Biomedical subjects

Graham J Emslie

Publications and source records attributed to Graham J Emslie.

At least 19 recordsLinked to original sources

PubMed2026

Clinical and psychological characteristics of adolescents at risk of mood disorders compared with adolescents with suicidal behavior.

Suicide is one of the leading causes of death among adolescents, yet little is understood about the biopsychosocial factors related to suicidality. The demographic, clinical, and biological characteristics of adolescents with and without psychiatric histories may help inform mechanistic approaches to treatment of mood disorders and suicidality. The 'characterizing the inflammatory profile and suicidal behavior in adolescents' and 'RAD arm of the Texas Resilience Against Depression' studies aimed to characterize the clinical and biological profiles of youth with suicidal behavior and youth at risk for mood disorders, compared to healthy adolescents (n = 75 in each group). Here, we report the descriptive baseline clinical and psychological characteristics of adolescents at risk of mood disorders and those with suicidal behavior. The adolescents with suicidal behavior reported 3.53 lifetime suicidal events on average, predominantly reported moderate to very severe depression (34.7%, 24%, to 9.3%), moderate to severe anxiety (58.6%), low optimism (91.9%), and mild (39.2%) to moderate (28.4%) degree of hopelessness. The at-risk adolescents predominantly reported no depression (60%) or anxiety (68.9%), moderate optimism (50%), and a positive outlook (85.7%). Healthy adolescents predominantly reported no depression (88.3%) or anxiety (93.2%), moderate optimism (59%), and a positive outlook (87%). The adolescents with suicidal behavior and those at risk of mood disorders exhibited significantly higher irritability and borderline personality disorder features (uncorrected p = 0.02 to p < 0.001) and lower resilience compared to healthy adolescents. Ongoing investigations using the longitudinal clinical and biological data will help identify the immune biosignatures of suicidality in youth.

Humans↗

PubMed2006

Adolescent suicide attempters in Hong Kong and the United States.

Using a nested case-control design drawing from a larger sample of 2272 adolescents, this study examined the characteristics of adolescents from Hong Kong (n = 99) and the United States (US) (n = 60), who indicated that they had made a suicide attempt at least once in the past, compared to their equally depressed sex- and age-matched counterparts who had not attempted suicide. The cross-cultural literature suggested three hypotheses which were tested: (a) depressive symptoms would differentiate between suicide attempters compared to non-attempters less in Hong Kong and more in the US; (b) discord in interpersonal relationships would be a more important distinguishing factor in suicide attempts in Hong Kong than in the US and (c) cognitive variables such as hopelessness would be less associated with suicide attempts in Hong Kong compared to the US. There were strong similarities in the two cultures with regard to characteristics that distinguished between attempters and matched controls. Hypotheses regarding cultural differences between attempters in Hong Kong and the US were not supported. Depression, current and lifetime suicide ideation, hopelessness, poor interpersonal relationships and exposure to suicide attempters and completers distinguished attempters from controls equally in the two cultures and in both genders. These findings do not support the proposition that depression is a less relevant variable in suicide attempts in Chinese versus western groups.

Adolescent↗

PubMed2006

The use of antidepressants to treat depression in children and adolescents.

The dramatic increase over the past 10 years in the amount of available clinical research on the use of antidepressants to treat major depression in children and adolescents has substantially improved our knowledge of the safety and efficacy of these medications in the pediatric population. Many questions remain, however, that highlight the need to continue research in this patient population rather than relying on the extrapolation of data from trials involving adults. In this article, we review the current state of research into antidepressant therapy for major depression in children and adolescents. In addition, we discuss methodologic issues and clinical implications specific to the pediatric population.

Adolescent↗

PubMed2006

Relapse and recurrence in pediatric depression.

Depression is a chronic illness in children and adolescents that often leads to long-term difficulties with recurrent episodes of depression. Standard treatment must continue beyond acute symptom reduction to a chronic disease management model, such as those used in pediatric asthma and diabetes. Within the chronic disease management model, treatment interventions are directed not only at the urgent or acute concern but also at the prevention of future problems. Lack of consistent efficacy in acute treatment studies has limited long-term prevention treatment research in pediatric depression. The impact of long-term treatments, both psychosocial and pharmacologic, is currently unknown.

