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P J Ambrosini

Publications and source records attributed to P J Ambrosini.

At least 19 recordsLinked to original sources
PubMed2003

49th Annual Meeting of the American Academy of Child & Adolescent Psychiatry. 22-27 October 2002, San Francisco, CA, USA.

The diverse programme covered recent advances in developmental neurobiology, genetics, psychotherapy and pharmacotherapy. Presentations included clinical consultation breakfasts, with experts in their specialities, clinical case conferences, media theatre events, symposia, special interest groups, workshops and poster presentations. Several awards were presented to members to acknowledge their research achievements and service to the academy, and to children in need. All the presentations were focused on keeping the clinician and the researcher up-to-date on the advancements within the field of child and adolescent psychiatry. This report will focus on the new research poster presentations, which highlight the current status of paediatric pharmacotherapy. The data will be presented within the major diagnostic groups of the affective, behavioural, anxiety and developmental, autistic and psychotic syndromes. In paediatric pharmacotherapy particularly, several agents are administered as broad spectrum pharmacotherapeutics, and therefore, are used across several disorders.

Adolescent↗
PubMed2001

Childhood depression: pharmacological therapy/treatment (pharmacotherapy of childhood depression).

Critiqued the published double-blind, placebo-controlled studies of antidepressant pharmacotherapy in child and adolescent major depressive disorder to assess their overall efficacy. The pharmacological mechanism of antidepressant action also was discussed. At best, antidepressant treatment for depressed youths is only modestly effective. In particular, the tricyclic antidepressants are not superior to placebo; however, early evidence with the selective serotonin reuptake inhibitors is more encouraging. The theoretical basis for this response pattern is discussed from a methodological perspective, from a neurodevelopmental status, and from a biological viewpoint. Study modifications are suggested which could improve some of the methodological limitations apparent in previous clinical drug trials.

Adolescent↗
PubMed2000

Historical development and present status of the schedule for affective disorders and schizophrenia for school-age children (K-SADS).

OBJECTIVES: To review the historical development, reliability, validity, administrative characteristics, and uses of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). METHOD: The various past and current K-SADS editions were reviewed as was the literature describing their uses. RESULTS: Three DSM-IV-compatible versions of the K-SADS are in general use, 1 present state (K-SADS-P IVR) and 2 epidemiological editions (K-SADS-E and K-SADS-P/L). All 3 interviews provide a current diagnostic assessment. The K-SADS-P IVR also evaluates the worst past episode during the preceding year, while the K-SADS-E and -P/L provide a lifetime diagnosis. The K-SADS-E and -P/L are primarily categorical diagnostic interviews while the K-SADS-P IVR, which also measures symptom severity, can be used to monitor treatment response. All editions have good rater reliability. However, the quality of the validating data set for the K-SADS is limiting. CONCLUSIONS: The K-SADS is a viable interview schedule to assess current, past, and lifetime diagnostic status in children and adolescents. It is has the potential to further aide in the validation of psychiatric disorders. The substantial rater training required for reliable administration and the need for more validation work remain its drawbacks.

Child↗
PubMed2000

A review of pharmacotherapy of major depression in children and adolescents.

OBJECTIVE: The review examined the historical progression and current status of pharmacotherapy of child and adolescent major affective disorder. METHODS: A MEDLINE search was used to identify double-blind, placebo-controlled studies of child and adolescent major depression. Only studies that used reliable diagnostic and recovery parameters were included. RESULTS: Few well-designed studies have compared placebo and tricyclic antidepressants in the treatment of major depressive disorder in children and adolescents. However, results consistently suggest that tricyclic antidepressants are not efficacious. Early results of double-blind placebo-controlled trials with fluoxetine and paroxetine have shown a significant drug effect. However, the results are inconsistent, which could reflect the ways that response to medication is defined, the ways that rating scales measure recovery, and uncertainties of dosing strategies with second-generation antidepressants. Hypothesized reasons for the unique response pattern in youths include the changing hormonal status of children, the differential maturation of the noradrenergic versus serotonergic neurotransmitter systems, and the possibility that a large proportion of depressed youths are in the early stages of bipolar disorder, which is not effectively treated by these medications. CONCLUSIONS: Tricyclic antidepressants are not superior to placebo for the treatment of child and adolescent major depressive disorder. Although two of three trials of second-generation antidepressants in this age group have had negative results, data suggest that these drugs may be more promising. It is too early in our investigation to know whether these agents will be effective in treating major depressive disorder in children and adolescents.

Adolescent↗
PubMed1999

Multicenter open-label sertraline study in adolescent outpatients with major depression.

