the modest differences in BMI for untreated (about 25.5 kg/m2) and treated (about 26.5 kg/m2) ADHD cases were projected by regression analyses at about 17 years of age, but at the ages when most observations of BMI were obtained (8-12 years), the differences were not clinically or statistically significant.
In addition, the differences in BMI trajectories attributed to differences in treatment could actually be due to differences in maturation, which could be evaluated by structural analysis with a mathematical model of human growth.Surprisingly, this sophisticated approach revealed early maturation in untreated ADHD children, which may masquerade as and be interpreted as growth rebound.Finally, initial growth suppression when stimulant medication is initiated in childhood is well established, but "catchup" growth is complicated: Longitudinal data from the Multimodal Treatment Study of Children With ADHD questioned whether catch-up in height occurs and suggested rebound in weight but not height.
This study has practical implications: Clinicians prescribing stimulant medication should keep longitudinal measures of growth of their patients to monitor the trajectory of BMI over time. Along with other studies, additional implications are that patients, parents, and clinicians need not worry about excessive weight loss with stimulants, clinicians should advise patients who are stopping stimulants about the danger of rebound obesity, and all patients should be educated about a balanced diet and coached in adjusting caloric density to appetite.
Dr. L. Eugene Arnold is professor emeritus of psychiatry at Ohio State University, Columbus, and has 40 years’ experience in child psychiatric research, including the multisite Multimodal Treatment Study of Children With ADHD, for which he received the National Institutes of Health Director’s Award and continues as executive secretary and current chair of the steering committee. Dr. Laurence L. Greenhill is the Ruane Professor of Clinical Child and Adolescent Psychiatry at Columbia University, New York, and has had a career-long interest in studying the long-term effects of stimulant medication on children with ADHD. James M. Swanson, Ph.D., is professor of psychiatry at Florida International University and professor emeritus of pediatrics at the University of California, Irvine, and his recent research has focused on assessments of long-term outcomes of individuals diagnosed with ADHD in childhood. Dr. Arnold has received research funding from Curemark, Forest, Lilly, and others, and he has consulted or been on advisory boards for Neuropharm, Novartis, Noven, and others. Dr. Greenhill has received grant support from Shire and Rhodes, and has served as a member of the scientific advisory board of BioBDX. Dr. Swanson has served on the advisory board of Noven Pharmaceuticals, and provided expert testimony for Janssen-Ortho on pharmacokinetic and pharmacodynamics properties of methylphenidate.
Dr. L. Eugene Arnold, Dr. Laurence L. Greenhill, and James M. Swanson, Ph.D., comment: This article provides a great example of the benefits of electronic health records, which provided access to a large sample size (approximately 15,000 with ADHD and about 11,000 treated with stimulants). It also addresses a very important question: Can a side effect of stimulants produce a secondary benefit by reducing obesity in ADHD individuals? And it provides a clear answer: No, the initial effect of stimulants is to reduce BMI in childhood, but the effect in adolescence is the opposite.
However, some technical issues also should be noted to put the basic findings into context. First, these effects on BMI do not represent a new pattern unique to ADHD; in the 1960s when these drugs were used often by non-ADHD adults for weight control, apparently initial weight loss later turned into weight gain.Next, the modest differences in BMI for untreated (about 25.5 kg/m2) and treated (about 26.5 kg/m2) ADHD cases were projected by regression analyses at about 17 years of age, but at the ages when most observations of BMI were obtained (8-12 years), the differences were not clinically or statistically significant.
In addition, the differences in BMI trajectories attributed to differences in treatment could actually be due to differences in maturation, which could be evaluated by structural analysis with a mathematical model of human growth.Surprisingly, this sophisticated approach revealed early maturation in untreated ADHD children, which may masquerade as and be interpreted as growth rebound.Finally, initial growth suppression when stimulant medication is initiated in childhood is well established, but "catchup" growth is complicated: Longitudinal data from the Multimodal Treatment Study of Children With ADHD questioned whether catch-up in height occurs and suggested rebound in weight but not height.