Antidepressive Agents↗

PubMed2006

Cognitions and depressive symptoms among ethnic minority adolescents.

Cognitive models have guided effective intervention strategies in the treatment of depression. However, little is known about the cognitive model's relevance in different cultural ethnic groups in the United States. This study examines the cross-sectional and longitudinal associations among cognitive variables and depressive symptoms among African American, Caucasian, and Hispanic adolescents in the United States. Community adolescents (N = 450) ages 14-18 years (African American n = 79; Caucasian n = 273; Hispanic n = 98) provided information regarding their depressive symptoms and cognitions at two surveys, 6 months apart. Self-efficacy, cognitive errors, and hopelessness were associated with concurrent depressive symptoms at baseline. In addition, cognitive errors at baseline, controlling for baseline depressive symptoms and the occurrence of stressful events, predicted depressive symptoms at follow-up. Ethnic differences disappeared when parent education level was controlled. Our findings demonstrate support for the cognitive model of depression across ethnic groups. The importance of controlling for social class when examining ethnic differences in psychological variables is highlighted by our findings.

Adolescent↗

PubMed2006

Sex and age differences in sleep macroarchitecture in childhood and adolescent depression.

SUBJECT OBJECTIVE: To evaluate age and sex differences in sleep macroarchitecture in children and adolescents with major depressive disorder. DESIGN: Ninety-seven (50 F, 47 M) symptomatic unmedicated depressed outpatients were compared with 76 healthy controls (42 F, 34 M) matched for age and sex. SETTING: Participants spent 2 consecutive nights in the sleep laboratory. PARTICIPANTS: One hundred seventy-three children and adolescents, aged 8 to 18 years. MEASUREMENTS AND RESULTS: Significant group-by-age-by-sex interactions were evident for total sleep period, percentage of Stage 1 sleep, percentage of Stage 2, percentage of slow-wave sleep, and rapid eye movement (REM) sleep latency. The depressed adolescent boys had the greatest sleep disturbance with the highest amount of percentage of Stage 1 sleep, the shortest REM latency, and the least percentage of slow-wave sleep and number of minutes of slow-wave sleep in the first non-REM period. There were minimal age differences in sleep parameters between depressed children and adolescent girls. Within age groups, the sex differences were minimal in the healthy controls. The sex differences within the depressed group were substantially larger than controls. CONCLUSIONS: These findings suggest a differential developmental influence on sleep in early-onset depression that is heavily dependent on sex. Sex differences are substantially smaller in healthy individuals compared with those with depression, in agreement with previous studies in depressed adults.

Adolescent↗

PubMed2006

Paroxetine treatment in children and adolescents with major depressive disorder: a randomized, multicenter, double-blind, placebo-controlled trial.

OBJECTIVE: To assess the efficacy and tolerability of paroxetine in pediatric major depressive disorder. METHOD: Subjects 7 to 17 years old with major depressive disorder received paroxetine (10-50 mg/day) or placebo for 8 weeks from 2000 to 2001. The primary efficacy measure was change from baseline in the Children's Depression Rating Scale-Revised total score at week 8 last observation carried forward). Safety was primarily assessed by spontaneous reporting of adverse events. RESULTS: A total of 206 patients (intent to treat) were randomized to paroxetine (n = 104) or placebo (n = 102). Week 8 Children's Depression Rating Scale-Revised total score adjusted mean changes from baseline for patients receiving paroxetine and placebo were -22.58 (SE 1.47) and -23.38 points (SE 1.60), respectively (0.80, 95% confidence interval -3.09 to 4.69, p = 0.684). Increased cough (5.9% versus 2.9%), dyspepsia (5.9% versus 2.9%), vomiting (5.9% versus 2.0%), and dizziness (5.0% versus 1.0%) occurred in >or=5% of the paroxetine group and at least twice that of the placebo group. Six of 104 (5.8%) paroxetine patients reported serious adverse events compared to 1 placebo patient (1.0%). The incidence of adverse events of suicidal behavior and/or ideation while taking study medication (excluding taper) was 1.92% (2/104) for paroxetine versus 0.98% (1/102) for placebo. CONCLUSIONS: Paroxetine was not shown to be more efficacious than placebo for treating pediatric major depressive disorder.