OBJECTIVE: The aim of this multicenter outpatient study was to assess the therapeutic benefits, response patterns, and safety of sertraline in adolescent major depressive disorder (MDD). METHOD: Fifty-three adolescent outpatients with MDD were treated in an open-label, 10-week, acute-phase trial with sertraline and, if responders, for an additional 12-week continuation phase. Diagnostic and response assessments included the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), 17-item K-SADS-derived depression severity score, Hamilton Depression Rating Scale, Beck Depression Inventory, and Clinical Global Impression Scale. RESULTS: By 2 weeks, when analyzed as continuous variables, all severity scores showed significant differences from baseline. This pattern persisted through 10 weeks, with a significantly greater response occurring when treatment was extended from 6 to 10 weeks. Both clinician- and patient-rated improvement was maintained during continuation treatment. Response rates varied considerably when depression rating scales were analyzed categorically. Sertraline was generally well tolerated and did not induce manic symptoms. CONCLUSIONS: In open treatment of adolescent MDD with sertraline, significant improvement occurred early on and was maintained for 22 weeks. Absolute response rates varied depending on the rating scales used, definition of response, and length of treatment. Maximal response rates were obtained by clinician-defined ratings after 10 weeks of treatment.

Adolescent↗
PubMed1998

Increased plasma valproate concentrations when coadministered with guanfacine.

A preliminary clinical observation suggests the possibility of changes in valproate level when coadministered with guanfacine. Two pediatric inpatients (8 and 9 years of age) were treated with valproic acid and guanfacine concurrently. In one child, when guanfacine was tapered and discontinued, the plasma valproate concentration decreased by 41% from 128 microg/mL to 76 microg/mL. In the other case, studied in an ABA design, the child exhibited a rapid increase in plasma valproate levels while guanfacine was administered. It is proposed that guanfacine may affect the pharmacokinetics of valproic acid and lead to a significant increase in valproate plasma levels when used concurrently with this agent. The mechanism of this proposed interaction may involve drug-drug competition at the level of hepatic glucuronidation (conjugation), although shifts in protein binding cannot be ruled out.

Adrenergic alpha-Agonists↗
PubMed1997

Relationship of Beck Depression Inventory factors to depression among adolescents.

Beck Depression Inventory (BDI) scores of 328 adolescents referred to a depression clinic were factor analyzed to test the discriminant validity of each factor. Three of the four factors (Negative Self Attitude. Performance Difficulty, and Somatic Symptoms) discriminated depressed adolescents from those with a behavior disorder or no diagnosis; the Negative Self Attitude and Performance Difficulty factors also discriminated depressed from anxious adolescents. The fourth factor, Physical Worry, failed to discriminate diagnostic groups. Diagnostic efficiency statistics are reported for both the BDI and for items comprising the 13-item BDI Short Form. Results indicate the BDI is a valid screening tool for adolescent depression in a clinical setting, regardless of the presence of comorbid conditions.

Adolescent↗
PubMed1993

Antidepressant treatments in children and adolescents. I. Affective disorders.

Part I of this review critically evaluates antidepressants' benefits for children and adolescents with affective disorders. The effectiveness of antidepressants is characterized with specific references regarding diagnostic methodology, measurement characteristics, response definitions, recovery rates, length of treatment, and plasma level monitoring. Antidepressants' efficacy for depressed youths is quite circumscribed, and their superiority to placebo remains unproved. Their intriguing lack of efficacy in affective disorders is discussed based on methodological issues and from a theoretical perspective. Clinical and research implications are presented.

Adolescent↗
PubMed1993

Antidepressant treatments in children and adolescents: II. Anxiety, physical, and behavioral disorders.

Part II of this review critically evaluates antidepressants' (AD) efficacy in children and adolescents with anxiety, physical, and behavioral disorders as well as AD's side-effect spectrum. AD are administered increasingly to youths with specific anxiety syndromes phenomenologically paralleling those in adults which are responsive to AD (e.g., panic, obsessive-compulsive disorders). While several trials have not substantiated earlier theoretical considerations suggesting their usefulness in separation anxiety, their recent success in ameliorating obsessive-compulsive symptoms is encouraging. Systematic drug treatment studies however are limited because of the common overlap of anxiety syndromes with each other and other prominent psychiatric disturbances. More consistent benefits with AD are seen in the physical (e.g., enuresis, bulimia nervosa) and behavioral disorders (e.g., attention deficit-hyperactivity disorder). The wide-ranging benefits of AD in nonaffective disorders suggest AD are more appropriately viewed as broad spectrum pharmacotherapeutics.

Adolescent↗
PubMed1992

Platelet imipramine binding in depressed children and adolescents.

