Journal of child and adolescent psychopharmacology最新文献

{"title":"Association of Atomoxetine Discontinuation Patterns with CYP2D6 Phenotype in Children and Adolescents with Attention Deficit Hyperactivity Disorder.","authors":"Jacob T Brown, Elise N Durgin, Courtney Paetznick, Jeffrey R Bishop, Benjamin Deonovic, Laylia Yang, David A Watson, David B Gregornik","doi":"10.1177/10445463261467214","DOIUrl":"10.1177/10445463261467214","url":null,"abstract":"<p><strong>Aims: </strong>The primary aim of this study was to determine whether CYP2D6 phenotypes are associated with atomoxetine treatment outcomes in children and adolescents with attention-deficit hyperactivity disorder.</p><p><strong>Patients and methods: </strong>Patients 21 years and younger with a known <i>CYP2D6</i> genotype and a prescription for atomoxetine were included in this electronic health record review. The primary outcome was defined as discontinuation of atomoxetine due to a lack of efficacy or due to toxicity. CYP2D6 activity scores were adjusted to account for phenoconversion if patients were concomitantly taking a CYP2D6 inhibitor medication.</p><p><strong>Results: </strong>Of 108 patients that met inclusion criteria, including 13 poor, 30 intermediate, 61 normal, and 4 ultra-rapid CYP2D6 metabolizers after adjusting for phenoconversion. Normal/ultrarapid metabolizers were significantly more likely to discontinue atomoxetine due to lack of efficacy (subdistribution hazard ratio [sHR] = 1.9, <i>p</i> = 0.04), while poor/intermediate metabolizers were significantly more likely to stop due to toxicity (sHR 0.4, <i>p</i> = 0.03). A significant nonlinear effect of adjusted activity score on likelihood of discontinuation due to lack of efficacy (<i>p</i> < 0.001) or toxicity (<i>p</i> < 0.001) was identified, where higher CYP2D6 activity scores were associated with more discontinuation due to lack of efficacy and lower activity scores were associated with more discontinuation due to toxicity. When <i>CYP2D6</i> genotype was available prior to prescribing atomoxetine in intermediate/poor metabolizers, lower median initial doses were observed (0.5 mg/kg/day) compared to those who underwent <i>CYP2D6</i> genotyping after the initial atomoxetine prescription (0.8 mg/kg/day).</p><p><strong>Conclusion: </strong>Patients with normal or increased CYP2D6 phenotypes may be more likely to discontinue atomoxetine due to a lack of efficacy, while those with reduced function CYP2D6 phenotypes may be more likely to discontinue atomoxetine due to toxicity.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"493-499"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction Gone Awry: A Computational Framework for Emotion Dysregulation Across Autism and Attention-Deficit/Hyperactivity Disorder.","authors":"Hari Srinivasan, Carissa J Cascio, Mark T Wallace","doi":"10.1177/10445463261448490","DOIUrl":"10.1177/10445463261448490","url":null,"abstract":"<p><p>Emotion dysregulation is a common issue across childhood and adolescence, including in autism and attention-deficit/hyperactivity disorder (ADHD). Yet most accounts remain descriptive-focusing on irritability, rapid escalation, slow return to baseline-without specifying the computational processes that stabilize emotions in context. We propose a predictive-coding account in which emotion regulation depends on how the brain predicts bodily and environmental signals, detects mismatches, between expectation and sensation, and determines how much confidence to assign those mismatches. Within this framework, dysregulation can arise when prediction errors are assigned excessive precision (i.e., incoming signals are overweighted relative to prior expectations, making them feel \"too loud\"), amplifying emotional reactivity or when prior expectations update too slowly (feelings get \"stuck\"), prolonging emotional states beyond contextual demands. We hypothesize that autism may involve heightened confidence assigned to surprising inputs together with sluggish updating of expectations, a combination that can produce both reactivity and emotional inertia. ADHD, by contrast, may be characterized by weaker expectations and unstable gain control, meaning the system's amplification of incoming signals fluctuates from moment to moment, contributing to rapid, reactive swings in affect. We outline candidate physiological correlates-including heart-rate variability dynamics, pupillary variability, mismatch negativity, and neural indices of interoceptive precision-that could evaluate these hypotheses. Framing intervention around restoring flexible inference rather than suppressing emotion offers a mechanistic direction for developmental research. These predictions await empirical validation in developmental samples.