1
|
Gerlach M, Renner T, Romanos M. [Particularities and problems of psychopharmacology in childhood and adolescence]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023:10.1007/s00103-023-03718-z. [PMID: 37277511 DOI: 10.1007/s00103-023-03718-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/08/2023] [Indexed: 06/07/2023]
Abstract
The drug treatment of mental illness in childhood and adolescence poses a particular clinical and legal challenge. Reasons for this include the often necessary off-label use and existing knowledge gaps regarding the long-term effects of the neuro-/psychotropic drugs used. In this article, the prerequisites for therapy with neuro/psychotropic drugs, such as the need for age-appropriate inclusion of children and adolescents in the decision-making and education process, as well as the evaluation of medication, the consideration of biological age- and maturation-related factors, and the special measures for off-label use, are discussed. We further discuss general problems in the development and use of neuro-/psychotropic drugs, such as the difficulties in relation to proof of effectiveness, reimbursement and liability issues of off-label administration, and the problems of conducting clinical trials with children and adolescents.
Collapse
Affiliation(s)
- Manfred Gerlach
- Klinik und für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie Zentrum für Psychische Gesundheit, Universitätsklinik Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Deutschland.
- Arbeitsgruppe "Kinder- und jugendliche Psychopharmakologie der Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie" (AGNP) e. V., Homburg/Saar, Deutschland.
| | - Tobias Renner
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinikum Tübingen, Tübingen, Deutschland
- Arbeitsgruppe "Kinder- und jugendliche Psychopharmakologie der Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie" (AGNP) e. V., Homburg/Saar, Deutschland
| | - Marcel Romanos
- Klinik und für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie Zentrum für Psychische Gesundheit, Universitätsklinik Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Deutschland
- Arbeitsgruppe "Kinder- und jugendliche Psychopharmakologie der Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie" (AGNP) e. V., Homburg/Saar, Deutschland
| |
Collapse
|
2
|
Dittmann RW, Rothenberger A. Psychopharmakologieforschung in der Kinder- und Jugend- psychiatrie – Entwicklungen, Herausforderungen, Perspektiven. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2019; 47:489-494. [PMID: 31702457 DOI: 10.1024/1422-4917/a000690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ralf W Dittmann
- AG Klinische Psychopharmakologie des Kindes- und Jugendalters, Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Mannheim/Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Deutschland
| | - Aribert Rothenberger
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsmedizin, Georg-August Universität Göttingen, Deutschland
| |
Collapse
|
3
|
Roessner V, Wolff N, Ehrlich S, Waltereit R. Need for a more developmental perspective: QTc prolongation under psychotropic medication. Eur Child Adolesc Psychiatry 2017; 26:871-873. [PMID: 28730428 DOI: 10.1007/s00787-017-1028-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Robert Waltereit
- Department of Child and Adolescent Psychiatry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| |
Collapse
|
4
|
[The new German drug market law AMNOG from a child and adolescent psychiatry perspective]. DER NERVENARZT 2017; 87:367-75. [PMID: 26992908 DOI: 10.1007/s00115-016-0094-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The European Union (EU) regulation 1901/2006 plus the implementation of pediatric investigational plans by the European Medicines Agency (EMA) have contributed to more clinical studies in pediatric psychopharmacology. A new drug market law (AMNOG) has been in force in Germany since 2011 that requires an additional process of assessment of benefits of newly authorized medications by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G‑BA), which also holds for medications licensed for pediatric populations. OBJECTIVES Summary of early assessments of benefits for newly registered compounds in the treatment of psychiatric disorders and critical discussion from the perspective of child and adolescent psychiatry. MATERIAL AND METHODS Application and critical review of documents and written statements by various institutions and stakeholders related to assessment procedures and respective decisions by the G‑BA for these medications. RESULTS AND CONCLUSION Clearly differing requirements for study designs and outcome parameters characterize the conditions for market authorization and for the assessment of benefits. Further adjustments to the regulations in implementing the AMNOG appear to be essential, integrating agencies involved so far, complimented by expertise from regulatory agencies and medical scientific societies.
