Tag-arkiv: evidence

Behandling af små børn med psykofarmaka (Guideline)

JAACAPFlere og flere før-skole børn kommer i medicinsk behandling med psykofarmaka for forwskellige psykiatriske lidelser som angst, ADHD, OCD etc.. Der er kun bekrænset forskning på området og der mangler kliniske vejledninger på området. Det første trin mod en standardisering af behandling af børn fra 3 til 6 år med medicin.

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Guideline for behandling af børn med angstlidelser

JAACAPSekretariatet for Referenceprogrammer (SfR) under Sundhedsstyrelsen afholdte onsdag den 28. november 2007 en høring om Referenceprogram for voksne med angstlidelser. (Referenceprogram er det saame som guideline). I referenceprogrammet anbefaler man bl.a. af der udarbejdes et Referenceprogram for børn med angstlidelser. Indtil det projekt måske bliver realiseret, kan jeg anbefale at man læser American Academy of Child and Adolescent Psychiatry udgave, såkaldte Practice Parameters, der kan hentes fra deres hjemmesider Anxiety Disorders (P-ANX) Vol 46 Feb 2007 . Anbefalingerne blev udgive i tidsskriftet Journal of the American Academy of Child & Adolescent Psychiatry:

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders
ABSTRACT
This revised practice parameter reviews the evidence from research and clinical experience and highlights significant advancements in the assessment and treatment of anxiety disorders since the previous parameter was published. It highlights the importance of early assessment and intervention, gathering information from various sources, assessment of comorbid disorders, and evaluation of severity and impairment. It presents evidence to support treatment with psychotherapy, medications, and a combination of interventions in a multimodal approach.

Journal of the American Academy of Child & Adolescent Psychiatry. 46(2):267-283, February 2007. Eller se PubMed.

For en tysk oversigt over en diskussion af evidensbaseret behandling af angstlidelser hos børn, se: Die psychotherapeutische Behandlung von Angststörungen im Kindes- und Jugendalter – Was ist evidenzbasiert? af Silvia Schneider & Tina In-Albon, Klinische Kinder- und Jugendpsychologie, Universität Basel, i Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, Volume 34, Number 3, 191-202 / 2006. Engelsk abstrakt medfølger.

Kognitiv adfærdsterapi mod OCD: virker det?

I Danmark er det som bekendt ikke muligt at få hjælp til kognitiv adfærdsterapi hos en psykolog. I stedet har man fra politisk side valgt at opretholde brugerbetaling på dette område, dog har der på det sidste vist sig et muligt kursskifte efter at de konservative har skiftet standpunkt (det er lidt uklart om deres udspild vil indeholde psykologhjælp til psykisk syge børn og voksne). Venstre er dog stadig i mod (Se denne artikel), og spørgsmålet er om de konservative kan få overtalt finansministeren?

Et argument kunne være at se på om kognitiv adfærdsterapi overhovedet virker. Det ansete Cochrane Collaboration, der undersøger evidensbaseret behandling i hele verden, har publiceret en undersøgelse, hvor de gennegår forskellige undersøgelser for at se om en behandling virker. Forfatterne kom frem til følgende konklusion: Læs resten

Sundhedsstyrelsen udarbejder klinisk vejledning til angst og OCD behandling

Sekretariatet for Referenceprogrammer under Sundhedsstyrelsen, der er Sundhedsministeriets faglige vejleder, har valgt at iværksætte et referenceprogram for angsttilstande hos voksne. Man har valgt at inddrage OCD-foreningen og Angstforeningen i arbejdet. Når man udarbejder et referenceprogram inddrager man behandlere og brugere med mest viden og erfaring på området, hvorefter man udarbejder et referenceprogram, hvorved “forstås en systematisk beskrivelse af de elementer, som bør indgå i undersøgelse, behandling, pleje, rehabilitering og forebyggelse af en bestemt sygdom eller et kompleks af symptomer på grundlag af dokumenteret viden.” (Sekretariatet for Referenceprogrammer‘ egen definition). Sekretariatet for Referenceprogrammer opslag om referenceprogram for Angsttilstande hos voksne er følgende: Læs resten

High-Dose Pharmaca Treatment Nonresponders to Acute Treatment for Obsessive-Compulsive Disorder

OCD suffers not responding to standard drug and CBT treatment might get greater symptom improvement with high-dose drug treatment. The Journal of Clinical Psychiatry has published a research article about high-dose treatment:

High-Dose Sertraline Strategy for Nonresponders to Acute Treatment for Obsessive-Compulsive Disorder: A Multicenter Double-Blind Trial Objective: To evaluate the efficacy and safety of high-dose sertraline for patients with obsessive-compulsive disorder (OCD) who failed to respond to standard sertraline acute treatment.

