American Academy of Child and Adolescent Psychiatry (AACAP): Annual Meeting

TORONTO – Topiramate in combination with quetiapine was well tolerated in adolescents who had bipolar disorder and reported frequent cannabis use, based on a 75-patient study presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Concurrent substance use is a barrier to treating adolescents with bipolar disorder, said Dr. Melissa DelBello of the University of Cincinnati. Topiramate is approved by the Food and Drug Administration as an antiepileptic drug for children as young as age 2 years. Topiramate has been shown to reduce drug cravings, but is not approved for that indication, she added.

The researchers recruited adolescents, aged 12-21 years, who met criteria for bipolar disorder, had a Young Mania Rating Scale (YMRS) score of at least 20, and were using cannabis an average of at least twice a week for the 28 days before entering the study. In a previous study, Dr. DelBello and her colleagues found that topiramate was effective for reducing mania symptoms in adolescents (J. Am. Acad. Child Adolesc. Psychiatry 2005; 44:539-47).

The 75 teens were randomized to a maximum of 800 mg of quetiapine and placebo or to quetiapine and a minimum dose of 75 mg of topiramate twice daily that was increased gradually to 150 mg twice daily by day 21 of treatment.

At baseline, the average number of joints smoked per week was 14 in the quetiapine and placebo group and 11 in the quetiapine and topiramate group.

After 16 weeks of treatment, the average weekly use dropped to four joints in the quetiapine and placebo group and to 0.4 joints in the quetiapine and topiramate group. The difference was statistically significant.

On average, teens in the quetiapine and topiramate group used cannabis 1 day per week, and teens in the quetiapine and placebo group used cannabis 2 days per week, Dr. DelBello said.

Over the 16-week study, scores on the YMRS improved significantly from baseline, with an average drop of –14 with quetiapine and topiramate and –16 with quetiapine and placebo. Scores on the Childhood Rating Depression Scale-Revised (CRDS-R) also improved significantly from baseline to 16 weeks in both groups.

The presence of conduct disorder and ADHD were significant predictors of reduction in cannabis use while taking topiramate, said Dr. DelBello. Teens given topiramate showed significant improvement in general scores on the Marijuana Craving Questionnaire, compared with teens given placebo.

The groups did not differ in laboratory measures or vital signs, but excitement and pallor occurred in 26% of the topiramate group and in 16% of the placebo group.

Eleven serious events occurred during the study; five occurred in the topiramate group (two cases of suicidal ideation with intent and three cases of mania) and six occurred in the placebo group (four cases of mania, one suicide attempt, and one pregnancy).

The study was limited by a lack of data on cognition, Dr. DelBello noted. The neurobiological effects of topiramate and its effects when combined with other medications and used in different mood states need further study.

Dr. DelBello has received research support and/or served as a consultant, advisory board member, or speakers’ bureau member for multiple companies including Schering-Plough, Merck, Bristol-Myers Squibb Somerset, Lilly, and Pfizer.

TORONTO – Topiramate in combination with quetiapine was well tolerated in adolescents who had bipolar disorder and reported frequent cannabis use, based on a 75-patient study presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Concurrent substance use is a barrier to treating adolescents with bipolar disorder, said Dr. Melissa DelBello of the University of Cincinnati. Topiramate is approved by the Food and Drug Administration as an antiepileptic drug for children as young as age 2 years. Topiramate has been shown to reduce drug cravings, but is not approved for that indication, she added.

The researchers recruited adolescents, aged 12-21 years, who met criteria for bipolar disorder, had a Young Mania Rating Scale (YMRS) score of at least 20, and were using cannabis an average of at least twice a week for the 28 days before entering the study. In a previous study, Dr. DelBello and her colleagues found that topiramate was effective for reducing mania symptoms in adolescents (J. Am. Acad. Child Adolesc. Psychiatry 2005; 44:539-47).

The 75 teens were randomized to a maximum of 800 mg of quetiapine and placebo or to quetiapine and a minimum dose of 75 mg of topiramate twice daily that was increased gradually to 150 mg twice daily by day 21 of treatment.

At baseline, the average number of joints smoked per week was 14 in the quetiapine and placebo group and 11 in the quetiapine and topiramate group.

After 16 weeks of treatment, the average weekly use dropped to four joints in the quetiapine and placebo group and to 0.4 joints in the quetiapine and topiramate group. The difference was statistically significant.

On average, teens in the quetiapine and topiramate group used cannabis 1 day per week, and teens in the quetiapine and placebo group used cannabis 2 days per week, Dr. DelBello said.

