September-October 2011 Update

I n this column, I would like to make the readership aware of two updates. The first, took place in June 2011 and involved the recall of two lots of the antipsychotic agent, Risperdal (risperidone), due to the detection of an uncharacteristic odor. The cause of the contamination was thought to be the result of a chemical preservative applied to the wood used in the construction of pallets on which the medication was located. In the other update, dated February 2011, it was announced that the United States Food and Drug Administration (FDA) approved the use of Shire's alpha2 adrenergic agonist, Intuniv (guanfacine extended-release tablets), as adjunctive therapy to stimulants for the treatment of attention-deficit/hyperactivity disorder (ADHD) in youth between the ages of 6 and 17 years of age. The approval was based on the results of a 9 week, multicenter, randomized , double-blind, placebo-controlled study . It is important to note that this is the second alpha2 adrenergic agent (the first was Kapvay, the extended release form of clonidine) to receive approval as adjunctive treatment (with stimulants) for the treatment of ADHD.

The seeking of FDA approval for this type of indication represents an important milestone in the treatment of children with mental health conditions that may not respond optimally to monotherapy. Often the use of adjunctive medication therapy in children is not well guided or substantiated. Seasoned child and adolescent psychiatrists often find themselves resorting to this sort of approach when treatment with individual agents either does not produce sufficient clinical effects or upward dose titration is limited due to the emergence of certain side effects. Nevertheless, other health care professionals do not always feel as comfortable in mixing and matching medications, in order to meet a particular child's needs. At least now, for children with ADHD, those other health care providers have an FDA-approved alternative to fall back upon. It would be most beneficial if the manufacturer of the other FDA-approved nonstimulant agent (atomoxetine) sought out a similar adjunctive status for their product.

Keeping with our tradition, I would like to break down some very interesting findings from a recently published article. In the article by Bledsoe, Semrud-Clikeman and Pliszka (2011) the authors examined the cerebellar anatomical and behavioral correlates in a cohort of 32 children with combined type of ADHD and compared them to 15 developing controls. Both groups' mean age was approximately 11.5 years old. The authors employed T1- weighted magnetic resonance imaging (MRI) technology. Though the cerebellum is often linked to motor coordination, its role in planning, attention shifting, and processing of visuospatial information has also been documented. In this sample, though overall cerebellar volumetric differences were not appreciated between the two groups, only the posterior inferior vermis (lobules VII-X) were significantly smaller in the ADHD group. Furthermore, regression analyses indicated that the volumes significantly predicted the variance in parent ratings on the BASC-II in the realms of attention and hyperactivity. The neurological underpinnings of attention, hyperactivity, and impulsivity are complex, and it should be understood that there is not a single characteristic difference that accounts for all the symptoms of this spectral illness.

We are including an updated list of conferences for your consideration.

• The 2012 Annual Meeting of the American Psychiatric Association will be held in Philadelphia, PA, from May 5-9, 2012, contact (888)357-7924.