When Adverse Childhood Experiences Present to a Statewide Child Psychiatry Access Program.

Many children experience adversity, yet few receive needed psychiatric services. Pediatric primary care providers (PCPs) are uniquely positioned to intervene but often lack training and resources to provide patients with adverse childhood experiences (ACEs) the psychiatric support they need. The current study examines characteristics of youth with and without ACEs who were the focus of PCP contacts with a statewide child psychiatry access program (CPAP).

Characteristics of Patients Served by a Statewide Child Psychiatry Access Program.

Objective: Maryland's Behavioral Health Integration in Pediatric Primary Care (BHIPP) is a child psychiatry access program offering child-adolescent psychiatry consultation, resource and referral networking, and direct-to-patient mental health intervention. This study investigated characteristics of patients for whom primary care providers sought BHIPP services.

Methods: Data from 6,939 unique patient contacts between October 2012 and March 2020 were collected on service type, demographic characteristics, presenting concerns, clinical severity, clinicians' diagnostic impressions, current treatments, and BHIPP recommendations.

Characteristics of Primary Care Providers' Consultations With a Statewide Child Psychiatry Access Program Regarding Autism Spectrum Disorder.

Background: Child Psychiatry Access Programs (CPAPs) provide consultative support for pediatric primary care providers (PCPs) to treat co-morbid mental health (MH) symptoms among patients with Autism Spectrum Disorder (ASD).

Objectives: We examined differences in illness severity, comorbidity, and psychotropic medication use between patients with and without ASD for whom primary care providers sought consultation from Maryland's CPAP.

Methods: We examined N = 3641 Maryland's CPAP consultations from 2012 to 2019; n = 311 were consultations for ASD.

Telepsychotherapy with Youth at Clinical High Risk for Psychosis: Clinical Issues and Best Practices during the COVID-19 Pandemic.

Early detection and prevention of psychosis has become an international priority. Much of this work has focused on youth presenting with attenuated symptoms of psychosis-those at Clinical High Risk for psychosis (CHR)-given their elevated probability of developing the full disorder in subsequent years. Individuals at CHR may be prone to exacerbated psychological distress during the COVID-19 pandemic and its subsequent physical isolation measures, due to heightened stress sensitivity and comorbid mental health problems.

Characteristics of Providers Using a Child Psychiatry Access Program.

Objective: Child psychiatry access programs (CPAPs) help increase access to mental health services. This study aimed to provide information on the types of pediatric primary care clinicians (PPCCs) who call Maryland's CPAP.

Methods: Descriptive statistics and multinomial logistic regressions were conducted with data from 676 PPCCs who called Maryland's CPAP at least once between October 2012 and June 2019.

Metformin add-on vs. antipsychotic switch vs. continued antipsychotic treatment plus healthy lifestyle education in overweight or obese youth with severe mental illness: results from the IMPACT trial.

Antipsychotics are used for many psychiatric conditions in youth. Although developmentally inappropriate weight gain and metabolic abnormalities, which are risk factors for premature cardiovascular mortality, are especially frequent in youth, optimal strategies to reduce pediatric antipsychotic-induced overweight/obesity are unclear. The Improving Metabolic Parameters in Antipsychotic Child Treatment (IMPACT) was a randomized, parallel group, 24-week clinical trial which enrolled overweight/obese, psychiatrically stable youth, aged 8-19 years, with a DSM-IV diagnosis of severe mental illness (schizophrenia spectrum disorder, bipolar spectrum disorder or psychotic depression), at four US universities.

Appetitive characteristics in children with cystic fibrosis: Questionnaire validation and associations with nutritional status.

Background: Appetitive characteristics are an important factor in the nutritional status of children with cystic fibrosis (CF). We administered a brief parent-report eating behavior questionnaire, validated in healthy children, to determine the relationship between appetitive characteristics and body weight in children with CF.

Methods: Parents of children attending the Johns Hopkins Pediatric CF Clinic completed the Child Eating Behavior Questionnaire (CEBQ) at a routine clinic visit.

Associations of neuroticism-impulsivity and coping with binge eating in a nationally representative sample of adolescents in the United States.

Objective: Binge eating behavior is a public health concern due to its negative physical and mental health consequences. Little is known about the interplay of personality traits, coping styles, and binge eating in the general adolescent population. We examined the associations among the combination of neuroticism and impulsivity (NI), maladaptive coping styles (poor problem solving, distraction, and escape-avoidance), and lifetime prevalence of binge eating in a nationally representative sample of U.

Gender and racial/ethnic differences in binge eating symptoms in a nationally representative sample of adolescents in the United States.

Objective: Binge eating disorder (BED) is the most prevalent eating disorder in the U.S. adolescent population.

Are Eating Disorders Related to Attention Deficit/Hyperactivity Disorder?

Attention deficit/hyperactivity disorder (ADHD) is a disorder characterized by impulsivity, hyperactivity, and inattention. Binge-eating behavior is often impulsive and is the hallmark of the two eating disorders, binge-eating disorder (BED) and bulimia nervosa (BN), both of which are associated with significant health impairment. Bingeing behavior is also seen in the binge purge subtype of anorexia nervosa.

Associations of Neuroticism and Impulsivity with Binge Eating in a Nationally Representative Sample of Adolescents in the United States.

Binge eating behavior is a public health concern with serious physical and mental health consequences. Certain personality traits have been found to contribute to the development of eating disorders in clinical samples of youth, but little is known about associations between personality traits and binge eating in the general adolescent population. We examined the associations of neuroticism and impulsivity-both independently and in combination-with lifetime prevalence of binge eating, using nationally representative, cross-sectional data from the National Comorbidity Survey: Adolescent Supplement (n=437).