Over the 16-week study, scores on the YMRS improved significantly from baseline, with an average drop of –14 with quetiapine and topiramate and –16 with quetiapine and placebo. Scores on the Childhood Rating Depression Scale-Revised (CRDS-R) also improved significantly from baseline to 16 weeks in both groups.

The presence of conduct disorder and ADHD were significant predictors of reduction in cannabis use while taking topiramate, said Dr. DelBello. Teens given topiramate showed significant improvement in general scores on the Marijuana Craving Questionnaire, compared with teens given placebo.

The groups did not differ in laboratory measures or vital signs, but excitement and pallor occurred in 26% of the topiramate group and in 16% of the placebo group.

Eleven serious events occurred during the study; five occurred in the topiramate group (two cases of suicidal ideation with intent and three cases of mania) and six occurred in the placebo group (four cases of mania, one suicide attempt, and one pregnancy).

The study was limited by a lack of data on cognition, Dr. DelBello noted. The neurobiological effects of topiramate and its effects when combined with other medications and used in different mood states need further study.

Dr. DelBello has received research support and/or served as a consultant, advisory board member, or speakers’ bureau member for multiple companies including Schering-Plough, Merck, Bristol-Myers Squibb Somerset, Lilly, and Pfizer.

TORONTO – Topiramate in combination with quetiapine was well tolerated in adolescents who had bipolar disorder and reported frequent cannabis use, based on a 75-patient study presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Concurrent substance use is a barrier to treating adolescents with bipolar disorder, said Dr. Melissa DelBello of the University of Cincinnati. Topiramate is approved by the Food and Drug Administration as an antiepileptic drug for children as young as age 2 years. Topiramate has been shown to reduce drug cravings, but is not approved for that indication, she added.

The researchers recruited adolescents, aged 12-21 years, who met criteria for bipolar disorder, had a Young Mania Rating Scale (YMRS) score of at least 20, and were using cannabis an average of at least twice a week for the 28 days before entering the study. In a previous study, Dr. DelBello and her colleagues found that topiramate was effective for reducing mania symptoms in adolescents (J. Am. Acad. Child Adolesc. Psychiatry 2005; 44:539-47).

The 75 teens were randomized to a maximum of 800 mg of quetiapine and placebo or to quetiapine and a minimum dose of 75 mg of topiramate twice daily that was increased gradually to 150 mg twice daily by day 21 of treatment.

At baseline, the average number of joints smoked per week was 14 in the quetiapine and placebo group and 11 in the quetiapine and topiramate group.

After 16 weeks of treatment, the average weekly use dropped to four joints in the quetiapine and placebo group and to 0.4 joints in the quetiapine and topiramate group. The difference was statistically significant.

On average, teens in the quetiapine and topiramate group used cannabis 1 day per week, and teens in the quetiapine and placebo group used cannabis 2 days per week, Dr. DelBello said.

Over the 16-week study, scores on the YMRS improved significantly from baseline, with an average drop of –14 with quetiapine and topiramate and –16 with quetiapine and placebo. Scores on the Childhood Rating Depression Scale-Revised (CRDS-R) also improved significantly from baseline to 16 weeks in both groups.

The presence of conduct disorder and ADHD were significant predictors of reduction in cannabis use while taking topiramate, said Dr. DelBello. Teens given topiramate showed significant improvement in general scores on the Marijuana Craving Questionnaire, compared with teens given placebo.

The groups did not differ in laboratory measures or vital signs, but excitement and pallor occurred in 26% of the topiramate group and in 16% of the placebo group.

Eleven serious events occurred during the study; five occurred in the topiramate group (two cases of suicidal ideation with intent and three cases of mania) and six occurred in the placebo group (four cases of mania, one suicide attempt, and one pregnancy).

The study was limited by a lack of data on cognition, Dr. DelBello noted. The neurobiological effects of topiramate and its effects when combined with other medications and used in different mood states need further study.

Dr. DelBello has received research support and/or served as a consultant, advisory board member, or speakers’ bureau member for multiple companies including Schering-Plough, Merck, Bristol-Myers Squibb Somerset, Lilly, and Pfizer.

TORONTO – Macroencephaly was not significantly more common in twins with autism spectrum disorders than in their unaffected co-twins, according to data from 202 twin pairs presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Macroencephaly, defined as a head circumference greater than the 97th percentile, is a common physical characteristic of children with autism spectrum disorders, said Dr. Wendy Froehlich of Stanford (Calif.) University and her colleagues.

The researchers recruited 404 children (202 twin pairs) aged 4-18 years. At least one twin in each pair met criteria for an autism spectrum disorder. The children were identified through the California Department of Public Health’s Department of Developmental Services.

"Macrocephaly may represent an endophenotype within autism spectrum disorders."

