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

ABSTRACT: Background:Pharmacotherapy is considered an evidenced-based treatment for anxious youth. There is a need to better understand the relation between medication adherence and child outcomes. Objective:This study prospectively examined:1) baseline predictors of adherence and 2) the relation between medication adherence and clinical outcomes in children and adolescents with anxiety disorders. Methods:Participants were 349 youth randomized to sertraline, pill placebo, or sertraline plus cognitive behavioral therapy in the Child/Adolescent Anxiety Multimodal Study (CAMS) and followed over 12 weeks. The measure of pharmacotherapy adherence used was pharmacotherapist (PT) ratings of adherence at each session. Four domains of baseline predictors were examined (demographics, child clinical variables, family/parent variables, and treatment variables). Results:Multiple regression analyses revealed few significant predictors of adherence. The most robust predictors of greater adherence were living with two parents and parents' positive expectations that medication would lead to better outcomes. Pharmacotherapists' ratings of higher adherence predicted higher global functioning at post treatment and treatment responder status. Conclusions:In order to increase adherence, improving expectations and instilling hope for positive outcomes and problem solving ways to overcome pragmatic barriers associated with single parent families is recommended.

SUBMITTER: Zehgeer A

PROVIDER: S-EPMC6289191 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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

Zehgeer Asima A Ginsburg Golda S GS Lee Phyllis P Birmaher Boris B Walkup John J Kendall Philip C PC Sakolsky Dara D Peris Tara T

Child & youth care forum 20180613 5

<h4>Background</h4>Pharmacotherapy is considered an evidenced-based treatment for anxious youth. There is a need to better understand the relation between medication adherence and child outcomes.<h4>Objective</h4>This study prospectively examined:1) baseline predictors of adherence and 2) the relation between medication adherence and clinical outcomes in children and adolescents with anxiety disorders.<h4>Methods</h4>Participants were 349 youth randomized to sertraline, pill placebo, or sertrali ...[more]

PMID: 30555217

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Project description:Anxiety disorders are the most prevalent psychiatric disorders and a leading cause of disability. While there continues to be expansive research in posttraumatic stress disorder (PTSD), depression and schizophrenia, there is a relative dearth of novel medications under investigation for anxiety disorders. This review's first aim is to summarize current pharmacological treatments (both approved and off-label) for panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and specific phobias (SP), including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), azapirones (e.g., buspirone), mixed antidepressants (e.g., mirtazapine), antipsychotics, antihistamines (e.g., hydroxyzine), alpha- and beta-adrenergic medications (e.g., propranolol, clonidine), and GABAergic medications (benzodiazepines, pregabalin, and gabapentin). Posttraumatic stress disorder and obsessive-compulsive disorder are excluded from this review. Second, we will review novel pharmacotherapeutic agents under investigation for the treatment of anxiety disorders in adults. The pathways and neurotransmitters reviewed include serotonergic agents, glutamate modulators, GABAergic medications, neuropeptides, neurosteroids, alpha- and beta-adrenergic agents, cannabinoids, and natural remedies. The outcome of the review reveals a lack of randomized double-blind placebo- controlled trials for anxiety disorders and few studies comparing novel treatments to existing anxiolytic agents. Although there are some recent randomized controlled trials for novel agents including neuropeptides, glutamatergic agents (such as ketamine and d-cycloserine), and cannabinoids (including cannabidiol) primarily in GAD or SAD, these trials have largely been negative, with only some promise for kava and PH94B (an inhaled neurosteroid). Overall, the progression of current and future psychopharmacology research in anxiety disorders suggests that there needs to be further expansion in research of these novel pathways and larger-scale studies of promising agents with positive results from smaller trials.

Dataset Information

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

Publications

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

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