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"461-472"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147873983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Psychiatric Readmission of Children and Adolescents Using Machine Learning.","authors":"Ethan A Poweleit, Jeffrey R Strawn, Rhonda D Szczesniak, Wei-Qi Wei, Tracy A Glauser, Laura B Ramsey, Judith W Dexheimer","doi":"10.1177/10445463261466534","DOIUrl":"10.1177/10445463261466534","url":null,"abstract":"<p><strong>Introduction: </strong>Recurrent psychiatric hospitalizations in youth are costly and burdensome to patients and families. While postdischarge planning rarely stratifies patients based on their risk of readmission, predictive modeling could identify at-risk youth to facilitate targeted intervention strategies. This study developed and validated machine learning models to predict psychiatric readmission in children and adolescents.</p><p><strong>Methods: </strong>This retrospective cohort study included 11,225 patients (20,339 psychiatric admissions) ≤ 18 years old with at least one psychiatric admission and an anxiety or depressive disorder diagnosis at any time during the study period from two tertiary-care academic medical centers. Machine learning models were developed to predict psychiatric readmission versus no readmission within 30, 90, and 180 days of discharge using electronic health record data from one institution. These models were internally validated at the development site and externally validated at the second institution.</p><p><strong>Results: </strong>Model development and internal validation using random forest models predicted 30-, 90-, and 180-day readmission with area under the receiver operating characteristic curves (AUROC) equal to 0.739, 0.742, and 0.746, respectively. The most important features identified across follow-up periods included previous psychiatric admissions, length of stay, age, and antipsychotic prescriptions. Models trained using a reduced set of 18 features obtained similar performance, with AUROCs ranging from 0.741 to 0.745. External validation of the models retrained using 12 features available at both institutions yielded AUROCs of 0.598, 0.634, and 0.657 for 30-, 90-, and 180-day readmission, respectively.</p><p><strong>Conclusion: </strong>The findings of this study suggest that machine learning models can identify children and adolescents at risk of psychiatric readmission.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"483-492"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Context Matters: Variation in Pharmacologic Management of Pediatric Agitation Across Emergency and Inpatient Psychiatric Settings.","authors":"Sean T Lynch, Angelo I Chaia, Ricky Burns, Chaden Noureddine, Timothy R Rice, Ashley N Sterchele","doi":"10.1177/10445463261458604","DOIUrl":"10.1177/10445463261458604","url":null,"abstract":"<p><strong>Background: </strong>Management of acute agitation in youth frequently involves intramuscular (IM) antipsychotics; however, little is known about how treatment strategies vary across care settings. Differences between emergency and inpatient psychiatric environments may influence medication selection and dosing.</p><p><strong>Methods: </strong>This retrospective secondary analysis included youth (<18 years) who received IM antipsychotics for agitation across multiple emergency departments and inpatient psychiatric units within a large urban health system (2019-2023). Comparisons between settings examined antipsychotic selection, coadministration of adjunctive medications, and dosing. To account for differences in medication selection, dosing comparisons were conducted within each antipsychotic agent. Secondary outcomes included repeat IM administration and restraint or seclusion within 24 hours.</p><p><strong>Results: </strong>The sample included 158 youth (86 emergency, 72 inpatient). Antipsychotic selection differed significantly by setting, with greater use of haloperidol in emergency settings and chlorpromazine in inpatient settings (<i>p</i> < 0.001). Midazolam coadministration was more common in emergency settings (10.5% vs. 1.4%, <i>p</i> = 0.020). When examined within agents, chlorpromazine doses were higher in inpatient settings (36.7 mg vs. 30.4 mg, <i>p</i> = 0.035), while haloperidol and olanzapine dosing did not differ. Rates of additional IM administration were similar across settings (<i>p</i> = 0.295), although restraint or seclusion was more common in inpatient settings (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Pharmacologic management of pediatric agitation varies by care setting, particularly in antipsychotic selection and adjunctive medication use. Differences in dosing were limited to chlorpromazine, suggesting that variation reflects agent-specific prescribing patterns rather than overall treatment intensity. These findings highlight the influence of clinical context and provider practice patterns in shaping management strategies for pediatric agitation.