Overall, there were no significant differences in the rates of macrocephaly between affected and unaffected twins. Macrocephaly was noted in 20% of boys and 27% of girls with autism spectrum disorders and in 19% of boys and 24% of girls who were unaffected co-twins.

The researchers also examined the relationship between head circumference and cognitive measures. After age and gender were controlled for, small but significant negative correlations were found between head circumference and Verbal Intelligence Quotient (VIQ) and Full Scale Intelligence Quotient (FSIQ) in twins with autism spectrum disorders, but there was no correlation between head circumference and other autistic symptoms or functioning.

"Other studies have demonstrated a positive correlation between head circumference and/or brain volume and IQ in typical individuals," the researchers noted.

"Macrocephaly may represent an endophenotype within autism spectrum disorders, and the process leading to macrocephaly is not sufficient for the development of autism," the researchers said. In addition, unaffected co-twins could represent "an intermediate phenotype between affected individuals whose head circumferences correlate negatively and truly unaffected and unrelated individuals whose head circumferences correlate positively with IQ."

The study was funded by grants from Autism Speaks, a nonprofit organization; and the National Institute of Mental Health. Dr. Froehlich had no personal financial conflicts to disclose.

TORONTO – Macroencephaly was not significantly more common in twins with autism spectrum disorders than in their unaffected co-twins, according to data from 202 twin pairs presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Macroencephaly, defined as a head circumference greater than the 97th percentile, is a common physical characteristic of children with autism spectrum disorders, said Dr. Wendy Froehlich of Stanford (Calif.) University and her colleagues.

The researchers recruited 404 children (202 twin pairs) aged 4-18 years. At least one twin in each pair met criteria for an autism spectrum disorder. The children were identified through the California Department of Public Health’s Department of Developmental Services.

"Macrocephaly may represent an endophenotype within autism spectrum disorders."

Overall, there were no significant differences in the rates of macrocephaly between affected and unaffected twins. Macrocephaly was noted in 20% of boys and 27% of girls with autism spectrum disorders and in 19% of boys and 24% of girls who were unaffected co-twins.

The researchers also examined the relationship between head circumference and cognitive measures. After age and gender were controlled for, small but significant negative correlations were found between head circumference and Verbal Intelligence Quotient (VIQ) and Full Scale Intelligence Quotient (FSIQ) in twins with autism spectrum disorders, but there was no correlation between head circumference and other autistic symptoms or functioning.

"Other studies have demonstrated a positive correlation between head circumference and/or brain volume and IQ in typical individuals," the researchers noted.

"Macrocephaly may represent an endophenotype within autism spectrum disorders, and the process leading to macrocephaly is not sufficient for the development of autism," the researchers said. In addition, unaffected co-twins could represent "an intermediate phenotype between affected individuals whose head circumferences correlate negatively and truly unaffected and unrelated individuals whose head circumferences correlate positively with IQ."

The study was funded by grants from Autism Speaks, a nonprofit organization; and the National Institute of Mental Health. Dr. Froehlich had no personal financial conflicts to disclose.

TORONTO – Macroencephaly was not significantly more common in twins with autism spectrum disorders than in their unaffected co-twins, according to data from 202 twin pairs presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Macroencephaly, defined as a head circumference greater than the 97th percentile, is a common physical characteristic of children with autism spectrum disorders, said Dr. Wendy Froehlich of Stanford (Calif.) University and her colleagues.

The researchers recruited 404 children (202 twin pairs) aged 4-18 years. At least one twin in each pair met criteria for an autism spectrum disorder. The children were identified through the California Department of Public Health’s Department of Developmental Services.

"Macrocephaly may represent an endophenotype within autism spectrum disorders."

Overall, there were no significant differences in the rates of macrocephaly between affected and unaffected twins. Macrocephaly was noted in 20% of boys and 27% of girls with autism spectrum disorders and in 19% of boys and 24% of girls who were unaffected co-twins.

The researchers also examined the relationship between head circumference and cognitive measures. After age and gender were controlled for, small but significant negative correlations were found between head circumference and Verbal Intelligence Quotient (VIQ) and Full Scale Intelligence Quotient (FSIQ) in twins with autism spectrum disorders, but there was no correlation between head circumference and other autistic symptoms or functioning.

"Other studies have demonstrated a positive correlation between head circumference and/or brain volume and IQ in typical individuals," the researchers noted.

"Macrocephaly may represent an endophenotype within autism spectrum disorders, and the process leading to macrocephaly is not sufficient for the development of autism," the researchers said. In addition, unaffected co-twins could represent "an intermediate phenotype between affected individuals whose head circumferences correlate negatively and truly unaffected and unrelated individuals whose head circumferences correlate positively with IQ."