This study has practical implications: Clinicians prescribing stimulant medication should keep longitudinal measures of growth of their patients to monitor the trajectory of BMI over time. Along with other studies, additional implications are that patients, parents, and clinicians need not worry about excessive weight loss with stimulants, clinicians should advise patients who are stopping stimulants about the danger of rebound obesity, and all patients should be educated about a balanced diet and coached in adjusting caloric density to appetite.
Dr. L. Eugene Arnold is professor emeritus of psychiatry at Ohio State University, Columbus, and has 40 years’ experience in child psychiatric research, including the multisite Multimodal Treatment Study of Children With ADHD, for which he received the National Institutes of Health Director’s Award and continues as executive secretary and current chair of the steering committee. Dr. Laurence L. Greenhill is the Ruane Professor of Clinical Child and Adolescent Psychiatry at Columbia University, New York, and has had a career-long interest in studying the long-term effects of stimulant medication on children with ADHD. James M. Swanson, Ph.D., is professor of psychiatry at Florida International University and professor emeritus of pediatrics at the University of California, Irvine, and his recent research has focused on assessments of long-term outcomes of individuals diagnosed with ADHD in childhood. Dr. Arnold has received research funding from Curemark, Forest, Lilly, and others, and he has consulted or been on advisory boards for Neuropharm, Novartis, Noven, and others. Dr. Greenhill has received grant support from Shire and Rhodes, and has served as a member of the scientific advisory board of BioBDX. Dr. Swanson has served on the advisory board of Noven Pharmaceuticals, and provided expert testimony for Janssen-Ortho on pharmacokinetic and pharmacodynamics properties of methylphenidate.
Dr. L. Eugene Arnold, Dr. Laurence L. Greenhill, and James M. Swanson, Ph.D., comment: This article provides a great example of the benefits of electronic health records, which provided access to a large sample size (approximately 15,000 with ADHD and about 11,000 treated with stimulants). It also addresses a very important question: Can a side effect of stimulants produce a secondary benefit by reducing obesity in ADHD individuals? And it provides a clear answer: No, the initial effect of stimulants is to reduce BMI in childhood, but the effect in adolescence is the opposite.
However, some technical issues also should be noted to put the basic findings into context. First, these effects on BMI do not represent a new pattern unique to ADHD; in the 1960s when these drugs were used often by non-ADHD adults for weight control, apparently initial weight loss later turned into weight gain.Next, the modest differences in BMI for untreated (about 25.5 kg/m2) and treated (about 26.5 kg/m2) ADHD cases were projected by regression analyses at about 17 years of age, but at the ages when most observations of BMI were obtained (8-12 years), the differences were not clinically or statistically significant.
In addition, the differences in BMI trajectories attributed to differences in treatment could actually be due to differences in maturation, which could be evaluated by structural analysis with a mathematical model of human growth.Surprisingly, this sophisticated approach revealed early maturation in untreated ADHD children, which may masquerade as and be interpreted as growth rebound.Finally, initial growth suppression when stimulant medication is initiated in childhood is well established, but "catchup" growth is complicated: Longitudinal data from the Multimodal Treatment Study of Children With ADHD questioned whether catch-up in height occurs and suggested rebound in weight but not height.
This study has practical implications: Clinicians prescribing stimulant medication should keep longitudinal measures of growth of their patients to monitor the trajectory of BMI over time. Along with other studies, additional implications are that patients, parents, and clinicians need not worry about excessive weight loss with stimulants, clinicians should advise patients who are stopping stimulants about the danger of rebound obesity, and all patients should be educated about a balanced diet and coached in adjusting caloric density to appetite.