Collapse
|
5
|
Gerlach M, Warnke A. [Drug therapy in child and adolescent psychiatry in Germany between ethical as well as social and legal conflicts]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 44:249-55. [PMID: 27434686 DOI: 10.1024/1422-4917/a000430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Manfred Gerlach
- 1 Zentrum für Psychische Gesundheit, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg.,2 Arbeitsgruppe "Kinder- und jugendpsychiatrische Pharmakologie" der AGNP
| | - Andreas Warnke
- 1 Zentrum für Psychische Gesundheit, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg
| |
Collapse
|
6
|
Gerlach M, Egberts K, Dang SY, Plener P, Taurines R, Mehler-Wex C, Romanos M. Therapeutic drug monitoring as a measure of proactive pharmacovigilance in child and adolescent psychiatry. Expert Opin Drug Saf 2016; 15:1477-1482. [PMID: 27551945 DOI: 10.1080/14740338.2016.1225721] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Off-label or unlicensed use of psychotropic drugs is common rather than the exception in child and adolescent psychiatry. This use exposes patients to an unknown additional risk of ineffective or even harmful treatment. In addition, treatment with psychotropic drugs during a period of life when the patient undergoes marked developmental hormonal and neurobiological changes often requires different dosing regimes in later life and may result in adverse drug reactions, which are either not seen in adults at all or not in the same frequency. Areas covered: Given these critical safety issues, efficient pharmacovigilance methods as part of routine practice are essential for the improvement of patient care. The purpose of this article is to introduce methods to increase the safety of psychotropic drug use in youngsters. In particular, therapeutic drug monitoring (TDM) as a routine measure of proactive pharmacovigilance is discussed. Expert opinion: Given the special features of psychopharmacological therapy in children and adolescents in day-to-day clinical practise, proactive surveillance by using a close standardized 'patient monitoring' and long-term follow-up with TDM is very important. This approach could minimize the risk of exposing paediatric patients to ineffective treatments of uncertain or unknown risks.
Collapse
Affiliation(s)
- Manfred Gerlach
- a Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Centre for Mental Health , University Hospital of Würzburg , Würzburg , Germany
| | - Karin Egberts
- a Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Centre for Mental Health , University Hospital of Würzburg , Würzburg , Germany
| | - Su-Yin Dang
- a Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Centre for Mental Health , University Hospital of Würzburg , Würzburg , Germany
| | - Paul Plener
- b Department of Child and Adolescent Psychiatry and Psychotherapy , Central Institute of Mental Health , Mannheim , Germany
| | - Regina Taurines
- a Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Centre for Mental Health , University Hospital of Würzburg , Würzburg , Germany
| | - Claudia Mehler-Wex
- a Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Centre for Mental Health , University Hospital of Würzburg , Würzburg , Germany.,c HEMERA Private Hospital for Mental Health, Adolescents and Young Adults , Bad Kissingen , Germany
| | - Marcel Romanos
- a Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Centre for Mental Health , University Hospital of Würzburg , Würzburg , Germany
| |
Collapse
|
7
|
Persico AM, Arango C, Buitelaar JK, Correll CU, Glennon JC, Hoekstra PJ, Moreno C, Vitiello B, Vorstman J, Zuddas A. Unmet needs in paediatric psychopharmacology: Present scenario and future perspectives. Eur Neuropsychopharmacol 2015; 25:1513-31. [PMID: 26166453 DOI: 10.1016/j.euroneuro.2015.06.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/17/2015] [Accepted: 06/12/2015] [Indexed: 12/20/2022]
Abstract
Paediatric psychopharmacology holds great promise in two equally important areas of enormous biomedical and social impact, namely the treatment of behavioural abnormalities in children and adolescents, and the prevention of psychiatric disorders with adolescent- or adult-onset. Yet, in striking contrast, pharmacological treatment options presently available in child and adolescent psychiatry are dramatically limited. The most important currently unmet needs in paediatric psychopharmacology are: the frequent off-label prescription of medications to children and adolescents based exclusively on data from randomized controlled studies involving adult patients; the frequent lack of age-specific dose, long-term efficacy and tolerability/safety data; the lack of effective medications for many paediatric psychiatric disorders, most critically autism spectrum disorder; the scarcity and limitations of randomized placebo-controlled trials in paediatric psychopharmacology; the unexplored potential for the prevention of psychiatric disorders with adolescent- and adult-onset; the current lack of biomarkers to predict treatment response and severe adverse effects; the need for better preclinical data to foster the successful development of novel drug therapies; and the effective dissemination of evidence-based treatments to the general public, to better inform patients and families of the benefits and risks of pharmacological interventions during development. Priorities and strategies are proposed to overcome some of these limitations, including the European Child and Adolescent Clinical Psychopharmacology Network, as an overarching Pan-European infrastructure aimed at reliably carrying out much needed psychopharmacological trials in children and adolescents, in order to fill the identified gaps and improve overall outcomes.
Collapse
Affiliation(s)
- Antonio M Persico
- Child & Adolescent NeuroPsychiatry Unit, University Campus Bio-Medico, Rome, Italy; Mafalda Luce Center for Pervasive Developmental Disorders, Milan, Italy.
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, and Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Christoph U Correll
- Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
| | - Jeffrey C Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, and Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Pieter J Hoekstra
- Department of Psychiatry, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Carmen Moreno
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | | | - Jacob Vorstman
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alessandro Zuddas
- Dept. Biomedical Sciences, Child & Adolescent NeuroPsychiatry Unit, University of Cagliari, Cagliari, Italy
| | | |
Collapse
|