The study was funded by grants from Autism Speaks, a nonprofit organization; and the National Institute of Mental Health. Dr. Froehlich had no personal financial conflicts to disclose.

TORONTO – Children and teens with bipolar disorder had a significantly longer recovery time and more recurrences if they had comorbid anxiety disorders, based on data from a longitudinal study.

Comorbid anxiety disorder has been previously associated with worse prognosis in teens with bipolar disorders, but the finding has based primarily on cross-sectional studies, and longitudinal data are limited, said Dr. Regina Sala of Columbia University in New York and her colleagues.

Data from the Course and Outcomes of Bipolar Youth study were reviewed for 413 youth aged 7-17 years (average age 13 years) with bipolar disorder; 256 study participants had comorbid anxiety.

The patients were assessed weekly for 5 years. After researchers adjusted for confounding variables, 37% of the children and teens with comorbid anxiety disorders and 55% of those without anxiety were asymptomatic on a weekly basis.

In addition, bipolar youth with comorbid anxiety took significantly longer to recover from their index episodes; the median times to recovery were 138 weeks for those with anxiety and 87 weeks for those without anxiety. Recurrence rates also were significantly higher at 76% for bipolar youth with comorbid anxiety and 57% for those without comorbid anxiety. The median time to recurrence was significantly shorter at 37 weeks in the comorbid group and 48 weeks with bipolar disorder alone.

The results suggest that characteristics of youth with comorbid bipolar and anxiety disorders include more syndromal and subsyndromal mixed cycling, more depression, and less euthymia than did bipolar youth without comorbid anxiety, the researchers said.

Dr. Sala was supported by a grant from the Alicia Koplowitz Foundation. Several study coauthors have received financial support and/or served as consultants or on advisory boards for multiple companies including Pfizer, Abbott, Schering-Plough, Bristol-Myers Squibb, and Forest.

TORONTO – Children and teens with bipolar disorder had a significantly longer recovery time and more recurrences if they had comorbid anxiety disorders, based on data from a longitudinal study.

Comorbid anxiety disorder has been previously associated with worse prognosis in teens with bipolar disorders, but the finding has based primarily on cross-sectional studies, and longitudinal data are limited, said Dr. Regina Sala of Columbia University in New York and her colleagues.

Data from the Course and Outcomes of Bipolar Youth study were reviewed for 413 youth aged 7-17 years (average age 13 years) with bipolar disorder; 256 study participants had comorbid anxiety.

The patients were assessed weekly for 5 years. After researchers adjusted for confounding variables, 37% of the children and teens with comorbid anxiety disorders and 55% of those without anxiety were asymptomatic on a weekly basis.

In addition, bipolar youth with comorbid anxiety took significantly longer to recover from their index episodes; the median times to recovery were 138 weeks for those with anxiety and 87 weeks for those without anxiety. Recurrence rates also were significantly higher at 76% for bipolar youth with comorbid anxiety and 57% for those without comorbid anxiety. The median time to recurrence was significantly shorter at 37 weeks in the comorbid group and 48 weeks with bipolar disorder alone.

The results suggest that characteristics of youth with comorbid bipolar and anxiety disorders include more syndromal and subsyndromal mixed cycling, more depression, and less euthymia than did bipolar youth without comorbid anxiety, the researchers said.

Dr. Sala was supported by a grant from the Alicia Koplowitz Foundation. Several study coauthors have received financial support and/or served as consultants or on advisory boards for multiple companies including Pfizer, Abbott, Schering-Plough, Bristol-Myers Squibb, and Forest.

TORONTO – Children and teens with bipolar disorder had a significantly longer recovery time and more recurrences if they had comorbid anxiety disorders, based on data from a longitudinal study.

Comorbid anxiety disorder has been previously associated with worse prognosis in teens with bipolar disorders, but the finding has based primarily on cross-sectional studies, and longitudinal data are limited, said Dr. Regina Sala of Columbia University in New York and her colleagues.

Data from the Course and Outcomes of Bipolar Youth study were reviewed for 413 youth aged 7-17 years (average age 13 years) with bipolar disorder; 256 study participants had comorbid anxiety.

The patients were assessed weekly for 5 years. After researchers adjusted for confounding variables, 37% of the children and teens with comorbid anxiety disorders and 55% of those without anxiety were asymptomatic on a weekly basis.

In addition, bipolar youth with comorbid anxiety took significantly longer to recover from their index episodes; the median times to recovery were 138 weeks for those with anxiety and 87 weeks for those without anxiety. Recurrence rates also were significantly higher at 76% for bipolar youth with comorbid anxiety and 57% for those without comorbid anxiety. The median time to recurrence was significantly shorter at 37 weeks in the comorbid group and 48 weeks with bipolar disorder alone.