Kinetic constants of platelet imipramine binding were determined in youths with major depression, and a contrast group. Subjects actively depressed (N = 10) had significantly fewer imipramine binding sites (Bmax) (877 +/- 148 fmol/mg protein) than recovering depressives (N = 12) (1220 +/- 428 fmol/mg protein) and contrasts (N = 10) (1270 +/- 230 fmol/mg protein). Affinity constants (Kd) (1.14 +/- 0.36 nM, 0.97 +/- 0.31 nM, and 1.17 +/- 0.39 nM, respectively) were similar among the groups. Actively depressed males but not females had fewer imipramine binding sites than both their sex-matched comparison groups. Although actively depressed females' Bmax was significantly lower than recovering depressed and nondepressed males, neither age, Tannner stage, nor circannual rhythms influenced Bmax, but suicidality may be associated with low Bmax. A decrease in Bmax may be a state-specific marker of major depression in boys or associated with a depressive disorder with a suicidal history.

Adolescent↗
PubMed1992

Regulation of sleep and growth hormone in adolescent depression.

This article reviews findings of sleep, growth hormone (GH), and cortisol measures from a number of separate controlled studies of prepubertal and adolescent depression carried out by Puig-Antich and colleagues since 1978. New data are presented comparing 24-hour GH measures in adolescents with major depressive disorder (MDD) (N = 44; mean age = 14.8 +/- 2.0) to normal control adolescents (N = 37; mean age = 15.3 +/- 1.5). There were no significant overall group differences in summary GH measures between MDD and normal controls. Splitting the MDD group on the basis of suicidality (definite plan or attempt) (N = 20), revealed a significant blunting of sleep GH compared to the nonsuicidal group (N = 24). These results are discussed in the context of the other sleep and neuroendocrine findings in this population, with evidence for dysregulation around sleep onset. The influences of development on sleep and GH regulation are also considered.

Adolescent↗
PubMed1991

Concurrent validity and psychometric properties of the Beck Depression Inventory in outpatient adolescents.

The concurrent validity of the Beck Depression Inventory (BDI) was evaluated in 122 outpatient adolescents referred to a clinic for depression. Criterion validators were Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) generated diagnoses and a 17-item clinician-rated depression scale extracted from the K-SADS. Initial BDI scores of greater than 13 yielded sensitivity, specificity, and positive predictive powers of 86%, 82%, and 83%, respectively, in differentiating syndromal major depressive disorder (MDD) from nonaffective disordered patients. In repeated interviews in 2 weeks with a BDI score of greater than 13, these parameters were 89%, 88%, and 93%, respectively, in those meeting MDD criteria. The BDI correlated significantly with the 17-item depression score in depressed females but not depressed males because BDI scores were more than 30% higher in females. BDI internal consistency among all cases was 0.91 and was higher in depressed than nondepressed patients.

Adolescent↗
PubMed1991

Hormonal responses to dextroamphetamine in depressed and normal adolescents.

Because of its neuroendocrine effects, amphetamine infusion has been used as a probe to investigate neurobiological correlates of depressive illness. In two separate studies, a total of 72 adolescents with major depressive disorder and 66 normal adolescents were given dextroamphetamine, 0.15 mg/kg, intravenously. Their cortisol, growth hormone, and prolactin responses were measured. These endocrine responses did not reliably distinguish adolescents with major depressive disorder from those without it, nor did they reliably delineate any specific depressive subgroup. These findings are compared with those from similar studies of adult depression.

Adolescent↗
PubMed1989

Videotape reliability of the third revised edition of the K-SADS.

Videotaped interrater reliability was assessed with the K-SADS-III-R on 25 children with a mean age of 10:9. Kappa statistics were computed in syndromes with a frequency rate of at least 20%. The following mean kappas were obtained: major depression = 0.83; overanxious disorder = 0.85; separation anxiety = 0.85; simple phobic disorder = 0.64; oppositional disorder = 0.89; attention deficit disorder = 0.88. The mean kappa for mother derived diagnoses was 0.86; for child derived diagnoses 0.79; and, for all diagnoses combined 0.84. These reliability findings are comparable to reports with similar methodology in the child literature. The improved kappas for the anxiety disorders achieved a primary goal for this revision of the K-SADS. This study has shown that the K-SADS-III-R has sufficient reliability for research purposes.

Anxiety Disorders↗
PubMed1989

Cortisol secretion in adolescents with major depressive disorder.

Plasma cortisol concentrations were determined every 20 min for 24 h, in a nonstressful environment, among 48 rigorously assessed, mostly outpatient, drug-free adolescent subjects during an episode of major depression (MDD) and among 40 normal adolescent subjects. There were no significant differences in the 24-h mean, peak, or nadir, or the time of the nocturnal rise, in plasma cortisol in the 2 groups. Analyses of different subgroups of MDD adolescents according to suicidality, severity of depression, separation anxiety, psychotic subtype, endogenicity, duration of episode, and sex also revealed no significant group differences. Only one adolescent (with MDD) was identified clearly as a hypersecretor of cortisol. These results indicate that abnormalities of spontaneous cortisol secretion are an unusual finding among adolescents with major depression when studied in a nonstressful environment.

Adolescent↗