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A A C A P Research Forum 2010 Grcevich


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Dr. Grcevich\'s lecture from the 2010 American Academy of Child and Adolescent Psychiatry Research Forum, New York, NY, October 26, 2010.

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A A C A P Research Forum 2010 Grcevich

  1. 1. Child Psychiatry Research: Equipping our Colleagues in the Trenches <ul><li>Stephen Grcevich, MD </li></ul><ul><li>President and Founder, Family Center by the Falls Chagrin Falls, OH </li></ul><ul><li>Assistant Professor of Psychiatry Northeastern Ohio Universities College of Medicine </li></ul><ul><li>Division of Child and Adolescent Psychiatry Case Western Reserve University School of Medicine </li></ul><ul><li>AACAP Research Forum, October 26, 2010 </li></ul>E-mail: Phone: (440) 543-3400 Twitter: @drgrcevich
  2. 2. Educational objective: <ul><li>Provide an office-based clinician’s perspective to the discussion of research priorities in child and adolescent mental health </li></ul>
  3. 3. Stephen Grcevich, MD: disclosures: Pharmaceutical Industry Consulting: Shire US (100% of compensation donated to charity since 1/1/08) Grant/Research Support Child and Adolescent Psychiatry Trials (CAPTN) Network-ASK, PARCA, NOTA studies funded through NIMH Speakers’ Bureaus None since 2006 Other Financial/Material Support Web MD/Medscape Leerink-Swann Major Shareholder None
  4. 4. What research would be most helpful to clinicians “in the trenches?” <ul><li>“ Real world” data-from more representative patient populations </li></ul><ul><li>Predicting adverse responses to medication </li></ul><ul><li>Research that helps answer common questions from parents </li></ul><ul><li>Research that would help improve accuracy of diagnosis </li></ul><ul><li>“ Personalized medicine”…offering the most effective or acceptable treatment first, knowing when to depart from algorithms…drug, dose, alternative treatments </li></ul>
  5. 5. The conundrum : What’s desirable may not be possible
  6. 6. The best possible treatments: <ul><li>More “real-world” clinical trials…atypicals in treatment-naïve bipolar patients, intermediate to long-term acceptability of medications (ADHD treatments) </li></ul><ul><li>How effective is community-based psychotherapy performed by clinicians on managed care panels? Working for public agencies? </li></ul><ul><li>Kids with severe irritability, aggression, self-injurious behavior in chaotic living situations (SMD, TDD) </li></ul><ul><li>Validation of existing algorithms, practice parameters (TMAP-ADHD) </li></ul>Pliszka, SR et al. J. Am. Acad. Child Adolesc. Psychiatry, 45:6, JUNE 2006
  7. 7. With the fewest adverse effects: <ul><li>Studies to help predict in advance which patients will experience serious adverse effects… </li></ul><ul><li>Who’ll develop metabolic syndrome, tardive dyskinesia on a SGA? </li></ul><ul><li>What are the intermediate to long term effects of SGAs? </li></ul><ul><li>Suicidal behavior, behavioral activation on a SSRI? </li></ul><ul><li>Precipitation or exacerbation of mania on stimulants, atomoxetine, SSRIs </li></ul>
  8. 8. Answering questions from parents: <ul><li>Long term effects on medications on neurodevelopment…unintended consequences of treatment? </li></ul><ul><li>For how long will their child need medication? </li></ul><ul><li>How does therapy, psychosocial treatment attenuate the need for medical intervention? </li></ul><ul><li>Safety, effectiveness of homeopathic treatments </li></ul>
  9. 9. Improving accuracy of diagnosis: <ul><li>Biological markers (DNA analysis, neuroimaging) to help confirm accuracy of diagnosis </li></ul><ul><li>Essential questions to include in electronic medical record templates-evaluation, follow-up </li></ul>
  10. 10. Personalized medicine: <ul><li>Identification of genetic factors contributing to response (or lack of response) to standard treatments </li></ul><ul><li>Rapid vs. slow metabolizers </li></ul>Rockhill, C, Althof R. J Am Acad Child Adolesc Psychiatry - December 2009 (Vol. 48, Issue 12, Pages 1135-1136) McGough JJ, McCracken JC, Loo SK. J Am Acad Child Adolesc Psychiatry - December 2009 (Vol. 48, Issue 12, Pages 1155-1164), ,
  11. 11. Questions?