The results suggest that characteristics of youth with comorbid bipolar and anxiety disorders include more syndromal and subsyndromal mixed cycling, more depression, and less euthymia than did bipolar youth without comorbid anxiety, the researchers said.

Dr. Sala was supported by a grant from the Alicia Koplowitz Foundation. Several study coauthors have received financial support and/or served as consultants or on advisory boards for multiple companies including Pfizer, Abbott, Schering-Plough, Bristol-Myers Squibb, and Forest.

TORONTO – Low vitamin D levels were associated with more psychotic features in mentally ill adolescents, based on data from 104 teens.

In previous studies, vitamin D deficiency has been linked with seasonal affective disorder, schizophrenia, and depression, said Dr. Barbara L. Gracious of the Ohio State University, Columbus, and her colleagues.

Dr. Gracious reported at the annual meeting of the American Academy of Child and Adolescent Psychiatry on 104 consecutive teens seen for acute or partial hospital stays for psychiatric symptoms during an 18-month period. The average age of the patients was 15 years; 27% were male, and 73% were white.

Overall, 72% of the study population had low vitamin D levels, defined as 25-OHD levels less than 30 ng/mL, and 34% were vitamin D deficient, defined as 25-OHD levels less than 20 ng/mL. By comparison, 9% of a cohort of teens from the NHANES (National Health and Nutrition Survey) were vitamin D deficient, the researchers noted.

Psychotic features were observed in 40% of the teens with low vitamin D levels and 16% of those with normal vitamin D levels, a statistically significant difference. Black ethnicity was associated with vitamin D deficiency, but vitamin D–deficient black teens were not significantly more likely than vitamin D–deficient white teens to exhibit psychotic features.

No studies indicate that vitamin D deficiency is a causative factor in psychosis.

Dr. Gracious is a consultant for Johnson & Johnson. None of her coauthors reported any financial conflicts. The study was supported by grants from several sources including the National Institutes of Health, the Ohio State University, and the University of Rochester (N.Y.).

TORONTO – Low vitamin D levels were associated with more psychotic features in mentally ill adolescents, based on data from 104 teens.

In previous studies, vitamin D deficiency has been linked with seasonal affective disorder, schizophrenia, and depression, said Dr. Barbara L. Gracious of the Ohio State University, Columbus, and her colleagues.

Dr. Gracious reported at the annual meeting of the American Academy of Child and Adolescent Psychiatry on 104 consecutive teens seen for acute or partial hospital stays for psychiatric symptoms during an 18-month period. The average age of the patients was 15 years; 27% were male, and 73% were white.

Overall, 72% of the study population had low vitamin D levels, defined as 25-OHD levels less than 30 ng/mL, and 34% were vitamin D deficient, defined as 25-OHD levels less than 20 ng/mL. By comparison, 9% of a cohort of teens from the NHANES (National Health and Nutrition Survey) were vitamin D deficient, the researchers noted.

Psychotic features were observed in 40% of the teens with low vitamin D levels and 16% of those with normal vitamin D levels, a statistically significant difference. Black ethnicity was associated with vitamin D deficiency, but vitamin D–deficient black teens were not significantly more likely than vitamin D–deficient white teens to exhibit psychotic features.

No studies indicate that vitamin D deficiency is a causative factor in psychosis.

Dr. Gracious is a consultant for Johnson & Johnson. None of her coauthors reported any financial conflicts. The study was supported by grants from several sources including the National Institutes of Health, the Ohio State University, and the University of Rochester (N.Y.).

TORONTO – Low vitamin D levels were associated with more psychotic features in mentally ill adolescents, based on data from 104 teens.

In previous studies, vitamin D deficiency has been linked with seasonal affective disorder, schizophrenia, and depression, said Dr. Barbara L. Gracious of the Ohio State University, Columbus, and her colleagues.

Dr. Gracious reported at the annual meeting of the American Academy of Child and Adolescent Psychiatry on 104 consecutive teens seen for acute or partial hospital stays for psychiatric symptoms during an 18-month period. The average age of the patients was 15 years; 27% were male, and 73% were white.

Overall, 72% of the study population had low vitamin D levels, defined as 25-OHD levels less than 30 ng/mL, and 34% were vitamin D deficient, defined as 25-OHD levels less than 20 ng/mL. By comparison, 9% of a cohort of teens from the NHANES (National Health and Nutrition Survey) were vitamin D deficient, the researchers noted.

