Pharmacotherapy Adherence for Pediatric Anxiety Disorders: Predictors and Relation to Child Outcomes

Gastrointestinal Symptoms in Pediatric Patients with Anxiety Disorders and Their Relationship to Selective Serotonin Reuptake Inhibitor Treatment or Placebo

Gastrointestinal symptoms are commonly reported as adverse effects of selective serotonin reuptake inhibitors (SSRIs), the first-line pharmacologic treatment for pediatric anxiety disorders; however, the temporal course of these symptoms during treatment, although believed to be transient, has never been prospectively evaluated. Additionally, rates of gastrointestinal symptoms and functional gastrointestinal syndromes in anxious youth are poorly understood. We examined gastrointestinal symptoms in youth with anxiety disorders during a double-blind, placebo-controlled trial of escitalopram (n = 51). Then, in a separate sample of prospectively treated children and adolescents with generalized, social and/or separation anxiety disorders (n = 56), we examined the frequency of gastrointestinal symptoms based on the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS) and ROME III criteria and the association of these symptoms with clinical and demographic characteristics using logistic regression. The frequency/severity of abdominal pain, diarrhea, bloating constipation or total gastrointestinal symptoms did not differ between patients receiving placebo (n = 25) or escitalopram (n = 26). However, escitalopram-treated youth had transient changes in nausea/vomiting and total upper gastrointestinal symptoms during the first two weeks of treatment. ROME III criteria for functional gastrointestinal syndromes were present in 12/56 patients (21.4%). QPGS-related functional gastrointestinal syndromes and symptoms were unrelated to treatment, treatment type, or clinical or demographic variables. Gastrointestinal symptoms are common in youth with anxiety and SSRIs produce transient-rather than sustained-gastrointestinal symptoms. Assessing gastrointestinal symptoms prior to pharmacotherapy and discussing factors that increase (or decrease) the likelihood of transient SSRI-related symptoms in youth may decrease patient uncertainty related to side effects and decrease medication-related anxiety.

Interrupting the Cycle: Association of Parental Stress and Child/Youth Psychotropic Medication Nonadherence

Efficacy of psychotropic medication depends in large part on successful adherence to prescribed regimens. This study investigated child/youth nonadherence in relation to family dynamics and informal support. The participants were 10,225 children and youth prescribed psychotropic medication and receiving services from 50 Ontario mental health agencies, assessed with the interRAI™ Child and Youth Mental Health (ChYMH) and ChYMH-Developmental Disability (ChYMH-DD) tools. Findings suggest a cycle of parental stress and child/youth medication nonadherence possibly leading to or even perpetuated by worsening psychiatric symptoms. Informal supports do not appear to moderate this cycle. While the present data cannot speak to causes of medication nonadherence in children/youth or where the cycle begins, the results are consistent with the extant literature calling for attention to parental wellbeing to support children/youth for optimal therapeutic benefits. Understanding home dynamics related to nonadherence can assist care planning that engages the family to achieve best possible child/youth outcomes.

Multi-informant Expectancies and Treatment Outcomes for Anxiety in Youth

Expectancies for a favorable treatment outcome have been associated with actual favorable outcomes but have been understudied in youth with anxiety. The current study applied structural equation modeling in a sample of anxious youth (N = 488; 7-17 years, M = 10.69, SD = 2.80) to examine whether a multi-informant latent expectancies factor, indicated by youth, parent, and therapist reports, predicted a latent posttreatment anxiety factor, controlling for a latent pretreatment anxiety factor. Both anxiety latent factors were indicated by youth, parent, and independent evaluator (IE) reports. Analyses also examined whether treatment condition (cognitive behavioral therapy, sertraline, combination, pill placebo) moderated the association between expectancies and outcome, and whether this association differed across development. Findings indicated that informant reports loaded similarly onto the latent factors. Results also demonstrated that treatment expectancies were positively associated with outcomes, and that this relationship held across treatment type and age group. Treatment implications and future research directions are discussed.