Adolescent↗

PubMed2006

The Texas Children's Medication Algorithm Project: revision of the algorithm for pharmacotherapy of attention-deficit/hyperactivity disorder.

OBJECTIVE: In 1998, the Texas Department of Mental Health and Mental Retardation developed algorithms for medication treatment of attention-deficit/hyperactivity disorder (ADHD). Advances in the psychopharmacology of ADHD and results of a feasibility study of algorithm use in community mental health centers caused the algorithm to be modified and updated. METHOD: We convened a consensus conference of academic clinicians and researchers, practicing clinicians, administrators, consumers, and families to revise the algorithms for the pharmacotherapy of ADHD itself as well as ADHD with specific comorbid disorders. New research was reviewed by national experts, and rationales were provided for proposed changes and additions to the algorithms. The changes to the algorithms were discussed and approved both by the national experts and experienced clinicians from the Texas public mental health system. RESULTS: The panel developed consensually agreed-upon algorithms for ADHD with and without comorbid disorders. The major changes included elimination of pemoline as a treatment option, adding atomoxetine to the algorithm, and refining guidelines for treating ADHD with comorbid depression, aggressive behaviors, and tic disorders. CONCLUSIONS: Medication algorithms for ADHD can be modified to keep abreast of developments in the field. Although these evidence- and consensus-based treatment recommendations may be a useful approach to guide the treatment of ADHD in children, additional research is needed to determine how these algorithms can be used to maximally benefit child outcomes.

Adrenergic Uptake Inhibitors↗

PubMed2006

A double-blind, randomized, placebo-controlled trial of oxcarbazepine in the treatment of bipolar disorder in children and adolescents.

OBJECTIVE: This multicenter trial examined the efficacy and safety of oxcarbazepine in the treatment of bipolar disorder in children and adolescents. METHOD: A total of 116 outpatients 7 to 18 years of age with bipolar I disorder, manic or mixed, were recruited at 20 centers in the United States and randomly assigned to receive 7 weeks of double-blinded, flexibly dosed treatment with oxcarbazepine (maximum dose 900-2400 mg/day) or placebo. The primary efficacy measure was the mean change from baseline to endpoint in the Young Mania Rating Scale (YMRS), using the last-observation-carried-forward method. RESULTS: Oxcarbazepine (mean dose=1515 mg/day) did not significantly improve YMRS scores at endpoint compared with placebo [adjusted mean change: oxcarbazepine, -10.90 (N=55); placebo, -9.79 (N=55)]. Dizziness, nausea, somnolence, diplopia, fatigue, and rash were each reported in at least 5% of the patients in the oxcarbazepine group with an incidence at least twice that of the placebo group. The majority of adverse events were mild to moderate and occurred during the titration period. Eleven patients (19%) in the oxcarbazepine group discontinued the study because of adverse events, compared with two (4%) in the placebo group. CONCLUSIONS: Oxcarbazepine is not significantly superior to placebo in the treatment of bipolar disorder in youths. While the overall adverse event profile was similar to that reported for patients with epilepsy, the incidence of psychiatric adverse events for both the oxcarbazepine and placebo groups was higher than that reported for the epilepsy population.

Adolescent↗

PubMed2006

Validation of the Mood Disorder Questionnaire for bipolar disorders in adolescents.