Psychotic features were observed in 40% of the teens with low vitamin D levels and 16% of those with normal vitamin D levels, a statistically significant difference. Black ethnicity was associated with vitamin D deficiency, but vitamin D–deficient black teens were not significantly more likely than vitamin D–deficient white teens to exhibit psychotic features.

No studies indicate that vitamin D deficiency is a causative factor in psychosis.

Dr. Gracious is a consultant for Johnson & Johnson. None of her coauthors reported any financial conflicts. The study was supported by grants from several sources including the National Institutes of Health, the Ohio State University, and the University of Rochester (N.Y.).

TORONTO – More than half of children and teens who reported definite insomnia before being treated for depression experienced significant improvement in both their sleep and depression during their first weeks of treatment with fluoxetine, data from clinical trials involving 234 young patients show.

Previous studies have shown that insomnia is one of the most common residual symptoms in depressed youth, said Dr. Ameena Isa of the University of Texas Southwestern Medical Center, Dallas, and colleagues.

To explore the interaction between depression treatment and insomnia, the researchers reviewed combined data from two open-label clinical trials in which children and teens aged 7-18 years were treated with fluoxetine for the 12 weeks. The patients were seen once a week for 4 weeks and then every other week through 12 weeks. A total of 141 patients (60%) had severe insomnia at baseline, 45 (19%) had mild insomnia, and 48 (21%) had no insomnia. Patients with definite insomnia at baseline were significantly more depressed than other patients based on the Children’s Depression Rating Scale, Revised (CDRS-R). Demographic and clinical characteristics were similar among the treatment groups. The mean age was 13 years; 55% were male, and 73% were white.

Within 2 weeks of starting fluoxetine treatment, 53% of the patients who had reported definite insomnia had improved to reporting mild to moderate insomnia. In addition, 64% of those who had reported mild insomnia at baseline no longer complained of insomnia after 2 weeks of treatment.

The findings were presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Patients whose insomnia improved within the first 2 weeks of treatment also had significantly lower depression severity scores on the CDRS-R, compared to those who showed no improvement in sleep (41 vs. 48, respectively).

The researchers noted that only six of the young people reported a worsening of sleep within 2 weeks of fluoxetine treatment. However, all but one of these patients reported little or no sleep disturbance by the end of the study, they added.

The patients whose insomnia improved after 2 weeks continued to have lower total scores on the CDRS-R at the end of the study, compared to those whose sleep did not improve (27 vs. 34, respectively). This difference remained significant even when sleep was removed from the equation, the researchers noted.

Although the study was limited in part by its open-label design, the findings suggest that children and adolescents with severe and persistent insomnia might gain more from their major depressive disorder treatment if their insomnia is treated when they begin treatment with an antidepressant, the researchers said.

Dr. Isa had no financial conflicts to disclose. Study coauthor Dr. Graham J. Emslie has received research support from numerous companies, including Eli Lilly, Forest, GlaxoSmithKline, and Somerset. This study was funded by a grant from the National Institute of Mental Health.

TORONTO – More than half of children and teens who reported definite insomnia before being treated for depression experienced significant improvement in both their sleep and depression during their first weeks of treatment with fluoxetine, data from clinical trials involving 234 young patients show.

Previous studies have shown that insomnia is one of the most common residual symptoms in depressed youth, said Dr. Ameena Isa of the University of Texas Southwestern Medical Center, Dallas, and colleagues.

To explore the interaction between depression treatment and insomnia, the researchers reviewed combined data from two open-label clinical trials in which children and teens aged 7-18 years were treated with fluoxetine for the 12 weeks. The patients were seen once a week for 4 weeks and then every other week through 12 weeks. A total of 141 patients (60%) had severe insomnia at baseline, 45 (19%) had mild insomnia, and 48 (21%) had no insomnia. Patients with definite insomnia at baseline were significantly more depressed than other patients based on the Children’s Depression Rating Scale, Revised (CDRS-R). Demographic and clinical characteristics were similar among the treatment groups. The mean age was 13 years; 55% were male, and 73% were white.

Within 2 weeks of starting fluoxetine treatment, 53% of the patients who had reported definite insomnia had improved to reporting mild to moderate insomnia. In addition, 64% of those who had reported mild insomnia at baseline no longer complained of insomnia after 2 weeks of treatment.

The findings were presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Patients whose insomnia improved within the first 2 weeks of treatment also had significantly lower depression severity scores on the CDRS-R, compared to those who showed no improvement in sleep (41 vs. 48, respectively).

The researchers noted that only six of the young people reported a worsening of sleep within 2 weeks of fluoxetine treatment. However, all but one of these patients reported little or no sleep disturbance by the end of the study, they added.

