Biomedical subjects

Mark A Riddle

Publications and source records attributed to Mark A Riddle.

25 records · Page 2Linked to original sources

PubMed2003

The relevance of prolonged QTc measurement to pediatric psychopharmacology.

OBJECTIVE: To consider the relevance of prolonged QTc (QT interval corrected for rate) to pediatric psychopharmacology. METHOD: The authors reviewed publications on QTc prolongation and publications on sudden death in Medline from 1968 to November 2002. RESULTS: The search yielded more than 20,000 publications. Review manuscripts with clinical recommendations outnumber the few pediatric studies of QTc duration during treatment. Most reviews have been published in the past 5 years, during a time when the Food and Drug Administration restricted five psychotropic medications because of QTc prolongation (sertindole: not approved; thioridazine, mesoridazine, and droperidol: black-box warning; and ziprasidone: bolded warning) and nine somatic medications because of QTc prolongation. CONCLUSION: Pretreatment screening, careful selection of psychotropic and/or somatic medication combinations, and recognition of QTc prolongation in electrocardiographic tracings during treatment with medications that prolong QTc are important components of clinical practice.

Adolescent↗

PubMed2003

A guide for managing acute aggressive behavior of youths in residential and inpatient treatment facilities.

This article presents recommendations developed in 2001 by a committee of the Maryland Department of Health and Mental Hygiene that are used for managing acute aggressive behavior of youths in residential and inpatient treatment facilities in Maryland. The recommendations are highly similar to practice parameters published by the American Academy of Child and Adolescent Psychiatry, although they were developed independently. The recommendations are not prescriptive, nor are they based on an algorithm. Rather, they are based on a therapeutic process and designed to acknowledge the importance of professional and patient autonomy. The first step in the therapeutic process is to define the problem by addressing three issues: the target symptoms, the severity of those symptoms, and possible precipitants of the aggressive behavior. The next two steps are to select the goals of the intervention and to choose among three levels of immediate intervention, from least to most restrictive. The recommendations describe specific interventions, including medications that can be used at each level. The authors caution that the recommendations should be used in accordance with current regulations of the Center for Medicaid and Medicare Services and the Joint Commission on Accreditation of Healthcare Organizations.

Adolescent↗

PubMed2002

Treatment of pediatric anxiety disorders: an open-label extension of the research units on pediatric psychopharmacology anxiety study.

BACKGROUND: An 8-week placebo-controlled study, the Research Units on Pediatric Psychopharmacology Anxiety Study, documented beneficial effects of fluvoxamine in the treatment of pediatric social anxiety, separation anxiety, or generalized anxiety disorders. Following completion of this study, participants were invited to enter a 6-month open-label treatment phase designed to examine three issues: (a) long-term maintenance of response in fluvoxamine responders, (b) acute response to fluoxetine in fluvoxamine nonresponders, and (c) acute response to fluvoxamine in placebo nonresponders. METHODS: Participants aged 6-17 years meeting criteria for social anxiety, separation anxiety, or generalized anxiety disorders previously treated in an 8-week placebo-controlled trial (n = 128) were offered open treatment. Changes in symptoms of anxiety during open treatment were assessed in three groups: (a) fluvoxamine responders maintained on fluvoxamine, (b) fluvoxamine nonresponders changed to fluoxetine, and (c) placebo nonresponders changed to fluvoxamine. Response was defined based on Clinical Global Impression criteria. RESULTS: During 6 months of continued open treatment, anxiety symptoms remained low in 33 of 35 (94%) subjects who initially responded to fluvoxamine. Among 14 fluvoxamine nonresponders switched to fluoxetine, anxiety symptoms appeared significantly improved in 10 (71%) subjects. Finally, among 48 placebo nonresponders, 27 (56%) showed clinically significant improvement in anxiety on fluvoxamine. CONCLUSION: The current findings concerning extended treatment of pediatric anxiety disorders are only preliminary, because treatment was uncontrolled. Results suggest that an initial fluvoxamine response is likely to be retained with continued treatment, that some fluvoxamine nonresponders may respond to fluoxetine, and that some placebo nonresponders may respond to fluvoxamine.

Adolescent↗

PubMed2002

Anxiety after severe pediatric closed head injury.

