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Sylvester CM, Luby JL, Pine DS. Novel mechanism-based treatments for pediatric anxiety and depressive disorders. Neuropsychopharmacology 2024; 49:262-275. [PMID: 37608220 PMCID: PMC10700626 DOI: 10.1038/s41386-023-01709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
Pediatric anxiety and depressive disorders are common, can be highly impairing, and can persist despite the best available treatments. Here, we review research into novel treatments for childhood anxiety and depressive disorders designed to target underlying cognitive, emotional, and neural circuit mechanisms. We highlight three novel treatments lying along a continuum relating to clinical impact of the disorder and the intensity of clinical management required. We review cognitive training, which involves the lowest risk and may be applicable for problems with mild to moderate impact; psychotherapy, which includes a higher level of clinical involvement and may be sufficient for problems with moderate impact; and brain stimulation, which has the highest potential risks and is therefore most appropriate for problems with high impact. For each treatment, we review the specific underlying cognitive, emotional, and brain circuit mechanisms that are being targeted, whether treatments modify those underlying mechanisms, and efficacy in reducing symptoms. We conclude by highlighting future directions, including the importance of work that leverages developmental windows of high brain plasticity to time interventions to the specific epochs in childhood that have the largest and most enduring life-long impact.
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Affiliation(s)
- Chad M Sylvester
- Washington University Department of Psychiatry, St. Louis, MO, USA.
- Washington University Department of Radiology, St. Louis, MO, USA.
| | - Joan L Luby
- Washington University Department of Psychiatry, St. Louis, MO, USA
| | - Daniel S Pine
- National Institute of Mental Health, Emotion and Development Branch, St. Louis, MO, USA
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McLennan S, Jansen C, Buyx A. The discussion of risk in German surgical clinical practice guidelines: a qualitative review. Innov Surg Sci 2021; 6:53-57. [PMID: 34589572 PMCID: PMC8435268 DOI: 10.1515/iss-2020-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/08/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives Clinical practice guidelines (CPGs) have a potentially important role regarding the assessment and communication of the risks of perioperative complications. This study aimed to (1) examine the content of German surgical CPGs in relation to surgical risks and (2) provide baseline results for future research in order to assess the development of surgical CPGs in Germany in relation to this issue. Methods In November 2015, all German surgical CPGs that provide guidance regarding illnesses that can be treated with a surgical procedure were collected from the websites of the German umbrella organisation of medical professional associations and the German Association for Cardiology. Results Data collection retrieved 230 CPGs of which 214 were included in the final analysis. The analysis identified four different groups: 1) 5% (10/214) of guidelines did not discuss “risks” or “complications” at all; 2) 21% (44/214) of guidelines discussed general risks that are not related to surgical complications; 3) 35% (76/214) of guidelines discussed surgical complications and often discussed their likelihood in terms of “high risk” or “low risk”, but did not provide numeric estimates and 4) 39% (84/214) of guidelines discussed specific surgical risks and also provided numerical risk estimates. Guidelines with higher methodological quality more frequently included numerical risk estimates. Conclusions It is positive that the vast majority of German surgical CPGs address the issue of risks. However, it would be helpful if more German surgical CPGs provide explicit and evidence-based estimates and recommendations relating to the surgical risk to support surgeons in providing high-quality care and to meet their ethical obligations to patients.
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Affiliation(s)
- Stuart McLennan
- Institute of History and Ethics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Carolin Jansen
- Fachbereich Medizinethik, Institut für Experimentelle Medizin, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Alena Buyx
- Institute of History and Ethics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Happo S, Keränen T, Halkoaho A, Lehto SM. Risk Assessment of Medical Study Procedures in the Documents Submitted to a Research Ethics Committee. J Empir Res Hum Res Ethics 2020; 15:396-406. [PMID: 32036724 PMCID: PMC7604935 DOI: 10.1177/1556264620903563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several frameworks assist research ethics committees (RECs) in risk assessment of medical studies. However, little is known about how researchers describe risks of the procedures in study protocols and participant information sheets. We examined 349 study protocols and participant information sheets submitted to an REC and evaluated the risk assessments performed for 1,510 study procedures. Risks had been assessed for 399 (26%) procedures in study protocols and for 425 (28%) procedures in participant information sheets. Physical risks were assessed six times more frequently than psychological risks. Risks of medical procedures are not always detailed in study protocols or participant information sheets. Risk descriptions of procedures believed to be familiar to potential participants may be omitted.