The patients whose insomnia improved after 2 weeks continued to have lower total scores on the CDRS-R at the end of the study, compared to those whose sleep did not improve (27 vs. 34, respectively). This difference remained significant even when sleep was removed from the equation, the researchers noted.

Although the study was limited in part by its open-label design, the findings suggest that children and adolescents with severe and persistent insomnia might gain more from their major depressive disorder treatment if their insomnia is treated when they begin treatment with an antidepressant, the researchers said.

Dr. Isa had no financial conflicts to disclose. Study coauthor Dr. Graham J. Emslie has received research support from numerous companies, including Eli Lilly, Forest, GlaxoSmithKline, and Somerset. This study was funded by a grant from the National Institute of Mental Health.

TORONTO – More than half of children and teens who reported definite insomnia before being treated for depression experienced significant improvement in both their sleep and depression during their first weeks of treatment with fluoxetine, data from clinical trials involving 234 young patients show.

Previous studies have shown that insomnia is one of the most common residual symptoms in depressed youth, said Dr. Ameena Isa of the University of Texas Southwestern Medical Center, Dallas, and colleagues.

To explore the interaction between depression treatment and insomnia, the researchers reviewed combined data from two open-label clinical trials in which children and teens aged 7-18 years were treated with fluoxetine for the 12 weeks. The patients were seen once a week for 4 weeks and then every other week through 12 weeks. A total of 141 patients (60%) had severe insomnia at baseline, 45 (19%) had mild insomnia, and 48 (21%) had no insomnia. Patients with definite insomnia at baseline were significantly more depressed than other patients based on the Children’s Depression Rating Scale, Revised (CDRS-R). Demographic and clinical characteristics were similar among the treatment groups. The mean age was 13 years; 55% were male, and 73% were white.

Within 2 weeks of starting fluoxetine treatment, 53% of the patients who had reported definite insomnia had improved to reporting mild to moderate insomnia. In addition, 64% of those who had reported mild insomnia at baseline no longer complained of insomnia after 2 weeks of treatment.

The findings were presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Patients whose insomnia improved within the first 2 weeks of treatment also had significantly lower depression severity scores on the CDRS-R, compared to those who showed no improvement in sleep (41 vs. 48, respectively).

The researchers noted that only six of the young people reported a worsening of sleep within 2 weeks of fluoxetine treatment. However, all but one of these patients reported little or no sleep disturbance by the end of the study, they added.

The patients whose insomnia improved after 2 weeks continued to have lower total scores on the CDRS-R at the end of the study, compared to those whose sleep did not improve (27 vs. 34, respectively). This difference remained significant even when sleep was removed from the equation, the researchers noted.

Although the study was limited in part by its open-label design, the findings suggest that children and adolescents with severe and persistent insomnia might gain more from their major depressive disorder treatment if their insomnia is treated when they begin treatment with an antidepressant, the researchers said.

Dr. Isa had no financial conflicts to disclose. Study coauthor Dr. Graham J. Emslie has received research support from numerous companies, including Eli Lilly, Forest, GlaxoSmithKline, and Somerset. This study was funded by a grant from the National Institute of Mental Health.

TORONTO – Young children who have daily temper tantrums are significantly more likely to have behavioral and emotional problems than are children who have tantrums weekly or less than weekly, a study of 1,478 children has shown.

Previous studies have found that about 70% of young children have temper tantrums. The data also have shown that the number and nature of the tantrums can differ between children with psychopathology and healthy children, said Dr. Heide Hullsiek of the University of Connecticut Health Center, Farmington, and her colleagues.

To determine which characteristics of temper tantrums might be clinically significant, the researchers recruited 751 boys and 727 girls from pediatric primary care settings in Chicago. About one-third of the children were white, one-third were black, and one-third were Hispanic. The children were aged 3-5 years.

Parents completed the Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), which includes an assessment of temper loss, aggression, noncompliance, and low concern for others. Anxiety was measured using parents’ responses to the Separation Distress and General Anxiety Subscales of the Infant-Toddler Social and Emotional Assessment.

About 79% of children with daily tantrums related to noncompliance had additional behavioral problems, compared with 20% of children with weekly tantrums, and 1% of children with less than weekly tantrums. In addition, behavioral and emotional problems were significantly associated with a greater frequency of temper tantrums related to aggression, noncompliance, a low concern for others, general anxiety, and separation distress.

Overall, high levels of behavioral problems were significantly more likely among children with daily tantrums, compared with those with either weekly tantrums or less than weekly tantrums. "Interestingly, although problems were much less prevalent in the weekly tantrum group, they were still significantly more common compared to the less than weekly group," Dr. Hullsiek noted.