Dr. L. Eugene Arnold is professor emeritus of psychiatry at Ohio State University, Columbus, and has 40 years’ experience in child psychiatric research, including the multisite Multimodal Treatment Study of Children With ADHD, for which he received the National Institutes of Health Director’s Award and continues as executive secretary and current chair of the steering committee. Dr. Laurence L. Greenhill is the Ruane Professor of Clinical Child and Adolescent Psychiatry at Columbia University, New York, and has had a career-long interest in studying the long-term effects of stimulant medication on children with ADHD. James M. Swanson, Ph.D., is professor of psychiatry at Florida International University and professor emeritus of pediatrics at the University of California, Irvine, and his recent research has focused on assessments of long-term outcomes of individuals diagnosed with ADHD in childhood. Dr. Arnold has received research funding from Curemark, Forest, Lilly, and others, and he has consulted or been on advisory boards for Neuropharm, Novartis, Noven, and others. Dr. Greenhill has received grant support from Shire and Rhodes, and has served as a member of the scientific advisory board of BioBDX. Dr. Swanson has served on the advisory board of Noven Pharmaceuticals, and provided expert testimony for Janssen-Ortho on pharmacokinetic and pharmacodynamics properties of methylphenidate.
The link between attention-deficit/hyperactivity disorder and later obesity may exist for both children with ADHD treated or not treated with stimulants, according to a study published online in Pediatrics March 17.
A longitudinal analysis of electronic health records for 163,820 Pennsylvania children, aged 3-18 years and 91% of whom were white, revealed variations in body mass index (BMI) trajectories for children with untreated ADHD, with ADHD and taking stimulant medications, and without ADHD, reported Dr. Brian Schwartz of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and his colleagues. Among the children, 8.4% were diagnosed with ADHD, 6.8% had been prescribed stimulants, and 9.5% had either an ADHD diagnosis or a stimulant prescription (Pediatrics 2014 [doi:10.1542/peds.2013-3427]).
Dr. Schwartz’s team analyzed modeled untransformed BMI values instead of BMI z scores because the former "yields estimates that are more interpretable, precise, and sensitive to factors that alter change," they wrote. The researchers identified a curvilinear average trajectory of BMI increasing with age, with girls having higher BMIs than boys at all ages and black children diverging by age 5 and continuing to widen with age.
Compared with children who neither had ADHD nor were taking stimulants, children with ADHD who were not taking stimulants showed more rapid BMI growth after age 10 years. Children prescribed stimulants but lacking an ADHD diagnosis had a lower average BMI trajectory than did the controls (neither ADHD nor stimulant use).
Meanwhile, those with ADHD and taking stimulants had slower BMI growth in early childhood but later "rebounded," ending with BMIs in late adolescence that exceeded those of controls – especially if they started taking stimulants at a younger age and took them for longer. "The earlier stimulants were ordered, the earlier and stronger that BMI growth ‘rebounded’ and eventually exceeded values in controls," the researchers wrote.
The findings suggest that stimulant use, rather than ADHD itself, is most strongly associated with growth trajectories in childhood, early BMI rebound, and later obesity," Dr. Schwartz’s team wrote. The researchers discussed possible ways that stimulants might affect usual growth patterns and noted that "behavioral therapy, specifically parent training, can be effective for ADHD management and has no known BMI rebound effect."
The study was funded by the National Institutes of Health. No disclosures were reported.
The link between attention-deficit/hyperactivity disorder and later obesity may exist for both children with ADHD treated or not treated with stimulants, according to a study published online in Pediatrics March 17.
A longitudinal analysis of electronic health records for 163,820 Pennsylvania children, aged 3-18 years and 91% of whom were white, revealed variations in body mass index (BMI) trajectories for children with untreated ADHD, with ADHD and taking stimulant medications, and without ADHD, reported Dr. Brian Schwartz of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and his colleagues. Among the children, 8.4% were diagnosed with ADHD, 6.8% had been prescribed stimulants, and 9.5% had either an ADHD diagnosis or a stimulant prescription (Pediatrics 2014 [doi:10.1542/peds.2013-3427]).
