From the Editor-in-Chief's Desk

To Our Readers:

First of all, I'd like to wish you a safe and happy end to an eventful year. Like all of you, the clinicians and researchers at my organization, the Child Mind Institute, have been working overtime to accelerate discovery, implement services, and meet the mental health challenges that face children around the world. This year we have been fortunate to accomplish the following:

Our School and Community Programs bring training resources to every teacher in California.

Our clinical centers in New York City and the San Francisco Bay Area had 50,000 patient visits.

We are helping build an insurance-based telehealth solution to improve access nationwide.

With the State of California, we are mentoring tomorrow's leaders, creating video resources for parents, and charting the future of app-based mental health technology.

With the Stavros Niarchos Foundation we are bringing what we know to Greece and beyond.

And most importantly, we continue to give parents the information they desperately need to help their kids. You can learn more at https://childmind.org

In this issue of the journal, I'd like to highlight two papers. Tan et al, in “Preliminary Observations of Resting-State Magnetoencephalography (MEG) in Nonmedicated Children with Obsessive-Compulsive Disorder,” report evidence of altered alpha and gamma networks in these mediation naïve children. While there are limitations to the study included its small sample size, it points the way towards future MEG-based studies of pediatric OCD that could produce markers of treatment response or illuminate methods of action for current or future psychopharmacological treatment. As the authors write, “Given the substantial portion of children and youth whose OCD symptoms do not respond to conventional treatments, our findings have implications for future treatment innovation research aiming to target and track whether brain connectivity patterns associated with having OCD may change with treatment, and to inform efforts to optimize and personalize our interventions.”

In the paper from Hobbs et al, “Psychopharmacological Treatment Algorithms of Manic/Mixed and Depressed Episodes in Pediatric Bipolar Disorder,” the authors set out to update the 2005 American Academy of Child and Adolescent Psychiatry (AACAP) treatment algorithms. Like that original work, this effort is extremely worthwhile and should be reviewed by treating clinicians and clinician-scientists. I appreciate the evidence-based focus of the authors and their thoughtful attention to emergent concerns (often highlighted in this journal) of long-term treatment with second generation antipsychotic medications (SGAs).

Hobbs et al provide a rationale for transitioning from first line treatments into maintenance treatments. “In the current algorithms for the treatment of acute manic/mixed episodes, we propose SGAs as the first-line treatment, with the choice of a specific agent left up to clinician's judgment,” they write. “To minimize adverse metabolic side effects of SGAs in vulnerable patients, clinicians might consider initiating lithium and tapering off SGAs for long-term maintenance treatment of PBD. This strategy might be particularly pertinent for risperidone and olanzapine, both highly effective agents for the treatment of acute manic/mixed episodes, but associated with high risk of weight gain and metabolic changes with long-term use.”

I hope you find the articles in this issue helpful, and happy new year!