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Affiliation(s)
- Saara Happo
- University of Eastern Finland, Kuopio, Finland
| | | | | | - Soili M. Lehto
- University of Eastern Finland, Kuopio, Finland
- University of Helsinki, Finland
- Helsinki University Hospital, Finland
- Kuopio University Hospital, Finland
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Macapagal K, Bettin E, Matson M, Kraus A, Fisher CB, Mustanski B. Measuring Discomfort in Health Research Relative to Everyday Events and Routine Care: An Application to Sexual and Gender Minority Youth. J Adolesc Health 2019; 64:594-601. [PMID: 30612810 PMCID: PMC6478526 DOI: 10.1016/j.jadohealth.2018.10.293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/19/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Understanding how sexual and gender minority (SGM) youth's comfort with research procedures compares to their comfort with everyday experiences and routine health care can help calibrate decisions about whether a study meets minimal risk criteria. We sought to quantify SGM adolescents' comfort with sexual health research relative to everyday events and activities often cited as benchmarks of minimal risk. METHODS A total of 616 SGM adolescents in the United States (mean age = 15.7 years, 41.7% racial/ethnic minority) completed online survey questions assessing sexual behavior, SGM identity, and a 53-item Measure of Adolescent Comfort with Clinical, Research, and Everyday Events that assessed comfort on a 7-point scale (1 = extremely uncomfortable and 7 = extremely comfortable). RESULTS The Everyday Events for Adolescents domain had the lowest mean comfort score (M = 3.49, standard deviation [SD] = .58) and was significantly lower than the Routine Medical and Psychological Tests domain (M = 4.43, SD = .92) and the HIV/Sexual Health Research Procedures domain (M = 4.19, SD = .94). Eleven of 17 items on the HIV/Sexual Health Research Procedures domain were ranked as more comfortable than a neutral rating of "neither comfortable nor uncomfortable." Higher levels of parental acceptance predicted greater levels of comfort across all four domains of the Measure of Adolescent Comfort with Clinical, Research, and Everyday Events. Participants who were out to their parents expressed greater comfort with both SGM Identity and Sexual Health-related procedures and events as well as HIV/Sexual Health Research Procedures. CONCLUSIONS Overall participants expressed equal or more comfort with research procedures than with everyday life experiences. These findings indicate that common sexual health research procedures may meet minimal risk criteria among SGM adolescent populations.
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Affiliation(s)
- Kathryn Macapagal
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois.
| | - Emily Bettin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA
| | - Margaret Matson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA
| | - Ashley Kraus
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA
| | - Celia B. Fisher
- Center for Ethics Education & Department of Psychology, Fordham University, 441 E. Dealy Road, Dealy 226, Bronx, NY 10458, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA
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Murdoch M, Partin MR, Vang D, Kehle-Forbes SM. The Psychological Risk of Minimal Risk Activities: A Pre- and Posttest Study Using the Self-Assessment Manikin. J Empir Res Hum Res Ethics 2018; 14:15-22. [PMID: 30406711 DOI: 10.1177/1556264618810302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is difficult to apply U.S. Federal Code of Regulation's criterion for "minimal risk," because benchmarks of minimal risk have not been quantified. Our goal was to examine the psychological risks of several day-to-day activities. Using the Self-Assessment Manikin (SAM), we assessed the state valence and arousal of 432 patients and employees at a large Midwestern Department of Veterans Affairs medical facility before and after they had their blood drawn, saw their primary care physician or mental health provider, or took part in an exercise class. Exercise was associated with near-large to large salutary effects (Cohen's d = 0.76-1.17); other effects were small or moderate in positive directions (Cohen's d = 0.02-0.51). Our findings are a promising start toward establishing benchmarks and quantifying the psychological harms of minimal risk activities. Estimates such as these may help researchers determine whether their own research exceeds minimal risk.
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Affiliation(s)
- Maureen Murdoch
- 1 Minneapolis VA Health Care System, MN, USA.,2 University of Minnesota Medical School, Minneapolis, USA
| | - Melissa Ruth Partin
- 1 Minneapolis VA Health Care System, MN, USA.,2 University of Minnesota Medical School, Minneapolis, USA
| | - Derek Vang
- 1 Minneapolis VA Health Care System, MN, USA
| | - Shannon Marie Kehle-Forbes
- 1 Minneapolis VA Health Care System, MN, USA.,2 University of Minnesota Medical School, Minneapolis, USA.,3 VA Boston Healthcare System, MA, USA
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