Dr. Schwartz’s team analyzed modeled untransformed BMI values instead of BMI z scores because the former "yields estimates that are more interpretable, precise, and sensitive to factors that alter change," they wrote. The researchers identified a curvilinear average trajectory of BMI increasing with age, with girls having higher BMIs than boys at all ages and black children diverging by age 5 and continuing to widen with age.
Compared with children who neither had ADHD nor were taking stimulants, children with ADHD who were not taking stimulants showed more rapid BMI growth after age 10 years. Children prescribed stimulants but lacking an ADHD diagnosis had a lower average BMI trajectory than did the controls (neither ADHD nor stimulant use).
Meanwhile, those with ADHD and taking stimulants had slower BMI growth in early childhood but later "rebounded," ending with BMIs in late adolescence that exceeded those of controls – especially if they started taking stimulants at a younger age and took them for longer. "The earlier stimulants were ordered, the earlier and stronger that BMI growth ‘rebounded’ and eventually exceeded values in controls," the researchers wrote.
The findings suggest that stimulant use, rather than ADHD itself, is most strongly associated with growth trajectories in childhood, early BMI rebound, and later obesity," Dr. Schwartz’s team wrote. The researchers discussed possible ways that stimulants might affect usual growth patterns and noted that "behavioral therapy, specifically parent training, can be effective for ADHD management and has no known BMI rebound effect."
The study was funded by the National Institutes of Health. No disclosures were reported.
FROM PEDIATRICS
Major finding: Those with ADHD taking stimulant medications, especially with longer use and earlier start, had slower BMI growth in childhood but rebounded with higher BMIs in later adolescence that exceeded the mean of those without ADHD.
Data source: A longitudinal analysis of electronic medical records for 163,820 children, aged 3-18 between January 2001 and February 2012, in Pennsylvania.
Disclosures: The study was funded by the National Institutes of Health. No disclosures were reported.
Do Antibiotics Contribute to Pediatric C difficile Infection Rate?
Nearly three-quarters of Clostridium difficile infections in children and teens were community associated, with the highest incidence among 1-year-olds, according to a study published March 3 in Pediatrics.
The 944 pediatric cases analyzed for the study involved 885 children identified in select counties throughout eight states in 2010 and 10 states in 2011 as part of the Centers for Disease Control and Prevention’s Emerging Infections Program. Among those cases, 71% were community associated, 17% were community onset health care facility–associated and 12% were health care facility–onset (Pediatrics 2014 March 3 [doi:10.1542/peds.2013-3049]).
The highest incidence of 66.3 children/100,000 occurred among those aged 12-23 months old, followed by an incidence of 35.7 in children aged 2-3 years, 15.6 for those aged 4-9 years, and 16.6 for children aged 10-17 years.
"The high C. difficile infection incidence we observed among the youngest age group may be related to the finding that children 0-2 years of age have the highest outpatient antibiotic prescribing rate," reported Dr. Joyanna Wendt, a medical officer at the CDC, and her colleagues. Antibiotic use increases risk of C. difficile infection because the medication can change or kill beneficial bacteria that protect against infection.
Among a smaller sample of 84 cases interviewed in the study and reporting diarrhea on the first day of stool collection, 73% (61 cases) reported taking antibiotics within 12 weeks before the diarrhea began. Ear, sinus, and upper respiratory tract infections comprised the most common reasons for antibiotic use.
"Improved antibiotic prescribing is critical to protect the health of our nation’s children," Dr. Tom Frieden, CDC director, said in a prepared statement. "When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems, including C. difficile infection and dangerous antibiotic-resistant infections."
Incidence did not differ by sex, but white children had a higher incidence, with 23.9 cases/100,000 children, compared with 17.4 for nonwhite children, "likely reflecting, in part, differences in health care access," the researchers wrote.
This study was supported by the CDC. Coauthor Dr. Dennis N. Gerding is a board member at Merck, Rebiotix, Summit, and Actelion and consults for Roche, Novartis, Sanofi Pasteur, and Cubist; he consults for and holds patents licensed to ViroPharma, which manufactures vancomycin to treat C difficile. No other authors reported disclosures.