The frequency of tantrums decreased with age, but no significant difference was found in the frequency of tantrums per week between boys and girls. In addition, neither poverty status nor maternal education had a significant impact on the frequency of tantrums.

From an early detection perspective, daily temper tantrums warrant further evaluation from providers, the study results indicated. Areas for further investigation include the association between daily temper tantrums and developmental patterns, and signs of emotional dysregulation, Dr. Hullsiek added.

Dr. Hullsiek said she had no relevant financial disclosures. The study was funded by a grant from the National Institute of Mental Health.

TORONTO – Young children who have daily temper tantrums are significantly more likely to have behavioral and emotional problems than are children who have tantrums weekly or less than weekly, a study of 1,478 children has shown.

Previous studies have found that about 70% of young children have temper tantrums. The data also have shown that the number and nature of the tantrums can differ between children with psychopathology and healthy children, said Dr. Heide Hullsiek of the University of Connecticut Health Center, Farmington, and her colleagues.

To determine which characteristics of temper tantrums might be clinically significant, the researchers recruited 751 boys and 727 girls from pediatric primary care settings in Chicago. About one-third of the children were white, one-third were black, and one-third were Hispanic. The children were aged 3-5 years.

Parents completed the Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), which includes an assessment of temper loss, aggression, noncompliance, and low concern for others. Anxiety was measured using parents’ responses to the Separation Distress and General Anxiety Subscales of the Infant-Toddler Social and Emotional Assessment.

About 79% of children with daily tantrums related to noncompliance had additional behavioral problems, compared with 20% of children with weekly tantrums, and 1% of children with less than weekly tantrums. In addition, behavioral and emotional problems were significantly associated with a greater frequency of temper tantrums related to aggression, noncompliance, a low concern for others, general anxiety, and separation distress.

Overall, high levels of behavioral problems were significantly more likely among children with daily tantrums, compared with those with either weekly tantrums or less than weekly tantrums. "Interestingly, although problems were much less prevalent in the weekly tantrum group, they were still significantly more common compared to the less than weekly group," Dr. Hullsiek noted.

The frequency of tantrums decreased with age, but no significant difference was found in the frequency of tantrums per week between boys and girls. In addition, neither poverty status nor maternal education had a significant impact on the frequency of tantrums.

From an early detection perspective, daily temper tantrums warrant further evaluation from providers, the study results indicated. Areas for further investigation include the association between daily temper tantrums and developmental patterns, and signs of emotional dysregulation, Dr. Hullsiek added.

Dr. Hullsiek said she had no relevant financial disclosures. The study was funded by a grant from the National Institute of Mental Health.

TORONTO – Young children who have daily temper tantrums are significantly more likely to have behavioral and emotional problems than are children who have tantrums weekly or less than weekly, a study of 1,478 children has shown.

Previous studies have found that about 70% of young children have temper tantrums. The data also have shown that the number and nature of the tantrums can differ between children with psychopathology and healthy children, said Dr. Heide Hullsiek of the University of Connecticut Health Center, Farmington, and her colleagues.

To determine which characteristics of temper tantrums might be clinically significant, the researchers recruited 751 boys and 727 girls from pediatric primary care settings in Chicago. About one-third of the children were white, one-third were black, and one-third were Hispanic. The children were aged 3-5 years.

Parents completed the Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), which includes an assessment of temper loss, aggression, noncompliance, and low concern for others. Anxiety was measured using parents’ responses to the Separation Distress and General Anxiety Subscales of the Infant-Toddler Social and Emotional Assessment.

About 79% of children with daily tantrums related to noncompliance had additional behavioral problems, compared with 20% of children with weekly tantrums, and 1% of children with less than weekly tantrums. In addition, behavioral and emotional problems were significantly associated with a greater frequency of temper tantrums related to aggression, noncompliance, a low concern for others, general anxiety, and separation distress.

Overall, high levels of behavioral problems were significantly more likely among children with daily tantrums, compared with those with either weekly tantrums or less than weekly tantrums. "Interestingly, although problems were much less prevalent in the weekly tantrum group, they were still significantly more common compared to the less than weekly group," Dr. Hullsiek noted.

The frequency of tantrums decreased with age, but no significant difference was found in the frequency of tantrums per week between boys and girls. In addition, neither poverty status nor maternal education had a significant impact on the frequency of tantrums.

From an early detection perspective, daily temper tantrums warrant further evaluation from providers, the study results indicated. Areas for further investigation include the association between daily temper tantrums and developmental patterns, and signs of emotional dysregulation, Dr. Hullsiek added.

Dr. Hullsiek said she had no relevant financial disclosures. The study was funded by a grant from the National Institute of Mental Health.