Overlapping neurobehavioral circuits in ADHD, obesity, and binge eating: evidence from neuroimaging research.

Attention-deficit/hyperactivity disorder (ADHD) and conditions involving excessive eating (eg, obesity, binge/loss of control eating) are increasingly prevalent within pediatric populations, and correlational and some longitudinal studies have suggested inter-relationships between these disorders. In addition, a number of common neural correlates are emerging across conditions, eg, functional abnormalities within circuits subserving reward processing and executive functioning. To explore this potential cross-condition overlap in neurobehavioral underpinnings, we selectively review relevant functional neuroimaging literature, specifically focusing on studies probing (i) reward processing, (ii) response inhibition, and (iii) emotional processing and regulation, and we outline 3 specific shared neurobehavioral circuits.

Decreased Escitalopram Concentrations Post-Roux-en-Y Gastric Bypass Surgery.

Background: There is a high coincidence between obesity and psychiatric disorders including depression. Depressive disorders are commonly treated with antidepressants, including the selective serotonin reuptake inhibitor Lexapro (escitalopram). Although candidates for elective Roux-en-Y gastric bypass (RYGB) surgery may be treated with escitalopram, drug dosing strategies are typically not adjusted postoperatively.

Pediatric loss of control eating syndrome: Association with attention-deficit/hyperactivity disorder and impulsivity.

Objective: Despite data linking Attention-deficit/Hyperactivity Disorder (ADHD) and adult binge eating, there are limited data in children with loss of control (LOC) eating. We examined inhibitory control in children with LOC eating syndrome (LOC-ES) and its association with ADHD.

Method: 79 children (8-14 years) over the fifth weight percentile were recruited, irrespective of LOC eating or ADHD status.

Chewing and spitting: a marker of psychopathology and behavioral severity in inpatients with an eating disorder.

Chewing and spitting out food is a frequent behavior in hospitalized patients with eating disorders (ED). Personality characteristics of those who frequently chew-spit (CHSP), the amount of food consumed during CHSP episodes, associated sense of loss of control overeating (LOC), and clinical response to hospital-based treatment have not been examined and were the focus of this study. Participants (N=324) were inpatients on a behavioral ED specialty unit.

Association between binge eating and attention-deficit/hyperactivity disorder in two pediatric community mental health clinics.

Objective: Attention-Deficit/ Hyperactivity Disorder (ADHD) has been linked with obesity; however its relationship with binge eating (BE) is less clear. We aimed to explore the associations among ADHD, weight, and BE in pediatric mental health clinics.

Method: We retrospectively reviewed consecutive intakes in two pediatric mental health clinics (N = 252).

Improving metabolic parameters of antipsychotic child treatment (IMPACT) study: rationale, design, and methods.

Background: Youth with serious mental illness may experience improved psychiatric stability with second generation antipsychotic (SGA) medication treatment, but unfortunately may also experience unhealthy weight gain adverse events. Research on weight loss strategies for youth who require ongoing antipsychotic treatment is quite limited. The purpose of this paper is to present the design, methods, and rationale of the Improving Metabolic Parameters in Antipsychotic Child Treatment (IMPACT) study, a federally funded, randomized trial comparing two pharmacologic strategies against a control condition to manage SGA-related weight gain.

Activation adverse events induced by the selective serotonin reuptake inhibitor fluvoxamine in children and adolescents.

Objective: The aim of this study was to examine the prevalence of activation cluster adverse events (AC-AEs) in youths treated with the selective serotonin reuptake inhibitor (SSRI) fluvoxamine for anxiety and the relationship of AC-AEs to SSRI blood levels.

Methods: Data from the Research Units on Pediatric Psychopharmacology (RUPP) Anxiety Study were examined for 45 youths (22 active fluvoxamine, 23 placebo) treated for Diagnostic and Statistical Manual for Mental Disorders, 4(th) edition (DSM-IV) anxiety disorders at the Johns Hopkins University site with an 8-week forced-flexible titration schedule. As part of the double-blind placebo-controlled trial, AC-AEs were recorded by clinicians at weekly patient visits.

Differential brain activation in anorexia nervosa to Fat and Thin words during a Stroop task.

We measured brain activation in six anorexia nervosa patients and six healthy controls performing a novel emotional Stroop task using Fat, Thin, and Neutral words, and words made of XXXXs. Reaction times increased in the patient group in Thin and Fat conditions. In the Thin-XXXX contrast, patients showed greater activation than controls at the junction of left insula, frontal and temporal lobes and in left middle and medial frontal gyri.

Medication management of pediatric eating disorders.

This article provides an overview of psychopharmacological treatments for pediatric eating disorders (EDs). Although EDs usually begin in adolescence, there are few pharmacological treatment trials specific to this age group and a paucity of controlled data. Empirical evidence suggests that psychological, behavioural and family interventions should be the primary modalities of treatment for these conditions.

The pharmacological management of childhood anxiety disorders: a review.

Rationale: Pediatric anxiety is a prevalent psychiatric disorder that may have important implications for school, social, and academic function. Psychopharmacological approaches to the treatment of pediatric anxiety have expanded over the past 20 years and increasing empirical evidence helps guide current clinical practice.

Objective: To review studies which examine the pharmacological treatment of pediatric anxiety disorders, including obsessive-compulsive disorder and to summarize treatment implications.