Method: Sixty-six nonresponders to 16 weeks of sertraline treatment who met DSM-III-R criteria for current OCD were randomly assigned, in a double-blind continuation phase of a multicenter trial, either to continue on 200 mg/day of sertraline or to increase their dose to between 250 and 400 mg/day for 12 additional weeks. Efficacy measures included the Yale-Brown Obsessive Compulsive Scale (YBOCS), the National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH Global OC Scale), and the Clinical Global Impressions-Severity of Illness and -Improvement (CGI-I) scales. Data were collected from July 26, 1994, to October 26, 1995.

Results: The high-dose (250-400 mg/day, mean final dose= 357, SD = 60, N = 30) group showed significantly greater symptom improvement than the 200-mg/day group (N = 36) as measured by the YBOCS (p=.033), NIMH Global OC Scale (p = .003), and CGI-I (p = .011). Responder rates (decrease in YBOCS score of > = 25% and a CGI-I rating < = 3) were not significantly different for the 200-mg/day versus the high-dose sertraline group, either on completer analysis, 34% versus 52%, or on endpoint analysis, 33% versus 40%. Both treatments showed similar adverse event rates.

Conclusion: Greater symptom improvement was seen in the high-dose sertraline group compared to the 200-mg/day dose group during continuation treatment. Both dosages yielded similar safety profiles. Administration of higher than labeled doses of selective serotonin reuptake inhibitors may be a treatment option for certain OCD patients who fail to respond to standard acute treatment.

(J Clin Psychiatry 2006;67:15-22) The research is rather old, done back in 1995 and another thing is its sponsored by Pfizer, the maker of the SSRI sertraline (Zoloft). At the other hand high-dose treatment is not a new thing and drugs like clomipramine (Anafrenil) and paroxetine (Paxil/Seroxat) have been tested too and proven effective. Evidence-based pharmacotherapy of obsessive-compulsive disorder. Fineberg NA, Gale TM., Int J Neuropsychopharmacol. 2005 Mar;8(1):107-29. Epub 2004 Sep 28. Read the entire article at the journals homepage A qualitative analysis of nonresponse: management of treatment-refractory obsessive-compulsive disorder, Pallanti S, Hollander E, Goodman WK., J Clin Psychiatry. 2004;65 Suppl 14:6-10.

Association Between Common Childhood Infection and Neurologic Conditions (ex. OCD)

News and research articles about strep throat associated with an increased risk for some neurologic conditions, ex. PANDAS, are poping-up on news site and medical journals. Keep clicking, more coming soon. Here are the two latest:

A new study adds support to an increasing body of evidence that the common childhood bacterial infection known informally as strep throat is associated with an increased risk for some neurologic conditions that frequently start in childhood — Tourette’s syndrome (TS), Obsessive-compulsive disorder (OCD) and tic disorder.

The study, conducted at the Group Health Center for Health Studies (CHS) in Seattle, is published in the July 5, 2005 edition of the journal Pediatrics, accessible online at http://www.pediatrics.org. It suggests that strep throat (streptococcal infection) doubles the risk for a first diagnosis of TS, OCD or tic disorder within three months after infection. Multiple infections appear to approximately triple the risk for a first diagnosis of these disorders within 12 months.

Source: Yahoo News/Group Health Center (US)

See also: Fox News: Strep Linked to Neurological Conditions?

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Updated 17. August 2005

Found this on News Channel KFOR Oklahoma (NBC news)

The causes behind mental illness have long been a subject for debate. Is it trauma in someone’s life or something more physical? There is research going on right now that is looking into whether kids can catch obsessive compulsive disorder from a very common bacteria and whether it could be treated with a simple dose of antibiotics.

You can watch more on KFOR

Combined Cognitive-Behavior Therapy Plus Sertraline May Be Best for Children and Adolescents With Obsessive-Compulsive Disorder

Medscape Oct. 27, 2004.

News Author: Laurie Barclay, MD

Combined cognitive-behavior therapy (CBT) with sertraline may be best for adolescents with obsessive-compulsive disorder (OCD), according to the results of a randomized trial published in the Oct. 27 issue of JAMA. �The empirical literature on treatment of obsessive-compulsive disorder (OCD) in children and adolescents supports the efficacy of short-term OCD-specific cognitive behavior therapy (CBT) or medical management with selective serotonin reuptake inhibitors ([S]SRIs),� write John S. March, MD, MPH, from Duke University Medical Center in Durham, North Carolina, and colleagues from the Pediatric OCD Treatment Study (POTS) Team. �However, little is known about their relative and combined efficacy.� Læs resten