Nearly three-quarters of Clostridium difficile infections in children and teens were community associated, with the highest incidence among 1-year-olds, according to a study published March 3 in Pediatrics.
The 944 pediatric cases analyzed for the study involved 885 children identified in select counties throughout eight states in 2010 and 10 states in 2011 as part of the Centers for Disease Control and Prevention’s Emerging Infections Program. Among those cases, 71% were community associated, 17% were community onset health care facility–associated and 12% were health care facility–onset (Pediatrics 2014 March 3 [doi:10.1542/peds.2013-3049]).
The highest incidence of 66.3 children/100,000 occurred among those aged 12-23 months old, followed by an incidence of 35.7 in children aged 2-3 years, 15.6 for those aged 4-9 years, and 16.6 for children aged 10-17 years.
"The high C. difficile infection incidence we observed among the youngest age group may be related to the finding that children 0-2 years of age have the highest outpatient antibiotic prescribing rate," reported Dr. Joyanna Wendt, a medical officer at the CDC, and her colleagues. Antibiotic use increases risk of C. difficile infection because the medication can change or kill beneficial bacteria that protect against infection.
Among a smaller sample of 84 cases interviewed in the study and reporting diarrhea on the first day of stool collection, 73% (61 cases) reported taking antibiotics within 12 weeks before the diarrhea began. Ear, sinus, and upper respiratory tract infections comprised the most common reasons for antibiotic use.
"Improved antibiotic prescribing is critical to protect the health of our nation’s children," Dr. Tom Frieden, CDC director, said in a prepared statement. "When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems, including C. difficile infection and dangerous antibiotic-resistant infections."
Incidence did not differ by sex, but white children had a higher incidence, with 23.9 cases/100,000 children, compared with 17.4 for nonwhite children, "likely reflecting, in part, differences in health care access," the researchers wrote.
This study was supported by the CDC. Coauthor Dr. Dennis N. Gerding is a board member at Merck, Rebiotix, Summit, and Actelion and consults for Roche, Novartis, Sanofi Pasteur, and Cubist; he consults for and holds patents licensed to ViroPharma, which manufactures vancomycin to treat C difficile. No other authors reported disclosures.
Nearly three-quarters of Clostridium difficile infections in children and teens were community associated, with the highest incidence among 1-year-olds, according to a study published March 3 in Pediatrics.
The 944 pediatric cases analyzed for the study involved 885 children identified in select counties throughout eight states in 2010 and 10 states in 2011 as part of the Centers for Disease Control and Prevention’s Emerging Infections Program. Among those cases, 71% were community associated, 17% were community onset health care facility–associated and 12% were health care facility–onset (Pediatrics 2014 March 3 [doi:10.1542/peds.2013-3049]).
The highest incidence of 66.3 children/100,000 occurred among those aged 12-23 months old, followed by an incidence of 35.7 in children aged 2-3 years, 15.6 for those aged 4-9 years, and 16.6 for children aged 10-17 years.
"The high C. difficile infection incidence we observed among the youngest age group may be related to the finding that children 0-2 years of age have the highest outpatient antibiotic prescribing rate," reported Dr. Joyanna Wendt, a medical officer at the CDC, and her colleagues. Antibiotic use increases risk of C. difficile infection because the medication can change or kill beneficial bacteria that protect against infection.
Among a smaller sample of 84 cases interviewed in the study and reporting diarrhea on the first day of stool collection, 73% (61 cases) reported taking antibiotics within 12 weeks before the diarrhea began. Ear, sinus, and upper respiratory tract infections comprised the most common reasons for antibiotic use.
"Improved antibiotic prescribing is critical to protect the health of our nation’s children," Dr. Tom Frieden, CDC director, said in a prepared statement. "When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems, including C. difficile infection and dangerous antibiotic-resistant infections."
