Child Psychiatry Research Priorities for Clinicians
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This document discusses priorities for child psychiatry research from the perspective of clinicians working in practice. It identifies several areas that would be most helpful, including: 1) More "real world" clinical trials using more representative patient populations to evaluate typical treatments. 2) Research to better predict adverse responses to medications and improve diagnostic accuracy. 3) Studies exploring the long-term effects of treatments on neurodevelopment, safety of alternative treatments, and factors that influence treatment needs and responses. The document notes it can be difficult to design research that addresses the most pressing needs faced by clinicians while also being feasible to conduct.
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Child Psychiatry Research Priorities for Clinicians
- 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
- 5. The conundrum : What’s desirable may not be possible
- 11. Questions?
Editor's Notes
- Clinicians “in the trenches” are getting squeezed We’re asked to do “evidence-based treatment” using evidence that has little to do with patients we see in the real world Example…Mixed Amphetamine Salts in adolescents Example: aripiprazole in newly diagnosed patients with bipolar disorder More pressure to see more kids in less time…how can we be more sure that we have it right? When to depart from practice guidelines?
- I’m realistic Cleveland will be challenged to win the NBA championship because free agents don’t want to come We won’t get what we want
- Why do so many kids stop taking medication that’s reportedly very helpful? Tolerability very different in patients with comorbid conditions Docs rely on medication because the results are more consistent…PATS/TADS study…how will anxious kids do with the therapists I have available to me in my community or my agency? TDD…discussion of need for diagnosis…how to treat them? Not much data to validate TMAP…ADHD with comorbidities is what we treat most often
- Conundrum…You’re in a mental health center…your patient is 8-in his parents’ bedroom with a knife…command hallucinations to stab and kill his parents African American-125# Father has HTN, 300+# both of his grandfathers spent 15+ years in state psychiatric hospitals You’d like to know risks of TD Acute-term studies with atypicals…what will he weigh in 12 months? 24 months? Two small, short-term studies evaluating stimulants in bipolar disorder, but most kids with bipolar disorder have ADHD
- Does long-term medication treatment impact the course of the illness? How does behavioral, psychosocial treatment effect the long-term course?
- When do we depart from the algorithms?