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"508-513"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Habenula Activity and Volume with Pediatric Irritability: Investigation of Inconsistent Parenting as a Moderator.","authors":"Gihyun Kim, Manish K Jha, Wan-Ling Tseng","doi":"10.1177/10445463261490857","DOIUrl":"https://doi.org/10.1177/10445463261490857","url":null,"abstract":"<p><strong>Objective: </strong>Irritability significantly impacts the mental health and well-being of youth and their families and is associated with adverse concurrent and future outcomes. Brain abnormalities in the reward system are a potential mechanism underlying irritability. However, the habenula, a region closely linked to reward processing, has not been investigated in youth irritability. Additionally, previous research has rarely explored how inconsistent parenting interacts with neurobiological factors to contribute to youth irritability. Thus, this study examined the associations of habenula activity and volume with irritability and the moderating role of inconsistent parenting in these associations.</p><p><strong>Method: </strong>Habenula activity and volume in 50 youth with varying levels of irritability (mean age ± standard deviation = 11.3 ± 2.0 years; 44% female) were measured during a frustration-inducing functional magnetic resonance imaging (fMRI) paradigm. Trait irritability was assessed using the parent- and child-reported Affective Reactivity Index. State irritability was measured using child-reported frustration during fMRI. Inconsistent parenting was assessed using the parent-reported Alabama Parenting Questionnaire.</p><p><strong>Results: </strong>At the unadjusted level, results showed interactions between left habenula volume and inconsistent parenting on child-reported trait irritability (Δ<i>R</i>² = 0.19, <i>b</i> = 0.15, <i>p</i> = 0.006) and state irritability (Δ<i>R</i>² = 0.16, <i>b</i> = 0.32, <i>p</i> = 0.026), which became nonsignificant following false discovery rate (FDR) correction. No main effects of habenula activity or volume on trait or state irritability were found.</p><p><strong>Conclusion: </strong>This preliminary study examined the role of the habenula in youth irritability in the context of inconsistent parenting. Neither habenula activity nor volume was directly associated with irritability, and the moderation findings did not survive FDR correction. Future research with larger, longitudinal samples is needed to replicate these preliminary findings and further examine environmental factors and their interactions with neurobiological factors in relation to pediatric irritability.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"10445463261490857"},"PeriodicalIF":1.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Irritability and Emotion Dysregulation Predict Escitalopram Response in Adolescents with Generalized Anxiety Disorder: A Secondary Analysis of a Randomized, Double-Blind, Placebo-Controlled Trial.","authors":"Jeffrey A Mills, Jeffrey R Strawn","doi":"10.1177/10445463261490409","DOIUrl":"https://doi.org/10.1177/10445463261490409","url":null,"abstract":"<p><strong>Objective: </strong>Irritability is increasingly recognized as an important aspect of emotion dysregulation in pediatric anxiety disorders. However, the relationship between irritability and treatment outcome in adolescents with generalized anxiety disorder (GAD) remains poorly understood. We examined whether irritability predicts clinical outcome and whether changes in irritability are associated with treatment-related improvement.</p><p><strong>Methods: </strong>This secondary analysis utilized data from a randomized, double-blind, placebo-controlled trial of escitalopram in adolescents (12-17 years) with GAD (<i>N</i> = 51). Irritability was assessed longitudinally using child- and parent-reported Affective Reactivity Index (ARI) scores. Clinical outcomes included treatment response (Clinical Global Impressions-Improvement ≤ 2) and anxiety symptom severity measured by the Pediatric Anxiety Rating Scale. Logistic regression and longitudinal mixed-effects models examined associations between irritability and treatment outcome.</p><p><strong>Results: </strong>Higher baseline child-reported irritability was associated with a lower likelihood of treatment response (adjusted OR per 1-SD increase = 0.51, 95% credible intervals [95% CrI] 0.35-0.73), as was higher parent-reported irritability (adjusted OR per 1-SD increase = 0.58, 95% CrI 0.40-0.83). Additionally, longitudinal reductions in child-reported (adjusted β = 0.27, <i>p</i> < 0.001) and parent-reported irritability (adjusted β = 0.18, <i>p</i> = 0.002) were associated with reductions in anxiety symptoms over time. Baseline irritability was not associated with statistically significant subsequent changes in anxiety symptom severity.</p><p><strong>Conclusions: </strong>Irritability is associated with clinical response in adolescents with GAD. Child- and parent-reported irritability predicted treatment response independent of baseline anxiety severity, while reductions in irritability paralleled improvement in anxiety. These findings suggest that irritability may represent a clinically important aspect of illness and a potential treatment target in pediatric anxiety disorders.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"10445463261490409"},"PeriodicalIF":1.