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Key Studies That Inform Clinical Practice: Child and Adolescent Psychiatry

Key Studies That Inform Clinical Practice: Child and Adolescent Psychiatry

© Aleutie/shutterstock.com© Aleutie/shutterstock.com

Given psychiatrists’ need to stay up-to-date with the most current evidence-based information—but faced with an overwhelming literature—we attempted to identify and evaluate research published within the past 12 months that may have a direct bearing on clinical practice.

This month we focus on child and adolescent psychiatry. We have chosen 6 articles based on their clinical relevance, applicability, and quality. However, the notion that these are definitively the “top” papers cannot be defended. It is likely that others would choose different papers to include or exclude. However, these 6 papers are of high quality and have direct clinical application.

We’ve highlighted the key take-home points in each and have noted which of these studies can be viewed or downloaded in its entirety for free.

Soria-Saucedo R, Walter HJ, Cabral H, et al. Receipt of evidence-based pharmacotherapy and psychotherapy among children and adolescents with new diagnoses of depression. Psychiatr Serv. 2016;67:316-323.

abstract available online
http://www.ncbi.nlm.nih.gov/pubmed/26725295

This study attempted to identify how children in whom depression was diagnosed in the private sector were treated based on evidence-based information. Annual data from 2008 to 2010 were reviewed on 61,599 children aged 6 to 17 years with depression. (Youths with bipolar disorder, schizophrenia, mixed disorders–depression and psychosis, and depression and bipolar were excluded).

Combination medication and psychotherapy has been identified as first-line treatment in the evidence base (Treatment for Adolescents with Depression Study [TADS] and Treatment of Resistant Depression in Adolescents [TORDIA]). In this study, however, fluoxetine was the first-line medication treatment. All other SSRIs were second-line. SNRIs, NDRIs, NsSSAs (noradrenergic and specific serotonergic antidepressants) and second-generation antipsychotics were grouped as non–evidence-based treatments.

key findings: In the private sector, fewer than 3% of children with depression received what the evidence supports as first-line combination treatment. Nearly one-quarter (24.8%) of all depressed youth received medication monotherapy, and nearly a quarter (24.8%) of those on monotherapy received non–evidence-based choices. The most surprising finding was that mental health specialists in the private sector (psychiatrists, psychologists, psychiatric nurses, and child psychiatrists) were more likely to stray from evidenced-based treatments and to choose newer antidepressants, second-generation antipsychotics, and psychotherapy alone than primary care providers.

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