Incidence did not differ by sex, but white children had a higher incidence, with 23.9 cases/100,000 children, compared with 17.4 for nonwhite children, "likely reflecting, in part, differences in health care access," the researchers wrote.
This study was supported by the CDC. Coauthor Dr. Dennis N. Gerding is a board member at Merck, Rebiotix, Summit, and Actelion and consults for Roche, Novartis, Sanofi Pasteur, and Cubist; he consults for and holds patents licensed to ViroPharma, which manufactures vancomycin to treat C difficile. No other authors reported disclosures.
FROM PEDIATRICS
Antibiotics may contribute to high pediatric C. difficile infection rate
Nearly three-quarters of Clostridium difficile infections in children and teens were community associated, with the highest incidence among 1-year-olds, according to a study published March 3 in Pediatrics.
The 944 pediatric cases analyzed for the study involved 885 children identified in select counties throughout eight states in 2010 and 10 states in 2011 as part of the Centers for Disease Control and Prevention’s Emerging Infections Program. Among those cases, 71% were community associated, 17% were community onset health care facility–associated and 12% were health care facility–onset (Pediatrics 2014 March 3 [doi:10.1542/peds.2013-3049]).
The highest incidence of 66.3 children/100,000 occurred among those aged 12-23 months old, followed by an incidence of 35.7 in children aged 2-3 years, 15.6 for those aged 4-9 years, and 16.6 for children aged 10-17 years.
"The high C. difficile infection incidence we observed among the youngest age group may be related to the finding that children 0-2 years of age have the highest outpatient antibiotic prescribing rate," reported Dr. Joyanna Wendt, a medical officer at the CDC, and her colleagues. Antibiotic use increases risk of C. difficile infection because the medication can change or kill beneficial bacteria that protect against infection.
Among a smaller sample of 84 cases interviewed in the study and reporting diarrhea on the first day of stool collection, 73% (61 cases) reported taking antibiotics within 12 weeks before the diarrhea began. Ear, sinus, and upper respiratory tract infections comprised the most common reasons for antibiotic use.
"Improved antibiotic prescribing is critical to protect the health of our nation’s children," Dr. Tom Frieden, CDC director, said in a prepared statement. "When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems, including C. difficile infection and dangerous antibiotic-resistant infections."
Incidence did not differ by sex, but white children had a higher incidence, with 23.9 cases/100,000 children, compared with 17.4 for nonwhite children, "likely reflecting, in part, differences in health care access," the researchers wrote.
This study was supported by the CDC. Coauthor Dr. Dennis N. Gerding is a board member at Merck, Rebiotix, Summit, and Actelion and consults for Roche, Novartis, Sanofi Pasteur, and Cubist; he consults for and holds patents licensed to ViroPharma, which manufactures vancomycin to treat C difficile. No other authors reported disclosures.
Nearly three-quarters of Clostridium difficile infections in children and teens were community associated, with the highest incidence among 1-year-olds, according to a study published March 3 in Pediatrics.
The 944 pediatric cases analyzed for the study involved 885 children identified in select counties throughout eight states in 2010 and 10 states in 2011 as part of the Centers for Disease Control and Prevention’s Emerging Infections Program. Among those cases, 71% were community associated, 17% were community onset health care facility–associated and 12% were health care facility–onset (Pediatrics 2014 March 3 [doi:10.1542/peds.2013-3049]).
The highest incidence of 66.3 children/100,000 occurred among those aged 12-23 months old, followed by an incidence of 35.7 in children aged 2-3 years, 15.6 for those aged 4-9 years, and 16.6 for children aged 10-17 years.
"The high C. difficile infection incidence we observed among the youngest age group may be related to the finding that children 0-2 years of age have the highest outpatient antibiotic prescribing rate," reported Dr. Joyanna Wendt, a medical officer at the CDC, and her colleagues. Antibiotic use increases risk of C. difficile infection because the medication can change or kill beneficial bacteria that protect against infection.