OBJECTIVE: The study was designed to determine the validity of the Mood Disorder Questionnaire-Adolescent Version (MDQ-A) as a screening instrument for bipolar disorders (I, II, not otherwise specified, and cyclothymia) in an adolescent outpatient psychiatric population. METHOD: 104 adolescents and their parents completed the MDQ-A. Three versions of the MDQ-A were compared: (1) self report of symptoms by adolescent, (2) attributional report-how the adolescent believed teachers or friends would report his/her symptoms, and (3) parent report of adolescent's symptoms. DSM-IV diagnosis was made based upon the clinician-administered Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL), a semistructured diagnostic interview. MDQ-A items were summed, yielding a score for each adolescent ranging from 0 to 13 on each of the 3 MDQ-A versions. Each possible scoring threshold, in combination with co-occurrence of symptoms and behaviors and with moderate to serious problems caused by symptoms, was crossed with the results of the K-SADS-PL diagnostic interview to assess sensitivity and specificity. The study was conducted from April 2002 to September 2003. RESULTS: A score of 5 or more items on the parent version yielded a sensitivity of 0.72 and specificity of 0.81, which were superior to self and attributional versions. CONCLUSIONS: The MDQ-A completed by parents about their adolescents' symptoms may be a useful screening instrument for bipolar disorders in an adolescent psychiatric outpatient population.

Adolescent↗

PubMed2005

Atomoxetine alone or combined with fluoxetine for treating ADHD with comorbid depressive or anxiety symptoms.

OBJECTIVE: Symptoms of depression and anxiety are commonly comorbid with attention-deficit/hyperactivity disorder (ADHD). The authors assessed the safety and effectiveness of atomoxetine monotherapy compared with combined atomoxetine/fluoxetine therapy in a population of children and adolescents with ADHD and concurrent symptoms of depression or anxiety. METHOD: Patients were randomized to treatment with fluoxetine (n = 127) or placebo (n = 46) under double-blind conditions for 8 weeks, with concomitant atomoxetine use the last 5 weeks. RESULTS: At end point, reductions in ADHD, depressive, and anxiety symptoms were marked for both treatment groups (p < .001 for the relevant scale in each symptom cluster). Some differences between treatment groups for depressive symptoms were significant, but the magnitudes of the differences were small and likely of limited clinical importance. Completion rates for the two groups were similar, as were discontinuation rates for adverse events. The combination group had greater increases in blood pressure and pulse than did the monotherapy group. CONCLUSIONS: In pediatric patients with ADHD and comorbid symptoms of depression or anxiety, atomoxetine monotherapy appears to be effective for treating ADHD. Anxiety and depressive symptoms also improved, but the absence of a placebo-only arm does not allow us to conclude that these effects are specifically the result of treatment with atomoxetine. Combined atomoxetine/fluoxetine therapy was well tolerated.

Adolescent↗

PubMed2005

Review of the efficacy and safety of antidepressants in youth depression.

BACKGROUND: Depression in children and adolescents is a cause of substantial morbidity and mortality in this population. It is a common disorder that affects 2% of children and up to 6% of adolescents. Although antidepressants are used frequently for the treatment of this disorder, there has been recent controversy about the efficacy and safety of these medications in this population. This review examined the available evidence from clinical trials of antidepressants in adolescents and children with depression. METHODS: Clinical trial data reviewed were obtained from published reports, including peer review journals and meeting abstracts, as well as unpublished data in the public domain. Clinical trials in this review included large RCTs of antidepressants in youth under the age of 19 with depression. Studies were identified in 2 stages: 1) all RCTs included in the 2004 FDA safety report were reviewed; and 2) to ensure that no additional studies not reported to the FDA were missed, MEDLINE and PSYCH Info were searched from inception until December 2004. A total of 8 published studies and 9 unpublished studies were identified and reviewed. RESULTS: Efficacy and safety results from each study are reviewed in detail. There are significant differences in remission and response rates between different antidepressants but also between placebo groups across studies. Adverse events are common in clinical trials involving children and adolescents with depression. Due to lack of access to full data sets, effect sizes could not be calculated. CONCLUSIONS: With the variability in trial methodology and the variation in the drug/placebo response rates within a single trial, clinicians need to be judicious in their interpretation of research data on pediatric antidepressant trials. Significant methodological issues may also have affected the efficacy and safety results from these clinical trials.

Adolescent↗

PubMed2005

Effect of structured interviews on evaluation time in pediatric community mental health settings.