OBJECTIVE: To assess the frequency of anxiety symptoms and disorders 1 year after severe pediatric closed head injury (CHI) and to determine the risk factors associated with these postinjury outcomes. METHOD: Ninety-seven subjects were prospectively followed for 1 year after severe CHI (Glasgow Coma Scale Score = 3-8). Assessments of preinjury and 1-year postinjury psychiatric status and psychosocial adversity were conducted. Frequency of anxiety symptoms and disorders 1 year after injury were the outcome measures. Data collection occurred between 1992 and 1996. RESULTS: There was a significant increase in the total number of anxiety symptoms after injury compared with before injury. The most frequent symptoms were overanxious symptoms, followed by obsessive-compulsive symptoms, separation anxiety symptoms, and simple phobia symptoms. There was a trend toward an increase in the frequency of overanxious disorder after injury. Preinjury anxiety symptoms correlated positively with postinjury anxiety symptoms and disorders. Younger age at injury correlated positively with postinjury anxiety symptoms. CONCLUSIONS: One year after severe CHI, children are at risk for a variety of anxiety symptoms and, possibly, overanxious disorder. Preinjury anxiety and younger age at injury are risk factors for these disturbances.

Adolescent↗

PubMed2002

Improving the management of acute aggression in state residential and inpatient psychiatric facilities for youths.

The Maryland Youth Practice Improvement Committee for Mental Health, which includes academicians, clinicians, and policymakers, was convened by the Maryland State Mental Hygiene Administration to advise on approaches to improve mental health care for youths in state inpatient and residential facilities. This report describes the development of a guide to improve the management of acute aggression. The process included the identification of key stakeholders, a literature review on managing acute aggression and promoting staff behavioral change, and many debates among the Committee members. An external peer review critiqued the Guide for content validity and feasibility in routine practice. The therapeutic process, a model to direct clinical decision-making used in other medical fields, forms the theoretical framework. Three levels of aggression and corresponding treatment options were established. The Committee hopes that acute aggressive episodes requiring restrictive interventions can be reduced with the combination of careful planning, adequate resources, and sufficient training. When selecting an intervention, the safety of all individuals involved is of primary importance and a patient's past stated preferences should also be considered. This report concludes with a brief discussion of future plans for the implementation and evaluation of this protocol in clinical practice.

Adolescent↗

PubMed2002

Obsessive-compulsive disorder: defining the phenotype.

Characterizing the obsessive-compulsive disorder (OCD) phenotype is important for treatment and etiologic studies. This article describes a family-study approach for identifying the spectrum of conditions related to OCD and subtyping OCD cases into homogeneous subtypes.

Age of Onset↗

PubMedDate not supplied

Selective serotonin reuptake inhibitor-induced apathy: a pediatric case series.

OBJECTIVES: Selective serotonin reuptake inhibitor (SSRI)-induced apathy is characterized by a lack of motivation that is not a result of sedation or symptoms of depression. This report describes two pediatric cases of SSRI-induced apathy, one of which is the first reported case in a child with a non-OCD (obsessive compulsive disorder) anxiety disorder. METHODS: The sample included 43 participants from the Johns Hopkins University site of the Research Units on Pediatric Psychopharmacology (RUPP) study of fluvoxamine in pediatric anxiety disorders. Data were reviewed for adverse events of at least moderate severity or that required a slowing of drug titration during the protocol; fluvoxamine blood levels were examined. RESULTS: Two (2) cases of apathy were identified (5%), 1 in a 9-year-old child and the other in a 16-year-old adolescent; neither had depressive illness. Similarities to existing reports included: Lack of insight, delayed onset, dose dependency, and reversibility with SSRI dose reduction or discontinuation. Plasma fluvoxamine levels were 459 ng/mL and 87 ng/mL, representing, respectively, the 90th percentile and 50th percentile, of the blood level sample groups at the time of apathy presentation (weeks 8 and 24). The 16-year-old also exhibited cooccurring disinhibition symptoms. CONCLUSIONS: Educating patients and families, and close monitoring by clinicians for symptoms of SSRI-induced apathy, are important to limit the impact of this reversible adverse event on compliance and quality of life.

Adolescent↗