Among a smaller sample of 84 cases interviewed in the study and reporting diarrhea on the first day of stool collection, 73% (61 cases) reported taking antibiotics within 12 weeks before the diarrhea began. Ear, sinus, and upper respiratory tract infections comprised the most common reasons for antibiotic use.
"Improved antibiotic prescribing is critical to protect the health of our nation’s children," Dr. Tom Frieden, CDC director, said in a prepared statement. "When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems, including C. difficile infection and dangerous antibiotic-resistant infections."
Incidence did not differ by sex, but white children had a higher incidence, with 23.9 cases/100,000 children, compared with 17.4 for nonwhite children, "likely reflecting, in part, differences in health care access," the researchers wrote.
This study was supported by the CDC. Coauthor Dr. Dennis N. Gerding is a board member at Merck, Rebiotix, Summit, and Actelion and consults for Roche, Novartis, Sanofi Pasteur, and Cubist; he consults for and holds patents licensed to ViroPharma, which manufactures vancomycin to treat C difficile. No other authors reported disclosures.
Nearly three-quarters of Clostridium difficile infections in children and teens were community associated, with the highest incidence among 1-year-olds, according to a study published March 3 in Pediatrics.
The 944 pediatric cases analyzed for the study involved 885 children identified in select counties throughout eight states in 2010 and 10 states in 2011 as part of the Centers for Disease Control and Prevention’s Emerging Infections Program. Among those cases, 71% were community associated, 17% were community onset health care facility–associated and 12% were health care facility–onset (Pediatrics 2014 March 3 [doi:10.1542/peds.2013-3049]).
The highest incidence of 66.3 children/100,000 occurred among those aged 12-23 months old, followed by an incidence of 35.7 in children aged 2-3 years, 15.6 for those aged 4-9 years, and 16.6 for children aged 10-17 years.
"The high C. difficile infection incidence we observed among the youngest age group may be related to the finding that children 0-2 years of age have the highest outpatient antibiotic prescribing rate," reported Dr. Joyanna Wendt, a medical officer at the CDC, and her colleagues. Antibiotic use increases risk of C. difficile infection because the medication can change or kill beneficial bacteria that protect against infection.
Among a smaller sample of 84 cases interviewed in the study and reporting diarrhea on the first day of stool collection, 73% (61 cases) reported taking antibiotics within 12 weeks before the diarrhea began. Ear, sinus, and upper respiratory tract infections comprised the most common reasons for antibiotic use.
"Improved antibiotic prescribing is critical to protect the health of our nation’s children," Dr. Tom Frieden, CDC director, said in a prepared statement. "When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems, including C. difficile infection and dangerous antibiotic-resistant infections."
Incidence did not differ by sex, but white children had a higher incidence, with 23.9 cases/100,000 children, compared with 17.4 for nonwhite children, "likely reflecting, in part, differences in health care access," the researchers wrote.
This study was supported by the CDC. Coauthor Dr. Dennis N. Gerding is a board member at Merck, Rebiotix, Summit, and Actelion and consults for Roche, Novartis, Sanofi Pasteur, and Cubist; he consults for and holds patents licensed to ViroPharma, which manufactures vancomycin to treat C difficile. No other authors reported disclosures.
FROM PEDIATRICS
Major Finding: Seventy-one percent of 944 pediatric C. difficile infections were community associated with the highest incidence among 1-year-old (66.3/100,000) and white children (23.9/100,000).
Data Source: A CDC Emerging Infections Program surveillance of pediatric (ages 1-17) C. difficile cases across eight states in 2010 and 10 states in 2011.
Disclosures: This study was supported by the CDC. Dr. Gerding is a board member at Merck, Rebiotix, Summit, and Actelion and consults for Roche, Novartis, Sanofi Pasteur, and Cubist; he consults for and holds patents licensed to Viropharma, which manufactures vancomycin to treat C. difficile. No other authors reported disclosures.