OBJECTIVE: The purpose of this study was to determine whether a structured interview administered by a master's-level clinician and reported to physicians before an initial evaluation would reduce physicians' evaluation time without compromising diagnostic accuracy or clinical outcomes in a pediatric sample. METHODS: A sample of 225 children and adolescents who were seen in public-sector community facilities was randomly assigned either to receive a structured interview (the Schedule for Affective Disorders and Schizophrenia for School-aged Children-Present and Lifetime Versions) by a trained interviewer before the initial physician visit or to receive assessment as usual. Clinical outcome data were collected prospectively, with follow-up at four months. RESULTS: Physicians' evaluation time was reduced by approximately half among physicians who were given preliminary diagnostic information. Physicians' diagnoses were strongly related to the results of the structured interview. Physicians' having access to previously obtained diagnostic information was associated with better psychosocial functioning at follow-up in terms of peer relations and spare-time activities compared with assessment as usual. CONCLUSIONS: Adding a trained diagnostic interviewer to the clinical team could reduce physicians' initial diagnostic evaluation time and improve diagnostic reliability and psychosocial outcomes.

Adolescent↗

PubMed2005

Depressive symptoms predict hospitalization for adolescents with type 1 diabetes mellitus.

OBJECTIVE: To examine the role of self-reported depressive symptoms in predicting hospitalization for complications of diabetes mellitus over a period of up to 2 years. STUDY DESIGN: Two hundred thirty-one adolescent outpatients (age range: 11-18 years) with type 1 diabetes completed the Center for Epidemiological Studies Depression Scale, a self-report measure of depressive symptoms. Glycosylated hemoglobin levels were also assessed, to account for this known predictor of hospitalization. With survival analysis methods, hospitalizations for medical complications that occurred up to 2 years after this assessment were recorded. RESULTS: After controlling for age, gender, socioeconomic status, and glycosylated hemoglobin levels at baseline, the odds ratio for prediction offered by Center for Epidemiological Studies Depression Scale scores above the cutoff point (12 for boys and 22 for girls) was 2.58 (95% confidence interval: 1.12-5.98). CONCLUSIONS: Young people with type 1 diabetes who show high levels of depressive symptoms are at increased risk for hospitalization for disease complications. Interventions aimed at improving their depressive symptoms may result in positive health outcomes, as well as improved quality of life.

Adolescent↗

PubMed2005

Continuation and maintenance therapy of early-onset major depressive disorder.

Child and adolescent depression is a serious and often episodic disorder with a high rate of recurrence equal to or surpassing that of adult depression. Symptoms of depression are similar in child, adolescent, and adult populations. The diagnostic criteria are the same, with the possible exception that children and adolescents are more likely to present with irritability without clear sadness. Despite the similarities between adult, adolescent, and child depression, results of studies of psychosocial and pharmacologic treatments in adult depression are not necessarily applicable to the pediatric population. The treatment of depression has been divided into three phases: acute (leading to clinical response and remission of symptoms); continuation (prevention of symptom relapse); and maintenance (prevention of new episodes or recurrences). According to research of acute treatment of child and adolescent depression with pharmacotherapy, selective serotonin reuptake inhibitors (SSRIs) are considered the first-line treatment. Recent controversies have caused some concern about the use of SSRIs in children and adolescents; however, SSRIs remain the initial pharmacologic treatment of choice. Acute treatment with non-specific psychotherapy is considered an essential component in the management of depression, but has not been shown to be equally effective as pharmacotherapy or specific psychotherapies by itself. There is increasing evidence that cognitive behavior therapy and interpersonal therapy are effective for the treatment of early-onset depression. Unfortunately, severe depression, comorbid diagnoses, family discord, and increased impairment may hinder the establishment of remission; these factors have been associated with treatment resistance. Once remission of depressive symptoms is established, continuation and maintenance treatment should be considered. Only one study of continuation treatment has been completed in child and adolescent depression; the results support the use of fluoxetine as a safe and effective treatment for reducing relapse. To date, no studies have been reported on maintenance treatment with specific therapies in child and adolescent depression, but trials in adults have demonstrated the importance of continued pharmacotherapy beyond the continuation phase of the illness. Although several factors are associated with response to treatment in children and adolescents with depression, including younger age, lower severity of depressive symptoms, higher family functioning, and fewer comorbid diagnoses, few studies have consistently demonstrated predictors of relapse and recurrence.

