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Coughlin et al. present a large meta-analysis reevaluating the risk of anxiety as a side effect of psychostimulant treatment for attention-deficit/hyperactivity disorder (ADHD). The results, they note, run contrary not only “to conventional wisdom” but also to FDA drug labels. “Meta-analysis demonstrated a significantly reduced risk of anxiety in children with ADHD given psychostimulant treatment as compared with placebo,” the authors write. Furthermore, their examination of 23 studies involving 2959 children revealed a related dosing effect “with higher doses of psychostimulants being associated with lower rates of anxiety.”
The limitations of these challenging findings are informative, and speak to the longstanding ambiguities over ADHD, anxiety, and stimulation medications. “The measurement of anxiety as a side effect differed among trials,” Coughlin et al. write, “from the informant, to the assessment of anxiety, to the degree of impairment. As there was no consistent measurement among studies, it is difficult to truly determine the presence and severity of anxiety as a side effect.”
As such, the authors suggest not only that clinicians be aware of the benefits of psychostimulant treatment in anxious patients, but also that “further research examining comorbid anxiety in psychostimulant trials would benefit from a standardized and consistent format for reporting across trials.” This recommendation nicely fits the authors' aim “to provide an evidence base for the care of children with ADHD who experience anxiety,” one which I know we all share.
Elsewhere, Gracious et al. raise an important treatment monitoring issue with their article on the risk of nonalcoholic fatty liver disease in youth with chronic exposure to atypical antipsychotic medications. The authors provide an informative picture of the clinical reality and the complications and benefits of a screening regimen. And their recommendations—to establish new guidelines for monitoring and referring at-risk youth—are worth reflecting on for all in the field concerned with “how best to lower risk for chronic liver disease in this already highly medically comorbid population.”
These serious weight-gain related medical complications are why work like that of Hellings et al. on low-dose loxapine as an adjunct or alternative to atypical antipsychotics is so welcome. Their small but intriguing sample of “naturalistic outpatient cases” with autism spectrum disorders (ASD) responded well when treated for irritability and aggression, with low-dose loxapine proving “superior to atypical antipsychotics in terms of ease of use and lack of metabolic side effects.” The authors call for more rigorous and expansive “double-blind, placebo-controlled trials of loxapine that test its efficacy in improving ASD symptoms,” which would be an appreciated development given the results of this investigation.
Finally, I would like to mention the article by Flamarique et al. on electroconvulsive therapy (ECT) in the treatment of schizophrenia spectrum disorders (SSD). Their study of perceptions of ECT treatment from those who have direct experience is invaluable, and its result deserves to be broadcast beyond the academy. “Our data show that most adolescents with SSD and treated with ECT had positive views about the treatment,” the authors write. And in conclusion: “It is important to assess the views and experience of patients who undergo ECT in order to demonstrate that patients consider it to be a safe and effective procedure in most cases. This information can help to counteract the stigma associated with this treatment.”
I hope you find these articles informative and of use.