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Autism-Related Characteristics and Tonic Versus Phasic Irritability Across Parent and Teacher Report.","authors":"Jamilah Silver, Debra Reicher, Daniel N Klein, Gabrielle A Carlson","doi":"10.1177/10445463261490868","DOIUrl":"https://doi.org/10.1177/10445463261490868","url":null,"abstract":"<p><strong>Objective: </strong>Irritability in youth is increasingly understood as comprising tonic irritability, reflecting persistent irritable mood, and phasic irritability, reflecting acute anger outbursts. This study examined whether these dimensions showed distinct associations with autistic characteristics across parent and teacher report.</p><p><strong>Methods: </strong>Clinical records were examined for 1534 youth ages 5-18 referred to a university outpatient psychiatric clinic, including 334 youth with a PDD/ASD diagnosis. Analyses were conducted separately in the PDD/ASD-restricted sample (<i>n</i> = 334) and the full diagnostic sample (<i>N</i> = 1534). Multiple regression models examined associations of social interaction differences, communication differences, and restricted and repetitive behaviors (RRBs) with standardized tonic and phasic irritability, adjusting for the alternate irritability dimension, psychiatric diagnoses, age, and gender.</p><p><strong>Results: </strong>RRBs were associated with parent-reported tonic and phasic irritability in both samples and with teacher-reported tonic and phasic irritability in the full diagnostic sample. Social interaction differences were more consistently associated with tonic than phasic irritability. Tonic irritability increased with age, whereas phasic irritability decreased with age across informants and samples. Psychiatric correlates varied by irritability dimension and informant.</p><p><strong>Conclusions: </strong>Tonic and phasic irritability showed overlapping but partially differentiated associations with autistic characteristics. RRBs were linked to both dimensions, whereas social interaction differences were more closely related to tonic irritability.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"10445463261490868"},"PeriodicalIF":1.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Corrigendum to:</i> \"Caregiver-Reported Monitoring of Catatonia in Autistic Adolescents: An Outpatient Measurement-Based Approach\".","authors":"","doi":"10.1177/10445463261490293","DOIUrl":"https://doi.org/10.1177/10445463261490293","url":null,"abstract":"","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"10445463261490293"},"PeriodicalIF":1.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Literature Review on Public Health Impacts of Tourette Syndrome and Persistent Tic Disorders: General Health, Health Conditions, and Health Behaviors.","authors":"Patricia L Whalen, Rebecca T Leeb, Helena J Hutchins, Brooke S Staley, Angelika H Claussen, Kimberly Newsome, Lara R Robinson, Rebecca H Bitsko","doi":"10.1177/10445463261484867","DOIUrl":"https://doi.org/10.1177/10445463261484867","url":null,"abstract":"<p><strong>Background: </strong>The association of tic disorders and physical health has not been comprehensively described. This systematic review summarized the associations between indicators of physical health (e.g., health-related quality of life [HR-QoL]), health conditions, and health behaviors with Tourette syndrome (TS) and persistent tic disorders (PTD) in individuals across the lifespan.</p><p><strong>Methods: </strong>We used multiple databases to search the literature through March 5, 2025, and identified 84 studies published in English in 2003 or later that reported health-related outcomes among individuals with TS/PTD and a comparison group without TS/PTD. In describing differences between groups, we considered statistical significance and the magnitude of the difference, particularly when statistical comparisons were not reported. Risk of bias was conducted using the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Several indicators of poor health and several health conditions were more prevalent among individuals with TS/PTD, compared with those without, including some measures of lower HR-QoL, overall poor health/disability, mortality, injuries, suicidal thoughts and behaviors, orthopedic conditions, neurological disorders, sleep disorders, endocrine conditions, immune-related disorders including asthma and allergy, and hearing and/or vision problems. Findings across studies were inconsistent for gastrointestinal and circulatory system conditions, and infection and fever. Findings did not differ by TS/PTD status for body mass index and health behaviors. Strengths and limitations of this body of literature are discussed.</p><p><strong>Conclusions: </strong>Findings from this review can be used to inform health care provider education activities and future research to improve the health and well-being of individuals with TS/PTD.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"10445463261484867"},"PeriodicalIF":1.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Therapeutic Opportunity of Glucagon-Like Peptide-1 Receptor Agonists in Pediatric Psychiatry.","authors":"Roger S McIntyre","doi":"10.1177/10445463261484023","DOIUrl":"https://doi.org/10.1177/10445463261484023","url":null,"abstract":"","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"10445463261484023"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}