Adolescent↗

PubMed2005

Major depressive disorder in children and adolescents: clinical trial design and antidepressant efficacy.

Major depressive disorder is a common, chronic, recurring, and disabling illness in children and adolescents. Epidemiologic data suggest that the mean age at onset for depression is becoming younger. Antidepressants are widely used in pediatric patients despite a relatively small evidence base from randomized, controlled studies. Compared with the adult population, there are very few controlled studies of antidepressants in children and adolescents, and the studies that have been conducted do not unambiguously demonstrate efficacy. These findings in general are contrary to clinicians' experiences with antidepressants in this population. The different factors associated with the outcome of antidepressant studies in children and adolescents are reviewed. Developmental issues in pediatric patients, such as age of puberty and maturity of neural circuitry, are considered in the context of failed clinical trials. Review of existing controlled trials demonstrates a wide variety in study methodology. Factors such as the study location, methods of patient recruitment, small sample sizes, inclusion/exclusion criteria, study design, and choice of outcome measures all influence the ability of a study to detect differences between an antidepressant and placebo. In the current atmosphere of increased concern about antidepressant side effects, including suicidality, it is increasingly important that clinicians who treat depressed children and adolescents make informed therapeutic decisions based on data from well-controlled clinical trials.

Adolescent↗

PubMed2004

A cross-cultural investigation of cognitions and depressive symptoms in adolescents.

Adolescents (N=2,272) from Hong Kong and the United States provided information regarding their depressive symptoms, cognitions (self-efficacy, negative cognitive errors, and hopelessness), and stressful events between 2 surveys 6 months apart. Depressive symptoms and hopelessness were higher, and self-efficacy and negative cognitive errors were lower in Hong Kong than in the United States. Cognitions were associated with concurrent depressive symptoms and predicted depressive symptoms 6 months later in both cultures. The "reverse" model was also supported with more variance predicted by depressive symptoms to later cognitions than from cognitions to depressive symptoms. There was some support for the hypothesis that self-efficacy is less salient in collective compared with individualistic cultures. These findings extend cognitive theories of depression to a non-Western culture.

Adolescent↗

PubMed2004

A feasibility study of the childhood depression medication algorithm: the Texas Children's Medication Algorithm Project (CMAP).

OBJECTIVE: To evaluate the feasibility and impact on clinical response and function associated with the use of an algorithm-driven disease management program (ALGO) for children and adolescents treated for depression with or without attention-deficit/hyperactivity disorder (ADHD) in community mental health centers. METHOD: Interventions included (1). medication algorithms, (2). clinical and technical support for the physician, (3). uniform chart documentation of outcomes, and (4). a patient/family psychoeducation program. Children eligible for entry into the study were referred to the child psychiatrist for initiation or change in medicine. Outcomes of treatment with the ALGO for up to 4 months are presented. Measures of change included clinical symptoms, functioning, and global improvement (Clinical Global Impression Scale). A historical chart cohort from the same clinics was used as a quasi-control. RESULTS: Thirty-nine individuals (depression = 24; comorbid depression with ADHD = 15) were enrolled for treatment with ALGO. One hundred fourteen children were in the control cohort (74 depressed, 40 comorbid). For the ALGO groups, Children's Depression Rating Scale-Revised depression severity scores decreased from 48.2 to 32.5 and Child Adolescent Functioning Assessment Scale function scores improved from 70.3 to 40.9 (all p < or =.0005). Clinical Global Impression Scale severity scores decreased from 5.7 to 3.7 in ALGO compared to only 5.8 to 4.8 in the control (p <.003). CONCLUSIONS: There was clear improvement in clinical symptoms, functioning, and global response with ALGO treatment. The magnitude of the improvement was greater in children and adolescents treated with the ALGO program compared with a historical cohort. These data support the need for controlled studies in larger populations examining the effects of algorithm-driven disease management programs on the clinical outcomes of children with mental illness.

Adolescent↗