pharmacological treatment
Research Papers
Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review
Top‐tier evidence on the safety/tolerability of 80 medications in children/adolescents with mental disorders has recently been reviewed in this journal. To guide clinical practice, such data must be combined with evidence on efficacy and acceptability. Besides medications, psychosocial interventions and brain stimulation techniques are treatment options for children/adolescents with mental disorders. For this umbrella review, we systematically searched network meta‐analyses (NMAs) and meta‐analyses (MAs) of randomized controlled trials (RCTs) evaluating 48 medications, 20 psychosocial interventions, and four brain stimulation techniques in children/adolescents with 52 different mental disorders or groups of mental disorders, reporting on 20 different efficacy/acceptability outcomes. Co‐primary outcomes were disease‐specific symptom reduction and all‐cause discontinuation (“acceptability”). We included 14 NMAs and 90 MAs, reporting on 15 mental disorders or groups of mental disorders. Overall, 21 medications outperformed placebo regarding the co‐primary outcomes, and three psychosocial interventions did so (while seven outperformed waiting list/no treatment). Based on the meta‐analytic evidence, the most convincing efficacy profile emerged for amphetamines, methylphenidate and, to a smaller extent, behavioral therapy in attention‐deficit/hyperactivity disorder; aripiprazole, risperidone and several psychosocial interventions in autism; risperidone and behavioral interventions in disruptive behavior disorders; several antipsychotics in schizophrenia spectrum disorders; fluoxetine, the combination of fluoxetine and cognitive behavioral therapy (CBT), and interpersonal therapy in depression; aripiprazole in mania; fluoxetine and group CBT in anxiety disorders; fluoxetine/selective serotonin reuptake inhibitors, CBT, and behavioral therapy with exposure and response prevention in obsessive‐compulsive disorder; CBT in post‐traumatic stress disorder; imipramine and alarm behavioral intervention in enuresis; behavioral therapy in encopresis; and family therapy in anorexia nervosa. Results from this umbrella review of interventions for mental disorders in children/adolescents provide evidence‐based information for clinical decision making.
View Full Paper →Selected forms of therapy for individuals with autism spectrum disorder
Abstract Autism spectrum disorder (ASD) is a condition of multiple origins. It is characterised by a range of behaviour patterns, in addition to disturbed social and emotional functioning. Of note, early therapy is conducive to better treatment results. A few recently discussed therapies have a particularly positive impact on children with ASD. Corbett et al. [2] proposed Sense Theatre. This involves instilling appropriate behaviours and communication patterns into the afflicted individual through acting. Role-playing and other similar techniques also offer an opportunity for children with ASD to improve their areas of empathy and social cooperation. With regard to bio-feedback-related techniques, Friedrich et al. [3] was noted for developing the Brain-computer method, a system of game interface connected to an external device. The method targets the mirror neuron system (MNS) in order to enhance cognitive, emotional and behavioural functions through neurofeedback. An approach put forward by Solomon et al. [10] is called ‘Play and Language for Autistic Youngsters (PLAY) Project Home Consultation’. Herein, volunteers visit patients’ homes on a regular basis to engage the children in play and games, after which they discuss with parents, the issues that came up. The PLAY reduces guardians’ stress levels and improves children’s skills. A pharmacological method is that of administering sulphoraphane [9], which reduces damaging effects. As others claim [8,1,7], other dietary approaches prove efficient as well. In summation, an early intervention and the employment of a multimodal treatment approach can be of importance for enhancing the life of ASD-affected children.
View Full Paper →Diagnostic and therapeutic utility of neuroimaging in depression: an overview
A growing number of studies have used neuroimaging to further our understanding of how brain structure and function are altered in major depression. More recently, these techniques have begun to show promise for the diagnosis and treatment of depression, both as aids to conventional methods and as methods in their own right. In this review, we describe recent neuroimaging findings in the field that might aid diagnosis and improve treatment accuracy. Overall, major depression is associated with numerous structural and functional differences in neural systems involved in emotion processing and mood regulation. Furthermore, several studies have shown that the structure and function of these systems is changed by pharmacological and psychological treatments of the condition and that these changes in candidate brain regions might predict clinical response. More recently, "machine learning" methods have used neuroimaging data to categorize individual patients according to their diagnostic status and predict treatment response. Despite being mostly limited to group-level comparisons at present, with the introduction of new methods and more naturalistic studies, neuroimaging has the potential to become part of the clinical armamentarium and may improve diagnostic accuracy and inform treatment choice at the patient level.
View Full Paper →Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder
Historically, pharmacological treatments for attentiondeficit/ hyperactivity disorder (ADHD) have been considered to be the only type of interventions effective for reducing the core symptoms of this condition. However, during the past three decades, a series of caseand controlled-group studies examining the effects of EEG biofeedback have reported improved attention and behavioral control, increased cortical activation on quantitative electroencephalographic examination, and gains on tests of intelligence and academic achievement in response to this type of treatment. This review paper critically examines the empirical evidence, applying the efficacy guidelines jointly established by the Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neuronal Regulation (ISNR). On the basis of these scientific principles, EEG biofeedback was determined to be "probably efficacious" for the treatment of ADHD. Although significant clinical improvement was reported in approximately 75% of the patients in each of the published research studies, additional randomized, controlled group studies are needed in order to provide a better estimate of the percentage of patients with ADHD who will demonstrate such gains in clinical practice
View Full Paper →EEG biofeedback: A new treatment option for ADD/ADHD
Attention Deficit Disorder is commonly treated with stimulant medications such as Ritalin (methylphenidate). However, this medication has short-term effects and numerous undesirable side effects including insomnia and loss of appetite. This study explores using EEG biofeedback, with its minimal side effects and long-term results, as an alternative to pharmacological treatments for ADD
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